India’s tuberculosis (TB) epidemic is the world’s largest; nearly one quarter of all people with TB live in India, although India is home to just over a sixth of the world population. TB is highly infectious, but when diagnosed early and treated properly, the disease is largely treatable.
In Bihar, India’s 3rd most populated and highly underdeveloped state, World Health Partners (WHP) is working to quickly identify and appropriately treat TB patients through its social franchise network of village providers. Eliminating TB in India requires all people in all communities who exhibit TB symptoms to be seen, tested and, if necessary, treated. Just as important as getting patients properly diagnosed and started on the right medications, people with TB must adhere to their full course of recommended treatment; this often involves months of daily medications with occasional unpleasant side-effects. Early and consistent treatment of TB is especially critical in curbing the rise of drug-resistant TB which is becoming an increasingly serious threat to TB control globally.
With funding and support from The Bill & Melinda Gates Foundation and the Grameen Foundation, WHP has deployed a TB management system built on the open-source Mobile Technology for Community Health (MOTECH) platform. MOTECH allows local frontline health workers to track patients’ progress with an events engine and a scheduler, among other tools, all linked to an electronic medical record system.
A software system may not seem like an essential tool in infectious disease management, but using MOTECH allows both WHP and its large scale network of providers to track and more effectively manage TB cases in rural communities.
The following MOTECH features help WHP and the rural providers in its social franchise network to quickly and appropriately diagnosis, manage and treat TB patients.
- Sample tracking: Using interactive voice response (IVR) and dashboard alerts, the MOTECH system electronically tracks specimen containers traveling between providers and laboratories to ensure the completion of sputum testing and provide rapid results to providers, and, in turn, to patients, allowing for quicker treatment initiation.
- Treatment registration: The system allows providers to log and track each patient’s treatment plan, with diagnosis provided by a qualified telemedicine doctor.
- Treatment adherence and patient tracking: The system creates an easy way for providers to log and share information about treatment adherence. Electronic medical records and an administrator dashboard allow program managers to track TB suspects and patients thereby minimizing loss to follow-up.
- Treatment reminders: The system sends providers reminders of when to seek another sputum sample to test and ensure the treatment is working, as well as reminders to share with their patients on how to prevent infecting people around them, dietary advice and other health tips customized to where each patient is in their treatment plan.
- Treatment alerts: The system generates automatic alerts to the provider, patient and program manager if the patient misses doses. The alerts will escalate the longer treatment is interrupted.
- Report generation: A real-time reporting mechanism allows WHP program managers or government officials to look across communities and track the status of TB cases and treatment adherence.
Software systems like MOTECH are useful for building shareable information systems to understand the TB epidemic, and to reinforce the appropriate actions patients and providers need to take to effectively respond to TB. These ICT systems also play an instrumental role in increasing cooperation and data sharing between India’s national TB program and the private sector, and form a critical foundation on which public-private collaboration in TB and other public health programs can be built.
In 2014, WHP, with the support of the Bill & Melinda Gates Foundation, will add an IVR-based training module to the existing MOTECH platform. This new training module will be accessible on any mobile phone allowing WHP to continuously update and train its rural provider network. This new remote training capability will extend high quality training with provider evaluation features to more providers, eliminating the need for expensive classroom-based trainings. Ultimately this means more rural providers utilizing MOTECH, helping to stem the TB epidemic in their communities and more effectively providing quality care for an ever-expanding suite of frontline health needs.
Co Authored by: Dr. Anna Stratis, Chief Medical Officer & Jacqueline Kingfield, Program Manager – Development & Communcations