Health

This summary is part of a research project carried out between March and October 2006 in support of the International Institute for Communication and Development (IICD), one of The Communication Initiative (The CI)'s partners.

The spread of infectious diseases such as Severe Acute Respiratory Syndrome (SARS) and Acquired Immune Deficiency Syndrome (AIDS) over the past few decades has raised awareness of the threat they pose to human life and to state and regional economies. Early disease detection and effective communication, however, can play a key role in inhibiting their spread. The ability of groups affected to contact authorities is critical to an appropriate and swift response. Voxiva, a social venture, has developed a technology platform called Alerta that is able to collect data from a large number of people in disparate locations in real-time and has the communication and messaging capacity to effect change immediately.

Alerta uses the existing telecommunication infrastructure in place, thus avoiding the prohibitive costs of other information technology (IT) applications. Combining the internet and the telephone, Alerta extends software application benefits to those without internet access. The application can be adopted by users with any communication device and at any level of technological capability, suitable for remote areas with limited infrastructure. Rural Peru was chosen for the Alerta pilot project as it was an ideal environment for testing the data collection system in relatively isolated conditions, and the country had also demonstrated a commitment to rural connectivity and had a strong public health orientation. Peru’s current disease surveillance system, however, lacked an effective communication system between health workers in rural areas and decision-makers in Lima.

The Alerta pilot project was intended to improve communication and reporting of health care workers in areas lacking internet access quickly and with no investment in additional hardware. The objectives of the pilot project were:

• To broaden the network of weekly-reporting health posts to include those located in less accessible, rural areas where inefficiencies inhibit reporting;
• To develop a feedback loop enabling the Ministry of Health to relay information to the health posts;
• To improve the quality of data collected in the database;
• To decrease the time spent by medical staff completing paper documentation.

Voxiva developed a simplified reporting information transferral system and health information database and created a user-friendly audio interface that enabled Alerta users to submit health reports via telephone. The pilot system connected approximately 204,000 individuals in two areas of low population density, Chilca-Mala and Canete, and incorporated 76 health centres, health clinics, and district centres.

In a non-urgent context, Alerta can also facilitate the management of medical professionals in rural areas. Providers and users are able to interact asynchronously through forwarded voicemail to one or many users. Additionally, Alerta can play a key role in forming a baseline for disease behaviour in remote areas of Peru where no epidemiological data exists.

The pilot project began in March 2002 and concluded in September 2002. Preliminary results indicate that 28 health posts reported weekly and 22 reported monthly prior to Alerta’s deployment, due to difficulties in transporting the reports. Twelve of the 22 which had been reporting monthly began reporting weekly by telephone after Alerta’s installation. In all, 204 health and management workers used the programme.

Near the project’s end, a survey indicated that 90% of respondents using the system saw the faster response time of supervisors as a main benefit of the system, while 70% stated that greater communication with supervisors and colleagues was a primary benefit. Fifty percent stated that reporting was facilitated, while 40% believed that a greater number of cases were reported and 40% stated time-savings over the paper-based system.

All health posts were obligated to use the paper-based reporting system because the Alerta project was a pilot, resulting in some officials not wanting to submit reports twice. Additionally, despite the assumption that the telephone would be a familiar enough tool to minimise the need for training, some reports were submitted inconsistently due to problems with the interactive voicemail and voice response system (IVR).

Alerta's benefits were identified as follows:

• Enables two-way communication between disease surveillance system users;
• Simplifies and facilitates management and operational coordination associated with disease surveillance;
• Provides a database useful for near real-time or historical trend analysis;
• Decreases database error as the reporter enters the data;
• Allows data to be exported to other software formats, and conforms to other database formats.

The following lessons learned were identified as a result of the pilot project:

• The type of communication device used will be determined by deployable resources and the environment. If data is to be collected from widely dispersed communities, data must be accepted from a wide variety of input devices.
• It is probable that a decrease in the cycle time of the process of data input and aggregation, resulting in near real-time assessment of the field situation, will help to prevent or diminish outbreak duration;
• The Alerta system raises the quantity and quality of data available for decision-making purposes;
• Implemented systems must be cost-effective;
• In order to facilitate the use and adoption of technology, it must be intuitive to use - ongoing training is critical;
• Problem-solving is driven by collaboration among partners, users, and clients;
• Rural areas with no telephone access use the radio to contact the nearest health post with a telephone for reporting purposes;
• Industry-wide best practices should be followed.