SMS for Life: a pilot project to improve anti-malarial drug supply management in rural Tanzania using standard technology.
BACKGROUND
Maintaining adequate supplies of anti-malarial medicines at the health facility level in rural sub-Saharan Africa is a major barrier to effective management of the disease. Lack of visibility of anti-malarial stock levels at the health facility level is an important contributor to this problem.


METHODS
A 21-week pilot study, 'SMS for Life', was undertaken during 2009-2010 in three districts of rural Tanzania, involving 129 health facilities. Undertaken through a collaborative partnership of public and private institutions, SMS for Life used mobile telephones, SMS messages and electronic mapping technology to facilitate provision of comprehensive and accurate stock counts from all health facilities to each district management team on a weekly basis. The system covered stocks of the four different dosage packs of artemether-lumefantrine (AL) and quinine injectable.


RESULTS
Stock count data was provided in 95% of cases, on average. A high response rate (≥ 93%) was maintained throughout the pilot. The error rate for composition of SMS responses averaged 7.5% throughout the study; almost all errors were corrected and messages re-sent. Data accuracy, based on surveillance visits to health facilities, was 94%. District stock reports were accessed on average once a day. The proportion of health facilities with no stock of one or more anti-malarial medicine (i.e. any of the four dosages of AL or quinine injectable) fell from 78% at week 1 to 26% at week 21. In Lindi Rural district, stock-outs were eliminated by week 8 with virtually no stock-outs thereafter. During the study, AL stocks increased by 64% and quinine stock increased 36% across the three districts.


CONCLUSIONS
The SMS for Life pilot provided visibility of anti-malarial stock levels to support more efficient stock management using simple and widely available SMS technology, via a public-private partnership model that worked highly effectively. The SMS for Life system has the potential to alleviate restricted availability of anti-malarial drugs or other medicines in rural or under-resourced areas.
Barrington
Jim
J
SMS for Life Program Director, Forum 1.P-94, Novartis Campus, CH-4056 Basel, Switzerland. jim.barrington@novartis.com
Wereko-Brobby
Olympia
O
Ward
Peter
P
Mwafongo
Winfred
W
Kungulwe
Seif
S
D000962:Antimalarials / Q000600:supply & distribution*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000600:supply & distribution*; D004338:Drug Combinations; D004356:Drug Storage / Q000379:methods; D004983:Ethanolamines / Q000600:supply & distribution*; D005449:Fluorenes / Q000600:supply & distribution*; D058016:Health Facility Administration; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D011803:Quinine / Q000600:supply & distribution*; D012424:Rural Population; D013636:Tanzania; D013685:Telecommunications
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011803:Quinine