Just How Much Difference Can An SMS Make?

By Esther Nakkazi

Research shows that an SMS can change lives. But how much difference can it make? TTC Mobile, a Dutch social enterprise that offers the technology to implement mobile interventions in Africa, Latin America and Asia, contracted the impact researchers from Avance to find the answer to this question.

Researchers found that in two projects found that text messages sent out resulted in behavioural change and better informed end users, nearly all of them directly applied their newly gained knowledge. According to the partners of TTC Mobile, mobile interventions appeared particularly more efficient than alternative methods, with regard to cost and scale.

The impact study resulted in eye-opening outcomes that make a great case for the social impact of mobile interventions. Participants from the two projects run by TTC Mobile were surveyed and/or interviewed and several partners of TTC Mobile were interviewed as well.

The ACLO project was an SMS service of Connect4Change consortium that sent up-to-date market information to small-scale farmers in Bolivia between November 2013 and December 2015. 

Healthy Pregnancy, Healthy Baby is a currently running SMS service of the mHealth Tanzania partnership that sends health information to pregnant women, mothers of newborns and male supporters since December 2012.

116 farmers of the ACLO project in Bolivia and 374 subscribers of Healthy Pregnancy, Healthy Baby in Tanzania were surveyed and/or interviewed. The results clearly show the great value of mobile interventions:

Mobile interventions led to behavioural change; In terms of behavioral change, nearly all of the participants indicated that the text messages they received had a direct effect on their behavior. 92% of the farmers adjusted the prices of their products based on information they received, whereas 94% of the Tanzanian women and their male supporters changed the way they took care of themselves during pregnancy. 

For example, they visited the clinic more often or increased their intake of iron folate tablets. “The doctor had forgotten to prescribe iron pills but after receiving the text I was able to remind the doctor,” said a respondent.

Mobile interventions improved conditions of end users; 80% of the farmers said that their income had improved due to the SMS service. In Tanzania, 93.2% of the participants said they gained knowledge from the text messages and 94% of the participants felt like the text messages increased the confidence in their own and in their baby’s health.

“My wife was shy to ask questions concerning the baby's health and so the messages received were very impactful,” said a respondent. 

Mobile interventions have great reach and are cost effective; In interviews, clients indicated that the mobile interventions of TTC Mobile reached more people than the traditional methods they had used previously and that they were better at reaching participants in rural, hard-to-reach areas. Also, clients indicated that the mobile interventions of TTC Mobile were more cost effective than methods that clients applied previously.

"Mobile interventions gave a total different dimension to our project: more reach and faster, more agile and real-time data.” Full study here: Read the entire research report of Avance here

New Partnership to strengthen health systems in Uganda, Kenya and Zambia

By Esther Nakkazi

Maternal mortality and Sexual and Reproductive Health Rights (SRHR) have been on the international agenda for many years, but the goal to reduce maternal mortality ratio by 75% percent remains elusive.

A five year project 30 million Euro project implemented at global and regional level as well as country level in Uganda, Kenya and Zambia hinging on this fact that now aims to reverse this trend.

The project focusses on strengthening the health system in order to realise a breakthrough, said Dr. Tim Reed from Health Action International.

According to the World Health Organisation (WHO) six interlinked and mutually reinforcing building blocks together make up the health system: human resources for health, health commodities, governance, financing, information and service delivery.

However, this project will focus on two building blocks; human resource for health, which entails increasing the availability and accessibility of skilled health workers. Human resource is essential in retaining equity and social justice.

As well as enhancing the availability of affordable medicines and family planning commodities to ensure that communities; women, girls and vulnerable groups have access to contraception and safe pregnancy, delivery and neonatal care.

“A multi prolonged approach is required to strengthen the perspective of availability and affordability of medicines,” said Dr. Emmanuel Higenyi from Joint Medical Stores.

The project will work through a partnership which comprises of Amref Health Africa, the African Center for Global Health and Social Transformation (ACHEST), Health Action International (HAI), Wemos Foundation funded by the Danish Ministry for Foreign Trade and Development Cooperation as well as Health promotion and social development (HEPS-Uganda).

