Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa
https://doi.org/10.4081/jphia.2023.2253
Accepted: 3 August 2022
HTML: 2
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, short message service (SMS) printers were deployed to fill this gap, with the global data service platform (GDSP) being primarily used to facilitate deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization.
Objective. The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa.
Methods. A cost analysis for 2020 was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: i) months active (based on internet protocol data); ii) signal; iii) battery strength.
Results. There were 4,450,116 results delivered to printers that were situated at 2232 primary health care facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength of ≥60% and a battery strength of ≥6 volts.
Conclusion. Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.
National Health Laboratory Service (NHLS). Annual Report 2019/20 Johannesburg, South Africa: National Health Laboratory Service (NHLS); 2020 [Available from: https://www.nhls.ac.za/wp-content/uploads/2021/03/NHLS_AR_2020_25_Nov.pdf. (Accessed Date: 23 July 2021).
TLC engineering solutions. TLC GSM Communication Johannesburg, South Africa: TLC engineering solutions; 2021 [Available from: http://www.tlc.co.za/pdf/sms_printer.pdf. (Accessed Date:
Vojnov L, Markby J, Boeke C, Penazzato M, Urick B, Ghadrshenas A, et al. Impact of SMS/GPRS Printers in Reducing Time to Early Infant Diagnosis Compared With Routine Result Reporting: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr. 2017;76(5):522-6. doi:https://doi.org.10.1097/QAI.0000000000001526 DOI: https://doi.org/10.1097/QAI.0000000000001526
Olsen F, Isherwoord L, Madumo P, Berrie L, Stevens WS, editors. Bi-Directional Printer Technology Rapidly Delivers HIV and TB Results to Health Care Facilities in South Africa. African Society for Laboratory Medicine 2016; 2016 2016/12/3; Cape Town, South Africa. Cape Town, South Africa: African Society for Laboratory Medicine
National Department of Health (NDOH). 2019 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy, Adolescents, Children, Infants and Neonates 2019 [Available from: https://www.knowledgehub.org.za/system/files/elibdownloads/2020-05/2019%20ART%20Guideline%2028042020%20pdf.pdf. (Accessed Date: 24 August 2021).
International Monetary Fund (IMF). Exchange Rates selected Indicators: South Africa Washington, DC, USA: International Monetary Fund (IMF); 2021 [Available from: https://data.imf.org/regular.aspx?key=61545850. (Accessed Date: 23 July 2021).
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ : British Medical Journal. 2013;346:f1049. doi:https://doi.org.10.1136/bmj.f1049 DOI: https://doi.org/10.1136/bmj.f1049
World Bank. Inflation, consumer prices (annual %) - South Africa 2021 [Available from: https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG?locations=ZA. (Accessed Date: 3 November 2021).
(NDOH) NDoH, National Health Laboratory Service (NHLS). Primary Health Care Laboratory Handbook - A Step by Step Guide Pretoria, South Africa: National Department of Health (NDOH); 2018 [Available from: https://www.idealhealthfacility.org.za/App/Document/Download/21. (Accessed Date: 24 April 2020).
Swarts L, Lahri S, van Hoving DJ. The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town. Afr J Emerg Med. 2021;11(1):165-70. doi:https://doi.org.10.1016/j.afjem.2020.09.016 DOI: https://doi.org/10.1016/j.afjem.2020.09.016
Chigudu K, Isherwood L, Marange F, Gorogodo B, Sofute N, Kadira B, et al. eLABS: Digital Health Intervention Strengthens the Clinical-Laboratory Interface for the HIV Viral Load Value Chain in the Luanshya District, Zambia Background Results Conclusions Methods Acknowledgements2021.
Mezzanine. eLABS 2021 [Available from: https://mezzanineware.com/digital-productivity-technology/healthcare-technology-solutions/laboratory-improvement-technology/. (Accessed Date: 23 November 2021).
President's Emergency Plan for AIDS Relief (PEPFAR). South Africa Country Operational Plan (COP/ROP) 2020: Strategic Direction Summary 2020 [Available from: https://www.state.gov/wp-content/uploads/2020/07/COP-2020-South-Africa-SDS-FINAL.pdf. (Accessed Date: 31 May 2022).
