Child eating ready-to-use therapeutic food for treatment for severe acute malnutrition. © UNICEF Niger 2013/ Harandane Dicko
Child eating ready-to-use therapeutic food for treatment for severe acute malnutrition. © UNICEF Niger 2013/ Harandane Dicko

In response to recurrent food and nutrition crises, Niger has developed one of the largest Integrated Management of Acute Malnutrition (IMAM) programs in the world. There are regularly over 400,000 cases of severe acute malnutrition in children treated annually. Up to one third of the national burden of cases of severe acute malnutrition are treated in the region of Maradi, a densely-populated, economically-productive area bordering Nigeria. In this region with great resources but that also faces many challenges, it is easily understood how innovation takes root.

UNICEF plays an important role in the fight against malnutrition in Niger, and its Maradi office works closely with the government’s health centers to monitor admission trends and provide the ready-to-use therapeutic food (RUTF) that helps treat severe acute malnutrition. However, with 135 health centers providing outpatient or inpatient services for malnourished children in the region of Maradi, obtaining quality, regular data was a challenge, which at times resulted in stock-outs of RUTF. The UNICEF team often relied on information that health workers sent from their own mobile phones. “We had to track data in excel data sheets with one tab for each of the 135 health centers. It was an enormous headache,” explains Hamidine Hassane, nutrition specialist at UNICEF Maradi. “In our office, we said ‘why can’t we have an automated tool to do this work for us?’”

In response, a team from UNICEF Maradi – Mohameden Fall, Head of Office, Hamidine Hassane, Nutrition Specialist, and Roufai Ouma, ICT Specialist – developed a RapidSMS-like tool in partnership with the Regional Direction of Public Health in Maradi and with telecommunication company Airtel. The tool, called GAIN (Gestion des Admissions et Intrants Nutritionnels; in English: Management of Admissions and Nutritional Stock), uses an internal network of mobile telephones, SIM cards and USB modems, purchased expressly for the project, to collect real-time data on admissions into nutritional centers and on RUTF stock.

Technical details

The data entry for the GAIN system is facilitated by a RapidPRO type of series of questions and answers. The tool can also send a validation of received data and reminders to send information for the immediate past week of program activities. The database is not publicly online, but is accessible through USB modem linked to a VPN. The programming of the tool was done in PHP with the database in SQL and database management is done through the private company hired to develop the tool.

The system took a few months to develop, and after an initial training was provided to users, the tool was launched in January 2014. Low-cost telephones and SIM cards, costing 5000 CFA Francs (about USD 10), were distributed to all 135 health centers to facilitate reporting. Every week, health workers receive an SMS prompting them for data from the preceding week. They then send program and stocks data via SMS directly to a database on a Nigerien-based server. Both public health officials and UNICEF staff have access to the information, that is, data on over 63,000 admissions and tracked delivery of over 32,000 cartons of RUTF collected between January and June 2014.

The development and launch of the tool took much effort. In the beginning, the on-the-job training demands took up a great amount of the team’s time. “At first I had to call the health workers to encourage them to use the system, and I constantly checked the database for errors,” Hamidine says. He used his leave time to get the project going. “Now we have a 95 to 98% rate of response every week, even though there is no mobile network in some health centers. Health workers send the SMS from elsewhere.”

Over time the UNICEF team trained government staff to help manage the technical assistance requests from the health centers, which has enabled them to step back from this on-call support role. The tool however continues to require regular oversight. The coordinators check the database on a daily basis to ensure that everything is functioning correctly.

Mothers and children in the inpatients ward for treatment of acute malnutrition. © UNICEF Niger 2013/ Harandane Dicko
Mothers and children in the inpatients ward for treatment of acute malnutrition. © UNICEF Niger 2013/ Harandane Dicko

The tool has improved the timeliness and completeness of reporting for the IMAM program in Maradi. Government counterparts and partners have adopted the use of the tool and greatly appreciate the labour-saving aspects of SMS for data entry and management. The quality of reporting has also notably improved with the use of SMS. RUTF stocks management is easier with real time data, which helps avoid stock-outs that would affect the availability of service for malnourished children. GAIN has also resulted in a more rational use of RUTF, with lower quantities being ordered.

Innovations projects do not take off and fly on their own. These projects need advocates, supporters and dynamic coordinators to ensure that small problems do not cause system failures. It took much skills and capacity to design, launch and manage the GAIN system, and the dedication and dynamism of the UNICEF team has paid off – their innovative tool has helped improve the IMAM programme in Maradi, and is now considered a model that might be expanded to other regions of the country.

Robert Johnston
Nutrition Specialist, UNICEF New York

You can follow Robert’s Nutrition RapidSMS blog here


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