SMS Printers for patient results - Observatory of Public Sector Innovation

The Namibia Institute of Pathology Limited (NIP) is the largest diagnostic pathology service provider in Namibia that operates 40 laboratories and 5 patient centers located in 14 regions across the country. The health facilities in the country are very far apart. NIP disseminates laboratory results via SMS printers deployed to 234 remote clinics using GSM cellular network.

Innovation Summary

Innovation Overview

NIP is a state-owned commercial entity that handles all public health sector pathology testing and provides an extensive array of disease monitoring services. The public health sector has 35 hospitals, 46 health centres and 274 clinics. NIP provides pathology-testing services through their network of 40 laboratories to 80% of the population whom relies on the government provided health care services. Therefore, the main beneficiaries of this project are the most vulnerable and underserved communities using public healthcare facilities in the rural areas who cannot afford the use of private pathology testing services, which are mainly available in the urban communities. In addition, the land surface area of Namibia is 824 116 square kilometres and the population size is 2 324 000 thus the health facilities/services are sparsely accessible thus community members have to travel some kilometres to their nearest health centre and clinic. The following challenges experienced before the project implementation:

• Laboratory results had to be printed at a laboratory level, and not at the health facilities.

• Paper printouts of the results had to be transported to the health facilities by a driver.

• Patient results were either not delivered or on time hence delayed diagnostics and treatment of patients.

• The distances and road infrastructure makes some remote clinics inaccessible at times such as rainy season. The main objective of the project was to reduce the turnaround time (TAT) to deliver time out patient results to clinical staff for early detection, diagnosis and treatment of sicknesses and diseases. Currently, 234 SMS printers are deployed in clinics countrywide.

Innovation Description

What Makes Your Project Innovative?

The innovation aims to leverage simple mobile technology and design to rapidly communicate laboratory test results from the laboratories back to the health facilities. It also aims to reduce the turnaround time of test results in order for healthcare practitioners to make informed decisions regarding the patient treatment. The SMS project will in the long run improve the quality of healthcare provided in the rural areas which is often compounded by the vastness of our country. Turnaround time is commonly defined as the time from when a laboratory test is ordered until the result is reported. The Ministry of Health and Social Services (MoHSS) is responsible for delivering samples from their facilities to the different NIP laboratories. NIP in turn is responsible for testing the samples and delivering the results to the nearest hospital which will then disseminate the results to the health centres and clinics. Prior to the introduction of the SMS printers, laboratory results would only be delivered when an ambulance or ministry vehicle travels to that specific clinic or health centre for an official trip. These trips can sometimes only be undertaken once every week or every second week which unnecessarily delays the delivery of patient results.

What is the current status of your innovation?

The project is in the implementation phase. The project is an adaptation from the pilot phase 1 that only dealt with the delivery of HIV results for infants and children. After the successful piloting of the project, final adaptations were made which included all laboratory results in phases two and three. Using mobile SMS technology and printers, health facilities can now receive and print laboratory test results without having telephony (fix line), computers, Internet and without waiting for a hard copy to be delivered. Operation of the SMS printers can easily be taught to health workers in remote areas. The devices also require limited maintenance and only thermal paper as a consumable. The ability to instantly transfer results from the laboratory to the health facility via SMS has been demonstrated to reduce turnaround time significantly, thereby helping caregivers and clinicians to promptly initiate the required treatment. In addition, NIP has developed a web application that provides monitoring of the SMS printers. It checks printer uptime, signal, battery life, paper jams, and results printed. Through the SMS portal a heartbeat is send every 24 hours to determine the SMS printer status.

Innovation Development

Collaborations & Partnerships

The project was realised through a collaborative partnership with Ministry of Health and Social Services, and funding from the U.S President’s Emergency Plan For AIDS Relief (PEPFAR), CDC Namibia who has supported the provision of SMS printers to clinics throughout Namibia. NIP played a major role as the enabler, implementer and the champion of the deployment of the printers. Ministry of Health and Social services staff are the recipients whereas the de facto beneficiaries are the patients and public at large.

Innovation Reflections

Results, Outcomes & Impacts

Previously it could take more than a month before laboratory results were delivered at the health care facilities. With the installation of the SMS printers in the health care facilities, printing of the laboratory results now means that the turnaround time has been drastically reduced to even less than a week or even a day. In this way more patients can be reached and less time is lost until the necessary therapy or treatment can be started. The advantages of using SMS printers for the printing of laboratory results are the following:

• Health facilities can receive their patient results much faster • Cost of printing laboratory results is reduced

• Health facilities do not have to wait for the physical laboratory results printout to get their results

• NIP can continue to provide affordable and sustainable health laboratory services to support clinical activities across Namibia.

The total of number of patients results printed for the past year (August 2016 to August 2017) is 84 000 compared to previous year 55 129. This demonstrates the increased usage of the SMS printers in the clinics. Finally, a total number of 575 nurses were trained on the use of the SMS printers.

Challenges and Failures

• The distances to certain health facilities was a huge challenge as some health facilities are only accessible with a 4x4 vehicle or never during the rainy seasons. We are in the process of expediting the use of drones for specimen transportation in these areas.

• Nominal number of power points or plugs in some facilities, some facilities do not have adaptors and when someone needs to charge their cellphone, they disconnect the SMS printer devices without realizing the negative impact thereof.

• Weak network signals at certain health facilities hamper the delivery of results to the SMS devices and when there is no signal, nurses cannot call to report faulty SMS devices. In order, to address this we are going to deploy signal boosters to those clinics, which often experience weak network signal issues.

• Power failures (the backup battery in the device only lasts for about two days).

Conditions for Success

The supporting infrastructure such as telecommunications infrastructure which supports GSM Cellular network is available. Electricity infrastructure also needs to be available as the SMS printers make use of electricity and only have a backup battery which lasts for about two days. Financial resource to deploy, support and maintain the SMS printers. Cost elements that should be taken into consideration are cellular subscriptions, text messages, SMS Gateway, printing paper and labour costs.

Replication

This innovation model can be replicated at health facilities in any country. In addition, it can expanded use for patient care, e.g. the Ministry of Health and Social services can sent reminders to pregnant mothers and chronic patients via sms to their mobile phones in order to attend ante-natal care or post-natal care clinics in case of chronic patients for medication or regular check-ups. Moreover, SMS reminders can also be sent to HIV patients on medication such as anti retrovirals to remind them when to collect their testing and medication form the health facility and to improve on adherence.

Lessons Learned

We are receiving very positive feedback from the nurses, health workers and patients. Due to the shortage of nurses in remote areas as well as nomadic nature of the profession, we experience high rotation of staff at the clinics. At times, where there are no nurse or the nurse in charge is on leave, the relief nurses often lack the necessary knowledge to operate the printers. Therefore, we seek it’s necessary to train all staff members at the facilities. During the early phases, we realised the use of job aids as essential for knowledge transfer and retention.