Hyderabad: A stitch in time saves nine. This well-worn adage was the premise on which a project for the Andhra Pradesh health department was designed in 2008.
The Integrated Disease Surveillance Project (IDSP), implemented by the National Informatics Centre (NIC), relies on the power of cellular phone technology for detecting communicable disease early. Identifying infectious diseases on time is critical for preventing a potential epidemic.
Communicable diseases can spread rapidly, often in a matter of minutes or seconds, and to prevent its proliferation, human communication has to be even faster, said K. Rajasekhar, senior technical director at NIC (Andhra Pradesh).
“This is the key to effective surveillance,” Rajasekhar said.
Otherwise, there is a risk that communicable diseases will assume epidemic proportions and may lead to pandemics, which in turn will result in loss of productive work hours and associated economic losses to the nation, he said.
The Andhra Pradesh team at NIC sought to leverage on mobile technologies to contain this risk. Equipped with mobile phones, health workers in the field transmit information pertaining to any disease detected in their jurisdiction, incidence of the disease and number of deaths caused by it, to a central computer server. As soon as the server receives the message, it sends an acknowledgement to field staff.
The data received from multiple locations is automatically marked on maps for authorities to easily pinpoint the incidence of any disease. The IDSP thus eliminates piles of paperwork, and makes officials’ task easier in tracking incidences of various diseases across the state through interactive maps.
Once a disease crosses a certain threshold, an outbreak alert is automatically generated, and district officials concerned are alerted through short message service (SMS). In some instances, officials of adjacent districts are also alerted to take remedial measures and contain the spread of a disease.
“Earlier it used to take about 40 days’ time for the data to be passed on from a remote place to the state headquarters,” Rajasekhar said. “Now it is done real time within four seconds.”
The system has come to the aid of the state’s health department. For example, when an incidence of anthrax was first observed in Prakasam district of Andhra Pradesh in 2009, health workers on the ground flashed messages that alerted officials who, acting on the inputs, could respond immediately and arrest the disease from spreading. The SMS surveillance system was also used to combat the challenges posed by the global H1N1 (swine flu) pandemic, NIC said.
Contrast this with the situation earlier, when surveillance used to be done manually or semi-automatically, Rajasekhar pointed out. Figures collected by field-level health workers would be collated by 12,500 sub-centres and 1,624 primary health centres (PHCs) that sent the data either by post or a courier to district units. After consolidating the data received, the district units would pass on the information to the state surveillance unit either by email or fax.
Today, about 130,000 health workers all over the state communicate directly with state health authorities. Field staff connect with the central server via SMS from their mobile phones. Those with Java-enabled phones have an application (a messaging template) installed on their devices into which they feed various parameters that are then converted into SMS before being transmitted. Alternatively, users can also send the information by directly keying in the inputs in a pre-fixed format of a text message.
The NIC team has devised a mechanism for authenticating the identity of the users. Health workers and their MSISDN (mobile station international subscriber directory number)—the mobile number of their SIM cards—are pre-registered with a database. Users have to key in their credentials to access the surveillance project.
“Everyone is given an ID. Their ID number and mobile number are a unique combination for ensuring authenticity,” said Rajasekhar. This means a health worker can change his or her phone, but not the cellular phone number, as it is this number that is registered with the database.