Text messaging to track patients

PIH FLSMS:Medic system

Hello from Neno! Here, I’ve drawn out the use case we’ll be focusing on for the Partners in Health pilot at Neno District Hospital. There is a lot of potential for the FrontlineSMS:Medic system to be used to track patients in a number of programs: e.g. ART, pre-ART (HIV-positive patients not yet on antiretroviral therapy), TB, PMTCT, Kaposi’s sarcoma, chronic care.

So, we have: touchscreens in the hospital for patient registration and clinical data entry, electronic medical records following patients and creating alerts, and cellphone-wielding village health workers tracking remote patients. I think it’s exciting, and we’ll be structuring the outcomes assessment this week.

VHWs TB training

We’re training 130-150 village health workers next week. In the picture above, the VHWs had gathered for a training session on multi-drug-resistant TB. You can see me in the back, watching intently.

Posted: July 12th, 2009
Categories: Other posts
Comments: 134 Comments.
Comment from Anne Marie Cunningham - July 12, 2009 at 4:41 pm

Thank you for sharing how your project is developing. I can’t help feeling that the talk of ‘tracking’ patients who may ‘abscond’ and the use of motorcycles, objectifies these patients to an extent that would never be tolerated in the developed world.
Am I very far of the mark?
Is the public health benefit of individuals taking ante-retrovirals enough to justify this intrusion into the patient rights?
Anne Marie

Comment from Josh - July 13, 2009 at 7:45 am

Many thanks for the comment, Anne Marie – always happy to rethink language (and I purposefully removed mention of patients “absconding”).

That said, the system is opt-in, and the overwhelming majority (>95%) of patients enrolled in the HIV and TB treatment programs choose to be paired with village health workers, who follow up on adherence, symptoms, social well-being, and (in the example, above) missed appointments.

Comment from Anne Marie Cunningham - July 13, 2009 at 9:24 am

Hello Josh

Thank you for clarifying this. If you have shared fuller details of the programme elsewhere I think it would be very useful to link to this. Infectious diseases, such as TB, do sometimes justify policies which supercede the rights of the individual. I was less convinced that there was sufficient evidence to justify this in the case of anti-retrovirals.

I did my medical student elective in Malawi in 1995. Healthcare was much more hierarchical in Malawi than in the UK, with patients very definitely bottom of the pile. Sometimes when immersed it is harder to see this.

I am glad that you are thinking about language. It is important.

Thanks again,

Anne Marie

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Comment from Frances Harrison - July 18, 2009 at 3:03 pm

I am a business school student at Imperial College in London (and an ex journalist!). I met Ken Banks and am researching user led innovation and mobile phone use in developing counties – I wondered what you’d seen in terms of innovation by the hospital CHW’s /staff themselves in this project. To what extent did you introduce the idea and its applications or did the hospital figure out surprising applications and uses? And how did the hospitals elsewhere like in Uganda find out about Frontline SMS Medic and vary in their use of the software?
frances Harrison

Comment from Josh - July 19, 2009 at 11:56 am

Hey Frances,

Thanks for visiting the site and chiming in.

In short, the use cases and applications for the software come almost entirely from local staff. What we’re doing is presenting tools, not solutions or programs. Certainly, the tools – cell phones, a laptop, GSM signal, and free software – are geared towards certain functionality (e.g. SMS, MMS, voice). That said, the most important component – what’s actually communicated, when, by whom, and why – is left up to the clinicians, data managers, hospital staff and village health workers.

That isn’t to say lessons are being learned and use cases aren’t shared between clinics. That sharing can happen via large media outlets like CNN, or I’ll be asked to rattle off different ways the software’s being used in a Skype call with a clinician in India. Usually, clinics become interested because they experience similar barriers to care as our previous partners; what we’re finding is that, as we build up more and more use cases, clinics can pick and choose from what’s already worked. Still, how the tools are applied will always be up to those who know what’s needed.

I hope I’ve answered your questions — if not, let me know!


Comment from Charles Howes - July 22, 2009 at 1:17 pm


Thank you for the great visual. I’m interested to know what you feel the largest hurdles are for implementation. How much customizing of the software do you have to do? What aspect of the system do staff find most difficult?

I look forward to reading more updates.

Be well,


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