A 21-week pilot study, 'SMS for Life', was undertaken during 2009-2010 in three districts of rural Tanzania, involving 129 health facilities. Undertaken through a collaborative partnership of public and private institutions, SMS for Life used mobile telephones, SMS messages and electronic mapping technology to facilitate provision of comprehensive and accurate stock counts from all health facilities to each district management team on a weekly basis. The system covered stocks of the four different dosage packs of artemether-lumefantrine (AL) and quinine injectable.
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The pilot study was 21 weeks in duration. This period was chosen because it covered two quarterly order cycles and five monthly delivery cycles. Data collection started on 1st October 2009 and ended on 25th February 2010.
During the 21-week study, the average response rate to SMS requests for stock count data was 95%. The response rate did not fall below 93% at any point (Figure 2). The proportion of late replies (i.e. after 17:00 on Friday) was low, averaging 3% overall. The rate of responses, and the proportion of late responses, did not vary markedly during the pilot, other than after the request sent on 14th January 2010 when there was a national problem with connectivity on one mobile telephone network (Figure 2). The highest response rate was in Lindi Rural (99%), compared to 93% in Ulanga and 94% in Kigoma Rural, which is likely to have been the result of disciplinary action in the Lindi Rural district, consisting of warning letters and interviews at the district office for non-compliant health facility staff. Across all three districts, feedback from district management and data from questionnaires completed by health facility workers indicated that the financial incentive of airtime credit was an important contributor to the high response rate.
The central NMCP log-in was activated on average once a day. The central Medical Stores Department and the Zonal Stores in the three districts virtually never accessed the system. At the district level, the weekly emails sent by the SMS for Life system were read by at least one team member in the district management team of each district every week during the pilot, with the exception of a single email to the Kigoma team. System usage in the Lindi Rural district decreased as stock-outs were eliminated after week 8, declining from 45 log-ins during October 2009 to 13 log-ins during February 2010. In Ulanga, log-ins increased (35 log-ins during October-December, rising to 70 log-ins during the last 6 weeks of the project) after the Clinical Officer in the District Medical Office was given a Blackberry and more prescriptive input from the SMS for Life project team. In the third district, Kigoma Rural, access to the system was low in the early phase (33 times in October-December) but increased to 28 times in the last 6 weeks after the District Pharmacist and Malaria Focal Person were each given a Blackberrry device to access stock count data.
There were marked differences between the three districts in terms of achievement of full stocking and in stock levels, for a variety of reasons. The Lindi Rural district was the most successful in managing stock levels, eliminating stock-outs for all five categories of medicine by week 8 and maintaining stocks of all three anti-malarials at almost all health facilities thereafter. Two key factors contributed. First, after receiving the first set of stock count data, the district management team made an emergency order to the Zonal Store. This delivery was distributed to health facilities according to priority based on their urgency of demand during weeks 2, 3 and 4, thereby eradicating most stock-outs. Second, when a health facility reported having only one box of any AL dosage pack, the district pharmacist either issued further stock or moved stock from a neighboring health facility in a pre-emptive manner. In the Ulanga district, the rate of stock-outs at week 1 was high (87% of health facilities), largely because no blue dosage packs of AL had been delivered to the district for almost a year. Also, Ulanga was transitioning from the 'push' system to ILS delivery during the pilot. As a result, deliveries were delayed and there were discrepancies between stock orders and the item delivered, for example with no blue AL dosage packs included and only very small quantities of other AL dosages. Furthermore, an emergency delivery was not received. Following two ILS deliveries, the second of which included blue AL dosage packs, 78% of all health facilities in Ulanga became fully stocked by week 21. The proportion of health facilities with no quinine injectable, however, increased from 3% at week 1 to 7% at week 21. In the third district, Kigoma Rural, almost all health facilities (93%) had a stock-out of at least one type of anti-malarial at week 1, and 36% were out of stock of all five products. There was an ongoing shortage of red AL dosage packs until the end of January 2010, with 42% of health facilities still having no red packs at the end of the study. Over 90% of health facilities, however, had stocks of all other products by week 21. The district relied only on regular ILS deliveries. Following the two ILS deliveries that were received during the pilot, the district management took 3-4 weeks to distribute medicines from the first delivery to all health facilities and after delivery of a complete ILS order in late December, including red AL dosage packs, stock counts of red packs only rose from 21 January onwards. Several factors contributed to outcomes in the Kigoma Rural district. The ILS delivery quantity for red dosage packs of AL was only sufficient to prevent stock-outs for three weeks, such that stock-outs were inevitable. Second, when red dosage packs were delivered they were distributed unevenly between health facilities, with some facilities receiving none, and no active redistribution was undertaken subsequently. Lastly, no emergency orders were submitted from the Kigoma Rural district despite severe stock shortages for the majority of the pilot.
The Vodafone 360 store gives customers the choice to download from over 8,000 applications ranging from checking the weather and news to the latest music and games. All the information, social contacts and content can also be seamlessly accessed online from PCs and Macs, in addition to handsets, allowing customers the freedom to connect via whichever channel is most convenient to them. Vodafone was the first operator to offer DRM-free bundles and now has the largest number of paid digital music subscriptions in Europe, with over 500,000 customers.
Microsoft Outlook includes an SMS message feature that allows you to send text messages in the same way you would normally send or forward an email or calendar appointment to a contact. To use the standard, free Outlook SMS feature your business must have a Microsoft Exchange Server 2010 account and a smartphone or wireless device running the Windows Mobile 6.5 operating system or later. Many businesses won't meet these requirements, so Outlook offers another method for sending or forwarding messages through a third-party SMS text messaging service, which links to the program to send and receive text messages on your behalf. During Outlook's sign-up process for this service, you can select your current wireless provider's SMS text service or choose another wireless provider.
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