IT, Health & Hope

Dr. Felix Kaigamba used to feel that Ruhengeri Hospital — the hospital that he supervises in the northern foothills of Rwanda, known for its lowland gorillas — was isolated from the head office of the Rwandan Health Ministry, 60 miles away in the country’s capital of Kigali.

“We have more than 3,500 HIV-positive patients, and we used to have to send someone all the way to Kigali to deliver all our reports and papers on their treatment. The trip would take a full day. And then we would have to wait for weeks to get a response to the reports. There was a big delay,” says Kaigamba.

Now communication is almost instantaneous. The district hospital uses cellular phones to upload vital information to a server at the ministry. Rural health workers are also able to immediately access information using cell phones.

“It is very handy,” says Kaigamba. “It has improved our treatment because we don’t have to travel to Kigali to deliver our reports. It cuts down on paperwork. It saves so much time. And it saves on transport and fuel costs. We are going to be able to reallocate funds for treatment. It’s very positive.”

Rwanda’s Treatment and Research AIDS Center Network (TRACnet) has tapped into cell phone technology to improve health-care systems in rural Africa. The two-year project has been so successful that it is going to be rolled out to 10 African countries in a joint partnership between several international technology and development agencies through the Phones for Health initiative, sponsored by the U.S. government’s President’s Emergency Plan for AIDS Relief (PEPFAR) in collaboration with the government of Rwanda.

“Africa, a continent with its face turned firmly to the future, has embraced new communication technologies like no other region in the world,” says Dr. Mark Dybul, U.S. global AIDS coordinator. “As the fastest growing cellular market, over 60 percent of sub-Saharan Africans now have access to wireless services, and that figure is projected to rise to 85 percent by 2010.”

The Phones for Health initiative, Dybul says, will leverage this communications infrastructure to coordinate the response to the HIV/AIDS pandemic and to extend the reach of that response out to the farthest village.

Serving Many

Ruhengeri Hospital, which serves the Musanze District in northern Rwanda, has 400 beds for about 400,000 people in the area. The hospital staff includes 20 doctors and 120 nurses and other workers, Kaigamba says. The medical team treats 3,538 HIV-positive patients, of whom more than 1,300 are receiving state-supplied anti-retroviral (ARV) drugs.

“Two doctors, three nurses and one social worker are running our HIV/AIDS program, and they are so happy with this new cell phone project,” he says. “They can provide the right patient information to TRAC easily and quickly. They go out and work with patients in the rural areas. They are able to use their phones to put in information such as the patient’s age, sex, condition and need for specific treatment.”

When the workers come within their cell phones’ signal range, they transmit the information to Kigali. The server in Kigali uses a standard Microsoft SQL Server database.

The Web-based application to gather the data uses simple question-and-answer text messaging. “The air time on the phones is prepaid so we don’t even have to pay for our phone calls,” Kaigamba says.

By gathering data from Rwanda, ministry administrators can determine whether demand for ARV drugs is outstripping supply at Ruhengeri Hospital or any other health clinic in the country. “It is a direct achievement because we can assure a regular supply of the drugs,” he says.

New Way

Dr. Anita Asiimwe, director of the Treatment and Research AIDS Center (TRAC), is equally enthusiastic.

“It is a quantum change in the way we do our work,” Asiimwe says. “We can do so much more with the phone system and so much more quickly. We can determine treatment for patients through the phone. We can keep weekly and monthly reports on a nationwide database through the phones.”

The most obvious change is in the ability to plan for and provide timely care, she says. For instance, if a health facility has several new patients all at once, the ministry can see immediately that it will need to supply more medications. “That’s one example,” Asiimwe says. “In the longer term, we are able to see if a health facility is enrolling enough patients and can use the information to develop strategies to improve that facility.”

Rwanda is rapidly expanding the number of patients receiving ARV treatment from 13,000 two years ago to a goal of more than 55,000 by the end of this year. Such a huge increase has been made easier since the rollout of the phone-computer information system, which is used by health facilities throughout the country that administer ARV treatment. Now, more than 200 field workers are trained to use the system.

“Before we started with this tool, we had so much paperwork coming in from every area,” Asiimwe says. “It would take months to come in and longer to be analyzed. Everything was much more cumbersome and slow.”

Now, the Health Ministry has begun plans to expand the use of the system to diseases other than HIV/AIDS, including disease surveillance for weekly reports on outbreaks of meningitis, malaria, polio, diphtheria, measles and other illnesses, Asiimwe says. “The same tool is very useful for tracking those diseases.”

Making the Leap

Ordinary mobile phones have been used in Rwanda combined with a voice-activated system and text messaging. Because most Rwandans already use cell phones and text messaging, the training to access the Web app and begin using it takes about 30 minutes. Once the PEPFAR effort begins this fall to deploy the system in other African countries, the plan is to use Java-enabled smartphones. For Phones for Health, Motorola will supply phones at cost for the 10-country rollout.

The costs of setting up the project and running it are relatively small. PEPFAR estimates that the price tag to start up the program in each country will be about $1 million and then the cost to run the program will be $500,000 per year.

The plan calls for launching the project in two countries by the end of 2007 and eight more in quick succession. South Africa, Nigeria and Tanzania have already been selected, and other African countries are being identified.

“Success will come from the coordinated efforts of the peoples of Africa, working together,” the State Department’s Dybul says. “The Phones for Health initiative puts the tools for effective communication and coordination in the hands of those people and unites them in their struggle.”