Design of a community-based mobile phone text message referral intervention in Tanzania

摘要

In sub-Saharan Africa, privately-owned drug stores are more accessible than government health facilities and therefore represent the first port of call for many of the poorest people, especially for sexual and reproductive health related conditions. Whilst these shops are only licensed to sell non-prescription drugs and are required to be headed by someone with basic medical training, research shows that in Tanzania some drug store attendants have no health related training and regularly sell prescription-only medicines without a licence. We have therefore designed an intervention to facilitate access to prescriptions by patients and drug stores using the mobile phone short-message service (SMS) to improve referral to formal health facilities. Mobile telephony is among the fastest growing resources in Africa. Up to 95% of Tanzania's population have access to a mobile phone. Previous work suggests that mobile phones can improve access to and delivery of health services in sub-Saharan Africa. Our intervention is designed to improve access to safe prescriptions and uptake of effective reproductive health services. The intervention is being implemented in two districts (Magu and Sengerema) in the Mwanza Regionon the northwest shore of Lake Victoria. It is nested within a larger randomised trial which aims to evaluate the effect of a complex reproductive health intervention on the uptake and integration of reproductive health services in Tanzania and Niger. The SMS intervention is being implemented in one region in Tanzania in a cluster-randomised trial. The study was approved by the appropriate ethics committees. Intervention The SMS intervention was developed in two phases, involving stakeholder consultation followed by the technical design. Twenty-three consultation meetings were held with 78 drug store owners and attendants, 45 dispensary and health centre clinical officers and nurses, and 148 adolescents in communities. These stakeholders prioritised the problems in existing reproductive health provision and suggested strategies to address them. One of the strategies was a managed reproductive health community referral to health facilities using SMS.