From paper to mobile: health innovation in Cambodia

Tharum Bun, the iLab SEA’s Communications and Digital Manager, recently sat down with Mr. Yi Sophonrith, the Kien Svay Operational District (OD) director, to discuss both challenges and successes as he has transformed his OD through the aid of technology and help of the iLab SEA team.

Could you please introduce yourself and your work leading the OD?

My name is Yi Sophonrith, MD, MPH, director of Operational District (OD) Kien Svay. My responsibilities are to oversee one referral hospital and ten health centers. And the work of my OD is to disseminate the health policies of Ministry of Health and the government to the local health facilities, citizens, local authorities, so that they’re informed of the policies, strategies, and planning that they can help implement. The second thing is we collect information and data on communicable diseases, situation of diseases, situation of citizens’ health; we collect those information and send them through a health information system to the Ministry of Health.

How long have you been working here?

I’ve worked here at OD Kien Svay for more than twenty years. For over ten years, I was the deputy director.

What are your daily responsibilities as the director of the operational district in Kien Svay?

The most important work is planning in which we need to plan ahead for the coming years as well as for monthly implementation. The second work is monitoring, through InSTEDD’s [tools], we can understand how many cases of communicable diseases up until now, how many cases of respiratory disease, and every other cases of diseases.

What is the mission of your organisation?

Our mission is to ensure the healthiness and wellbeing of hundred thousand citizens in our coverage area . Second, it’s to contribute to the government to help them meet the Millennium Development Goals (MDGs), as well the World Health Organization (WHO), like the campaign to eradicate measles, and many others.

Why is the mission of your organisation important to the Kien Svay District?

The OD or my unit is to connect the Ministry of Health and the government with citizens, including policies, strategies, and everything related to health. If my unit does well, it will benefit them. Any problems related to citizens, if we don’t do well, it [information] will be lost; it will be buried here. Therefore, all these useful data we’ve strived to collect will be sent to the government in a good way.

I have an example, because this district is bordering with Vietnam. So most of the infectious diseases in recent years includes bird flu, swine flu, new cold; these cases happened. It’s a gateway and if my unit cannot get information early and perform well, the outbreak will spread in my area. Because we do our work well, the outbreak can be prevented. if there is any emerging issue, the intervention will be quick and we’ll be ready to send reports to the top level. And as you know, this work requires both the people and the authorities to participate. However, if they don’t get information from us, how can they participate? For behaviour change in particular; if we don’t give them information, how can there be any change in behaviour?

Tell me about an individual or family that benefited from your work?

The benefit is for everyone, especially poor people. Because we have proper guidelines for our services; those with some money will contribute. However, it’s a priority that it’s free for poor people and this policy is the Health Equity Fund. If there’s an accident on the street, we don’t ask whether you have money or not, we put them in the ambulance to Phnom Penh. If you have money, you pay, if not, it’s free. In addition, the government also benefits from our work as they can help improve the lives of citizens. WHO also benefits from our work and success of eradicating polio, which is also being done globally. We’re also starting a campaign to eradicate measles in the near future. In the case of [HIV] AIDS in Cambodia, especially in Kien Svay district, we have reduced the rate of the HIV/AIDs patients from more than 1% to 0.8%. Consequently, everyone benefits.

Why do you think it is important to implement these tools?

Moving forward to use IT makes things easier as health centres’ staff can use the [Reporting] Wheel, press SEND on their mobile phone, and the data enters the system. For us, it’s convenient because we used to send the paper reports and we have to call them have them mail it by taxi to our place. Now they just use their phone report to us and we can look up all the data in one system on the Internet.

How did the change from paper based data to mobile based data change your job?

The difference between paper-based and the technology is about 15%. It’s much different. Before it took long to send [the data] in paper but now it’s fast via mobile. However, we still have to monitor everything that’s going on. If the leader doesn’t care, the project will not be successful. We have to provide feedback to them at the monthly meeting about being late a week. Once it’s been a week late, everything is no longer correct. In this case, if one week late, the new week starts. It’s not in the last week. If we don’t monitor, follow up, and evaluate their work, we’ll fail. That’s a little constraint. Unless the leaders, not just me, all the leaders of each level have to pay attention to this matter.

