Recently, I came across my old friend Dr. Nick Lorenz, a physician with whom I had worked in Western Africa.

 

In 1983, we left Germany for Nick to go to Burkina Faso and myself to the Republic of Niger. Lorenz is now deputy director of the Swiss Tropical and Public Health Institute in Basel. So I was delighted when I had a chance to call him up. We chatted for a while about all what had happened since we had seen each other the last, and he sent me an old photo of our group shortly before we were to leave Paris for our destinations.

 

Looking at the picture, I tried to remember the names of the people, where they went and what they were supposed to accomplish. There was one woman I remembered quite well, although I could only recall her first name: Elfriede. She was a children’s nurse, going to Ouaihiguia in Burkina Faso, a very desolate place in an already very desolate country. I visited her once, on my way through to the Ivory Coast. And I can still clearly see her in front of me, crying her eyes out, because that particular day, she lost eight young children and babies.

 

Since those days in 1984, the health situation for many of the poorest countries in Africa has not changed much. The World Health Organization still states that “health facilities in low-income countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce.”

 

There is hardly a regular flow of supplies. Equipment is poorly maintained if existent at all. Doctors are left on their own – they have to rely on history, signs and symptoms to determine what to do. To provide quality care under these circumstances is more than a challenge.

 

In response, the WHO and UNICEF have developed a strategy called the Integrated Management of Childhood Illness. IMCI is an integrated approach that aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. According to the WHO, “IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.”

 

The Republic of Tanzania is one of the countries that embraced IMCI from the very beginning. The national standard in Tanzania focuses on the three main components of IMCI:

 

 

As in other countries with extreme poverty and health care challenges, a few diseases such as malaria, pneumonia, diarrhoea and measles are the immediate cause for many childhood. These diseases can be successfully treated if diagnosed in their early stages.

 

The IMCI protocol lays out a series of investigations (for example, take respiratory rate, check for sunken eyes, ask if fever has been present every day, and so on) for each complaint, leading to the determination of a treatment. However, while IMCI in Tanzania “has been shown to lead to rapid gains in child survival when correctly applied, the use of IMCI is limited by the expense of training, the lack of sufficient supervision, the time it takes to follow the IMCI chart booklet and the tendency to adhere to protocols less rigorously over time.” (As per De Renzi, B., et al, 2008: e-IMCI: Improving Pediatric Health Care in Low-Income Countries, CHI 2008, Florence, Italy.)

 

To improve health outcomes and reduce death rates in Tanzania, health authorities started a program called e-IMCI using PDAs and smart phones for administering the IMCI protocol. e-IMCI guides a health worker step-by-step through the IMCI treatment algorithm.

The idea of using ITC technology in conjunction with health care for children benefited from a dramatic development in the Tanzanian mobile telecom sector.

 

While in 2002 there were around 300,000 mobile phones in Tanzania, eight years later nearly half the population own a mobile phone: 15 million people. All of these phones have SMS, and many have MMS and broadband capabilities. Providers include Vodacom, Zain (News - Alert), Tigo, Sasatel and Zantel as well as the state utility firm Telecom Tanzania Ltd. This level of cellular access has contributed greatly to making the use of smart phones and PDAs for child care in rural areas a reality.

 

In, 2008, e-IMCI was introduced and tested with the aim to ‘reduce skipped steps, branching-logic errors, and miscalculations.” (As per De Renzi, B., et al, 2008: e-IMCI: Improving Pediatric Health Care in Low-Income Countries, CHI 2008, Florence, Italy.)

 

The benefits were quickly apparent. Training in the IMCI protocol demanded less time, and more sophisticated protocols could be applied since the constraints of the paper-based approach (use of flip charts for teaching, and so on) were avoided. Updates of the protocols could be applied much faster. The data collected was readily available to assist with further treatment of the individual as well as to provide valuable health data to the health departments.

 

Reports about the effectiveness of e-IMCI in rural Tanzania show that this approach has the potential to significantly improve the care for children, reduce infant mortality, and increase the rate of properly diagnosed diseases. If this approach proves itself over a longer period of time to be efficient and successful, it will be time to spread the word about mobile health benefits all over the world.