Originally published on 27 May 2015, on The East Africa Public Health Laboratory Network (EAPHLN) website. To read the original article, click here.
The recent Ebola Outbreak in West Africa was a wake-up call for many governments in Sub-Saharan Africa. In many instances, the already fragile health care systems in the affected countries (Liberia, Sierra Leone, and Guinea) in areas including infrastructure, human resource management, effective health communications, and disease surveillance prior to the outbreak, were overwhelmed.
There have been numerous efforts globally to combat the outbreak while resources are still being mobilized to treat, care and prevent further damage to communities, livelihoods and national economies. Uganda is one of the countries that has contributed teams of health workers and technical expertise to assist the affected countries in West Africa.
Although Uganda has been hit by several Ebola Virus Disease and Marburg outbreaks in the last fifteen years (2000, 2007, 2011, 2012, 2014), it has successfully managed them with limited morbidity and mortality rates. More recently, one of the factors providing for successful management of outbreaks has been the use of rapid messaging and communication with frontline health workers using a mobile phone based system known as mTrac.
mTrac, led by the Ugandan Ministry of Health, UNICEF and WHO, with funding from DFID, is an open-source SMS, USSD and web-based data collection tool built on the RapidSMS framework. mTrac is enabling close to 30,000 frontline health workers at over 3,700 health centers to electronically submit weekly HMIS reports with a focus on disease surveillance and essential medicines. Additionally, rapid surveys, alerts and other communications are regularly employed via mTrac.
Through a complementary anonymous hotline, health workers and community members are also able to deliver complaints to assist monitoring of healthcare service delivery. In 2013, the Hotline assisted with the recovery of over $400,000 in stolen and misappropriated funds, equipment and medicines. This community level information is then tri-aged with official data to identify bottlenecks. Full integration with the country’s DHIS2 system was achieved in 2014 as well.
mTrac provided much of the inspiration, best practices and logic that was used to develop mHero, which is being used by the government of Liberia in their fight against Ebola. mHero was built by UNICEF, IntraHealth, ThoughtWorks, Jembi and the Ugandan Ministry of Health, using RapidPRO, the next generation of RapidSMS.
In Liberia, mHero is now being used to update the national health worker registry, strengthen communications, provide real time data on critical health sector services, and support improved communication with the Ministry of Health and Social Welfare. It is expected to expand in 2015 to include sharing of reference materials and resources and improving the knowledge of the health workers.
This was largely made possible due to prior investments by the Uganda and Liberia governments implementing iHRIS, a system designed by IntraHealth that acts as a registry for health workers (human resource information system) and is now in 19 countries. During an initial mapping of available data in Liberia, UNICEF and IntraHealth quickly identified a huge opportunity – Liberia had recently completed a mapping of approximately 9,000 Health Workers, and the countries iHRIS database contained mobile phone numbers of the vast majority of them.
The mHero was created by making RapidPro,iHRIS and DHIS2 tools interoperable through a interlinked registry, allowing RapidPro to import phone numbers from iHRIS and location hierarchies from DHIS2. Before the mHero pilot, interoperability capabilities between the two technologies were being developed for Uganda, but Liberia gave UNICEF and IntraHealth an opportunity to accelerate work on this and a chance to fine tune it in a real-world context. Working with senior technology experts from UNICEF and IntraHealth, Liberian Ministry of Health and Social Welfare Information Specialists were able to adapt, test, and enhance the mHero system.
The mTrac and mHero innovations confirm that supporting frontline health workers through strengthening existing, routine information systems is vital both during the current Ebola outbreak as well as with post outbreak recovery efforts. Preventatively investing in robust communication and data collection systems for frontline health workers in advance of potential disasters and outbreaks has clearly helped deal decisively with them when they occur. Information is power and finding the fastest and most efficient ways to disseminate this information to stakeholders is key.
Sean Blaschke is Health Systems Strengthening Specialist at UNICEF Uganda & Thomas Alinaitwe is ICT Specialist at the World Bank-funded East African Public Health Laboratory Network in Uganda.