e-Health INITIATIVE

The National Health Hotline (115): A Digital Innovation for the Communicable

Disease Alert System in Cambodia

Field report carried out on March 23 and 26, 2018 in Cambodia by Ms. Florence Delcher, project

manager of the Asia Zone - Pierre Fabre Foundation.

Foreword (source WHO)

Control of communicable diseases is based on effective surveillance of these diseases. In order to

respond to priority transmissible diseases, it is fundamental to have a national surveillance system

for transmissible diseases which functions effectively. This system represents a key element of public

health decision-making (identification of priorities, planning, mobilization and allocation of

resources, prediction and early detection of epidemics, continuous monitoring and evaluation of

disease prevention and control programs). The development and strengthening of national

surveillance systems requires a significant and long-term commitment of material and human

resources. Communicable disease surveillance is a national activity. For the system to function as an

early warning system, notification, confirmation, decision-making and action must occur quickly. The

list of priority diseases or syndromes to be monitored is an important element of the national

surveillance plan. This list, which should be as short as possible, is drawn up by the national health

authorities.

In Cambodia, seven communicable diseases (or syndromes) are currently being monitored by the

Ministry of Health:

1. acute diarrhea, 2. fever with rash *, 3. acute flaccid paralysis *, 4. severe respiratory infection, 5. dengue fever 6. meningitis and encephalitis, 7. acute jaundice.

* a single case must lead to immediate action.

Thanks

To the Communicable Disease Surveillance Department of the Ministry of Health of Cambodia; for

your welcome, your enthusiasm and your availability throughout this mission (by email, in Phnom

Penh and the provinces).

At InSTEDD iLab; for your help in preparing this mission and your availability.

To all the health staff and patients we met in the Kandal District, for your testimonials and trust.

Discussion with Dr. Preak Virak, Director of the Svay Lo Rum Health Center.

Friday, 23 March 2018

It is to the Department of Communicable Disease Surveillance (DSMT) within the Ministry of Health of

Cambodia in Phnom Penh, that I find Mr. Sok Samnang, Deputy Director of the Department, in charge

of the national health emergency line (115) set up by the Ministry of Health. He is accompanied by

Mrs. Channe Suy Lan, Director of InSTEDD iLab South East Asia, which has been responsible for

producing the tool.

Cambodia

This constitutional monarchy, located in the peninsula of South-East Asia,

has almost 16 million inhabitants. The country is in 143rd place,

according to the human development index (0.56). Life expectancy is 68.5

years. With an area of 181 035 km2, Cambodia is organized in 24

provinces. There are 6.55 health centers and 0.57 hospitals per 100 000

population.

Mr. Sok Samnang is passionate about new technologies: he holds a Master's degree in Public Health

and Computer Science from Mahidol University in Thailand. He is convinced that "new technologies

can make a big difference in improving health around the world."

In 2014, during a Health Hackathon dedicated to epidemiological surveillance, organized in Cambodia

and at the initiative of the Ministry of Health, emerged the idea of setting up a sanitary emergency

line allowing better epidemiological surveillance and optimizing the response capacity in case of

serious events, that were considered too weak and slow at the time by the Ministry of Health.

InSTEDD iLab is identified by the Cambodian authorities as the partner for the implementation of such

a tool within the DSMT.

InSTEDD iLab is a non-profit organization born in Silicon Valley. Its mission is

to put technology (non profit) at the service of the major problems of the

least developed countries, in terms of health, safety and development.

InSTEDD iLab cooperates with all types of infrastructures (governmental,

non-governmental, public or private institutions) and has developed over

the years a real e-expertise to answer major public health issues (eg intervention of InSTEDD iLab in

Sierra Leone during the Ebola outbreak).

The InSTEDD iLab South East Asia branch works more specifically on the monitoring and management

of infectious diseases identified in the region (malaria, tuberculosis, diarrhea, etc.). It has set up

various programs notably with Laos, Cambodia, Vietnam, Nepal, Thailand and Myanmar.

"We needed to develop a reliable, simple, low-cost tool that could be used by everyone, across the

country. It was intended to provide for the control of communicable diseases monitored by the

Ministry of Health as well as the early warning of events that constitute a potential threat to public

health" (Ms. Channe Suy Lan).

The DSMT, in cooperation with InSTEDD iLab, has therefore developed an e-health tool, within the

Ministry of Health of Cambodia, allowing:

→ To all citizens: ▪ To report suspicious or proven cases, for free and with all types of phones. ▪ To receive free prevention messages, information and health recommendations. ▪ To directly contact the DSMT in case of emergency.

→ For Health Care Workers: ▪ Save time during weekly reporting of cases of illnesses under surveillance. ▪ To inform the authorities, in real time, of suspicious and urgent events. ▪ To be contacted quickly by the authorities to intervene with a suspect case.

→ For The Ministry of Health ▪ To follow, in real time, the evolution of an epidemic (infectious focus, localization, speed of

propagation, symptoms). ▪ To ensure weekly control of the seven communicable diseases under surveillance. ▪ To make a quick decision at the national or local level. ▪ To give citizens the right recommendations.

The creation and implementation of this tool was funded by the SKOLL GLOBAL THREAT FUND and

the Ministries of Health and Telecommunications of Cambodia. Thanks to an agreement between

the two ministries, the line 155 is now free for all citizens, some 16 million potential users. The

Ministry of Health communicates extensively on this tool through poster campaigns, TV and radio.

