Reducing stock-outs of life saving malaria commodities using mobile phone text-messaging: SMS for life study in Kenya.
BACKGROUND
Health facility stock-outs of life saving malaria medicines are common across Africa. Innovative ways of addressing this problem are urgently required. We evaluated whether SMS based reporting of stocks of artemether-lumefantrine (AL) and rapid diagnostic tests (RDT) can result in reduction of stock-outs at peripheral facilities in Kenya.


RESULTS
All 87 public health facilities in five Kenyan districts were included in a 26 week project. Weekly facility stock counts of four AL packs and RDTs were sent via structured incentivized SMS communication process from health workers' personal mobile phones to a web-based system accessed by district managers. The mean health facility response rate was 97% with a mean formatting error rate of 3%. Accuracy of stock count reports was 79% while accuracy of stock-out reports was 93%. District managers accessed the system 1,037 times at an average of eight times per week. The system was accessed in 82% of the study weeks. Comparing weeks 1 and 26, stock-out of one or more AL packs declined by 38 percentage-points. Total AL stock-out declined by 5 percentage-points and was eliminated by the end of the project. Stock-out declines of individual AL packs ranged from 14 to 32 percentage-points while decline in RDT stock-outs was 24 percentage-points. District managers responded to 44% of AL and 73% of RDT stock-out signals by redistributing commodities between facilities. In comparison with national trends, stock-out declines in study areas were greater, sharper and more sustained.


CONCLUSIONS
Use of simple SMS technology ensured high reporting rates of reasonably accurate, real-time facility stock data that were used by district managers to undertake corrective actions to reduce stock-outs. Future work on stock monitoring via SMS should focus on assessing response rates without use of incentives and demonstrating effectiveness of such interventions on a larger scale.
Malaria Public Health Cluster, KEMRI-Wellcome Trust-University of Oxford Collaborative Programme, Nairobi, Kenya. sgithinji@nairobi.kemri-wellcome.org
Sophie
S
Githinji
Samwel
S
Kigen
Dorothy
D
Memusi
Andrew
A
Nyandigisi
Agneta M
AM
Mbithi
Andrew
A
Wamari
Alex N
AN
Muturi
George
G
Jagoe
Jim
J
Barrington
Robert W
RW
Snow
Dejan
D
Zurovac
D000962:Antimalarials / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D040421:Cell Phone / Q000706:statistics & numerical data*; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005449:Fluorenes / Q000627:therapeutic use*; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D011634:Public Health / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D060145:Text Messaging / Q000706:statistics & numerical data*; D013997:Time Factors
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes