Part 4: Future Recommendations

Both Uganda and Zambia have experienced an increase in mobile usage while the introduction of mhealth programs and their development have led to an improvement in the health sector of both countries. Prior to the introduction of information communication technologies, Uganda worked upon decreasing HIV rates through; the cultivation of an open environment to discuses HIV/AIDS, a national political commitment and reorganization of HIV/AIDS as a public health issue. Mass media campaigns and the ABC approach lead to a reduction from 15% 1991 to 4% in 2003 of new cases of HIV among Ugandans (Cohen, 2003; Green, Halperin, Nantulya, & Hogle, 2006). Uganda has recently experienced an increase in HIV to 6.7% (Uganda AIDS Commission, 2012). Uganda continues to struggle with providing consistent health facilities throughout the country between urban and rural areas. Zambia on the other hand has yet to see dramatic decreases in the HIV prevalence rate. Although it has seen a minimal decrease of HIV in the adult population, as well as a decrease in the rate of transmission from mother to child from 7.72% in 1997 to 1.99% in 2011 (UNGA, 2012).

The introduction of HIV prevention via mobile phones has begun a new era in disease prevention. As discussed in the previous section, ‘Text to Change’ offers a fun engaging way to involve youth in their own health and safety. TTC saw increases of 30% in visits to the Aura clinic for HIV testing and counseling, as well as a three-fold increase in HIV test requests among factory workers in Uganda. However these projects were small and short term, and although they had successful results, there are areas in which improvements could be made to further the accomplishments of TTC.

Uganda: Future Recommendations
Perhaps in the future one recommendation would be to consider using multiple telecommunication networks which span across the country and are delivered to different demographics. Developing an integrated action plan with multi-sectoral stakeholders would encourage higher participation rates as seen in the factory quiz. One reason why the factory quiz’s participation rates remained high is because it was socialized extensively within the factories. In addition the factories had trained HIV/AIDS peer educators who were consistently promoting the program through the factory’s education outreach program (Danis et al., 2010). Therefore one possible solution would be to integrate TTC programs within community centers, youth programs and schools. The ministry of education, individual elementary and secondary schools along with students would be identified as the stakeholder groups to be involved. These stakeholder groups would participate under the supervision of the NGO, and TTC could collaborate and work together on establishing a supportive environment to advertise TTC. HIV prevention programs would also encourage continued participation through the entire quiz. In addition both community groups and schools, via AIDS prevention groups, could provide discussion groups to talk through past questions. This would allow individuals who did not answer questions correctly to be immersed in an environment where they could be educated on HIV/AIDS information, and thereafter they would strive to get questions correct. Conclusively this would encourage participation, rather than resulting in individuals getting discouraged from receiving incorrect answers. Therefore, identifying the national and district level Government, as key players in HIV prevention is essential. Their continued support is also required in order to sustain going projects, which can run independently.

This could be taken one step further using the factory quiz project as inspiration. In addition to collaborating with schools and youth groups, the working age population could be educated. This would create a similar program involving TTC, local NGOs including multi and bilateral organizations and the Ministry of Labour and Social Security. In order to seek companies, both private and governmental that would be interested in working in collaboration with stakeholders to develop similar quizzes that could be used within the workplace setting. 

Zambia: Future Recommendations
In Zambia despite specific HIV prevention programs remaining minimal, Project Mwana was focused on reducing the time between an infant’s HIV test and results. This also began to involve the use of community health workers dedicated to ensuring that expectant mothers were obtaining regular trimester check ups and utilizing Zambia’s HIV prevention services. Unlike Uganda’s program of focus, Project Mwana is an ongoing project (although initial pilot tests were conducted), which continues to register birth, deaths, infant mortality and maternal mortality, and ensures that women are aware of their upcoming visits. Recommendations to improve the project were also important in order to see further reductions in HIV transmission from mother to child, but also can be incorporated to include the general public.

