Table 3 Summary of main themes identified in the thematic analysis across the MAPS domains
MAPS Domain | Main themes identified | |
|---|---|---|
Positive | Negative | |
Groundwork | ➢ Very successful pilot ➢ The goal of the programme aligned with the country’s priorities | ➢ SMS for Life was short in objective-setting (focus on stock-out visibility and not on an appropriate response to stock-outs) |
Partnerships | ➢ SMS for Life aimed to engage with all key stakeholders | ➢ Not all key stakeholders were involved in the design and deployment (e.g district pharmacists) ➢ Narrow partnership scope focussed on limited commodities for a single disease control programme ➢ No inclusion of Zonal or National MSD in the system ➢ Lack of ownership at MSD and district level led to a lack of action when stock-outs were reported ➢ Changes in government, ministerial leadership and political agendas led to the loss of SMS for Life’s momentum ➢ This loss of momentum was strongly influenced by the arrival of competitor mHealth solutions |
Financial health | ➢ SMS for Life project managers described the system as a very low cost solution as it didn’t need any maintenance or technical support | ➢ The costs of the programme were stated as one of the main reasons for discontinuation although no real costing was done ➢ It was difficult for the government to allocate a substantial share of its budget to malaria commodities and not to others ➢ Main drivers of the programme’s costs were: SMS and health worker incentives (pay-for-performance) |
Technology & architecture | ➢ Real-time data in rural health facilities in a time when this was uncommon ➢ Described as a user-friendly system ➢ Technology included quality checks ➢ Interoperability within mobile network operators was an innovation and at the same time challenge for the programme ➢ Technology was an innovation for Tanzania and mHealth globally | ➢ Lack of adaptability of the technology to new circumstances in the country ➢ Data server and hosting in the United Kingdom seen as a political challenge ➢ Lack of interoperability with the national health management information system (HMIS) ➢ No change or improvement in the user interface between 2009 and 2015 |
Operations | ➢ SMS for Life trained health facility personnel to store commodities more efficiently, these changes are still visible today | ➢ The scale-up planning only included the organization of training ➢ Lack of response from the health system in case of stock-outs (see Table 4) ➢ High turnover of personnel at the health facilities caused a knowledge loss of the programme, as only one person was trained per facility. This led to high attrition rates from the system ➢ No continuing training plans |
Monitoring & evaluation | ➢ Antimalarial stock situation improved during the years, mainly due to other changes in Tanzanian supply chain system (e.g. MSD Direct Delivery system). | ➢ No monitoring and evaluation framework ➢ One external evaluation conducted in 2013 reported several challenges that were never addressed |