Berhane Gebru: Disease Surveillance with Mobile Phones in Uganda

Posted by dsasaki on Jul 30, 2008

Berhane Gebru is Program Director at AED-SATELLIFE, an international organization which aims to strengthen health care in resource-poor countries by providing disease surveillance solutions and health information distribution to rural healthcare workers using mobile technology. He took some time out from this week's meeting on mHealth and Mobile Telemedicine to describe SATELLIFE's current project in Uganda which equips rural health workers with PDA's and GPRS wireless access points in order to transmit their health data collection to the ministry of health. We also discuss an upcoming project, currently being field-tested, which would allow those same health care workers to make their disease surveillance reports using simple mobile phones.[Editor's note:  A full case study of AED Satellife's project is written up in our recent report "Wireless Technology for Social Change," commissioned by the UNF/Vodafone Group Foundation Technology Partnership]

At the bottom of the post you can download an audio recording of our entire 20-minute conversation. This is an edited and abridged transcription.

DS: How did AED-SATELLIFE come to focus on delivering health information using mobile phones?

BG: SATELLIFE has been involved in using ICT solutions for health since 1989. SATELLIFE was the first email provider in Africa using satellite connections - so it was about 20 years back that SATELLIFE really started providing eHealth technologies. We started using mobile technologies in 2001. We started using the mobile devices because 1.) they are low cost, 2.) they can be easily maintained, 3.) the power requirements are very low, and 4.) they can work in areas where there is no electricity because you can recharge them using low cost solar panels.

So SATELLIFE started using mobile technologies in 2001 in Ghana, Uganda, and Kenya to establish health information delivery that is relevant for clinicians to heal their patients.

DS: Can you give me one specific example of how mobile phones have already been implemented - either in a clinic, hospital, or advocacy project?

BG: I can give you one example from Uganda where we use PDA's for disease surveillance, collection, and reporting, as well as for health management information systems that broadcast relevant heath information to health workers in rural clinics. The system works like this: Clinicians collect health data at the point of care. They point their PDA to a wireless access point connected to the national cellular network to transmit the health data. It consolidates all this data and then sends it to a server located at the Ministry of Health in Kampala. Health workers can also compose emails using the PDA's. At the same time they receive health information that is relevant in order to take care of their patients. We also send daily news from mainstream media because for some of the health workers there is no print media available.

In 2004 we conducted a cost-effectiveness assessment to assess the cost efficiency of using this network with PDA's on the cell phone carrier's network versus the paperwork approach and it showed a cost savings of 24% per unit spending compared to the traditional paper approach. This was done by independent consultants from the Uganda Economic Research Policy Institute. We also conducted another impact assessment to see to what extent the health information we are broadcasting is actually improving the quality of healthcare that they provide the patients and 87% of the users in five districts said that the information they received is helping them make a faster and more accurate diagnosis to prescribe the right drugs.

We are currently field testing the use of cell phones for disease surveillance reporting and event detection.

DS: Why did you go with PDA's for the first round of disease surveillance rather than using cell phones?

BG: It requires a huge amount of memory that you cannot get on cell phones. The forms for the data collection are also relatively complex.

DS: So it's a device problem as far as memory goes and also an interface problem as far as the size of the screen goes in order to do the data input?

BG: The size of the screen is important in terms of the delivery of health information so that they can read and scroll down and so on. But for the data entry, you need more processing speed and memory. Probably the cell phones that are coming out now might have those capabilities, but I don't think we're there yet.

So, going back to the disease surveillance reporting platform using mobile phones that we have developed with Rockefeller Foundation funding, it uses cell phones so that health workers at the health centers are able to collect data and send it in using SMS text messages. You can also use a mobile web interface and you can also use voice.

DS: How would that work? Can you run me through how a voice data collection would work?

BG: I would call a server from a rural health center using a cell phone or a landline. The server would pick up the call and ask me the name of the district - for example, 'say or enter the name of the district.' Then it would ask me about the occurrence of diseases, for example, 'are there any reports of cholera? For yes, press 1, for no press 2.' I would do that and then it would walk me through all the other questions to collect the data.

