Texts Saving Lives? An eHealth Initiative in Tanzania

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Usually when I ignore a text on my phone I manage to evade calamitous circumstances. However, the use of mobile and SMS technologies in ICT4D initiatives increasingly places greater importance on the act of sending a text.

As with many ICT4D initiatives, mobile SMS based projects have often failed to achieve their desired impact. Just as frequently, it is difficult to draw meaningful conclusions from their results, which may further complicate project design. Yet another challenge lies in the scaling up of successful projects for application in different areas.

Launched in 2009, SMS for Life is one example of a promising eHealth initiative with the potential to significantly increase the efficiency of supply chains for malaria drugs. This collaboration among IBM, Novartis, Vodafone, Roll-Back Malaria, and the Tanzania Ministry of Health and Social Welfare monitors the availability of malaria reduction drugs in Tanzania to reduce the number of malaria-related deaths through increased access to these medications.

SMS for Life works by sending healthcare staff automated text messages every Thursday, which prompt them to check their stock of anti-malarial drugs. The health workers then reply with this information via free SMS to the central database system. If they haven’t responded by Friday, they receive another text reminder. On Monday, the system sends this gathered information to a district management officer who makes the arrangement to deliver the needed supplies.

According to Vodafone’s Mobile Health Scientific Adviser Dr. Diane Sullivan, “The SMS for Life solution shows the tremendous potential of mobile technology to deliver social good through lateral thinking by helping to ensure supplies of life-saving drugs.” Indeed, 3rd party evaluation results from the six-month pilot program in 229 villages suggest that Dr. Sullivan’s optimism for this public-private partnership is well placed. At the beginning of the pilot, 26% of health facilities had no dosage of artemisian-based combination therapies (ACTs), while at the end of the program this figure was less than 1%. Additionally, over the course of the period stock-outs reportedly dropped from 79% to 26%. By the end of the pilot, the number of people with access to malaria treatments, including ACTs and quinine injectables, increased to 888,000 from 264,000.

One likely reason for the success of SMS for Life is the model of a public-private partnership that combines the expertise of business, government and NGO professionals. Too often these actors fail to coordinate their activities in an effective manner, or they leverage power against one another. The SMS for Life model has streamlined the medicine supply chain and ameliorated many of these concerns. Certainly, another great advantage of SMS for Life is the potential it has to be scaled up and applied in other areas. Over 5,000 health facilities across Tanzania are using the SMS for Life system. To date, plans are in place for country scale ups following pilot programs in Ghana, Kenya, and Cameroon. Furthermore, this model could also be used to monitor other medicines.

While the SMS for Life model has positive implications for health systems worldwide, it is important to recognize that the system is not a solution on its own. Reporting on the supply needs of rural health clinics will not be effective without sufficient infrastructure to deliver drugs to these facilities. In addition, corruption stands to interrupt even the most efficient supply chain. Mobile and SMS technologies can be hugely effective tools for the provisioning of eHealth services, but they can’t do all the work themselves.

Read more about the Novartis SMS for Life initiative here.

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