The different partners will have diverse roles: Amref will handle HRH and reproductive health commodities advocacy interventions at community or district level. ACHEST will handle SRHR and Health system governance advocacy aimed at national, regional and global levels. HEPS-Uganda will do advocacy around reproductive health commodities at national level.

The partnership will work to achieve outcomes by following two interconnected strategies that go beyond influencing policies and aim for sustainable social changes as well as changes in the entire SRH sector.

The overall goal of the project is to enable communities to realise their right to the highest attainable sexual and reproductive health impact said Patricia Vermeulen from Amref Health Africa, Netherlands.

She said the project aims to contribute to achieving Sexual and reproductive health rights by training and creating space for a civil society to engage effectively with governments, the private sector and other stakeholders accountable for health systems, deliver equitable, accessible and high quality SRHR services.

Dr Jane Ruth Aceng, director general, Health Services at Uganda Ministry of Health said it will be good for civil society to be trained so that they do not take government to court without real evidence.

She cited the case of when civil society took government took government to court in 2011 because of a maternal death.

“We are excited it is building the capacity of civil society so that when they are lobbying they know how the government systems work.”

Dr. Francis Omaswa the director ACHEST said Uganda has well designed health plans however, implementation still remains an issue. He said communities should be empowered to demand for services from the health sector.

He ended with his signature phrase ‘health is made at home and repaired in health facilities.’

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Uganda Cares celebrates World TB day: It is Curable

By Esther Nakkazi

As the world celebrates World Tuberculosis Day today, 24 March 2016, I am one of the tweeps at Uganda Cares, which is a partnership between Aids Healthcare Foundation (AHF) and the Uganda Ministry of Health (MOH) to provide antiretroviral therapy.

The theme for the day is 'United to end TB: Find, Treat, Cure'. We have Dr. Augustine Lubanga the training manager of Uganda Cares and Dr. John Ssali,  national medical director Uganda cares as panelists talking about Tuberculosis in Uganda.

We have also heard from two former TB patients who have been healed. So TB is curable. It costs about $200 to treat a patient with uncomplicated TB in Uganda but there are usually drug stock outs in the country.

George William has been treated twice from TB by Uganda Cares. Here is his testimony; “When I came to Uganda Cares I was diagnosed with HIV and later with TB in 2006. I used the drugs the first time and they assured me that I was healed of TB. In 2011, I was told that the virus is back and I was quarantined in Entebbe. They checked me after 8 months and told me I was okay. In 2015 I came back to Uganda Cares and they sent me for check up and they found that I was with TB. Its now 6 months but I have been assured that the virus has gone.”

However, George William has issues with the big TB tablets. Experts say the big tablet encourages patients to take it and it has three drugs in it anyway.

“I got problems with taking these drugs. I would feel dizzy but gradually my body got used to it. I have been active in taking these drugs. I still have some itching in the throat but it is now better.”

Another former TB patient Rose Nabasirye was diagnosed with TB in August last year. “Two weeks into taking the drugs I started feeling better. I used to swallow my drugs diligently. They advised me to remove my eating utensils from the rest of the family. I cover my mouth with a handkerchief when I cough. Now I feel better. I have been fasting sometimes but even then the drugs did not treat me badly. ”

World wide, 9 percent of people diagnosed with TB die during treatment, 27 percent stop working, 73 are hospitalised and 37 percent require home isolation.

Uganda ranks 18th out of the 22 countries responsible for all the TB cases in the world. The people who are most at risk are those who have been infected with TB before like George William, people with HIV and those suffering from diabetes, cancer and malnourished. Those who live in congested areas like slums are also at risk.

According to Dr. Ssali, the risk of getting infected with TB is twice as high for people with HIV. But Uganda suffers from numerous TB drugs stock outs and then it culminates to drug resistance.

Dr. Augustine Lubanga says TB screening should be extended to the lower level health facilities including health centre II and better technologies should be adopted. Patients should also be encouraged to adhere to treatment to avoid MDR-TB that is also high in Uganda.