The server aggregates all the information, all the data coming from several health centers and it would automatically produce reports for the ministry of health and it would also detect events based on action and alert thresholds. For example, how many measles cases? If one measles case is the threshold for further action, it would send an automatic email to the officials who must be notified about the occurrence of this disease the moment that the data is received. It can also produce weekly epidemiological reports that are shared with other agencies, pulling all that data together.

We are field testing it now. And, you know, part of the discussion in this meeting is about building disease surveillance platforms so we are thinking about building on this and making it global. And, if needed, to give it additional functionality. The next step is that we want to add geo-location functionality so that the data that is coming in would also be on a map for visualization and for linking with other relevant data.

DS: So you're starting to bring up what hardware the phone would have to have too ... for example, if it has geo-information, then the phone probably needs to have GPS, right?

BG: Yes and no. Eventually yes, because if you want to make the data household specific, then you need to have the GPS coordinates of that household, but as of today you can just report the location of the health center. Eventually though, you are right, you need to map where that household is.

DS: What have been your impressions of this week's meeting so far? Is there a shared vision that is coming together?

BG: Yes, you know, mHealth is relatively new and many of the players involved in it ... some of they may know each other, but it is difficult to know who is doing what and so I think it gives an opportunity to know who is who, who is doing what, and avoid the risk of re-inventing the wheel. We have very scarce resources and if there is already a tool that has been developed, then there is no need to do so again.

DS: What do you think are a couple of the most exciting applications of mobile health?

BG: Well, two. 1.) Health data collection and reporting and 2.) delivery of continuing medical education to health workers - the information that they need to heal their patients.

DS: Where do you think the innovation for developing those two applications is going to come from?

BG: It will come from different organizations, but it will also come from the private sector. The private sector is a huge player here. I don't think any solution would be sustainable if it's not commercialized and if the private sector is not involved so I think there is a huge role for the commercial sector to play, but it's really the concerted efforts of different players that would really make a huge difference. And social innovation must respond to the actual needs on the ground. There needs to be a very very strong link and understanding of what the problems are in those rural areas of Tanzania or Zimbabwe or Uganda or Rwanda, for example, in order to make a meaningful innovation.

DS: Is there anyone who is not here this week who is a fundamental part of that process? Who would you have liked to invite?

BG: I would have liked to invite representatives of the ministries of health that have a technology background. In the mHealth section I think there is probably only one person representing the ministry of health from a developing nation. I think that they are critical and I would definitely invite them.

DS: What do you see as the ideal outcome of this meeting?

BG: I would hope for a common vision about the future of mHealth and how it can be used to improve the quality of health in the Global South. Also, establishing a means of disseminating that shared vision so that those who did not come here will have the opportunity to know the vision of those of us who did participate here and establishing a mechanism to get their input before we aim for a global consensus.

During our 20-minute conversation we also talked about who has access to the information that is aggregated by the SATELLIFE disease surveillance system, whether it might one day be publicly accessible on a website, and a project in Uganda which teaches medical students at Makerere University in Kampala using mobile phones. An MP3 file of our conversation is available for download. (Right click, save as.)

Berhane Gebru

Requesting private adress of Berhane Gebru

My Name is Assefa Gebreamlake From Ethiopia. I have Graduated from Addis Ababa University Faculty of Social science Departement of Applied Geography and Enviromnental Studies. I have work My senior essay Project on Spatial utilization of selected health facility in Addis Ababa Twon. After Graduation I have Extended My research On Disease serviellance System Using Mobile phone In Ethiopia. In Studying The Exprience of simmilar projects in other countreis, I came up with your website. If it is possible I would like to make a personal contact with Mr. Berhane Gebru.

With Best regardes

Assefa Gebreamlake

Berhane Gebru

Dear Assefa,

We do not give out information of this nature without the permission of the people involved, as you can surely understand. Please email me with your email address and I will gladly forward it to Berhane. You can reach me at katrin at mobileactive dot org.  Thanks!




Great Initiative!

This is great initiative and hope you can expand it to the rest of Africa.

Roger Frederick

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