TRACnet: Fighting Pandemics through Information Technology

Dr. Prof. Dr. Michael Kramer, Director General

Head of Surveillance, bioonformatics and ICT unit: 

Ubuntunet Alliance contact: Albert Nsengiyumva

TRAC Plus – Center for Treatment and Research on AIDS, Malaria, Tubercolosis and other epidemics,  www.tracrwanda.org.rw 

Vision: TRAC Plus will be a Centre of Excellence for disease prevention, control and research in Rwanda and beyond. 

Overall goal : To promote and facilitate measures and actions taken in respect to the prevention, care, treatment, and research in the fields of HIV and AIDS, Malaria, Tuberculosis and other Epidemics Infectious diseases. 

Mission statement: Contribute to the improvement of the health status of the population (reduce morbidity and mortality) 

Strengthen the health and public health system (with the help of partners [government and NGO] and stakeholders) 

Define national needs, priorities, and approaches, and establish policies/guidelines in line with government development framework such as Vision 2020 and EDPRS and international developments goals such as Millennium Development Goals. 

Conduct independent applied research and disseminate findings for use of those concerned (political level, partners, communities, care providers, individuals …). 

Contribute to improving quality of health services. 

Enable and facilitate participation of population through information and guidance.

TRACnet was established and implemented by TRAC (Treatment and Research AIDS Centre), an institution of the Ministry of Health of Rwanda in 2005. It is a dynamic information technology system designed to collect, store, retrieve, display and disseminate critical program information, as well as to manage drug distribution and patient information related to the care and treatment of HIV/AIDS. This system enables practitioners involved in anti-retroviral (ARV) treatment programs to submit reports electronically and have timely access to vital information. By dialling 3456, a toll free number, or logging onto a bilingual website (English and French), health centre staffers can submit or receive programme results on HIV/AIDS patients as soon as they are processed. TRACnet uses solar energy chargeable mobile phones, which can be used in the most remote parts of the country. TRACnet was planned in 2003 and has been gradually implemented since then. RwandaTel and MTN-Rwanda Cell both set up toll free numbers and donated free network time. 

Voxiva Inc, an American based company, provided  ICT support to the project.  The flexible nature of the Voxiva platform offers an easily scalable solution. The country now plans to offer universal access to care and treatment to all those needing it. Some 60,000 people living with HIV and AIDS were targeted to be reached by end of 2007 as compared to 8,000 in December 2004. In light of the TRAC- net success, the Ministry of Health plans to monitor all other healthcare indicators with the same tool in line with the  country’s development vision to 2020.

TRACnet became operational in December 2004. Initially, sites that started to use the electronic transmission had to keep the paper-based system (the type of forms and content were similar), which increased  the burden on them. However, at the beginning of 2005, 21 sites were allowed to switch to TRACnet exclusively. The total cost of the project for the five years is US$2.1 million.  The previous system was cumbersome, largely paper-based, with a one-way information flow which was time consuming. It usually took up to a month for HIV/AIDS patients and doctors in the countryside to have access to blood test results, as most laboratories are in Kigali. 

The National Reference Laboratory provides results of blood tests; CAMERWA, a pharmaceutical company keeps stock of the availability of ARV drugs; and TRAC monitors and supervises health facilities that provide ARV treatment in the country.

TRACnet has enabled HIV/AIDS practitioners to monitor Anti-Retroviral (ARV) therapy drug stocks in real time, allowing local hospitals to send urgent requests to central managers to replenish stocks. Furthermore, it gives rapid and reliable access to CD4 molecule and viral blood test results in remote health facilities. Authorities get timely access to critical tracking indicators which permits a better public monitoring of HIV/AIDS patterns of transmission. Disease outbreaks at various levels can be better managed through national/regional/local tables, called “dashboards”, which compile all sources of information related to HIV. 

The deployment of TRACnet has faced challenges. For instance, there is still a need for increased education on HIV/AIDS, to encourage patients willingly to come forth to be tested and counselled. The new system has had to cope with a soaring demand among the population. At the same time, the shortage of health workers has been an obstacle to scaling up the number of patients and coverage areas. CAMERWA has experienced problems with drug coordination and maintaining adequate levels of stock for meeting demand. Finally, financial needs were sometimes difficult to meet in the early stages of the TRACnet deployment. 

However, the results have been striking. At the end of 2007, the system covered the 168 health facilities offering ARV  therapy in Rwanda accounting for 100 per cent of the 43,000 ARV patients in Rwanda. In the long run, 400 health facilities  are to be part of the network. Four hundred TRACnet users in health facilities have been trained to send their monthly programme indicator reports and their weekly consumables reports. Most users (over 90 per cent) are able to access the system conveniently and cheaply via the toll free telephone interface with Interactive Voice Response (IVR) technology. Physicians are now able easily and quickly to discuss with highly qualified specialists details of difficult cases  all over the country. This technology has been easily adopted, as most users are accustomed to text messaging from phones after 15-30 minutes of training. 

TRAC also has a team of IT personnel, who train health care providers at the health facilities in how to use TRACnet, and who also monitor reporting into TRACnet and publish monthly reports.