What InSTEDD tools does OD Kien Svay use?

We use GeoChat to collect data, which is use case; data collection is through GeoChat. The second thing is for communication. For example, if there is any emergency at the grassroots level, they can report to us through GeoChat.This is problematic because they have limited knowledge in terms of using language and have difficulty in sending the report, but they prefer a phone call. But for us, it’s easy to reach them by just sending a mass SMS. Another is issue is that only some of their phones can read Khmer font.

Please explain how your staff use tool work?

To reach all members, we set up a technical group so if I want to send information, say a meeting tomorrow or a disease outbreak, I’ll compose a message using GeoChat, send it once, and it will reach everyone in the group. The second group of 6–7 members leads the operational districts and the process is also the same for them. The other group is for all the directors of health centres and the same process works.

Why do you think it is important to use these tools?

Through messages, so far, they’re about 10 communicable diseases and other diseases we have to report urgently; it’s called Zero Reporting. We have to report every week even if there aren’t any cases and we have to report a zero . Diseases like diarrheas, cholera, tetanus, and others need to be reported by the Ministry [of Health] in a timely manner on a weekly basis.

Before having these InSTEDD tools, what tools did you use?

With these InSTEDD [tools], the staff have to report at the same time. Unlike before, the staff had send in a print copy which took a few days to reach us. In addition, now when they send us the report, we no longer need to calculate [the number of cases]. Before, with all the paper reports, we had to make manual calculations. Now I can just open GeoChat and see t the number of cases from each [health] center; how many cases of zero? The other advantage is that it’s also quick for me to forward the report directly to the provincial [health department].

How do you find ICT tool in connection with health support and people?

It’s crucial because the diseases today are modern; they spread fast; they’re infectious. And if we don’t intervene in a timely manner, it will affect public health regionally or even globally. Thus, the faster we get the information, the better intervention. For bird flu, if we wait for two or 3 days, the outbreak of the disease will be higher than when we know about it quickly. For me, I highly value IT and health; they’re very important. If we can connect the two domains well, like what InSTEDD tools do we can respond fast in an emergency. When there is anything happening, there will be an alert SMS. For example, I get SMS alerts from the Ministry of Health everyday through my mobile phone and they also use GeoChat [of InSTEDD]. The Ministry regularly sends the alerts of which country is having which outbreak; now in our neighbouring country Vietnam, there are many cases of bird flu. The team sends the alerts to all the operational district directors nationwide, so we can spread this information to our health centres; make copies of those information to the health centres to alert them to be cautious because the bird flu outbreak is in Vietnam. Then the health centres can continue to spread the information through this successful measure.

Without this system, information won’t be able to spread as fast for everyone to access.

What did you achieve with the support of the iLab?

Actually if we get information about communicable diseases faster, we can minimise the high rate of outbreak. For example cholera, if we’re one or two hours late, hundreds of people are at risk of being infected. Let’s say cholera starts in village A, without having this information, people in this area are vulnerable to the infection. Because cholera spreads through food, water, and anything in the area we can publicise this information so that people can be more cautious. People might not go to that area or health officials may intervene by isolating the area for public safety.

Were there other options you had tried before? How did the iLab service differ in your opinion?

I don’t want any options beside working with the iLab because I’ve tried it all.

I’ve started working since 1986 and been through it all, reporting through couriers by foot, bicycle, motorcycle, fax, telegraph, two-way radio, until this IT solution that’s easier and of a wider spectrum. That’s the only option we want and need.

Any big changes between before you used InSTEDD iLab technologies and after?

The Ministry of Health also has a similar system called HIS or Health Information System, which we also access via the Internet. We use it to send information and reports. Instead of going through the difficult process of sending a print copy like before, we can input the data using a computer into the Ministry’s system. This is also the case for communicable disease reporting but what’s different about our tools, the InSTEDD iLab’s tools, is that we use it through mobile phone. That’s the difference; we can either use it on mobile or even landline phone. When using the Reporting Wheel, we can just input the code and the system will tell us the disease.

Note: this interview was conducted in Khmer and translated into English with slight editing for clarity and length. Editing by Voleak Sroeung, a Communications and Digital Media intern at InSTEDD iLab Southeast Asia.