support for international change monthly monitoring at a small ngo: mobile phones vs. paper kati...
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Support for International ChangeMonthly Monitoring at a Small NGO: Mobile Phones vs. Paper
Kati Regan1,2, Y. David Seo1,3, E. Churchman1,4, J. Kiwango1, S. Gervas1, L. Whiddon1
1Support for International Change (SIC), Arusha, United Republic of Tanzania, 2University of Maryland, College Park, Education Policy Studies, College Park, United States, 3University of Michigan Medical School and the William Davidson Institute, Ann Arbor, United States, 4Emory University, Hubert Department of Global Health, Atlanta, United States
Kati ReganManaging Director, SIC
support for international change Paper-based reporting system is not timely, the cost is high, and the data incomplete. To address this, SIC developed an inexpensive pilot to explore whether an SMS-based client monitoring system will be better (quality/accuracy of data, consistency of reporting).
background
Ta n za n i a
Population served
Activities
Staff
750 people living with HIV 96 villages home to 300,000
60,000 HIV tests to dateAwareness campaigns and individual patient follow-up
12 full-time staff (11 Tanzanians)182 Community Health Workers
accuracy
usage
time
cost
Inconsistent reporting, legibility
Manual data entry required
Slow turn-around time
Transportation, paper costs
SMS Data Collection
No legibility issues, no lost forms
Automatic entry into database
Instantaneous receipt of data
No transportation, no paper cost
at the start
- Need for better practice
- Expansion strategy- Better program
management
the pilot
- Platform- Resources
(human and financial)
- Implementation
Can we do it? Should we do it?
setupperson A
CHWperson B
person C
#A 0224146 2008 0 Lemongo
#B 0232393 2010 1 Oldonyo
#C 0928172 2011 1 Mlangarini
RAW DATA
SIC database
Manual error
check
Reimbursements
results
6/d/yy 7/d/yy 8/d/yy0tan28a566028
0tan10a566010
0tan21a566021
0tan3a56613
0tan14a566114
0tan25a566125
Pilot start 1 month 2 months 6 months
363 SMS received @ 2 months
501 SMS received @ 6 months
warning systemLast CD4 count <200
Date SIC ID CD4 Gender Age Abx ARV Field Officer Ward Village CHW Names6/30/11 1051 150 M 21 Y N Aisha Oldonyo Sambu Oldonyowass Laban Mollel7/3/11 1029 59 F 44 N N Aisha Oldonyo Sambu Lemongo Andrea Laizer7/4/11 1015 19 F 70 Y N Aisha Oldonyo Sambu Lemongo Andrea Laizer7/4/11 1010 130 43 Y Y Aisha Oldonyo Sambu Lemongo Andrea Laizer7/4/11 1034 104 Y N Aisha Oldonyo Sambu Lemongo Maria Elisha7/5/11 1017 35 F 43 Y N Aisha Oldonyo Sambu Lemongo Andrea Laizer7/7/11 1018 125 M 15 N N Aisha Oldonyo Sambu Lemongo Andrea Laizer7/8/11 2010 118 Y N Lucy Makiba Majengo Johari Juma
7/19/11 2029 154 F 55 Y N Lucy Makiba Patanumbe Fred Raphaely7/29/11 2013 3 F 9 N N Lucy Makiba Makiba Emanuely Sumary8/10/11 2035 180 Y Lucy Makiba Valeska Augustino Kimutho8/13/11 2026 106 F 43 Y N Lucy Makiba Makiba Juma Kisindo8/15/11 2034 166 M 18 N N Lucy Makiba Valeska Augustino Kimutho12/8/11 2010 118 Y N Lucy Makiba Majengo Johari Juma12/8/11 2010 118 Y N Lucy Makiba Majengo Johari Juma12/8/11 2010 118 Y N Lucy Makiba Majengo Johari Juma12/8/11 2010 118 Y N Lucy Makiba Majengo Johari Juma12/9/11 2010 118 Y N Lucy Makiba Majengo Johari Juma12/9/11 2026 106 F 43 Y N Lucy Makiba Makiba Juma Kisindo12/9/11 2010 118 N N Lucy Makiba Majengo Johari Juma
Date SIC ID Adherence Gender Age Field Officer Ward Village CHW
7/4/11 1006 2 F 28 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/4/11 1010 2 43 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/4/11 1019 2 F 25 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/4/11 1034 2 Aisha Oldonyo Sambu Lemongo Maria Elisha
