Many developing countries are leveraging new mobile phone technologies to improve healthcare communication and infrastructure. In Rwanda, the TRACnet system uses mobile phones to improve communication between remote HIV/AIDS clinics and administrative centers. This allows health officials to follow individual HIV/AIDS patients and aggregate national data on the epidemic.
According to Dr. Innocent Nyaruhirira, the minister of HIV/AIDS in Rwanda, the transfer of health information from rural areas to city centers has long been cripplingly slow. “Information from clinics is written on a piece of paper that a porter carries by hand to the district before the information can be brought to Kigali,” said Dr Nyaruhirira. “We are a country of one thousand hills, so it often takes one month to receive a message from the field about a disease outbreak or drug shortage”  The TRACnet system is an attempt to improve this slow and unreliable communication within the Rwandan healthcare system using new mobile phone technology.
Ruhengeri Hospital pharmacist Andre Nsanzabandi uses TRACnet (image courtesy of FedTech Magazine
The TRACnet system, developed by the company Voxiva, is a web-based application that is accessible both through computers and mobile phones. The system allow clinics to send HIV/AIDS patient information from mobile phones with SMS text messaging to a central database using a standard Motorola phone with a downloadable application.  Using TRACnet, health care workers can track and follow up with HIV patients in remote areas with no electricity and little infrastructure. Clinics can also receive the results of laboratory tests and drug=recall alerts on their mobile phones. They can also send health alerts and inventory counts of antiretroviral drugs, as well as download treatment guidelines and training materials. The system is designed to increase accountability among health care workers through an electronic record that is created by every input into the system. TRACnet also facilitates better communication from clinic to clinic as well as from individual clinics to the Health Ministry in Kigali.
Click here to watch the PEPFAR video on the TRACnet project in Rwanda
The TRACnet system can be accessed through any PC with an internet connection. It features a “dashboard” that shows data and government HIV indicators from the field, giving the viewer a comprehensive view of the status, patient load, and drug supply levels of all of the HIV/AIDS programs in Rwanda. The aggregated information from all of the clinics also allows healthcare and government workers to identify trends in the data and to track the effectiveness of the program over time. The dashboard also includes a geographic information system (GIS) mapping feature that shows all of the clinics offering HIV/AIDS services, and identifies particular clinics experiencing shortages of anti-retroviral drugs. The system now connects 75% of Rwanda’s 340 clinics and covers over 32,000 people. The health ministry in Rwanda plans to expand the TRACnet system to the monitoring of measles, polio, meningitis, and malaria, and other diseases.
TRACnet system "dashboard" showing data from all participating clinics in Rwanda
Results and Evaluation:
Based upon the results of the two year TRACnet pilot project, a partnership has been formed between the GSM Association’s Development Fund, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Accenture Development Partnerships, Motorola, MTN and Voxiva to create the $10 million dollar Phones-for-Health system, which will use mobile phones to communicate health information in developing countries in order to improve the treatment of HIV/AIDS. Phones-for-Health will be implemented in nine other countries in Africa with plans to eventually expand the program further into Africa and Asia and to focus on the treatment and prevention of other infectious diseases such as malaria and tuberculosis. The cost to begin the Phones-for-Health system in each country is $1 million, with the annual cost to run each program of $500,000 per year.
There are, however, some limitations to using mobile phones to transmit health information. The depth and detail of reporting about a patient’s health status or information about a health emergency could suffer when it can only be communicated in 160 characters, the length of a mobile phone text-message. Another potential problem with the technology is that in very remote or hilly areas, mobile phone reception is spotty or non-existent. In these circumstances, health workers must walk (or climb) to a location where there is a signal so they can send their information to Kigali.
Would it be a better use of resources to try to bring Internet access and PCs to remote regions in Rwanda? Perhaps in the long run. But one of the reasons the impact of TRACnet technology has been so immediate is because it utilizes the existing mobile phone infrastructure and is based upon SMS, a mobile phone feature that Rwandans use regularly in their daily lives.  Thanks to their familiarity with the technology, health workers are trained to use the system in an average of only 30 minutes.
Despite its potential drawbacks, TRACnet is a valuable model of a technology that could lead to increased efficiency, accountability, and better health outcomes in treating infectious diseases worldwide.
India: The Heroes Project--HIV/AIDS Advice through SMS
Along with improving health-care service delivery, SMS can be used to provide accurate public health information on topics that are often not openly discussed, such as sexuality and HIV/AIDS. In India, the Heroes Project allows individuals to SMS a question about HIV and receive an anonymous text-message answer.
The Heroes Project is a public service campaign on HIV/AIDS launched in 2004, as a partnership between India’s STAR Television Network and Avahan, the India AIDS initiative (of the Bill and Melinda Gates Foundation and the Kaiser Family Foundation). The program developed its SMS advice line in March, 2007. Users can SMS the word “ASK” to the number 7827 and type in their question about HIV/AIDS. The question is then read on a computer screen by a counselor who sends a response, which the user gets in the form of an SMS message.
In addition, the Heroes Project designed an interactive contest in 2006 using SMS, aimed at the 15-24 year-old audience, who account for 35% of all new HIV cases. Participants sent an SMS to “AIDS” (the number 7827) and answered five questions about HIV/AIDS. If they got a question wrong, they were able to attempt to answer it until they got it right. Three winners a day were selected from those who answered everything correctly and were given prizes as a reward. The rational driving the project is the notion that in India sex and HIV/AIDS are not openly discussed, so it is difficult to obtain accurate information about prevention and treatment of the disease. According the Heroes Project website, “Given India’s societal fabric and cultural norms, not many can avail of the information from their elders without facing chastising questions. This medium will provide easy access to life saving information for the young generation” 
The service provides an anonymous, private means to access information about the disease in a country with the second highest number of people infected with HIV in the world. The "ASK" advice line appears to be especially effective, receiving 25,000 SMSs in its first month of operation.  There are some problems with the SMS advice line, including the reluctance of some users to have their mobile numbers visible to the counselor on the receiving end of the message. The Heroes Project is looking into a way to work with phone companies to fully mask callers’ identities.