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'RapidSMS' and mobile apps create waves of change in the fight against HIV and AIDS in Zambia

© UNICEF Zambia/2011/Nesbitt
A dried blood spot test is performed on a 6-week-old baby boy enrolled in a programme aimed at preventing transmission of HIV from mothers to children at the Nameembo Rural Health Centre in Southern Province, Zambia.

MAZABUKA, Zambia, 10 August 2012 – In a cubicle at Nameembo Rural Health Clinic in southern Zambia, Gloria Moonga quietly holds her six-week-old son Issac Simooya.   Nurse Eklina Chibenga pricks the infant’s tiny toe to collect five dime-sized circles of blood onto a sheet of paper. 

The 21 year old mother is HIV positive and Eklina is collecting a ‘Dry Blood Spot’ (DBS) sample to determine the baby’s HIV status. Before giving birth, Gloria received ‘Prevention of Mother-To-Child Transmission’ (PMTCT) services which have successfully lowered pediatric HIV infection in many parts of the world.  Gloria, who has known her status for over a year, will get her son’s results in two week’s time.  The results will be delivered via mobile Short Messaging Service (SMS) to Eklina’s phone. “I feel good because I know that my child will be protected,”  says Gloria.

SMS for HIV prevention
The collection of the DBS samples is part of an innovative HIV prevention project named Programme Mwana, supported by the Zambian Ministry of Health (MoH) and UNICEF Zambia, in collaboration with the Clinton Health Access Initiative (CHAI) and the Boston University affiliate Zambia Center for Applied Health Research (ZCHARD). Programme Mwana uses mobile phones to improve early infant HIV diagnostic services (EID), patient tracing, and post-natal follow-up and care.

Programme Mwana launched in June 2010 as a pilot strategy to deliver HIV early infant diagnosis results via SMS, in order to reduce typical delays in transmitting results from HIV test laboratories to rural health clinics.

Programme Mwana is designed to find innovative, scalable, and effective solutions to health services for mothers and infants in underserved and hard-to-reach rural health clinics. The technology utilizes RapidSMS, a free and open-source framework for building mobile applications for dynamic data collection, logistics coordination and communication.

© UNICEF Zambia/2011/Nesbitt
Zgambo Bede Majiwaka, environmental health technologist and PMTCT provider at the Nameebo Rural Health Centre uses SMS technology to receive the results of an early infant diagnosis test (EID) in Zambia's Southern Province.

Saving time, saving lives
At Nameembo Rural Health Clinic the turn-around time to receive the results has been reduced from 66 day, when couriers were used, to 14 days. “The SMS delivery of the DBS results has really helped us. Before it was difficult to get results, the time was too long and the nearest main health facility from where we went to collect results is 28 kilometers from here,” says Eklina, who has worked at Nameembo Rural Health Clinic for 10 years. “Many of our clients have to walk.”

“On average, results are 50 percent faster between sample collections and delivery at the facility, while the number of SMS results arriving at the facility has increased by 30 percent compared to the hardcopy paper result,” said Zgambo Bede Majiwaka, the clinic’s environmental and health technician and PMTCT provider.

To maintain confidentiality, the system is securely managed with a strong verification process. Only trained staff with pin codes can access it using their personal cellular phones to retrieve results. 

Mobile App fights AIDS
A tour of the five-room clinic providing various services to an estimated 15,000 local people demonstrates the scope and innovation of the SMS system. Another young mother has just delivered a baby girl and Lina Choonya, a RemindMi agent, is by her bedside registering the birth of the new born. RemindMi is a mobile application that stores, shares and provides notifications of important reminders and dates, which is used to improve post-natal follow-ups.  It was a RemindMi agent that traced Gloria to her house to remind her about her post-natal appointment.

Programme Mwana is currently running in  62 health facilities in 14 predominantly rural districts across six provinces of Zambia, and is planned to be scaled up to all health facilities offering EID services by 2014.



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