Improved monitoring of mass drug administration through mobile
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Collecting data via SMS has vastly improved the efficiency of our neglected tropical disease elimination programme in Cameroon. Geordie Woods presented on our mHealth pilot at the 2015 American Society of Tropical Medicine and Hygiene.
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Improved monitoring of mass drug administration through mobile
- 2. Typical MDA Community directed distributors implement census and MDA across the area and report data at the end of the campaign Chief of Centers do spot checks on CDDs to monitor progress National coordinator sends drugs based off of the previous year’s regional census -No transparency -No accountability -Not cost-effective
- 3. mango platform Technology partner used for multiple health projects in Sub-Saharan Africa Began in Cameroon with the National Malaria Control Program (Novartis, MoH) Data collection via mobile onto an online platform
- 4. Cameroon MDA Health District Data Managers monitor progress against targets and take action when necessary Community Directed Distributors bring their registers to Health Facilities weekly Chief of Centers verify data, aggregate, and send via SMS weekly Regional and National NTDs Coordinators monitor progress
- 5. Work behind the scenes New forms and registers Getting everyone online Work with mobile operators Training at all levels
- 6. Impact 951,511 censured 777,631 treatments Cut down on time spent on MDA by 1/3 6.7% treatment increase 100% data available at the regional meeting $70k saved on drug waste & monitoring costs
- 7. Scale-up costs Q: Are the heavy first year costs worth the investment? • Supervision costs (100% first year, ~30% second year and after) • Training (one time cost, ~20% year two for turnover then can be added to other trainings) • Register printing (one time cost) • Technology (continuing yearly fees) A: Yes! Project will pay for itself in Year 1 and save the program money in Year 2.
- 8. Keys to success Immediately incentivizing Health Facility Workers. Data uploaders automatically receive an incentive of airtime once they’ve sent in. Having a strong technology partner. Greenmash negotiated shortcodes and rates with mobile operators, helped with platform setup and led user trainings. Improving processes first, then adding technology. The team changed when data had to be reported in before they actually started the program, easing in the new system. Creating enthusiasm in country. The team transferred their excitement about the benefits of the system – starting with the MoH and going all the way down to the Community Directed Distributors.
- 9. Next steps Continue scale-up in Cameroon; start work in Nigeria and potentially South Sudan Research in 2016 with Tulane School of Public Health and Tropical Medicine and Sightsavers using matched control and intervention areas during the scale-up in the Western region Work with Greenmash to build a ‘global’ MDA monitoring system that any organization, country or disease could use
- 10. Thank you!
Editor's Notes
- Many of you know how a typical MDA works – but for context this is how the system worked before we added a technology component: -- The National coordinator sends drugs based off of the previous year’s regional census and 2.6% growth rate --Community directed distributors implement census and MDA across the area --Chief of Centers do spot checks on community directed distributors to monitor progress --Community directed distributors report data to health facilities at end of the campaign --This obviously could be improved – we know we are losing money and time because we lack transparency and cannot properly monitor – to add to that no one in the process is accountable
- --Began looking at how we could use technology to how we do MDA --Found a strong partners already working in Cameroon
- Set up an MDA data collection system for the the Oncho/Lf MDA in half of the Southwest region - 10 districts covering 74 health facilities Chiefs of Center used a set of shortcodes to input the indicators - Census. Treatment. Adverse effects. Refusals. (M/F for both) Completely transformed how data was monitored!
- --There was a great deal of work behind the scenes as well --New forms and registers for easier aggregation at all levels --Ensuring each District manager at a dongle to monitor progress online --Help from our technology partner (a shortcode, reverse billing, platform configuration) --Training at all levels – from community directed distributors using a new register, to chief of centers on sending SMS to district level managers on how to monitor progress
- -The team collected four simple indicators – --For time - census and treatment lasted only two months compared to the neighboring control area where the entire process took three months. --For treatments - The mHealth area saw a 10.2% increase in treatments distributed over the previous year; the non-mHealth control area saw a 3.5% increase --For data – 100% of data from the mHealth area were available at the regional planning meeting; in the control area, only 55% of data was available. In addition, 90% of data was available for district appraisals compared to 40% in the control area. -For costs -- $13,500 was spent on monitoring in 2014 compared to $31,000 in 2013; tablet loss reduced from 28,385 in 2013 to 8,532 in 2014.
- Expensive to begin but costs go down year after year About $50,000 for 1M people (would change depending on local context)
- Random: no data share with MoH now, but possible with Greenmash
- Random: no data share with MoH now, but possible on Greenmash
- Random: no data share with MoH now, but possible on Greenmash