The Sivagangai District (Tamil Nadu, India) Deputy Director of Health Services (DDHS), Dr. Raghupathy, compared the Real-Time Biosurveillance Program (RTBP) to a comprehensive machine with multiple flavors that can give the required surveillance results with the touch of a button. Kurunegala RE (Region Epidemiologist, Sri Lanka), Dr. Hemachandra’s words were “RTBP will give a booster to surveillance in our region”. Evaluation planning workshops took place in Karraikudi, Tamil Nadu and Kurunegala, Sri Lanka.
The document describes the Standard Operating Procedures (SOPs) for data collection, data processing, data reporting, and database/system administration. Data collection involves Setting up of the Biosurveillance Module (BSM) initial information (i.e. implement database) through the web application and direct Database Administration (DBA) functions Installing, configuring, and maintaining the m-HealthSurvey mobile application Health worker expected practices in submitting data Documenting and reporting problems associated with the BSM and m-HealthSurvey Data processing involves Installing, configuring, and maintaining the T-Cube Web Interface (TCWI) analytical tool Installing, , configuring, and maintaining the detection algorithms Health Officials (epidemiologist) expected practices in analyzing the health data Defining priority levels for particular diseases Documenting events of interest Documenting and reporting problems associated with TCWI and detection algorithms Data reporting involves Installing, configuring, and maintaining the Sahana Alerting and Messaging Module (MAM) Initializing the MAM contact lists, jurisdictions, geographical areas, message templates Verification and Authorization procedures for issuing health alerts
The health departments and health workers involved in the Real-Time Biosruveillance Program (RTBP) pilot see the benefits in the m­-HealthSurvey for real­-time data collection, T­Cube Web Interface for near­-real­-time outbreak detection, and Sahana Alerting Module for real­-time health risk information dissemination. Preliminary lessons to date indicate the need for more robust mobile application for data collection with complete standardized content in disease­-syndrome for reduction of noise and increase of reliability in the datasets. More rigorous capacity building and frequent use is required for health officials to take advantage of the full potential of TCWI. Further exercises need to be carried out with the Sahana Alerting Module to understand its shortcomings. Given that the system has been in preliminary use for less than six months, it is anticipated that the usability issues will subside in time to come.
The   objective   of   this   document: Guidelines for Evaluating RTBP v0.4 is   to   outline   the   evaluation   methodology   for   assessing   the upstream   communication:   data   collection,   data   processing:   event   detection,   and   downstream communication: alerting/reporting stages (verticals in Figure 1) on the aspects of social, content, application, and technology of a Real­Time Biosurveillance Program (RTBP). The blue arrows across the verticals and the horizontals indicate the interoperability between elements.
A m-HealthSurvey Certification Exercise was carried out as part of the m-Health Real-Time Biosurveillance Program (RTBP) to measure the usability and adoptability of the m-HealthSurvey mobile application. The exercise was conducted with health workers in Sivagangai District, Tamil Nadu, India and in Kurunegala District, Sri Lanka. The final results of the exercise will be published in the near future. m-HealthSurvey is a mobile application developed by indian Institute of technology Madras’s Rural Technology and Business Incubator (RTBI) for collecting near real-time patient disease, syndrome, and demographic data for rapid detection of disease outbreaks. It is a J2ME midlet that allows users to select categorical data as well as type information to generate patient clinical records to be submitted via GPRS to a central database.
m-Health Real-Time Biosurveillance Program (RTBP) interviewed Medical Officers in Kurunegal District in Sri Lanka and Sivagangai District in Tamil Nadu, India, during the months of September and October, 2009. These interactions revealed that outpatient health record entry in real-time by Medical Officers, using the mobile phone key pad is inefficient and the idea was rejected by them. The aim of the RTBP is to collect digitized patient disease, syndrome, and demographic information from the point of care to rapidly detect disease outbreaks. Village Health Nurses in Tamil Nadu examine at most 70 patients a week. Ninety percent of the Village Health Nurses opt to jot down the records on paper and later enter them leisurely after the day’s work is complete.
Village Health Nurses (VHN) are the last-mile health workers attending to the primary health care needs of the rural villagers in the state of Tamil Nadu; where the real-time biosruveillance program (RTBP) is being pilot tested in India. They work under harsh conditions. For instance transportation schedule is limited to a bus that leaves in the morning and returns in the afternoon. Baking and sweating in the hot sun in Sivaganga District of Tamil Nadu, they walk for several kilometers, carrying a heavy load of Registers, making house calls to give the much needed health care to the rural poor. During a recent workshop, in Tamil Nadu, a discussion around the accountability of submitting data revealed that the VHN sometimes cheat on the statistics they tediously record on large volumes of paper forms.