title: Strengthening pharmaceutical systems for palliative care services in resource limited settings: piloting a mHealth application across a rural and urban setting in Uganda.
abstract: BACKGROUND
  Medicine availability is improving in sub-Saharan Africa for palliative care services. There is a need to develop strong and sustainable pharmaceutical systems to enhance the proper management of palliative care medicines, some of which are controlled. One approach to addressing these needs is the use of mobile technology to support data capture, storage and retrieval. Utilizing mobile technology in healthcare (mHealth) has recently been highlighted as an approach to enhancing palliative care services but development is at an early stage.
  
  
  METHODS
  An electronic application was implemented as part of palliative care services at two settings in Uganda; a rural hospital and an urban hospice. Measures of the completeness of data capture, time efficiency of activities and medicines stock and waste management were taken pre- and post-implementation to identify changes to practice arising from the introduction of the application.
  
  
  RESULTS
  Improvements in all measures were identified at both sites. The application supported the registration and management of 455 patients and a total of 565 consultations. Improvements in both time efficiency and medicines management were noted. Time taken to collect and report pharmaceuticals data was reduced from 7 days to 30 min and 10 days to 1 h at the urban hospice and rural hospital respectively. Stock expiration reduced from 3 to 0.5% at the urban hospice and from 58 to 0% at the rural hospital. Additional observations relating to the use of the application across the two sites are reported.
  
  
  CONCLUSIONS
  A mHealth approach adopted in this study was shown to improve existing processes for patient record management, pharmacy forecasting and supply planning, procurement, and distribution of essential health commodities for palliative care services. An important next step will be to identify where and how such mHealth approaches can be implemented more widely to improve pharmaceutical systems for palliative care services in resource limited settings.
authors.affiliation: African Palliative Care Association, Kampala, Uganda. eve.namisango@africanpalliativecare.org.
authors.forename: Eve
authors.initials: E
authors.lastname: Namisango
authors.affiliation: Hospice Africa Uganda, Kampala, Uganda. ntegechris@gmail.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Ntege
authors.affiliation: African Palliative Care Association, Kampala, Uganda. emmanuel.luyirika@africanpalliativecare.org.
authors.forename: Emmanuel B K
authors.initials: EB
authors.lastname: Luyirika
authors.affiliation: African Palliative Care Association, Kampala, Uganda. fatia.kiyange@africanpalliativecare.org.
authors.forename: Fatia
authors.initials: F
authors.lastname: Kiyange
authors.affiliation: Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK. m.j.allsop@leeds.ac.uk.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Allsop
mesh_terms: D003153:Community Health Services / Q000592:standards; D003906:Developing Countries; D006295:Health Resources / Q000592:standards*; D006801:Humans; D010166:Palliative Care / Q000379:methods* / Q000639:trends; D010593:Pharmaceutical Services / Q000592:standards* / Q000706:statistics & numerical data; D010865:Pilot Projects; D012424:Rural Population; D014454:Uganda; D014505:Urban Population