Innovations in Monitoring Vital Events:Mobile Phone SMS Support to Improve Coverage of Birth and Death Registration: A Scalable Solution

Civil Registration (CR) of births and deaths is an essential component of any health information system.\ud Globally, across low income countries, CR suffers from unacceptably poor quality coverage. This Health\ud Information Systems Knowledge Hub (HIS Hub) working paper summarises and reports the results, conclusions and outlook from a small six-month project that investigated the potential of introducing a mobile phone step into the routine CR system in a rural district in Tanzania. The project developed a computer application that could receive SMS messages—from existing basic mobile phones of community-based CR officers—and feed them directly to the District Registrar’s office and computer. The message contained the details from the birth or death notification form. The system provided instant access to notifications and automatic feedback to the Village Executive Officer (VEO) if the family that experienced the birth or death event failed to register the event for certification. It also prompted the VEO to follow up with the family by conducting a questionnaire, administered by mobile phone, to determine and communicate the reasons for the non-registration. The District Civil Registrar was also able to monitor trends in these notifications via a user-friendly webbased browser and dashboard. The system was tested for six months and validated against an independent prospective household surveillance system that monitors pregnancies, births and deaths in the same period. In summary, the findings showed that the routine CR system notified only 28% of total births in the period. Adding the SMS step increased this to 51% of births. The routine CR system notified only 2.1% of deaths in the period. Adding the SMS step increased this to 14% of deaths. The SMS step therefore made significant improvements in the notification step (and modest improvements in the registration step) of routine CR. However, both notifications and registrations still fell well short of reality at community level. The most important finding of this pilot is that the current CR system in at least the study district, and likely in most of rural Tanzania, is essentially unable to provide adequate registration coverage for births and deaths, and that coverage is so low that even log order improvements are insufficient to lift it to satisfactory levels (in excess of 90%). This, as yet, says nothing regarding the quality of the data. No overwhelming reason is provided by families for the low reporting rate, suggesting that the problems are highly systemic and will need a radical redesign of CR processes to solve. To the extent that similar problems prevail in other low-income countries, it is clear that whatever these processes will be, some form of scalable real-time mobile communication such as SMS will greatly facilitate coverage levels. This pilot shows\ud that such technology is feasible. But these results also emphasise the need for an end-to-end overhaul of the\ud architecture and processes of how CR systems are built and integrated into the information fabric of a country. Small incremental technical fixes will not suffice\u

Control of Neglected Tropical Diseases: Integrated Chemotherapy and Beyond

Utzinger and de Savigny discuss the implications of a new policy paper, which argues that the control of "the big three" diseases (HIV, TB, and malaria) should be integrated with control of the neglected tropical diseases

Paludisme, le tsunami silencieux d'Afrique

Version anglaise disponible dans la Bibliothèque numérique du CRDI : Malaria : Africa's silent tsunam

Malaria : Africa's silent tsunami

French version available in IDRC Digital Library: Paludisme, le tsunami silencieux d'Afriqu

Effective coverage and systems effectiveness for malaria case management in sub-saharan african countries

Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and intervening to tac them become key priority areas for malaria control and elimination policies in the region

Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya.MethodsA micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel®, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated.ResultsIn Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future

State of inequality in malaria intervention coverage in sub-Saharan African countries

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries.; Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015.; There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions.; Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity