Within the health sector, telecommunications are crucial, not only for an epidemiological monitoring, but also for a more global coordination of public health. That is how Télécoms Sans Frontières and the NGO PATH collaborated to create an information sharing system enabling the SILAIS in Matagalpa to obtain the health data necessary to prevent pneumonia.

The aim of this project is to develop and implement an SMS sharing system via FrontlineSMS software for a more global approach of prevention, diagnosis and treatment of pneumonia among children under 5, in the department of Matagalpa.

Read out the actions of TSF in Matagalpa, Nicaragua here.

Mobile technologies serving the health sector in Nicaragua
SMS solutions, broadcast, information gathering, etc

In 2009, TSF implemented an epidemiological monitoring system for the Ministry of Health in Nicaragua (MINSA), using GSM technology to fight the dengue fever epidemic in Managua. Today, TSF is still working alongside the System of Integral Health Services (SILAIS) in the capital, and also supports MINSA to reduce maternal mortality rates and improve epidemiological monitoring in the Jinotega region. Great advances are already noticeable in terms of medical coordination and TSF hopes to be able to extend the system to other areas in the country.

The communication system used by TSF is based on a computer and a GSM card to create a central server for communications (FrontlineSMS technology). Once installed, the program enables the exchange of messages between many interlocutors via mobile phone. Equipped with a mobile by TSF, each health institution can send different types of information via SMS, based on a pre-completed form.

Since the launch of this collaboration program with MINSA, TSF has been following up the project and accompanying the SILAIS units and health centres for a total appropriation and mastery of the new system: organisation of ICT training sessions in the use of the system and software like ACCESS, and Google Earth, creation of new forms, regular updates and revision of the system, in consultation with the Ministry of Health, etc.

SMS for monitoring dengue fever, diseases, pregnancies, and missing patients in Managua
    
Following the successful conclusion of the first project during the 2009 dengue fever crisis, SILAIS and TSF have renewed their collaboration to create a generalised epidemiological monitoring system in the capital. Thus, in 2011, TSF put into action a mobile health system linking the SILAIS in Managua (where the central server for communications is set up), 15 health units and 5 public hospitals, and allowing them to communicate all their medical data. The forms have been prepared notably for the monitoring of dengue fever, H1N1 (bird flu) and pregnancies. The system is particularly useful in the face of recurrent epidemics in the area, communicable diseases, high maternal mortality rates and malnutrition. With this sharing of information, common measures can be taken; for example, fumigation for dengue fever.

Questioned about the system, Dr Ligia Aragón, manager of epidemiological monitoring for SILAIS Managua, claimed: “The service was very useful to us during the 2009-2010 dengue fever epidemic. Today, the system provides indispensable communications, for the health centres, at a low cost. Equally, the system has been used to search for patients who leave hospital prematurely: their life depends on this service. In this situation, we contact the local health centre by SMS so that they can help us find the patient, and they can receive the necessary care.”

The system enables the generation of interactive maps for epidemiological monitoring with Google Earth. Lastly, the financial gains are considerable for SILAIS, which previously had to create reports based on information gathered during extremely long phone calls. According to Dr Ligia Aragón, urgent information needing to be sent to 30 people might have cost 79 dollars and taken 4 hours. Today, in just a few clicks, information can be sent for close to 2 dollars.
 
During the period between January 2010 and February 2012, 17,199 SMS were exchanged between the SILAIS and the health units (6% of which were forms and 94% text messages). Of the 16,167 text messages, 10% related to the medical meetings, 25% to field assessments for viral diseases and 18% to localisation of patients. In addition, 8% of the forms sent concerned Pneumonia Surveillance and 7% the Surveillance of Hemorrhagic Dengue in health units.

Participation in actions to reduce maternal mortality rates in the Jinotega region

The maternal mortality rate in Nicaragua is over 170 women per 100,000 births, and the government has committed itself to reducing this figure by 75% by 2015.  As part of this agenda, TSF has been called upon to establish an epidemiological monitoring system for maternal mortality in the Jinotega region. The Jinotega region is situated in a mountainous and isolated zone in the north of the country.

Twenty-eight health establishments and one hospital were identified to join the program. The central server for communications is set up at the SILAIS in Jinotega. Since the launch of the project in January 2011, TSF has supplied mobile phones to 10 of the health units; whilst 19 others were equipped by SILAIS. Additionally, 13 forms have been created, in collaboration with the health centres and the SILAIS, to generate analytical reports. To accompany SILAIS in this new organisation, training was provided in March 2011.

Also, as early as April 2011, the staff of the different establishments could use the application to exchange information. For this, simple predefined forms are filled in and collected via mobile phone, for example, information concerning morbidity, mortality, emergency transfer of patients, drug stocks, monitoring of chlorine levels (in water wells used for drinking), activities of the health centres or even the frequency of pregnant women missing their medical appointments.

Similarly, during the period between April 2011 and February 2012, 3,198 SMS were exchanged between the health establishments: 1,628 forms and 1,570 text messages. Of the 1,570 text messages, 83% related to the Epidemiological Surveillance Service, 15% to the Warning Program for Women, Children and Adolescents and 2% to other projects. In addition, 65% of the forms sent concerned the Diarrhea Surveillance Service and 10% the Surveillance of Maternal, Perinatal and Child Mortality.

Through becoming involved in the fight against maternal mortality with the Ministry of Health in Nicaragua, TSF is contributing to the 5th Millennium Development Objective defined by the United Nations. The mHealth system constitutes an indispensable tool for the exchange of vital data, with possibilities to be extended to numerous other districts in the country. It is noted that the training offered by TSF to users of the system has been a key factor in the success of the project.