“R U Ok 2day?" SMS Check-Up Takes Off in Kenya
Phoebe Mapelu's job as a community health worker in Kenya's Kajiado District always meant going from door to door - sometimes with long distances between homes - to check up on patients on life-prolonging antiretroviral therapy (ART).
"In a day, I can visit 15 people. It's hard because they stay far away from each other, but they need you," she told IRIN/PlusNews. "I am their bridge to the health facility or the doctor."
Mapelu's life has been made considerably easier by the growing use of mobile phone technology, even in rural areas like Kajiado. Even though she still has to make visits, she can track her patients more easily through calls and text messages.
Mobile phone use in Kenya has risen rapidly from 200,000 users in 2000 to an estimated 17.5 million today.
"Making a visit does not mean you will get them at home; they have work to do too, but since they started using these phones, I am now able to know whether a client is home or not," she said. "They are also able to call me if they want me before my scheduled visit."
Sarah Karanja, study coordinator of the Weltel Project, an initiative to use mobile phones to improve health systems, says the use of mobile phones to track patients has taken a burden off health workers.
"Eighty percent of those [health workers] we talked to in Nairobi and Kajiado said they feel relieved - health workers need that kind of relief," she said. "Patients, on the other hand, feel they are cared for which is good for their health and wellbeing."
An ongoing Weltel study uses a weekly text message to study mobile-phone effectiveness for health; the message to the patient reads "Mambo", Swahili for "how are you", to which the patients can respond "Sawa", OK, to show they are fine, or "Shida", which means problem, to show they need attention.
Patients who respond Shida and non-responders are followed up with a call from the clinic nurse to identify and handle any problems.
Initial study findings reveal that 80 percent of patients are comfortable with the use of mobile phones to manage their HIV care and treatment.
"Now I don't have to wait... I can ask if she is coming or not," said Meshack, a patient in Kajiado. "When I leave home to attend to my business, I can let her know and I can tell her my problem anywhere."
According to Daniel von Rege, field coordinator for the medical NGO Médecins San Frontières - which runs a large HIV programme in Kibera, a slum in the capital, Nairobi - the use of mobile phones leads to better follow-up of patients.
Remember the displacement of people during the election violence, or even in the floods? Phones remained the only viable way to reach people
"Mobile phones help reduce cases of stigma because they create a sense of privacy," he said. "Health workers are known and some patients do not want them to visit their homes or go to the facility frequently because this will give away their status; when you give them a platform to interact with the facility without a physical visit, then you improve their stay within the care and treatment programme."
He noted that one drawback to the use of mobile phone technology was cost. "In Kibera, for example, many people cannot afford the cost of airtime and they have to prioritize between buying airtime and food," Von Rege said.
"Many families in these poor settings have one handset that is held by the head the family, normally the man, so it is hard to reach any member of the family who needs your services... they only have access to the phone occasionally," he added. "It is further challenging when they may not want other family members to even know their status."
According to Weltel's Karanja, however, in areas where the health centre is a long distance from a patient's home, the cost of airtime is still cheaper than the cost of transport to the clinic.
"Remember the displacement of people during the election violence, or even during floods? Phones remained the only viable way to reach people," she said.