The Ugandan Ministry of Health has launched an initiative to digitize the country’s health management systems. Because mobile technology can be the fastest, cheapest means of collecting and analyzing data, especially in rural areas, the Minstry is embracing mobile technology to create a seamless system of health management and early warning techniques across the country. The Ugandan UNICEF country office has developed projects to work with the Ministry’s goal of digitizing the health systems. mTrac and Community Vulnerability Surveillance are two new projects that use SMS to gather and disseminate data and news, with a focus on health and public services.
UNICEF Uganda is taking a two-pronged approach in their strategy to incorporate mobile technology into existing health systems; first, to set up a long-term, digitized health information source, and second, to create a set of protocols and best practices that can be used as guidelines for good mobile/electronic health systems.
mTrac: SMS Data Collection at Scale
Traditional paper and pen methods of recording data at health centers can lead to errors, slow communication, and a lack of central oversight between district health centers and national distributors. mTrac, an SMS-based data collection tool, creates a reliable flow of information between district health facilities and national distributors by allowing workers at district health centers to track incoming and outgoing medications and monitor case management data via mobile phones.
mTrac was originally piloted as a project by FIND Diagnostics, a non-profit focused on developing diagnostic tests for poverty-related diseases, in roughly 170 different health facilities in the Gulu and Kabale districts. UNICEF has now partnered with the World Health Organization and the Ugandan Ministry of Health to take over the project and roll out mTrac nationwide to track medication stocks and patient information at the country’s 5000 health facilities and 8000 local medication distribution centers. The mTrac system creates detailed stock reports so that local district centers have evidence of medication stocks and can track where medication is needed via case management data. mTrac allows workers at health facilities and medication distribution centers to monitor supplies in order to decrease shortages and overstocks.
Sean Blaschke, a Technology for Development specialist at UNICEF Uganda, explains that the program, which was built on RapidSMS, used SMS because it was the most scalable system for collecting and reporting information. He explains, “[It was] developed with sustainability and scalability in mind, so that meant not designing it for iPhones or Android phones, or even J2ME or Java-enabled phones, but phones that are already in the hands of people in the communities.”
In the year and a half the pilot has been running (originally with support from FIND Diagnostics, then as a government-supported project), Blaschke says that he was impressed by the high level of retention the system achieved in the Gulu and Kabale districts. A year after FIND Diagnostics handed control of the pilot over to the government, Blaschke says that they still received a response rate of roughly 90% on a weekly basis from the facilities using mTrac; he adds, “Particularly around ICTs, you see fatigue. And as soon as partners pull out, the usage of the system often quite quickly drops off and disappears. This is one of the only systems I’ve seen that had been handed fully over to a government and, with no additional support or financial support, saw pretty much the same uptake level from implementing partner to government.”
Another benefit of the program is that it allows health centers to shift stock among centers more easily because they can view which facilities have stock and which don’t, allowing workers to manage their resources more effectively.
Community Vulnerability Surveillance
A second part of UNICEF and the Ministry of Health’s approach to using mobile technology for health services is as an early warning system called Communality Vulnerability Surveillance. CVS is a system to collect routine data via SMS from field workers on a variety of factors, including disease outbreaks, birth/death rates, and nutrition information.
“With CVS, the idea is that we’re setting specific thresholds and looking for trend data, changes. In the past, a lot of surveillance systems […] tend to be quite heavy, quite expensive, and quite limited in geographic scope. And so this is an incredibly light-weight system that would flag a couple of indicators – it wouldn’t give us a ton of information into the root causes, but what we hope it will do is give us that smoke signal as early as possible that there is a problem and that we do need to send in a more rigorous survey team to gather more data.”
As part of a two-pronged approach with mTrac, each service has a distinct function that creates a clearer picture of the landscape of the Ugandan health field. mTrac focuses on strengthening the existing health management information systems, while CVS focuses on collecting indicators of regional and countrywide trends to turn data into actionable information. Explains Blaschke, “CVS and mTrac are different modules of a wider mHealth strategy to strengthen Uganda’s health information system.”
Because both projects operate in the health field, Blaschke estimates that there will be overlap between the services saying, “Really the difference between mTrac and CVS will be how the data is being used and analyzed, and how the data is being actioned. Essentially the same approaches are coming together more than diverging.”
In order to close the loop between mTrac and CVS, the group is also using Ureport, a citizen feedback service, to get information from beneficiaries about what’s happening on the ground. In addition to free SMS polls for registered users, Ureport also sends out information to its subscribers letting them know the results of the polls to increase transparency between the health centers and beneficiaries. The goal of the UNICEF mobile projects is to create a strong information system that focuses on management, service deliverability, and accessibility. By bringing together data from mTrac and CVS, along with the on-the-ground information from Ureport, the organization is working to build a digitized system for Uganda’s health services.
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