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Support for International Change Monthly Monitoring at a Small NGO: Mobile Phones vs. Paper

Support for International Change Monthly Monitoring at a Small NGO: Mobile Phones vs. Paper. Kati Regan Managing Director, SIC. Kati Regan 1,2 , Y. David Seo 1,3 , E. Churchman 1,4 , J. Kiwango 1 , S. Gervas 1 , L. Whiddon 1

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Support for International Change Monthly Monitoring at a Small NGO: Mobile Phones vs. Paper

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  1. Support for International ChangeMonthly Monitoring at a Small NGO: Mobile Phones vs. Paper Kati Regan Managing Director, SIC 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

  2. 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).

  3. background Population served 750 people living with HIV 96 villages home to 300,000 60,000 HIV tests to date Awareness campaigns and individual patient follow-up Activities Staff 12 full-time staff (11 Tanzanians) 182 Community Health Workers Tanzania

  4. at the start SMS Data Collection Inconsistent reporting, legibility No legibility issues, no lost forms Manual data entry required Automatic entry into database Slow turn-around time Instantaneous receipt of data Transportation, paper costs No transportation, no paper cost

  5. Can we do it? Should we do it? the pilot • Platform • Resources (human and financial) • Implementation • Need for better practice • Expansion strategy • Better program management

  6. scope Bangata Mlangarini 154 total patients 33 CHWs 4 wards 17 villages OldonyoSambu Makiba

  7. setup person A #A 0224146 2008 0 Lemongo CHW RAW DATA person B #B 0232393 2010 1 Oldonyo person C #C 0928172 2011 1 Mlangarini Manual error check Reimbursements SIC database

  8. setup

  9. results 501 SMS received @ 6 months 363 SMS received @ 2 months 6 months Pilot start 1 month 2 months

  10. warning system ARV adherence Last CD4 count <200 Recent hospitalizations Recent pregnancies or births

  11. results After 2 months After 6 months 37% of patients had usable monthly report 43% of patients had usable monthly report Only 6% of monthly reports collected Received 85.5% of monthly reports (but with more information missing) Paper

  12. CHW survey Reasons that CHWs stopped texting Tired of using the system Felt they were not being reimbursed for SMS Thought pilot was over

  13. CHW survey Focus group with 24 of the 33 CHWs involved • 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

  14. what worked internal external • Real-time usable client data • Warning system • CHW motivation • Client confidentiality

  15. what didn’t work internal external • Database maintenance • Technical troubleshooting • Consistent power • CHW training and errors • Reporting inconsistency • Reimbursement issues

  16. the bill Human • 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

  17. reality check No legibility issues, no lost forms Errors in SMS and non-compliance Automatic entry into database Database maintenance Instantaneous receipt of data Training and supervision time No transportation or paper cost Upfront costs, CHW reimbursement

  18. Can YOU do it? Should YOU do it? the question • All-or-nothing operational system (front and back end) • Maintenance is as important as setup • 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?

  19. acknowledgements For financial and logistical support Community health workers and all staff on the ground

  20. Asante Sana (Thank You)

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