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

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?

scopeBangata

Makiba

Mlangarini

Oldonyo Sambu

154 total patients33 CHWs4 wards17 villages

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

setup

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

Asante Sana(Thank You)