SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

El-Khatib, Ziad; Shah, Maya; Zallappa, Samuel N; Nabeth, Pierre; Guerra, José; Manengu, Casimir T; Yao, Michel; Philibert, Aline; Massina, Lazare; Staiger, Claes-Philip; Mbailao, Raphael; Kouli, Jean-Pierre; Mboma, Hippolyte; Duc, Geraldine; Inagbe, Dago; Barry, Alpha Boubaca; Dumont, Thierry; Cavailler, Philippe; Quere, Michel; Willett, Brian; Reaiche, Souheil; de Ribaucourt, Hervé; Reeder, Bruce

A number of limitations of this work should be recognized. This pilot project focused only on electronic transmission of data from health facilities to the district office; there was no extension to the national level, although the app provides such functionality. Surveillance data that were aggregated and analyzed at the health district office were transmitted verbally by mobile phone to the national office. Clearly, smooth electronic integration of the district program with the national surveillance and health information systems will be vital in the future. We have assessed the impact of smartphones on the quality of disease reporting in a district disease surveillance program. No attempt was made to conduct a comprehensive evaluation of the technology's effects on the broader dimensions of the IDSR system. According to the national IDSR protocol, cases and deaths of most of the listed conditions are to be notified immediately as Alerts as well as in a summative manner in the Weekly Reports, however, it is apparent from Table 1 that the Alert function is underused. Clearly more intensive training and supervision is required to ensure an immediate reporting of these conditions so as to enable a timely public health response. Comparison was made of the completeness and timeliness of reporting in the district of MK during the pilot period (MK 2016) with that observed in the district during the same time period the previous year (MK 2015). However, the poorer quality of reporting in 2015 may have reflected not only the limitations of a paper-based system, but also the residual effects of civil unrest on the functioning of health facilities in the district at that time. Only a simple cost analysis is presented; a full cost comparison and cost-benefit analysis merits future study. Usability of the system was measured with a short semi-quantitative questionnaire. The responses of the focal points show little variability and the app were ranked highly on all dimensions. It is possible that the instrument used was not adequately sensitive and/or that participants chose to provide a positively biased evaluation of the app to the investigators.