One of the major challenges of sustaining ehealth projects are finances. Developing countries including Uganda and Zambia need to find sustainable financing and business models that allow them to attract attention, and capital needed to support and scale up projects (WHO, 2012). One way to achieve this is through the Government, including the MOH playing a larger role in managing health clinics, as well as incoming donors. The MOH could play a bigger role in the oversight and management of project Mwana. Local NGOs and organizations need to think of innovative ideas to allow projects to continue being delivered in communities after the pilot phase as they do not always remain sustainable. Therefore, the MOH needs to create a position, such as that of a central coordinator who is responsible for the on going management of project Mwana. The central coordinator could include attracting other resources from organizations such as the Gates Foundation, due to their interest and support in technological innovations projects. As well as Norad, (Norwegian Agency for Development Cooperation) who has a special interest in channeling aid to public health projects. On-going involvement by district and national health departments is key, in order to ensure a commitment to progress for project Mwana (Thea, 2012). Finally the central coordinator would be the central contact for CHW in surrounding districts. As the program grows the number of coordinator positions would grow as well. The central coordinator would be able to communicate progress, issues and suggestions to the MOH overlooking the project.

Most of the initial costs came from setting up the project. This was in terms of training the nurses and community health care workers as well as providing cell phones (Thea, 2012). As the program expands to include more facilities which are discussed in the future plans for the Zambian Government. On-going costs reflect the continued addition of new staff and phones for health facilities that are starting to participate in the program. Therefore it is critical for the local and national governments to be able to finance these costs, and plan for the expansion of the program either through directing a portion of the health budget to include these costs or through seeking additional international funding.

Guidelines are also important to measure success and continue evolving and expanding the program. Long-term guidelines are important for keeping the projects on time and progressing. A National ehealth policy with continued support is critical for sustaining projects. As discussed previously Zambia implemented an ICT policy in 2001, which incorporated various areas such as agriculture, education and health. However, Zambia never implemented a national ehealth strategy. Zambia is heading in the right direction, by incorporating ICT infrastructure needed to run ehealth initiatives within district health clinics. Establishing a position within the ministry of health to monitor ehealth activities would allow further room for the evaluation of current projects, and allow this information to be shared with other government officials. Community health care workers also need to be held accountable by district level authorities within the Ministry of Health.

Thus ehealth is important to enhance the already existing components of healthcare, for example, in enhancing the guidelines to prevent mother to child transmission. Investing in preventive health care via mobile phones and the internet would allow prevention programs to be implemented with improved patient consistency. This is further enhanced by reminders from CHW via mobile phone messages from the clinic. This service can be extended to personal mobile phones as personal ownership continues to increase.

Once the management and guidelines are instilled among clinics in Zambia it would be interesting to expand this project to include youth. One way to do this would be to establish Youth AIDS Groups, which meet in the vicinity of local rural clinics to discus HIV/AIDS related issues. Mobile phones could be used to increase the attendance at these meetings, either to remind youth of up-coming meetings or to use ‘Text to Change’ as inspiration. This would allow the Ministry of Health and local stakeholders to begin a similar fun and engaging way to educate Zambia’s youth.

In conclusion, it is fascinating to imagine all the ways in which technology has changed the lives of billions in the western hemisphere, from mobile phones, the internet, most feel bare leaving home without their mobile phone. Similarly, for billions in developing countries mobile phones have begun to change the ways in which individuals conduct daily activities. Educating youth, adults and children via mobile phones is an innovative way to reach groups of individuals that may not be educated about HIV otherwise. Through the continued support of governments, NGOs, Multilateral and bilateral organizations, collaboration will allow ideas to transform into sustainable initiatives that reach millions while contributing to a decrease in HIV prevalence rates.

References

Danis, C., Ellis, J., Kellogg, W., Van Beijma, H., Hoefman, B., Daniels, S., et al. (2010). Mobile Phones for Health Education in the Developing World: SMS as a User Interface.

ACM Symposium on Computing for Development, London, UK.

Thea, D. (2012, August 7). HIV Prevention in Zambia. (J. Burns, Interviewer)

WHO. (2012). The bigger picture for e-health. Bulletin World Health Organication , 90, 330-331.