Principles for Design & Development

International Quality Short Messaging System: Using SMS Reporting to Improve HIV Services Case Study

Using mobile technology to improve distribution and availability of HIV commodities in remote health facilities in Tanzania.

How Solution Meets Need

In July 2012, the Local Partners Excel in Comprehensive HIV & AIDS Service Delivery (LEAD) project introduced the use of International Quality Short Message Software (IQSMS) to support facilities in routine reporting and sharing HIV commodity information, with a design that allowed for rapid scale up of the system. IQSMS provides district, regional, and national stakeholders with up-to-date, vital information and assists with decision making about the distribution and re-distribution of HIV commodities to avoid disruption in the testing of pregnant mothers and exposed infants. IQSMS uses healthcare workers’ mobile phones to send preformatted commodity reports to a central server via SMS. Messages sent to the server undergo quality checks, with responses sent to the sender before the data is integrated into the server. These messages contain key HIV stock status for Determine, Unigold, and Dried Blood Spot (DBS) test kits. The stock reports are then retrieved, analyzed, and shared with key stakeholders for immediate action.

The application enables facilities, districts, and implementing partners to make profitable decisions about HIV commodities ordering cycles and quantity levels, from product consumptions to product reallocations and forecasting. Districts and facilities have been able to boost HIV testing services, improve proper medicine distribution according to consignments, and ensure successful preparations of Report and Request (R&R) forms. The application at a glance provides real time data from health facilities and supports health care workers to submit national core reporting indicators that are found on the national health information system, MTUHA, capturing monthly data. The tool also enables districts to receive a full order of all commodities as quantified by the system based on what has actually been consumed. All quantifications and calculations are handled by the system, which considers physical stock taking.

To avoid parallel reporting, the system is now interoperable with both DATIM and DHIS2, based on OpenHIE using DXF2. The system is able to use an Application Program Interface (API) to feed data collected from the health facility level directly into DHIS2’s central server. During data exportation, IQSMS performs an information comparison to see if data has already been captured by DHIS2 and quantifies the relationship.

Principles Addressed

Design for Scale: When the LEAD project started, twenty staff were supporting 509 PMTCT facilities and submitting five monthly reports per facility. Reports were supposed to be submitted by the fifth day of the following month, but were often submitted a month or two months later. The facilities needed a better method for reporting and managing inventory. In response, the team created IQSMS. Since the goal was to rapidly implement across all supported facilities, the team employed a systems approach, basing the design of IQSMS on the reports and tools already being used by Tanzania’s Ministry of Health and Social Welfare. The software could be installed on health care providers’ personal phones, facilitating rapid deployment and scale. Automated processes for validating reports, checking data quality, and confirming submission also contributed to scale up by reducing the time needed to report and enter data, thereby increasing the time available for mentoring and data analysis for decision making.

Outcomes and Lessons Learned

• Combining both a mobile system and a Web-based system helps ensure that the data collected is available for use by MOHs and is interoperable with systems at the central/national level.
• Mobile phone SMS technology is a cost-effective, quick, and simple mechanism that requires minimal training for system use and implementation by health care workers.
• The use of IQSMS has reduced reporting times from 1-2 months to 5 days. All monthly reports are now received on time.
• The use of IQSMS to track inventory has nearly eliminated test kit stockouts and increased the HIV testing rates across facilities. SMS-based reporting can be applied across other program areas for effective monitoring of health services.
• Initially, many health care providers did not want to use their personal phones for reporting. Some believed that frequent reporting would age their phones, while others wanted monetary incentives for participating.
• Some district coordinators were not interested in using IQSMS, despite completing the training and committing
to using the tool.
• Purchasing a short code for IQSMS from the Tanzania Communications Regulatory Authority was too expensive and would have taken too long. Instead, the LEAD project has used several regular mobile numbers, which incur slightly higher charges per SMS.
• An anticipated future challenge involves the end of LEAD project funding. Currently, health care providers do not pay for sending messages; the project pays for all messaging costs. Some district coordinators have not yet incorporated the budget for IQSMS in their district plan, in which case the software will not be available in these districts when the project ends in March 2016.

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