Treatment for TB is now takes a shorter period. It is not 6 months from 8 months for uncomplicated TB says Amos Kasembeli a pharmacist. MDR-TB treatment takes about 24 months.

Follow up should also be emphasised and there should be increased case finding emphasised Dr. Ssali.

Since 1990, Uganda has had 2.2 million TB illnesses and 900,000 TB deaths. In 2014, there were 61,000 cases of TB in Uganda and 11,000 deaths. But overall, since 1990 the number of TB cases has almost been halved and deaths fallen by 70 percent.

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Rift Valley Fever outbreak in Uganda

By Esther Nakkazi

Two cases of the Rift Valley Fever have been confirmed in Kabale district, Western Uganda. The two people; a 45-year old butcher and a 19-year-old student from Kabale town council are admitted in Kabale Regional Referral Hospital.

Rift Valley Fever is an important Notifiable and Zoonotic Disease. The disease has never been reported in humans and animals in Uganda before this outbreak.

The Rift Valley Fever outbreak has been confirmed by the Ministry of Health today 15th March and the declaration follows laboratory tests done at the Uganda Virus Research Institute (UVRI) which confirmed two samples positive of this infectious viral haemorrhagic fever. 

Preliminary reports further indicate that three new suspect cases have been identified and their blood samples are yet to be tested but no deaths have been recorded since the onset of the outbreak on 4th March.

The Ministry of Agriculture Animal Industry and Fisheries is raising public awareness on the clinical signs of the disease in animals and humans and owing to the dangers that this disease poses to animals and  population, the Ministry has declared this outbreak to all international animal health organisations.

Rift Valley Fever is an acute, fever causing viral disease that affects domestic animals like cattle, sheep, goats, buffalo, camels and humans. It is most commonly associated with mosquito-borne epidemics during years of unusually heavy rainfalls. 

A person suffering from Rift Valley Fever may have either no symptoms or a mild illness associated with fever and liver abnormalities. However, in some patients, the illness can progress to haemorrhagic fever, inflammation of the brain which can lead to headaches, coma or seizures or eye disease.

People who become ill usually experience fever, generalised weakness, back pain, dizziness and weight loss at the onset of the illness. Typically patients recover within two days to one week after onset of the illness. Approximately 1% of people that become infected with the Rift Valley Fever die of the disease.

In animals, the disease is characterized by abortions, occasionally bloody nasal discharges in mature animals, haemorrhagic diarrhoea and jaundice. There is high morbidity and mortality in young animals.

The disease is transmitted from animals to humans through close contact with infected animals and their products such as milk, meat and body fluids.  Animals become infected with the disease through the bites of infected mosquitoes. Other insects that can transmit the disease are ticks and biting midges.

Prevention and control of this disease in animals relies on maintaining a strong surveillance system. In case of outbreaks, appropriate biosecurity and biosafety measures must be exercised.

A Multi-sectoral National Task Force has been set up to coordinate all efforts towards the control and management of the outbreak under the One Health Approach. This task force is composed of officials from the Ministries of; Health; Agriculture, Animal Industry and Fisheries; Water and Environment; Uganda Wildlife Authority together with development partners; the World Health Organization and the US Centers for Disease Control and other implementing partners like MSF.

The Task Force has put in place a number of measures to control and limit the spread of the disease.
Investigations: A multi sectoral rapid response team of experts has been dispatched to the district to support both clinical and public health investigations.

The Ministry of Agriculture is undertaking a detailed investigation to confirm the virus in susceptible animal species.

Surveillance; the Multi Sectoral National Task force has boosted up surveillance programs in Kabale district, Rwanda and DRC borders. So far a total of 59 animal and 11 human samples have been collected for testing at the Uganda Virus Research Institute. Results will be available by Friday 18th this week.

Case management; The team has already conducted a training for health workers at Kabale Regional Referral Hospital on the Rift Valley Fever and developed a new triage protocol.

Research; The multi-sectoral team is to undertake a risk assessment of human exposure from animals. The team will also determine the current prevalence of RVF infection among exposed asymptomatic individuals in affected areas in Kabale district

Social Mobilisation; A Committee is developing sensitisation messages on preventive measures to raise awareness about the disease.

