Project Title:
A Community-based Child Injury Surveillance System: Rapid Data Collection Using Short Messaging Service (SMS)

Recipient Institution:
Medical Informatics Unit, College of Medicine,
University of the Philippines Manila

547 Pedro Gil Street
Ermita,
Manila 1000
PHILIPPINES

Tel/Fax: 632-522-9231

Project Leader:
Prof. Herman D. Tolentino
hermant@I-manila.com.ph

URL:
http://www.upm.edu.ph/

Amount and Duration: US$ 22,642 / 9 months

Commencement Date:
1 January 2004

Project Proposal
Project Background and Justification

Injury is the one of the most common cause of morbidity and mortality in the productive ages. Around the world, research have shown that prevention is the most effective and strategic method of decreasing the risk of injury.

In the Philippines, there is no national trauma registry that can help policy makers direct their laws or research. It is important to identify which mechanisms of injury take a big portion of the resources of the personal and public health sectors to facilitate the formulation of effective prevention programs. The first step therefore is the collection of field data of injury, or an injury surveillance system that will serve to support policy.

Outdated surveillance systems often lead to surveillance bodies collecting huge amounts of data and rarely provide feedback to the data collectors. Very rarely is attention given to using the data at each level of the health service.

Community-based data collection systems for disease surveillance have been an elusive dream whenever implementation of information technology is required. Oftentimes, resource constraints, trainee qualifications and data quality issues become obstacles to successful implementation. In this study, open-source tools from the Linux community combined with community-based people-centric strategies are explored to enable implementation of a child injury surveillance system by community health workers. In particular, the innovative use of mobile phone technology, professionalized technology transfer and training and the use of open-source tools is explored in setting up a data collection system for child injury surveillance in an urban poor community in Metro Manila.

Currently there is no reported use of wireless and wired telecommunications technology, for disease surveillance. The early detection of disease, which this study covers, is an emerging field in public health informatics. Using low-cost, low-technology and widely deployed tools (phones) packaged with capacity building could unlock hidden service potential in community health workers in third world countries. Furthermore, in the light of delivery of devolved health care at the local government unit, this could serve as the platform for digital integration of community data in national surveillance databases.

PROJECT OBJECTIVES

General: To establish a community-based child injury surveillance system using mobile phone technology and people-centric strategies

Specific:

1. Design, develop and implement telephony-based data collection system using open-source tools in one local government unit
2. Design, develop and implement professional training program for community health workers in one local government unit
3. Develop community partnerships for child injury surveillance and prevention activities

PROJECT BENEFICIARIES

Among the beneficiaries of this project would be community health workers in Pasay City, Metro Manila, Philippines. One urban poor community from the Pasay City local government will be selected. Purposive sampling from the population of community health workers from one barangay will be done. The other beneficiary would be the local government officials themselves who will be receiving the health reports generated by the system to be used in community-level and local government level decision-making.

Among the partnerships to be established are:

University of the Philippines Manila (3 departments and one students organization)
SafeKids Philippines and SafeKids Worldwide
Smart Communications
Pasay City Local Government

PROJECT SUSTAINABILITY

To ensure sustainability of the system when the project ends, partnerships with telecommunications companies will be in place to cover telecommunications recurring expenses for data submissions. At the same time, personnel from the local government health unit shall be trained as trainors so that they can carry out training and system deployment activities on their own with minimal support from the University of the Philippines. The adoption of child injury prevention and control as a part of the advocacy work of a people's organization in the grassroots (i.e., Pasay Barangay Health Worker Federation) shall be pursued.

PROJECT METHODOLOGY

Study Population. The study population consists of community health workers from one barangay (village) and they will be divided into two groups based on the two major project outputs below.

Project Initiation

This is the first activity for this project to ensure that all stakeholders have buy-in and the project team will have a high level of confidence for project implementation.

Telephony-based Data Collection System

Rapid Prototyping. Multiple meeting sessions with the end users shall be set up to observe behavior and interaction with the mobile phone interface for the data collection system. An "adaptive" software development technique will be utilized to respond to evolving conditions previously unseen in the computer laboratory. The key objective for data submission is for community health workers to be able to validate and integrate surveillance data prior to phone submissions into a database. During this phase, all data collection activities of community health shall be observed for potential usability and training issues. The UP Medical Informatics Unit has existing open source SMS and telephony applications that will be reused in this project.

Data Modeling. After interface prototyping and entry validation exercises, the final data model shall be created and implemented.

Applications Development. Development shall be carried out using open source tools (Linux, PHP, Apache, MySQL and Gnokii). Once the data flow has been established, this shall be communicated to the wireless telecommunications partner for implementation of appropriate technology on their end (SMS). Wired telephony will involve the use of wired SMS or "landline texting", a technology similar to GSM-SMS but uses POTS .

Application Testing. Test submissions shall be carried out and sample reports shall be generated so these can be validated by community health workers and local government health unit personnel.

Professional Community Health Worker Training

Formulation of Training Objectives. Training objectives shall be developed after observation of community health workers in their preliminary data gathering activities. Proponents will concentrate on maintaining quality of data submissions training community health workers to do big-picture thinking for surveillance activities through simulations, and exercises. Community health workers will also be taught basic diagnostic skills and are expected to maintain a high level of accuracy and precision.

Content Creation and Instructional Design. Once objectives have been set, content creation and instructional design shall be carried out to be able to meet training objectives. The strategic aim for content is simplicity, clarity and memory-friendliness.

Pilot Training Sessions. Once content creation is completed pilot training sessions will be held with selected community health workers who have not participated in the technology prototyping exercises above.

Maintenance. After training, the local government unit should be taking over the system with technical support from the Medical Informatics Unit. Personnel from the local government health unit shall be invited for further skills enhancement training in the University in short courses offered by the Medical Informatics Unit. Community health workers shall also be submitting child injury surveillance data with weekly feedback meetings with local government health unit personnel and the Medical Informatics Unit for regular assessment of implementation. At the community level, community health workers should be using data they gather for localized decision making.

PROJECT TIMELINE

PROJECT OUTPUTS

PROJECT MONITORING

For the data submission system, SMS and landline submissions will be monitored and feedback sessions from community health workers and local government health unit personnel will be conducted to find out how the system is being used.

For the training program, summative and formative evaluations will be carried out to identify areas of improvement before turnover to the local government unit.