Reporting Drug Stocks

Neglected Tropical Diseases (NTD) include lymphatic filariasis, (elephantiasis), Onchocerciasis (river blindness), schistosomiasis (bilharzia; snail fever), Soil-transmitted helminthiasis (intestinal worm infection), and Trachoma (blinding eye infection). Although largely unknown in developed nations, NTDs cause severe disabilities such as blindness, reduced mobility, impaired childhood growth, and disfigurement. The economic toll of NTDs includes loss of productivity and poverty. According to the World Health Organization, approximately one billion people—one-sixth of the world’s population—suffer from one or more NTDs, and the diseases annually cause 415,000 deaths worldwide.

RTI leads the Neglected Tropical Disease (NTD) Control Program (2006-2012), a 6-year global effort funded by the U.S. Agency for International Development. The program is designed to support national NTD control and elimination programs to integrate and scale up delivery of preventive chemotherapy for the following five targeted NTDs: lymphatic filariasis (elephantiasis), schistosomiasis (bilharzias or snail fever), trachoma (blinding eye infection), onchocerciasis (river blindness), and soil-transmitted helminthiasis (intestinal worm infection).

The NTD Control Program, now in its fifth year, has supported the distribution of more than 385 million treatments to more than 69 million at-risk people in 10 countries around the world.

In the fight against neglected tropical diseases (NTDs), lost time can mean lost lives and disabling health effects. Accurate and timely information on available drug stocks and treatment rates are needed to help health clinics save time and money and thus improve quality of care.

Solution

RTI developed and tested a new system for reporting clinical data about drug stocks and treatments via SMS text messages on mobile phones. The pilot project was funded by the Bill & Melinda Gates Foundation.

The information is received by a centralized data processing system that interprets the message, processes the data, and makes it available for instant reporting and analysis. The SMS system can be automated to not only receive and store information, but also to generate reports, maps, and alerts.

The system covers up to 20 communities in Uganda in conjunction with the Mass Drug Administration (MDA), which involves a community-based, preventative chemotherapy campaign to control NTDs. The system allows clinics to quickly update the head office about their drug stock levels and the number of patients they have treated in order to avoid a stock-out of one of the several drugs instrumental to fighting the diseases.

Without the SMS system, clinics typically resort to reporting stock levels by submitting paper documents, which are easily lost, or by phone, which is costly and complicates data aggregation. The impact can be insufficient drug supplies and patients that go untreated. We believe this system will prove to be cheaper, faster, and more accurate than paper-based data, and will help clinics better provide for those who need help.

The pilot phase includes in-country training for approximately 40 clinic staff and local administrators on how to run and use the system, and gives project staff the opportunity to gather and respond to feedback from local users about desired alterations and features. RTI will also help prepare documentation on the application setup and operation so that the system can eventually be scaled up or replicated in other countries.

Web-based system

RTI has developed a simple web-based system to gather information from mobile phones sent as text or binary SMS. The system presents this information both on maps and lists, allowing for a quick detection of sites running out of drugs, or falling behind on their treatment provision rate.

SMS Reporting

A user can send two types of messages: one to report on the stock level for a given drug, and one to report on the number of treatments provided.

The location to which those reports will be attached is given by the location to which the phone number sending the reports is currently registered.

Reporting on a drug is very similar to reporting on a treatment. Drugs are identified by a three-letter code, while treatments are identified by a four-letter code.

All messages are encoded using the following format:

[drug/treatment] [quantity]

For example, a message to report 5000 units of Albendazole remaining at a clinic would be send as follows:

ALB 5000

A message to report that 120 people had been provided with a run of Mectizan, Ivermectin, and Praziquantel would be sent as follows:

PIMX 120

Every time a message is received, the system checks the sender against the list of active phone numbers, and checks the data against the drugs and treatments defined in the system. The system reports any problems to the user via an SMS text message. If no problems were detected, the system sends an SMS text message to acknowledge a successful transmission.

Internally, the system uses a decision tree to process eachincoming message. This decision tree can be modified by adding, and removing decision logic. For example, the decision tree may direct the system to send an alert upon receiving a report indicating a low level for a given drug.

Form-based reporting

By integrating its database with FrontlineSMS, the system allows users to send data using forms stored in a Java-enabled phone. Many phones currently support Java, including low-cost (<US$ 20) models.

Before a phone may download forms and transmit data messages, it must be registered with the system. Registering a phone is a simple one-time process that can be done remotely.

Most mobile phones are capable of downloading and using the data entry forms. The form-based approach makes data entry easier for users, reduces training requirements, and improves data quality. The phone-based forms include selection lists and some data validation checks.

Data are transmitted from the phone handsets using binary rather than text SMS messages. This enables data from a form to be transmitted in a single message, which reduces messaging costs.

More Information

• Text Messaging Enables Timely Care in Uganda