The Union launched a pilot project in collaboration with Eli Lilly and Dimagi, aimed at strengthening the process of patient referral and tracking through mobile technology in the tribal district of Khunti in Jharkhand, India. The intervention covering nearly 300,000 people is designed to improve referral and case notification rates through the active involvement of rural health care providers (RHCPs) and lab technicians, the frontline workers of the Indian health care system. This pilot is also among the first uses of mobile technology in TB care and control.
RHCPs are very often the "first point of contact" for health services, especially in tribal and geographically remote areas, across the country. Under this project, selected RHCPs, lab technicians, and non-governmental organisation supervisors have been trained and provided Android-based mobile phones pre-loaded with Commcare, an open-source customisable mobile application developed by Dimagi to track and create a database of referred chest symptomatics in a given area.
Commcare comes in two versions for its end users. The first has RHCPs entering details of referred patient, including the designated microscopy centre (DMC) to which they have been referred, thereby creating a database of referrals. The other application has the lab technician retrieve the patients' records and input the results of their sputum tests when completed. Notification of test results is then sent to both patients and RHCPs, so that the patients can be initiated on treatment, if found positive for tuberculosis. Irrespective of their test results, patients are also counseled about respiratory disease infection control and importance of treatment adherence using the theme "Shared air, safe air" with the help of audio-visual aids incorporated into the application.
Updated and monitored in real time, the management system is designed to assist in the follow-up of referred chest symptomatics by reducing delays around communicating test results as well as visits to DMCs by frontline workers. The central database of referrals helps in the retrieval of patients lost to follow-up, and also provides a platform to assess and acknowledge the contribution of frontline workers to the national TB control programme.
The RHCPs have been trained to provide directly observed treatment (DOTS) under the implementing project, so that they can provide care to those of their patients who are diagnosed with TB. Thus, this pilot looks to benefit both patient and provider, thereby strengthening the efficiency of the larger health care system.