SMS reminders, a simple way to improve health care in Africa

Despite chronic poverty and weak infrastructure, many African countries have recently overcome communication problems through the widespread adoption of mobile phone technology. A study published today in the Lancet revealed that the use of such technology could improve health worker practices in health facilities.

In Africa, it is vital for health workers to follow national malaria treatment guidelines to make sure that patients with malaria are correctly treated. However, although the guidelines are relatively simple, numerous studies from across the continent have found that health workers often do not follow the guidelines.

To help improve health workers practices, researchers at the Kenya Medical Research Institute (KEMRI) – Wellcome Trust Research Programme carried out a study looking at the impact of sending Short Message Service (SMS) reminders to health workers’ personal mobile phones. The study showed a 25% improvement in health worker practices in providing correct care to patients with malaria. The intervention resulted in a substantial increase in the number of patients who received prompt antimalarial treatment at the health facility and were correctly counselled to take remaining tablets when they were at home.

Lead author of the study Dr Dejan Zurovac says, ‘Malaria is still a major killer in Africa. This trial, the first one using text-messaging to target health worker behaviour in a developing country, has shown that a simple intervention like SMS can substantially improve the quality of care patients receive. But also, this strategy has the potential for improving quality for other diseases, too. Text-messaging should complement traditional approaches to support clinical management such as health worker training, supportive supervision, or job-aids.’

Professor Bob Snow, who heads the group in Nairobi, says that “the role of the mobile phone in improving health providers’ performance, health service management and patient adherence to new medicines across much of Africa has a huge potential to engage and promote health to many people, who despite being poor and often living in remote areas, nevertheless have access to cell phone communication”. However, Snow adds that “it is important to rigorously test good ideas to measure their impact before they become practice”.

Co-author and head of the Department of Disease Prevention and Control, in the Kenyan Ministry of Public Health and Sanitation, Dr Willis Akhwale emphasized that, ‘this is an excellent example of high quality research responding to immediate needs of policy implementers who are continuously searching for simple and low cost solutions to strengthen weak health systems and provide better care for Kenyans. We need to explore ways of scaling up such intervention to all health workers in the country.’