The Government of Uganda urges the general public to observe the following protective measures;
report any suspected RVF patient to a nearby health facility; report any suspected sick animals to the nearest veterinary or local authority; avoid direct contact with body fluids of animals suspected to be suffering from RVF by using protective materials like gloves.

Avoid eating dead animals or animals not certified by veterinarians. The Government calls upon the public to stay calm as all possible measures are being undertaken to control the situation. The country will be kept informed on the outcome of this health emergency.

Merck gives hope to infertile African women

By Esther Nakkazi

Many women in Uganda and other developing countries disproportionately carry the social burden of a couple’s failure to have children.

Childless African women are discriminated, ostracised and stigmatised when a couple fails to have children, even when sometimes the man is to blame. Men are rarely blamed when a couple is childless. The men also go on rampage to find other women who can bear for them children or specially a heir.

Uganda is in the ‘Africa infertility belt’ that stretches from Tanzania to the East and Gabon to the West. Here ‘bareness amidst plenty’ is a common phrase that means infertility exists in a high fertility region. Uganda’s fertility rate remains among the highest in the world, about 6 children per woman.

Lady Nakintu, a childless old woman was once told by a pastor that ‘childless people do not go to heaven’ she cried herself sick. No consolation from the community women could reconcile her with going to church ever again. She hit the bottle, drinking all sorts of booze and died two months after.

Now such people may have hope as Merck, www.Merckgroup.com, a leading science and technology company, provides training for African embryologists in Indonesia starting with candidates from Uganda and Kenya.

Training African embryologists will offer a viable alternative to infertile African couples as most of them seek treatment from herbalists. Hopefully, the African embryologists services will be cheap as such couples cannot afford IVF services because of the exorbitant prices.

Merck through its “ Merck More than a Mother “ campaign will start the African Embryologists Training Program in partnership with Indonesian Reproductive Science Institute (IRSI) with the aim to improve access to quality and safe fertility care across the African continent.

“Merck more than a Mother” campaign, is a pan-African initiative aimed to build fertility capacity, raise awareness about infertility prevention and male infertility. It also opens a dialogue to define interventions to reduce the stigma and social suffering of infertile women in Africa which includes discrimination and physical and psychological violence.

The initiative was announced on the International Women’s Day 8th March 2016.

“Countless women in Africa face fear, abuse and discrimination every day simply because they are infertile,” said Belén Garijo, Member of the Executive Board of Merck and CEO Healthcare in a statement.

“After Kenya, we are proud to launch the More than a Mother campaign in Uganda and work with the Ministry of Health, the medical community and parliamentarians to change perceptions and reduce the harsh social suffering of infertile women in Africa.”

The campaign was first implemented in Kenya in 2015 and is being rolled out this year in Uganda, in collaboration with the Ministry of Health, Uganda Women Parliamentary association (UWOPA) and Africa Fertility Society (AFS) and progressively rolled-out in more African countries.

Minister of State for Health for Uganda, Hon. Sarah Opendi said the campaign addresses a very sensitive topic for the first time in Africa, which exists but no one wants to talk about it. “This initiative will help to empower infertile women by improving access to information and change in the culture and mind set,” said Opendi.

“Most Sub-Saharan African countries don’t have trained embryologists hence providing training to our embryologists will contribute significantly to improve the quality and accessibility to fertility care to couples in Uganda and Africa so that they can start their families,” she added.

According to the World Health Organization (WHO), lower levels of development are thought to be associated with higher levels of non-genetic and preventable causes of infertility such as poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequence of infections caused by the practice of female genital mutilation, exposure to smoking and to leaded petrol and other environmental pollutants. Hence prevention awareness is very important.

Dr. James Olobo-Lalobo, Vice-President of Africa Fertility Society said together with Merck, “we can challenge the perception about infertile women, their roles and worth in society, both within and beyond the medical profession in order to achieve any systemic shift in the current culture of gender discrimination in the context of fertility care”.

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