Lomofsky L, Lazarus S. South Africa: First steps in the development of an inclusive education system. Cambridge Journal of Education. 2001;31(3):303-17. doi:https://doi.org.10.1080/03057640120086585 DOI: https://doi.org/10.1080/03057640120086585
Mboweni SH, Makhado L. Conceptual framework for strengthening nurse-initiated management of antiretroviral therapy training and implementation in North West province. Health SA. 2020;25:1285. doi:https://doi.org.10.4102/hsag.v25i0.1285 DOI: https://doi.org/10.4102/hsag.v25i0.1285
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi:https://doi.org.10.1016/j.jbi.2019.103208 DOI: https://doi.org/10.1016/j.jbi.2019.103208
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. doi:https://doi.org.10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
Fraser H, Biondich P, Moodley D, Choi S, Mamlin B, Szolovits P. Implementing electronic medical record systems in developing countries. Journal of Innovation in Health Informatics. 2005:13. doi:https://doi.org.10.14236/jhi.v13i2.585 DOI: https://doi.org/10.14236/jhi.v13i2.585
Katurura MC, Cilliers L. Electronic health record system in the public health care sector of South Africa: A systematic literature review. African Journal of Primary Health Care & Family Medicine. 2018;10:1-8. doi:https://doi.org.10.4102/phcfm.v10i1.1746 DOI: https://doi.org/10.4102/phcfm.v10i1.1746
Ohuabunwa EC, Sun J, Jean Jubanyik K, Wallis LA. Electronic Medical Records in low to middle income countries: The case of Khayelitsha Hospital, South Africa. African Journal of Emergency Medicine. 2016;6(1):38-43. doi:https://doi.org.https://doi.org/10.1016/j.afjem.2015.06.003 DOI: https://doi.org/10.1016/j.afjem.2015.06.003
Mazibuko B, Ramnarain H, Moodley J. An audit of pregnant women with prosthetic heart valves at a tertiary hospital in South Africa : a five-year experience : cardiovascular topics. Cardiovascular Journal of Africa. 2012;23(4):216-21. doi:https://doi.org.doi:10.10520/EJC120166 DOI: https://doi.org/10.5830/CVJA-2012-022
Iwuji C, Osler M, Mazibuko L, Hounsome N, Ngwenya N, Chimukuche RS, et al. Optimised electronic patient records to improve clinical monitoring of HIV-positive patients in rural South Africa (MONART trial): study protocol for a cluster-randomised trial. BMC Infectious Diseases. 2021;21(1):1266. doi:https://doi.org.10.1186/s12879-021-06952-5 DOI: https://doi.org/10.1186/s12879-021-06952-5
Asah FN. Creating a “Community of Information Practice” for improved routine health data management in Resource Constrained Setting: The case of Mbingo Primary Healthcare facility, South Africa. Electronic Journal of Information Systems in Developing Countries. 2021;87(5):e12178. doi:https://doi.org.https://doi.org/10.1002/isd2.12178 DOI: https://doi.org/10.1002/isd2.12178
Botha A, Herselman ME, Alberts R, Fogwill T, Chetty M, Geldenhuys P. Phase 1a: Literature overview of health in South Africa. Literature overview of health in South Africa2016.
KwaZulu-Nala Provincial Department of Health (NDOH). 2022 [Available from: https://www.ialch.co.za/our-vision-history/. (Accessed Date: 20 April 2022).
Teich JM, Hurley JF, Beckley RF, Aranow M. Design of an easy-to-use physician order entry system with support for nursing and ancillary departments. Proc Annu Symp Comput Appl Med Care. 1992:99-103.
Baron J, Dighe A. Computerized provider order entry in the clinical laboratory. Journal of Pathology Informatics. 2011;2(1):35-. doi:https://doi.org.10.4103/2153-3539.83740 DOI: https://doi.org/10.4103/2153-3539.83740
Westbrook JI, Georgiou A, Dimos A, Germanos T. Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: a controlled before and after study. J Clin Pathol. 2006;59(5):533-6. doi:https://doi.org.10.1136/jcp.2005.029983 DOI: https://doi.org/10.1136/jcp.2005.029983
Kuperman G., Gibson R.F. Computer Physician Order Entry: Benefits, Costs, and Issues. Annals of Internal Medicine. 2003;139(1):31-9. doi:https://doi.org.10.7326/0003-4819-139-1-200307010-00010 %m 12834316 DOI: https://doi.org/10.7326/0003-4819-139-1-200307010-00010
National Department of Health (NDOH). Standard Treatment Guidelines and Essential Medicine List for Primary Health Care 2020 [Available from: https://www.idealhealthfacility.org.za/App/Document/Download/28. (Accessed Date: 24 August 2021).
Girdwood S, Crompton T, Cassim N, Olsen F, Sejake P, Diallo K, et al. Optimizing courier specimen collection time improves patient access to viral load testing in South Africa. 2022. DOI: https://doi.org/10.2139/ssrn.3829643
Venter WDF, Fischer A, Lalla-Edward ST, Coleman J, Lau Chan V, Shubber Z, et al. Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019;7(4):e12652. doi:https://doi.org.10.2196/12652 DOI: https://doi.org/10.2196/12652
Lalla-Edward S, Mashabane N, Isherwood L, Scott L, Fyvie K, Duncan D, et al. Feasibility and Acceptability of iThemba: A mobile health application to support engagement in HIV care and viral load suppression: A pilot study. 2022.
Farley J, McKenzie-White J, Bollinger R, Hong H, Lowensen K, Chang L, et al. Evaluation of miLINC to shorten time to treatment for rifampicin-resistant Mycobacterium tuberculosis. The International Journal of Tuberculosis and Lung Disease. 2019;23:980-8. doi:https://doi.org.10.5588/ijtld.18.0503 DOI: https://doi.org/10.5588/ijtld.18.0503
Fischer AE, Phatsoane M, Majam M, Shankland L, Abrahams M, Rhagnath N, et al. Uptake of the Ithaka mobile application in Johannesburg, South Africa, for human immunodeficiency virus self-testing result reporting. 2021. 2021;22(1). doi:https://doi.org.10.4102/sajhivmed.v22i1.1197 DOI: https://doi.org/10.4102/sajhivmed.v22i1.1197
Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med. 2006;44(6):750-9. doi:https://doi.org.10.1515/CCLM.2006.123 DOI: https://doi.org/10.1515/CCLM.2006.123
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Downloads
Citations
