Health Systems and Policy Research

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Strengthening Health System: Using Mobile Phones for Coordinated Community Case Management of Childhood Diarrhea and Pneumonia in District Badin, Pakistan

Zahidie Aysha, Sangrasi Kashif , Iqbal Saleem, Perveen Shagufta, Aftab Wafa and Rabbani Fauziah

Background: Fourth evaluation of Lady Health Worker’s Program identified weak supervision of Lady Health Workers (LHWs) by their supervisors (LHSs) as a determinant of poor community case management of childhood diarrhea and pneumonia. Weak supervision was explained by lack of coordination among them. To improve coordination between LHWs and LHSs, this study used mobile phones for timely case reporting by LHWs and supervisory follow-up by LHSs.

Materials and Methods: Short Message Service was added to track diarrhea and pneumonia cases within existing Management Information System of the Lady Health Worker’s Program in District Badin. Total 34 LHSs and 170 LHWs were enrolled. The LHSs were given mobile phones for real-time communication with LHWs. Upon case identification, LHWs relayed information using text messages and arranged appropriate follow-up with LHSs.

Results: Between the first and final quarters of surveillance, LHW to LHS case reporting via text messages improved from 43% to 98%. Almost all cases were reported within 24 hours of identification. LHSs followed up cases at households and provided written feedback to LHWs. LHWs provided oral rehydrating salts to 23% diarrhea and antibiotics to 2% pneumonia cases only. Referral rates to other facilities were high (76% diarrhea; 88% pneumonia). Outcome of cases was tracked via mobile phones 72 hours later; 47% were recovering with private, 26% with government facility and only 3% with LHW treatment.

Conclusion: Mobile phones have the potential to improve supportive supervision by enhancing coordination among health workers for timely case reporting and appropriate follow-ups. This could be a useful strategy for strengthening health system.