SMS Monitoring: An offline, real-time digital monitoring system for tracking an integrated SBC program in 4 regions of Ethiopia

Summary:

Communication for Heath, an integrated social and behavior change (SBC) project aims to improve health service utilization and increase healthy behaviors in rural Ethiopia. The project focuses on multiple health areas including Reproductive, Maternal, Newborn and Child Health and Malaria. It supports the public health system including lower level primary health care units (PHCU), and health posts (HPs) to facilitate radio listeners group discussions, disseminate maternity waiting home videos and share mobile application to rural communities in 160 districts. Monitoring of community level SBC activities was a challenge due to distance of intervention woredas, poor internet connectivity, inadequate project staffing and workload of PHCU/HP staffs. Most of PHCU and HP staffs have mobile phones. Communication for Health introduced FrontlineSMS (an SMS based application) to monitor performance of community level SBC activities. We identified 12 priority indicators for the SMS reporting and provided short orientation trainings to the public health staffs on how to use the system. Trained woreda SBC focal persons did similar orientation training for PHCU and HPs staffs. Woreda SBC focal persons collect performance data from PHCU and HPs upon completion of the tasks through text messages and send monthly report to the project office via text message. FrontlineSMS receive text message from the SBC focal persons and automatically send acknowledgement to the sender. Text messages exported into spreadsheet and used to project performance monitoring. The project spends nearly 1 USD/month per woreda. SMS monitoring is simple, smart and cost-effective system for monitoring of integrated SBC programs.

Background/Objectives:

The Communication for Heath project aims to improve health service utilization and increase healthy behaviors at the community level using integrated social and behavior change (SBC) interventions. The project intervened radio program, videos for health clinics, mobile application with relevant health messages, and social mobilization activities engaging local communities. It supports the public health system including lower level PHCUs and Health Posts to facilitate community meetings, to distribute SBC materials to the rural community. Monitoring of SBC activities was challenged by distance of intervention woredas, poor internet connectivity, inadequate project staffing and workload on health workers in the health system.

Description of Intervention and/or Methods/Design:

Short Message Services (SMS) is the most widely used, low cost and inclusive technology in Ethiopia. Most people in the public health system and volunteer community health workers use SMS. The project introduced FrontlineSMS system to monitor performance of community level SBC activities. In consultation with stakeholders 12 priority indicators (E.g radio listeners group discussions conducted disaggregated by sex) were identified, and designed the SMS reporting platform. We developed guidelines for the SMS reporting system and provided short orientations to the woreda SBC focal persons in the 160 intervention Woredas. Trained woreda SBC focal persons did similar orientation for the primary health care unit (PHCU) staffs, and Health posts. Woreda SBC focal persons collect performance data from PHCUs and HPs upon completion of the tasks through text messages and send monthly report to the project office via text message.

Results/Lessons Learned:

FrontlineSMS receive text message from the SBC focal persons and automatically send acknowledgement to the sender. We export the text messages into spreadsheet, analyze and use it to monitor project performance. Data is entered into the SMS message as simple codes. For Example: jan, lgds:s5,f30,m25, mwd:i3,s3,f75,m4, map:f35,m25 is a monthly report from one of the woreda SBC focal persons. It means in January, there was listener group discussions in 5 sessions, which attended by 30 female, and 25 male; maternal and child health video played in 3 clinics with attendance of 75 female and 4 male; mobile application was shared to 35 female and 25 male community members in the reporting woreda. Additionally, CCP conducted supportive supervision and review meetings to the woredas to verify the reports and ensure quality of program. The project spends nearly 1 USD per woreda for monthly FrontlineSMS and SMS messaging, which is low cost.

Discussion/Implications for the Field:

The SMS monitoring system is a simple, smart and cost-effective approach for monitoring of integrated social and behavior change programs in Ethiopia. Most importantly it provides real time monitoring data without adding to the burden of the health system staff. Integrated communication programs with diverse implementing partners may use SMS to monitor performance of the program. SMS monitoring is digital monitoring which is not dependent on the internet, provides us an opportunity to monitor SBC programs in real time and at scale.

Abstract submitted by:

Habtamu Tamene - JHU CCP Ethiopia
Mouz Asfaw - JHU CCP Ethiopia
Nandita Kapadia Kundu - JHU CCP Ethiopia
Sanjanthi Velu - JHU CCP Ethiopia
Feleke Tanga - JHU CCP Ethiopia