How mTrac works
The mTrac system has been designed for the real time data collection, verification, accountability and analysis of aggregate data and community engagement for the improvement of healthcare service delivery.
Sources of Data
There are three main sources of data within mTrac. The first data source comes from health care workers who report on notifiable diseases, malaria case management and stock quantities of artemisinin-based combination therapies (ACTs) on a weekly basis. Using their own mobile phones, health workers send a series of text messages (SMS) to a toll-free short code each week. The data submitted is based on the existing Health Management Information System (HMIS) paper form 033b. The information from the paper form is coded based on keywords. For example, if a health worker has completed the disease cases section of the HMIS form at end of the week, this is what it will look like:
The resulting SMS message would be coded and sent to mTrac like this:
The information is aggregated, tabulated and graphed onto an online dashboard and made available to the District Health Teams. Each District Health Team and selected national stakeholders are able to view and approve all data submitted by health workers in their district before being submitted to the Ministry of Health in Kampala.
The flow of information is demonstrated by this diagram:
The second source of data within mTrac is from the village health teams (VHTs). VHTs are volunteer health workers based in the community providing a first line health care service to households. Similar to the health workers, VHTs submit data through SMS on a weekly basis based on their existing HMIS paper form 095, the VHT register. The data submitted includes the number of identified cases of malaria, severe malnutrition and cases referred to the nearest health facility during the week, as well as ACT and Amoxycillin stock.
The third source of data within mTrac are community reports through the anonymous SMS hotline, 8200. The hotline is advertised at all health facilities, on posters and through radio and print advertisements. By sending SMS reports to 8200 community members are able to report on health service delivery issues impacting their communities ranging from health worker absenteeism, drug stock-outs to a great service at the health facility. The community is encouraged to include the district and health facility for which they are reporting so that the mTrac team can take appropriate action.
Accountability and Data Verification
Each week the district health teams are able to review, verify and approve the data submitted by their health workers through the mTrac dashboard website. They access the dashboard by a computer and modem provided by the Ministry of Health and partners. This provides the district and opportunity to identify erroneous data, contact the reporting health worker and correct the data. The dashboard also allows the district team to view the facilities are failing to report and follow-up. Communication is made simple by the use of a simple interface on the website which allows the district team to send free SMS messages to their health workers. There is also a useful feature for the district teams to manage the users of mTrac in their districts and assign them to specific health facilities. Once the district team is happy with their data they indicate their approval and the data is submitted to the Ministry of Health in Kampala for further analysis. Certain SMS reports, as defined by the MOH, will also initiate an “alert”. This will occur when events such as a notifiable disease or drug stock out is reported. These alerts will be sent automatically by SMS to the District Health Teams and appropriate Health Centers for action.
In addition to health worker reports, the valuable community reporting through the SMS hotline provides additional data to improve accountability. A dedicated team at the Ministry of Health reviews and if necessary, responds to, the anonymous SMS reports. Each report is categorised by District and issue area (e.g. stock out, drug theft, fraud) and forwarded on to action centres. This includes the district health teams who are first in line to investigate reports but also national response centres like the National Medical Stores, the Ministry of Health and the Medicines and Health Medicines Delivery Monitoring Unit. The reports of health service delivery issues are available for viewing on the district dashboard websites and follow-up actions are recorded.
An example of the information flow that leads to improved accountability in responding to drug stock outs:
Data Analysis and Tracking Results
The mTrac system provides for basic data analysis in each district. District biostatisticians and HMIS officers are able to view trends in drug stock levels, disease incidence and health facility reporting performance. With this trend data in hand, the district teams are able to make more informed management decisions such as re-distributing drugs and initiating responses to disease outbreaks.
In addition to district level data analysis, the Ministry of Health Resource Centre (RC) has access to the national set of mTrac data. This data is also regularly submitted to the District Health Information System 2 (DHIS2) which is the Ministry of Health’s tool for the analysis of all aggregate HMIS data collected nationally.
Through these two means of data analysis, the mTrac team and the Ministry of Health is able to view the results of the mTrac initiative, which to date have included the reduction in drug stock outs and improved responsiveness to community feedback.
In addition to the anonymous SMS hotline, the mTrac program includes a number of mechanisms for community engagement. These include regular radio talk shows in local languages that focus on health issues of concern raised by the communities and provide a means to give feedback to the community about actions taken based on the SMS reports received. Additionally, the mTrac team publishes regular articles in the national press to highlight health issues of national interest, promote the SMS hotline and provide feedback to the country on actions taken to improve healthcare delivery.
Summary of the Users of mTRAC
- Community members – who send in SMS messages on any Health Service Delivery issue, such as stock-outs and conduct of health workers to 8200.
- VHTs in selected Integrated Community Case Management (iCCM) districts – fill and submit a simple weekly reporting form (HMIS 095).
- Health Care Workers (HCWs) – SMS their weekly HMIS 033b report on disease surveillance, malaria case management and stock quantities of ACTs. HCWs also submit alerts should they identify a notifiable disease mid-week.
- District Health Teams (DHTs) – have been provided with a computer and an Internet modem to access an online “Dashboard” so that they can monitor activities (such as quality of reports, reporting compliance, stock quantities of ACTs by health facility) and identify health trends. The platform has been designed to ease the process of data analysis and dissemination.
- Ministry of Health, Resource Centre and Epidemiology Surveillance Division – ensure that DHTs fulfil their reporting responsibilities, and that high levels of reporting compliance are maintained. With support from UNICEF and WHO, they will also provide any technical support or assistance needed with mTrac.
- Other stakeholders – National Malaria Control Programme, Pharmacy Division, National Medical Stores, Joint Medical Stores, the Medicines and Health Medicines Delivery Monitoring Unit, Foundation for Innovative New Diagnostics are all involved with mTrac rollout and putting the collected data to use for improving healthcare delivery.
The Technology Behind mTrac
mTrac is based on RapidSMS, a free and open source framework for dynamic data collection, logistics coordination and communication, leveraging basic short message service (SMS) mobile phone technology. As an open source project, the software is free to use and distribute. More information about RapidSMS is available at www.rapidsms.org. For those interested in contributing to the RapidSMS project or deploying mTrac or another RapidSMS application the software code is made available at https://github.com/rapidsms.