Mobile Phone Text Messaging Referral (SMS4Health)

• Increase the number of patients receiving reproductive health services at dispensary and health centre level after referral from a drug store. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  This will be measured by comparing data of referred patients by text message in intervention wards with patients' data from comparison wards - comparing the number of referrals from drug stores in both arms.
  
  

• Referred number of patients attending HIV, STI, pregnancy prevention (including numbers of condoms, VCT, and post-abortion care) and treatment [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Obtained from data on the text messaging system and from comparison communities
  
  
• Referred number of patients attending other contraceptives (the pill, intra-uterine devices, injection, female condom and sterilisation where available) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Obtained from data on the text messaging system and from comparison communities
  
  
• Referred number of patients testing HIV positive (where there is a testing service) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Obtained from data on the text messaging system and from comparison communities
  
  
• Referred number of patients diagnosed with STIs (syndromic diagnosis) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Obtained from data on the text messaging system and from comparison communities
  
  
• Prevalence of HIV and STIs in the data from study areas [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Obtained from data on the text messaging system and from comparison communities
  
  

The SMS intervention was developed in 2 phases: (i) stakeholder consultation and (ii) 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 key deficiencies in existing RH provision and preferred strategies to address them. Detailed methods and results of these consultations are presented elsewhere (Consultation Paper in preparation). In brief government health facilities wanted an intervention that allows dispensaries and health centres to take charge of STI treatment and provide skilled service for other RH needs. Drug stores wanted an intervention that recognises and integrates their contribution to the health system, while adolescents wanted an intervention that promotes accessibility, confidentiality and trust of service providers. Through subsequent meetings, an SMS intervention strategy was identified because all clinical officers and drug store attendants demonstrated use mobile phones on a day-to-day basis.

The intervention design prioritised patients' ease of access to service: when a patient comes to a drug store to buy medicines for a RH related problem that may require a prescription drug, the drug store explains the referral system. If the patient accepts, the drug store sends a text message with the patient details to a toll-free number connected to a web-system. The system processes and forwards the patient details including a password to a dispensary matched with the referrer drug store. At the same time, that password is sent back to the referrer drug store so that it can be passed on to the patient. While at dispensary, patients with a password are received, matched with details received in text messages, and given fast track RH service, after which the dispensary sends a text message to the toll-free number confirming the completeness of patient treatment. This intervention is implemented in all 9 intervention wards in Mwanza. No intervention is implemented in the 9 comparison wards.