At the DSMT, four people are dedicated to line 115. The server can process up to thirty simultaneous

calls. Three types of surveillance are carried out: by recording cases from the field (every week), by

event (punctual) and by sentinel (continuous watch).

Monday, 26 March 2018

This morning, I meet Mr. Sok Samnang, we go to the Tkamea Health Center (Kandal Province). We

have an appointment with M Sour Leang, health officer in charge of weekly reporting of cases and

deaths related to communicable diseases under surveillance.

Mr. Sok Samnang explained to me that before the introduction of line 115, the declaration was made

on paper, only. Each person in charge had to bring the case reports to the nearest OD (operational

district) (98 throughout the country). Each DO then synthesized the cases that were reported to the

Department of Health (25 across the country), which transmitted the data to the DSMT. From the

local level (health center) to the national level (DSMT), it took more than 15 days for the information

to rise and with a high risk of errors. DSMT received only 50-60% of case reports each week.

Today, thanks to line 115, each health worker, responsible for the statement, can do it remotely using

all types of phones and does not need internet access. By dialing 115, he comes across a voicemail (in

Khmer) that invites him to enter the number of cases and deaths by illness. Once the call is over, the

agent receives a confirmation SMS.

"Before, I had to go on a motorcycle to the OD to report cases every week. I did not always have

enough money to buy gas. Now in 5 minutes it's done and it's free. I have more time to take care of

patients." (M Sour Leang)

The names and phone numbers of the health workers responsible for the weekly statements are

recorded in the software. "If an agent does not transmit the case report, an alert SMS is always sent

to him and we can contact him by phone".

Each OD centralizes the data from its health centers and verifies the quality of the data received

before transmitting it to the Health Department, which will send it to the DSMT. The DSMT can see in

real time the declarations at each level.

This system has reduced to zero the cost for reporting by the health worker. The latter can report

anytime and anywhere, without an Internet connection. Staff adherence to data reporting has

improved significantly. "Today, we receive more than 95% of weekly reports from the DSMT, which

are reliable in terms of quality and quantity.”

At the national level, the Ministry of Health is now able to have a vision of the epidemiological

situation throughout the Cambodian territory every week and to act accordingly. An official bulletin

with the dataset collected on the territory is published every Thursday on the website of the Ministry

of Health of Cambodia. (www.cdc.moh.gov.kh).

Example of graph generated automatically

following data collection.

We then go to Svay Ro Lum Health Center where we meet Dr Preak Virak, director of the center.

Dr. Virak Preak makes the same observation as M Sour Leang. "This national health emergency line is really very

convenient, economical and saves us a lot of time. It is important to relay information about this tool to our

patients."

Every citizen can contact the 115, 24h/24h and 7/7days is to report an event, or to have information

on communicable diseases. An answering machine automatically directs the patient according to his

requests. In the case where all lines of 115 are busy, the patient can

record a message. He will be contacted as soon as possible.

"When we talked about the H5N1 virus in the information, many citizens

wanted answers to their questions: line 115 was able to answer them

without cluttering the health centers". (Mr. Sok Samnang)

This national health emergency line also allows for quick action. The supervisors of the weekly

surveys form a Rapid Respond Team (RRT) in each province. If an episodic, serious and localized event

is reported (dead animal, unexplained death, massive food poisoning ...) in a commune, the nearest

health worker is sent to immediately go to the site and make a precise report of the situation. at the

provincial level (and / or national, if necessary). On average, a RRT officer arrives at the scene less

than 2 hours after a call. The members of this team communicate by FaceBook, which is the most

effective way to quickly contact all agents, according to the DSMT.

During the establishment of this line 115, a great work of identification and training of referent

health agents in each health center and the hospitals of the country was carried out by the Ministry

of Health of Cambodia. This exploration and training work lasted a year. It is thanks to this effective

territorial network that Line 115 works and that good surveillance of communicable diseases is

possible.

Conclusion

The national health emergency line (115) set up by the Ministry of Health of Cambodia is an effective

surveillance and event detection tool that allows today a rapid and adapted response from the

health authorities. Once set up, the cost of such a tool is almost zero; the Ministry of Health pays a

symbolic fee of USD 150 to the Ministry of Telecommunications for unlimited use of the hotline.

Citizens can use it for free and from any phone. Health workers do not need the internet to transmit

their weekly statements. Since its launch on January 29, 2016, line 115 accounts for 448,322 calls

including 301,002 calls from citizens.

Vietnam has already shown interest in setting up a similar system on its territory.

Contacts:

→ (Mr. Sok Samnang) MsIT, MBHI, ERA

→ Deputy Director of CDC Department → # 80, St. Penn Nouth (289). Ministry of Health → Phnom Penh, Cambodia. → Mobile: (+855) 12 738 394

samnanglati@gmail.com

Ms. Channé Suy Lan

→ InSTEDD iLab Southeast Asia | Regional Lead → Phnom Penh Center, Building E, 4th Floor | Web | Twitter | Google+ | Facebook → Cell: (+855) 12 697 767 | Skype: channe.suy | Twitter: @s_channe | Linkedin → channe@instedd.org

Publication

Video Cambodia's National Disease Hotline in Action https://youtu.be/q0WTY-jnnRQ

Sources

World Bank: http://www.worldbank.org/

WHO: http://www.who.int

www.cdc.moh.gov.kh