Mission, Vision, Objective

Malaria remains one of the most important diseases in Uganda in terms of morbidity, mortality and economic losses. It accounts for 26% of the burden of disease, 25% to 40% of Out Patient Department (OPD) attendances, 20% of health facility admissions and 9% -14% of in-patient deaths. Prompt and effective case management is one of the key strategies of reducing morbidity and mortality due to malaria. Availability and use of ACTs, the first line medicine in Uganda to treat malaria, is an important ingredient to effective case management. Yet because of challenges in supply chain management and pilferage, Uganda suffers from regular stock-outs.

Previous strategies to strengthening the collection and usage of vital health information has historically been hamstrung by lack of infrastructure, threat of bottlenecks at each step in the chain, lack of transparency and significant transaction costs on scarce government resources.

In early 2010, NGO FIND Diagnostics initiated an SMS-based monitoring system in over 140 Health Facilities in two Districts in Uganda. A toll-free shortcode was acquired, and the Health Facilities used the phones that staff already owned. HMIS 033b, covering disease outbreaks including malaria, and ACT tracking were part of the standard weekly reporting package. The project produced impressive results, with more than 85% health facilities reporting weekly without monetary incentives or additional supervision at a monthly cost of around US$14 per District. The Ministry of Health, UNICEF and WHO identified this promising mHealth pilot for national scale-up.

With funding from DFID, the Ministry of Health is jointly implementing an innovative package of interventions under the name of mTrac that builds on the unprecedented growth of telecommunication infrastructure, including network coverage and high rates of mobile phone penetration (estimated in 2011 at 34%). Leveraging tools such as mobile phones that already exist in the Health Facilities and Communities which we are targeting, we have the opportunity to implement – at very low cost and at scale – tools that extend and enhance the existing HMIS, complemented by information from the community.

The primary focus of mTrac is to strengthen disease surveillance and the national medicines monitoring system, and generate community action for improved health system accountability to reduce ACT stock outs at facility and community level. This system, using RapidSMS technology already deployed in Uganda, is capturing and accelerating transmission of key information related to disease outbreaks, including malaria, and ACTs at both facility and community level thus providing an optimized tool for management and programmatic response.

Formal government Health Management Information System (HMIS) data is complemented with independent reporting from (1) an anonymous, toll-free SMS-based health service delivery complaints hotline and (2) by a network of community-based monitors called U-Report. U-Report, an SMS-based social monitoring tool with over 150,000 registered members in every community in Uganda, aims to strengthen community-led development and citizen engagement. The general public now has an outlet to independently report ACT stock-outs, as well as other service quality information (such as health facilities closed during normal work hours, health workers rationing or charging for ACTs that should be provided at no cost).

Through regular SMS dialogue and situational polling, communities are now discussing issues important to them, are better informed of their rights and provided with information on how to enact change from the bottom up. At the same time, this information is being fed directly to officials in the Ministry of Health and presented regularly to Parliament and other stakeholders. Information collected from these channels is being used to build a real-time “accountability chain” within the formal health sector at all levels, with external stakeholders playing an active role in supporting and overseeing the health sector to ensure they are addressing bottlenecks in a timely manner.

By capturing real-time data throughout the continuum of care, bottlenecks can be immediately identified and addressed while accountability at all levels is strengthened. The mTrac initiative is expected to improve timeliness in the detection of low medicine stock-levels, prompting response to avert unwarranted ACT stock-outs.