MHealth system against dengue fever and H1N1 in Nicaragua
Every fall, Nicaragua faces a major public health crisis as dengue fever cases spike. In April 2009, the H1N1 epidemic led the Nicaraguan government to recognise the need for a monitoring and action plan. The Health Ministry of the Central American nation (MINSA) has set up a crisis unit (SILAIS) which focuses its activities in response to both the dengue fever and H1N1 plagues.

Due to this worrying situation and the necessity to improve the collection of information, TSF, in collaboration with PATH (an international non-profit organisation that aims at enabling communities worldwide to break longstanding cycles of poor health) has been reinforcing SILAIS’ capacities in Information and Communications technologies.

Duration of the programme: 24th October 2009 - 8th July 2010


Implementation of an SMS system
Objective: to improve the collection of epidemiological data for the SILAIS

In order to monitor the spread of the diseases and to conduct mobile health actions, TSF implemented, for the first time, a very innovative system based on a widespread, cheap and solid technology, the GSM, using FrontlineSMS software. To set up the program, TSF used FrontlineSMS software which turns a laptop and a mobile phone into a central communications hub. Once installed, the program enables users to send and receive text messages with large groups of people through mobile phones.

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The FrontlineSMS server in SILAIS was connected with 27 health units in Managua. Each health unit was given a mobile phone by TSF, in order to send different kinds of information through SMS to the server.

Following the installation of the system, TSF organised trainings for all the beneficiaries of the project. The health units and SILAIS staff were trained on the application’s functionalities and available services.

Collection and transmission of crucial health data from the field


Field Hospitals and health centres fill in predefined forms from their mobile phones and send them by SMS to SILAIS. Designed by PATH and SILAIS, those forms provide data about the classic and hemorrhagic dengue fever cases, about the 2009 H1N1 cases and the need for medicines when the stock nearly runs out.
Once the forms are received, the server stores the information and puts them in a database in order to facilitate statistical analysis, on Excel format for example.




Thanks to this system, SILAIS is receiving and gathering daily reports and messages from the health units. Meanwhile, SILAIS is also able to communicate important information to them through SMS (such as an alert or a warning about coming meetings for example) or give them automatic answers to predefined questions.



Results of the campaign

The first results of the project have been very promising. Only within the first month, more than 5,708 SMS have been sent between the health units and SILAIS.





Forms received by the server: 1554
Messages sent by the server: 1775
SMS sent by health units: 1721




Critical stock: 133


Health units

Classic dengue: 229

Haemorrhagic dengue: 101

Swine flu: 154

Arrival of a patient to hospital from a health centre: 134



Classic dengue: 280

Haemorrhagic dengue: 224

Swine flu: 299


From November 2009 to April 2010, more than 12, 000 SMS were sent between the health units and SILAIS. The 27 health centres involved in the programme send an average of 1200 forms per month.



In order to improve the information treatment, TSF set up an acknowledgement system for each form sent from the health units. An SMS is automatically sent to them from SILAIS to confirm the reception of the form. Moreover, to handle the high traffic generated by SILAIS and the health units’ messages, and to insure a better information flow, TSF decided to install a second phone (used as a modem) for SILAIS, improving the speed and capacity of SMS sending. TSF closely follows the evolution of exchanged messages and continually seeks new solutions to optimise the information coordination between SILAIS and the health units.
The objective of TSF is to expand the Health Ministry's mHealth system so it can gather real-time information from every health centre in Managua, as well as to improve the system to allow the Ministry to broadcast health response information to health centres during normal and emergency situations.

By providing communication links between health structures and SILAIS, TSF allows the Health Ministry to have more accurate information about the disease spread within Managua and can quickly survey and assess the needs in affected areas. By collecting key indicators from all affected areas, the objective is to implement effective and adequate measures to stop the spread and avoid an uncontrollable epidemic. Through this program, TSF participates in strengthening health systems in Nicaragua.

TSF helps health professionals use advanced methodologies such as smart phones and open-source software. Mobile devices are great tools to track and transmit crucial data in order to detect an epidemic threat at an appropriate time.