7/5/11 1005 2 M 33 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/5/11 1027 2 F 43 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/5/11 1031 2 Aisha Oldonyo Sambu Lemongo Maria Elisha
7/5/11 1028 2 F 37 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/5/11 1014 2 M 44 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/7/11 2007 3 M 12 Lucy Makiba Majengo Johari Juma
7/7/11 1012 2 F 39 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/7/11 1033 2 29 Aisha Oldonyo Sambu Lemongo Maria Elisha
7/8/11 2010 2 Lucy Makiba Majengo Johari Juma
7/8/11 2011 2 Lucy Makiba Majengo Johari Juma
12/9/11 2007 3 M 12 Lucy Makiba Majengo Johari Juma
ARV adherenceRecent hospitalizationsDate SIC ID Gender Age Field Officer Ward Village CHW
7/3/11 1002 36 Aisha Oldonyo Sambu Lemongo Andrea Laizer7/3/11 1029 F 44 Aisha Oldonyo Sambu Lemongo Andrea Laizer7/4/11 1015 F 70 Aisha Oldonyo Sambu Lemongo Andrea Laizer7/4/11 1019 F 25 Aisha Oldonyo Sambu Lemongo Andrea Laizer7/5/11 1017 F 43 Aisha Oldonyo Sambu Lemongo Andrea Laizer7/7/11 1018 M 15 Aisha Oldonyo Sambu Lemongo Andrea Laizer
7/18/11 1038 F 35 Aisha Oldonyo Sambu Losinoni Wilson Laizer8/10/11 2035 Lucy Makiba Valeska Augustino Kimutho12/6/11 1057 Aisha Oldonyo Sambu Oldonyowass Laban Mollel12/9/11 2008 M 11 Lucy Makiba Majengo Johari Juma12/9/11 2008 M 11 Lucy Makiba Majengo Johari Juma12/9/11 2008 M 11 Lucy Makiba Majengo Johari Juma12/9/11 2029 F 55 Lucy Makiba Patanumbe Fred Raphaely
Recent pregnancies or birthsDate SIC ID Pregnancies Births Gender Age Field Officer Ward Village CHW Names
7/18/11 1042 0 1 27 Aisha Oldonyo Sambu Losinoni Wilson Laizer7/18/11 1039 1 0 F 36 Aisha Oldonyo Sambu Losinoni Wilson Laizer12/8/11 1038 1 1 F 35 Aisha Oldonyo Sambu Losinoni Wilson Laizer12/9/11 1039 1 0 F 36 Aisha Oldonyo Sambu Losinoni Wilson Laizer
resultsAfter 2 months After 6 months
Paper
37% of patients had usable monthly report
Only 6% of monthly reports collected
43% of patients had usable monthly report
Received 85.5% of monthly reports (but with more information missing)
CHW survey
56%25%
19%
Felt they were not being reimbursed for SMS
Tired of using the system
Thought pilot was over
Reasons that CHWs stopped texting
CHW survey Focus group with 24 of the 33 CHWs involved
successes
challenges
• Felt more likely to answer every question• Increased sense of impact and confidentiality• All CHWs indicated they would like to continue
SMS reporting
• Only one CHW could explain reimbursement system
• All CHWs believed they had not been reimbursed properly
what worked
• Real-time usable client data
• Warning system
• CHW motivation
• Client confidentiality
internal external
• Database maintenance
• Technical troubleshooting
• Consistent power
what didn’t work
• CHW training and errors
• Reporting inconsistency
• Reimbursement issues
internal external
the billHuman One full-time fellow for 8 weeks (WDI funded)
• Proficient in Excel• No experience with SQL
Financial Upfront costs• GSM modem • Training costs Variable costs• Total SMS cost
Total
$65.8$136.6
$19.0
$221.4
reality checkaccuracy
usage
time
cost
No legibility issues, no lost forms
Automatic entry into database
Instantaneous receipt of data
No transportation or paper cost
Errors in SMS and non-compliance
Database maintenance
Training and supervision time
Upfront costs,CHW reimbursement
- How will better data change management?
- Can this be applied to a larger scale?
- Do you have capacity (current and potential) to act on success?
the question
- All-or-nothing operational system (front and back end)
- Maintenance is as important as setup
Can YOU do it? Should YOU do it?
acknowledgementsFor financial and logistical support
Community health workers and all staff on the ground