PARIS:To Rwanda's top HIV/AIDS official, communication within the national health care system can be slow enough to present a threat to health.
“Information from clinics is written on a piece of paper that a porter carries by hand to the district before the information can be brought to Kigali,” said Dr. Innocent Nyaruhirira, who holds the Cabinet-level post of minister for HIV/AIDS. “We are a country of one thousand hills, so it often takes one month to receive a message from the field about a disease outbreak or drug shortage.”
The travel time cripples drug supply management, prevents live tracking of disease outbreaks, undermines monitoring of health programmes and delays delivery of laboratory test results to patients.
Enter Voxiva, a US company that has built a system that lets health workers send reports by cell phone directly from the field. First deployed five years ago to track disease outbreaks in the Amazon basin, Voxiva's system is also being used in Indonesia for avian flu reporting and in India to test a new drug for leishmaniasis, a disease spread by sand flies.
In Rwanda, the system started tracking HIV/AIDS patients two years ago and now connects 75% of the country's 340 clinics, covering a total of 32,000 patients.
“By identifying individual patients in a central database, we can now follow up on individual patients, even when they change clinics,” Nyaruhirira said. “The wonderful thing with Rwanda is that mobile phones are everywhere.”
Using mobile phones makes sense across the developing world, said Howard S. Zuckerman, assistant director general of health technology and pharmaceuticals at the World Health Organization.
“I was recently in Mozambique and saw a child who looked extremely malnourished and unwashed standing next to a stream with dirty water,” Zuckerman said. “The remarkable thing is that this same child was speaking on a mobile phone.”
Phones could also fight the growing scourge of counterfeit pharmaceuticals, Zuckerman added.
“SMS messages could be used by patients to authenticate code numbers on individual bottles,” he said, referring to the short message service offered by wireless phones.
Operating through servers in Kigali that are owned by the South African telecommunications operator MTN, the Rwanda system gets field clinic reports via text message, a voice-call system or on the Internet using a computer or Internet-enabled cell phone.
Each time a new patient enters the system, the information is sent in, while weekly reports cover data like a clinic's stocks of drugs, and monthly reports cover the number of patients under treatment. Clinics receive messages including the results of laboratory tests and drug recall alerts sent by the ministry of health.
“Large companies use a series of integrated systems along with e-mail to communicate among their employees and customers around the world,” said Paul Meyer, co-founder and chairman of Voxiva, which is based in Washington. “We have shown you can accomplish the same thing with nothing more than cell phones.”
For all the benefits, however, Nyaruhirira warns that putting the program into place is not easy. “People like me are so beloved of our hand notes that we must train a new generation of nurses and doctors that are comfortable with the mobile phone,” he said.