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This evaluation looks at a project led by On Cue, a small company based in Cape Town, which sends Short Message Service (SMS) messages to patients, reminding them to take their TB medication at pre-determined times. The compliance service aims to provide an affordable solution to improve patient adherence to TB treatment and reduce the associated costs of the DOTS system for both patients and clinics. This technology is not a silver bullet to solve the problem of patient adherence: it is all down to the way in which it is implemented. The paper notes that if the compliance service were re-implemented and re-evaluated, leveraging on the lessons learned in this evaluation, treatment outcomes can be improved.

Key findings:
• The compliance service has potential as a cost-effective system that would be appropriate to complement DOTS in Cape Town clinics and beyond.

• Project implementation clearly limited the effectiveness of the compliance service, but it is not a reflection on the usefulness of the technology itself.

• Mobile phones and SMS have proven to be effective tools in the context of health care in South Africa in terms of accessibility, appropriateness and cost.

• Both patients and healthcare workers liked the service and were able to use cellular technology effectively. Yet a significant number of patients interviewed were not using the service as instructed.

• Monitoring for treatment adherence is a problem where patients are not seen daily (as they are with DOTS).

• An overall lack of ownership of the project at the clinic limits the pro-active participation of the staff, and no one on-site takes responsibility for ensuring the Service is implemented effectively.

• A lack of regular feedback and interaction between the city, On Cue, and the clinic creates a “disconnect” that hinders success in a number of ways.

• Clinic staff schedules are tight and many staff members feel that they are over-worked.

• Issues of privacy, data protection, and security will affect the widespread use of technology in healthcare in Africa over the long-term.

Key recommendations:
• The renewed pilot should be conducted according to clear, written procedure for running the Service, and recording data derived from it.

• Patients must be educated such that the healthcare worker is satisfied they will remain adherent if selected for the compliance service.

• Scaling up will depend on the ability of On Cue to address the obstacles outlined here, but there is no reason that this could not be done.

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