Use of SMS Reporting to Improve Program Monitoring and Performance: A Case Study of EGPAF Kenya

Quality and use of health data and systems : Use of SMS Reporting to Improve Program Monitoring and Performance: A Case Study of EGPAF Kenya Author: Sikuku Evallyne 1 , Ejimba Eric 1 , Ondenge John 1 , Rose Masaba 1 , Eliud Mwangi 1 , Bondo Philip 2 1 Elizabeth Glaser Pediatric AIDS Foundation, Kenya 2 Ministry of Health, Homabay County, Kenya. Corresponding author: Sikuku Evallyne: esikuku@pedaids.org Word count:2 pages Introduction : Monitoring is an integral part of project management. Data are collected routinely to provide continuous feedback on the project implementation to assist in the identification of potential successes and constraints to facilitate decision making. PEPFAR funded programs require intense implementation and quick decision making to ensure achievement of targets hence the need for timely availability of results by site. Most of the existing data transmission systems are paper based and data is reported on a monthly basis that leads to delayed decision making and program reorientation. Kenya is one of the countries with an increased penetration of mobile technology at 82% driven by a continuing availability of affordable smartphone industry brought on by a result of increased competition with market players. The use of mobile technology has been demonstrated in the past to be one way to transmit information within the shortest time; it has been used to improve HIV clients’ outcomes through appointment reminders. Due to low cost and wider coverage compared to mobile data, Short Messaging Service (SMS) for reporting leverages on technology to collect and send data from wide geographical location. The purpose of the abstract is to demonstrate the effectiveness of the SMS reporting system on program monitoring for timely decision making. Methodology : Elizabeth Glaser Pediatric Aids Foundation (EGPAF) Kenya is funded by PEPFAR to support implementation of HIV prevention, care and treatment services in 159 health facilities in Homa Bay and Turkana counties. Data are availed to the program team on a monthly basis through the District Health Information System Software (DHIS) platform that has been configured into an in-house EGPAF’s Knowledge Management system (EKMS). The data are visualized through different templates like excel Performance Monitoring Plan (PMP) and PowerBI dashboards; program decisions could only be made on a monthly basis. In order to closely monitor performance against targets, there was need for data to be availed on a more frequent basis to enable responsive and targeted programming. In April 2018 just after the first Semi-annual performance reporting, EGPAF program team identified key “Hot” indicators which are key PEPFAR performance monitoring indicators that would be monitored weekly to drive overall performance by the end of the year. The indicators included clients newly identified HIV, clients newly initiated on ART, appointment keeping, viral load uptake among others. EKMS-SMS android application was developed and availed on Google Play Store to facilitate reporting to EKMS through SMS weekly. EGPAF Strategic Information and Evaluation (SI&E) team rolled out the application by installing and configuring it on selected health facility staff smartphones. The team also sensitized the facility staff on how the solution works and provided technical support on need basis. Messages sent on a weekly basis from the application incurred no cost to the health facility staff.  A confirmation message was sent upon successful delivery of the data into EKMS. The SI&E team would then monitor the reporting rates of all facilities for completeness as per the set timelines. Hot indicators data in EKMS are transformed into data visuals using PowerBI application which is a Microsoft Business intelligence and analytics solution. This platform allows the user to visually explore data, share dashboards and interactive reports and deliver quick insights for informed decision making across an organization. These visuals are refreshed daily and reviewed by the program team on a weekly basis to monitor performance and identify gaps that would require interventions. The data reported on a weekly basis was triangulated and compared with what is reported on a monthly basis for validity. Description of the application The SMS system has three main components. The EKMS application that is responsible for data capture from the end-user. This application encodes and encrypts the entered data and sends it via SMS messaging. There is also the SMS middleware which is responsible for decrypting and decoding the SMS message sent from the android application. The middleware uses a modem or an SMS gateway service to receive the message. Finally, there is the EKMS instance where the data is loaded and stored for use. Results : The implementation of SMS reporting to avail data to the program team on a weekly basis ensured 100% seamless and timely reporting for all the 159 facilities by end of every week as compared to the manual monthly reporting. This enabled improved, timely, and accelerated review of program data for quick guided technical assistance that saw the improvement of second semi-annual performance compared to the first semi-annual. The improvement was also observed in facilities across the different cadres as classified in the Kenya Master Health Facility List (KMHFL) Conclusion : The use of SMS reporting improves timeliness and use of data for decision making for program improvement.