PLoS Medicine
http://www.plosmedicine.org/
(Accessed 16 April 2016)

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Health in Action
Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania
Zacharia Mtema, Joel Changalucha, Sarah Cleaveland, Martin Elias, Heather M. Ferguson, Jo E. B. Halliday, Daniel T. Haydon, Gurdeep Jaswant, Rudovick Kazwala, Gerry F. Killeen, Tiziana Lembo, Kennedy Lushasi, Alpha D. Malishee, Rebecca Mancy, Matthew Maziku, Eberhard M. Mbunda, Geofrey J. M. Mchau, Roderick Murray-Smith, Kristyna Rysava, Khadija Said, Maganga Sambo, Elizabeth Shayo, Lwitiko Sikana, Sunny E Townsend, Honorathy Urassa, Katie Hampson
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002002
Summary Points
:: Surveillance is critical to manage preventative health services and control infectious diseases. Integrated surveillance involving public health, veterinary, and environmental sectors is urgently needed to effectively manage zoonoses and vector-borne diseases. However, most surveillance in low-income countries is paper-based, provides negligible timely feedback, is poorly incentivised, and results in delays, limited reporting, inaccurate data, and costly processing.
:: The potential of mobile technologies for improving health system surveillance has been demonstrated through small-scale pilots, but large-scale evaluations under programmatic implementation remain rare.
:: An intersectoral mobile-phone–based system was developed and implemented for rabies surveillance across southern Tanzania. Since 2011, the system has facilitated near real-time reporting of animal bites and human and animal vaccine use (almost 30,000 reports) by over 300 frontline health and veterinary workers across a catchment area of 150,000 km2 with >10 million inhabitants, improving data quality, timeliness, and completeness while reducing costs.
:: The surveillance system infrastructure is a platform that can be further developed to improve services and deliver health interventions; for example, generating automated personalized text messages (SMS) to alert patients to their vaccination schedules improved their compliance with regimens. Other interventions targeting patients and health workers can now be implemented easily.
:: The system has become an integrated, popular, and valuable tool across sectors, used routinely throughout southern Tanzania to evaluate the impacts of rabies control and prevention activities and to improve their management, directly informed by the experiences of frontline users.
We discuss challenges encountered during development and deployment, how we overcame these, and our recommendations for scaling up mobile-phone–based health (mHealth) interventions in low-income countries.

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Policy Forum
Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries
Mike English, Grace Irimu, Ambrose Agweyu, David Gathara, Jacquie Oliwa, Philip Ayieko, Fred Were, Chris Paton, Sean Tunis, Christopher B. Forrest
| published 12 Apr 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1001991
Summary Points
:: Achieving universal coverage that supports high-quality care will require that health systems are designed to integrate the delivery of health services with the generation of new knowledge about the effectiveness of these services.
:: System strengthening and research will need to be better integrated to achieve this in low- and middle-income countries (LMIC) so that changes in coverage, quality, and impact are measured, costs are contained, and health systems are responsive to users’ needs and concerns.
:: In high-income countries, learning health systems (LHS) are emerging to meet similar needs. The LHS vision aspires to engage policy makers, researchers, service providers, and patients in learning that uses and strengthens routinely collected data to conduct pragmatic, contextually appropriate research, promote rapid adoption of findings to improve quality and outcomes, and promote continuous learning.
:: Although there are significant challenges, we should begin to develop LHS in LMIC for their immediate and longer term benefits and to avoid having to retrofit health systems with the capability to promote learning at a later date and even greater cost.
:: A global coalition on how to build LHS effectively that shares accumulating learning could enable such a strategy.