Moeun Chhean Nariddh reports on a mobile phone-based frontline reporting system for detecting malaria cases in Kampot province.

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From her house in Snay Anchit Village, about five kilometres from the health centre in Kampot province’s Chum Kiri district, 20-year-old village malaria worker Kong Lida can clearly hear the noise of a generator roaring in the distance. This generator is an important source of power where Lida and other villagers have their car batteries charged every day so that their houses can be lit up at night from electric lamps and at the same time charge up their mobile phones.

But soon Lida and other village malaria workers in her village and other communes will not need to pay the generator owner to have their car batteries charged any more. Now, all these VMWs will get their power from a ubiquitous source of energy – namely solar power.

As part of the country’s malaria elimination strategy, the National Centre for Parasitology, Entomology and Malaria Control (CNM), with technical support from the World Health Organisation and Malaria Consortium, has launched a pilot program to train VMWs in Kampot, Siem Reap and Kampong Cham provinces on how to send simple mobile phone text messages (SMS) to report in real time on detected malaria cases. These SMS messages also support the paper reporting that feeds into the health information system from the health centres.

CNM and Malaria Consortium also provide each of the VMWs with a solar panel and a lamp together with a mobile phone and a charger since there is no electricity in their villages.

“This collecting of data from villages and its analysis at the most peripheral level at either the health centre or at the operational district is a major achievement,” said Dr Charles Delacollette, WHO’s coordinator of the Mekong Malaria Program.

Cambodia is currently seeing a revolution in communications with the roll-out of affordable wireless services to much of the rural population. The potential of approaches based on mobile phones and web-based technology to address the gaps in field data collection for malaria is now widely recognised.

“I think using a mobile phone is good, because I can report immediately when I come across a malaria case,” said village malaria worker Lida. Previously, the VMWs would record the data in a logbook which they would then report to the health centres at the end of every month before it was sent to the operational district hospitals and finally to CNM.

InSTEDD, an innovative humanitarian technology NGO, designed the system, utilising SMS messages in Khmer script that interact with mapping software to generate maps on the World Wide Web for the locations of malaria cases reported by the VMWs. These malaria cases are also known as Day Zero cases, to indicate the locations of the patients before they are given appropriate and effective treatment.

“The web-based system uses simple SMS, which is four to five digit codes in the case of VMWs,” said Malaria Consortium’s information systems manager Steve Mellor. “In addition to the targeted alerts, all cases are displayed on-line which allows registered users to view cases,” added Mellor.

The SMS from the village malaria worker only includes a code for the type of malaria, the patient’s sex, age and the village name to indicate the sick person’s location.

The InSTEDD-designed system, Mellor pointed out, has a unique threshold feature which allows it to be used in low transmission settings to promptly identify the last few remaining cases and can also be used in high transmission settings to identify possible malaria outbreaks as they occur.

“The system allows for VMWs and health centre staff to alert the relevant (based on location) district, provincial and national staff to malaria cases as they are diagnosed facilitating a prompt response,’’ he emphasized.

This project also highlights the effective co-operation with the private sector for a public good with low start-up cost that is estimated at US$100 for each VMW, which includes a mobile phone, SIM card, solar charger and training.

“Due to the collaboration between CNM and Mobitel, all SMS messaging is free which essentially results in zero maintenance cost,’’ noted Ngor Pengby, Malaria Consortium’s data manager. “Mobitel have pledged SIMs and free SMS for all VMWs and health facilities in Cambodia should CNM decide to scale up the system in the future,” he added.

One of the consequences associated with the delays in paper-based reports is frequent stock-outs of essential anti-malarial drugs in the health facilities that can deprive target populations such as migrant workers of access to effective treatment.

Deputy Director of CNM, Dr Chea Nguon, said the SMS reporting would also help identify mobile migrant workers so that the district or provincial hospitals could request more anti-malarials when they detect an increase in migrant workers in certain locations.

“If we request the same amount of medicines, we might have a stock-out if there is an increase in the number of malaria cases among the mobile migrant population,” he added.