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

The time taken to transmit complete Weekly Reports in this project was substantial (median 12 h) and highly variable (IQR 1-63). This was due to several factors: i) the poor quality and unreliable nature of GSM telephone network connectivity in the district; ii) the reception of transmissions by a single SIM card of the health district server; iii) the arrival of the bulk of transmission in the few hours before the reports were due. Variation in the proportion of reports that were timely, complete and validated did not differ significantly according to the distance of the healthcare centre from the district office and the associated degree of insecurity, but rather appeared related more to the quality of the communications network and aptitude of the participating staff. It is clear from the progressive reduction in transmission time over the 15-week period that staff quickly became more adept at sending complete, correct reports, and submitting them adequately in advance of the deadline. Participating staff reported developing a sense of comfort and ownership of the electronic surveillance system [26] , and could become the future trainers for the implementation of this surveillance program in other districts, should the Ministry of Health proceed to scale-up this project to the national level.