The resulting surveillance is being used to evaluate the impacts of ongoing rabies control activities and improve their management, directly informed by the experiences of frontline users. As a result, the system has become an integrated, popular, and valuable tool within the health and veterinary sectors in southern Tanzania. MHealth has been criticised for the proliferation of pilot studies with little coordination and programmatic evidence of effectiveness to inform scale-up [ 3 , 21 , 22 ].
Although the pace of ongoing technical advances is exciting, with mHealth piggybacking on this momentum, the goal for mHealth now is to move beyond pilots to sustainable integration within health systems and culture [ 20 , 23 , 24 ]. Box 1 lists technical and acceptability challenges of large-scale mHealth programmes, possible solutions, and further opportunities for development as drawn from experiences of our system.
For neglected zoonotic diseases, such as anthrax, cystic echinococcus, leishmaniasis, human African trypanosomiasis, Rift Valley fever, and plague, that cause considerable mortality and morbidity in low-income countries, there is a real unmet need for integrated intersectoral surveillance systems, which could be facilitated through shared architecture [ 21 ].
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In Tanzania, there is demand to expand the system to other zoonoses and to further harmonize it within existing health and veterinary systems. Using phones as the building blocks for establishing and maintaining relationships with users can make systems participatory, empowering otherwise isolated frontline workers and, critically, can lead to the improved control and management of disease [ 22 ]. The period of monitoring prior to the SMS intervention was from 1 May to 18 Nov , whilst the period of monitoring during the implementation of SMS reminders was from 19 Nov to 1 July One phone was allocated to each facility clinic or livestock office , but four health workers per clinic and five livestock officers per office were trained.
Similarly we did not consider depreciation of capital costs such as vehicles for distributing phones and registers, as we assumed the same assets would be required for both types of surveillance. Our colleague Dr. Eberhard Mbunda sadly passed away before this work was published. Mbunda was a great champion of rabies control in Tanzania. We wish to honour his memory. Summary Points Surveillance is critical to manage preventative health services and control infectious diseases.
Integrated surveillance involving public health, veterinary, and environmental sectors is urgently needed to effectively manage zoonoses and vector-borne diseases.
However, most surveillance in low-income countries is paper-based, provides negligible timely feedback, is poorly incentivised, and results in delays, limited reporting, inaccurate data, and costly processing. The potential of mobile technologies for improving health system surveillance has been demonstrated through small-scale pilots, but large-scale evaluations under programmatic implementation remain rare.
An intersectoral mobile-phone—based system was developed and implemented for rabies surveillance across southern Tanzania. The surveillance system infrastructure is a platform that can be further developed to improve services and deliver health interventions; for example, generating automated personalized text messages SMS to alert patients to their vaccination schedules improved their compliance with regimens.
Other interventions targeting patients and health workers can now be implemented easily. The system has become an integrated, popular, and valuable tool across sectors, used routinely throughout southern Tanzania to evaluate the impacts of rabies control and prevention activities and to improve their management, directly informed by the experiences of frontline users.
We discuss challenges encountered during development and deployment, how we overcame these, and our recommendations for scaling up mobile-phone—based health mHealth interventions in low-income countries. Introduction There is huge potential for mobile technologies to improve health care and public health service delivery, especially in resource-poor settings [ 1 — 3 ].
Download: PPT. Development and Deployment of the Surveillance System This project was conceived during an outbreak of rabies in the Kilombero Valley, southern Tanzania, in Fig 2. Mobile phones as potential tools for surveillance in Tanzania.
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Surveillance In Action Since establishing the system in , we have registered over users from the human and animal health sectors stationed at the four health facilities per district that provide PEP through the control programme and all the district livestock offices. Box 1. Given the pace of technological advances, interoperable platforms compatible with a range of handsets are imperative [ 22 ].
Sufficient resources need to be allocated to user training, support, and feedback, which are vital to the user experience. Support personnel were able to rapidly trace and solve difficulties and help maintain standards, and their regular communication helped motivate users, while recognition of their submitted data and feedback were incentives in themselves.
Competitive contracts with mobile phone service providers for large user groups should reduce costs.
These should also facilitate the use of helpline services and cross-sectoral communication by making data upload and calls free between users; this was frequently requested from users. Public—private partnerships could be further explored to reduce costs. Recommendations for improvement of our mobile-phone—based surveillance identified from stakeholder meetings and user feedback SMS alerts of vaccine shortages, human deaths, and rabies outbreaks; reminders to users of scheduled tasks and feedback on submissions to encourage reporting.
Automated and dynamic reporting to local, regional, and national stakeholders to enhance update and use of information for disease control and prevention, including targeted programme management, e. Adaption of the application to smartphones in addition to Java-enabled phones. Migration to cloud storage to overcome server maintenance and power issues. Free rabies phone helpline for public and closed user group contract for free communication between surveillance users, and to support intersectoral and district and regional coordination of control and prevention activities.
System Usability and Evaluation We used observations of 40 health workers and 27 livestock officers to examine factors affecting system usability and support required. Conclusion Through the development, implementation, and evaluation of this mobile-phone—based surveillance system in southern Tanzania, we have demonstrated the considerable value and feasibility for mobile technologies to improve health systems, services, and outcomes in LMICs.
Supporting Information. S1 Data. Example data reported through the surveillance system presented in Fig 1. S2 Data. S1 Table. Helpline log enquiries categorized by form type. Data summarized in Fig 2D. S2 Table. S3 Table.
S4 Table. Mean records of animal bite injuries detected in each region captured by paper records from January to December and mobile-phone—based surveillance from January to January Numbers in brackets give the quarterly range reported for each region. S5 Table. Breakdown of costs for setup and maintenance of mobile-phone—based and paper-based surveillance for rabies across 28 districts in southern Tanzania. S1 Text. Additional methodological information. References 1. New horizons for health through mobile technologies. Geneva, Switzerland: World Health Organization, The effectiveness of mobile-health technologies to improve health care service delivery processes: A systematic review and meta-analysis.
Five Popular Cell Phone Surveillance Options
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