Costs and Cost-Effectiveness of a Mobile Phone Text-Message Reminder Programmes to Improve Health Workers' Adherence to Malaria Guidelines in Kenya
Open accessAbstract
BACKGROUND: Simple interventions for improving health workers' adherence to malaria case-management guidelines are urgently required across Africa. A recent trial in Kenya showed that text-message reminders sent to health workers' mobile phones improved management of pediatric outpatients by 25 percentage points. In this paper we examine costs and cost-effectiveness of this intervention. METHODS/FINDINGS: We evaluate costs and cost-effectiveness in 2010 USD under three implementation scenarios: (1) as implemented under study conditions in study areas; (2) if the intervention was routinely implemented by the Ministry of Health (MoH) in the same areas; and (3) if the intervention was scaled up nationally. Under study conditions, intervention costs were 19,342 USD, of which 45% were for developing and pretesting text-messages, 12% for developing text-message distribution system, 29% for collecting health workers' phone numbers, and 13% were costs of sending text-messages and monitoring of the system. If the intervention was implemented in the same areas by the MoH, the costs would be 28% lower (13,920 USD) due to lower costs of collecting health workers' numbers. The cost of national scale-up would be 97,350 USD, and the majority of these costs (66%) would be for sending text-messages. The cost per additional child correctly managed was 0.50 USD under study conditions, 0.36 USD if implemented by the MoH in the same area, and estimated at only 0.03 USD if implemented nationally. Even if the effect size was only 5% or the cost on the national scale was 400% higher than estimated, the cost per additional child correctly managed would be only 0.16 USD. CONCLUSIONS: A simple text-messaging intervention improving health worker adherence to malaria guidelines is effective and inexpensive. Further research is justified to optimize delivery of the intervention and expand targets beyond children and malaria disease.
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Mobile messaging is cost effective to implement and is rated highest for achieving favourable outcomes in health programmes.
“Mobile messaging has been cited to be cost effective to implement, and is rated highest for achieving favourable outcomes in health programmes [42–44].”
From mHealth communication to strengthen postnatal care in rural areas: a systematic review (2019) · cites this paper as [42]
Drug intake reminders have been found to improve treatment adherence of people with AIDS and Malaria.
“drug intake reminders have been found to improve treatment adherence of people with AIDS and Malaria [37–39]”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [39]
The use of text-message reminders is an inexpensive and effective way to improve health workers' adherence to malaria treatment guidelines.
“This analysis showed that the use of text-message reminders is inexpensive and effective way to improve health workers adherence to malaria treatment guidelines.”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [50]
Only one project reported a cost-effectiveness analysis of the intervention deployed.
“Only one project reported a cost-effectiveness analysis of the intervention deployed [50].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [50]
SMS communications were cost-effective and reliable.
“These types of interventions have been proven to be effective as evidenced by the small sample of evaluated mHealth interventions [16, 20, 32, 33, 45], that showed that SMS communications had positive effect on patient behaviour and health outcomes and was also cost-effective and reliable [50].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [50]
SMS communications had a positive effect on patient behaviour and health outcomes.
“These types of interventions have been proven to be effective as evidenced by the small sample of evaluated mHealth interventions [16, 20, 32, 33, 45], that showed that SMS communications had positive effect on patient behaviour and health outcomes and was also cost-effective and reliable [50].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [50]
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References 15 · Cited by 76
- Authors
- Zurovac, D., Larson, B. A., Sudoi, R. K., & Snow, R. W.
- Affiliations
- Boston University (US)
- Kenya Medical Research Institute (KE)
- Corresponding author
- Zurovac, Dejan
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-12-18
- Volume
- 7
- Issue
- 12
- Pages
- e52045
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3525566
- OpenAlex
- W2041531745
- Cited by
- 76
- References
- 15
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 4 · 2016: 20 · 2015: 6 · 2014: 10 · 2013: 2
- FWCI
- 10.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- Wellcome Trust (092654, 084253, 079080)
- Ministry of Public Health and Sanitation
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- SMS reminders, text messaging, pediatric malaria, cost-effectiveness, intervention costs, scale-up, health worker education, Kenya
- MeSH terms
- Cost-Benefit Analysis, Health Personnel, Humans, Kenya, Malaria, Reminder Systems, Guideline Adherence, Cell Phone, Text Messaging
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