AIDSRelief Tanzania is comprised of four of the five AIDSRelief global consortium members, Catholic Relief Services (CRS), Futures Group International (Futures), Interchurch medical assistance World Health (IMA) and the University of Maryland School Of Medicine – Institute of Human Virology. AIDSRelief is funded by PEPFAR through HRSA and CDC and is currently in its seventh year of program implementation.
AIDSRelief support 353 Prevention of mother to child transmission (PMTCT) facilities in Tanga, Mara, Mwanza and Manyara region in Tanzania. With these existing sites; it is not cost-effective to staff each PMTCT site with a dedicated strategic Information staff and receive accurate and reliable reports in a timely manner. Most of these sites are in remote locations, the roads are not accessible during rainy season, unreliable or lack of funds to deliver compiled paper based reports to the central level makes the PMTCT reports received at district, region and central level to be not reliable.
Quality data is needed at program and patient level for management and planning decisions. In order to have a high quality data, there was a need of a strong tool which would be able to give the treatment facilities flexibility on the indicators the facility want to follow and make easier sending of reports to district, region, Ministry of Health/Social welfare and other stakeholders.
Futures Group as consortium member of AIDS Relief, manages data collection, data quality, analysis and generation of reports for donors, government and other key stakeholders. Futures group are involved in building LPTF capacity in collecting, managing, and analyzing clinical and programmatic information, and is building an accessible patient database.
Futures Group International introduced IQSM software which helped report submission from PMTCT facilities to district, regional and National level in timely manner. International Quality Short Message Services (IQSMS) is the software package technology that uses mobile phone sms to report data in predetermine format to a dedicated centralized computer server that transform sms to an integrated database by using mobile operating system. IQSMS was developed as freely available, open source software tool, under creative commons license. This allows IQSMS software to be used by local implementing partners, NGOs and local ICT groups in Tanzania. By taking an open approach to designing ICT solutions enables Ministry of Health and Government of Tanzania to have country ownership over the software and ensure sustainability of this innovative ICT mhealth solution.
The project started in April 2010; the central database receives all SMS from the sender without sender being charged for service encountered as the communication have been made between Tanzania Communications Regulatory Authority (TCRA), three mobile companies with wide coverage operating in Tanzania and AIDSRelief not to charge the sender rather a receiver of the message which is AIDSRelief. IQSMS Server is connected to three 3G Modems which have different SIM cad from three different mobile companies. To ensure computer and Modems are on prolonged hours during power cuts, a server is connected to UPS and if server or power goes off, report will continue to be received by Modems and after power restore server retrieves all reports. Since the server accept three modems, it make easier for staff having different mobile numbers from different mobile companies be able to send the short messages to the server and this server accept all messages sent by staff from PMTCT facilities. By August 2010, a total of 100 sites have been able to send their reports to centralized server in Dar es Salaam Office on time. The reports being sent includes; PMTCT Antenatal Clinic (ANC) Monthly Summary Form, PMTCT Care Monthly Summary Form, PMTCT Mother- Child Follow-up Monthly Summary Form, Labor and delivery monthly summary form. These four monthly summary reports give an overview of what has happened in the previous report in all PMTCT areas of implementation including Antenatal clinic and labor and delivery wards in all PMTCT facilities. IQSMS has reduced the need for facility staff, Regional and district child health coordinators of the Ministry of Health and social welfare and Futures Group field officers to spend more time traveling to and from facilities for data collection, compilation and aggregation. Complaints about the accuracy of the transcription of paper-based reports are no longer an issue IQSMS has reduced time in error checking as the system checks automatically the errors when sending reports within 20-30 seconds.
Providing Treatment, Restoring Hope As part of the President’s Emergency Plan for AIDS Relief, funded by the Centers for Disease Control and Prevention and the Health Resources and Services Administration, the project provides rapid scale up of antiretroviral therapy (ART). Futures Group is collaborating with a consortium led by Catholic Relief Services that includes Catholic Medical Mission Board, Interchurch Medical Assistance, and University of Maryland Institute for Human Virology. The goal for introducing the IQSMS was to ensure there is improvement of quantitative and qualitative reporting within district, region, Ministry of Health and social welfare and donor/stakeholders designated reporting requirements using the limited resources. This will be achieved using IQSMS because its quick, effective , low technology solution that allow for a some level of patient data automation which will be acceptable, cheap and used by different levels of stakeholders.
IQSMS has been identified to be used for report submission as its familiar to users. At least one of the PMTCT staff in all 535 facilities are able to send SMS. No special software required for user handsets, any handset can be used and no special requirement for the handset to be used for sending sms to the central server. The coverage of mobile network across Tanzania is great especially if one is using combination of mobile companies. There are other places which are reachable by either one or all of the mobile companies, the network is available almost anywhere within Tanzania and it’s an Excellent solution for rural and resource challenged environments. When the reports are received by The central server, the error checking is performed and within 20-30 seconds, system send the feedback on whether there are errors in the reports and the person sending needs to re-work on the reports or the reports are accepted if no error has been noted.
The target Group for this IQSms is PMTCT facilities providing services to all mothers, fathers and children to infected or affected by HIV/AIDS in PMTCT settings. The plan is to scale up to include more PMTCT sites supported by AIDSRelief. The IQSMs has been demonstrated to the Ministry of Health and Social welfare and are thinking of introducing the system to other regions not supported by AIDSRelief. The IQSMS has made reports to be available on time at District, Regions and National level from facilities. It has reduced the need for facility staff, DRCHCO, RCHCO and Futures Group field officers to spend more time traveling to and from facilities for data collection and sending reports to the district and region The Staff at District, Regions and National level will not re-aggregate data that is first recorded on paper from facility level and time in error checking has been reduced as the system checks automatically the errors when sending reports within 20-30 seconds. The IQSMS has also helped the District and Regional offices to be able to compare their reports with other regions for improvement.
100 PMTCT facilities have been reached. These sites have managed to send report to the central server and have received feedback. Central team are able to compile the reports within first week after the end of each month which was not there before introduction of IQSMS.
No paper based reports are stored at office anymore hence increased office space for other use rather than storage purposes; electronic reports available in the office can be printed to produce paper reports if required. The health workers working where this project function no longer pay transport costs for sending reports to District and Regional offices.
The IQSMS has supported using same reports between partners, Ministry of Health and Social welfare and facility health workers with mobile phone technology without a significant investment in data collection labor, transportation and storage costs.