Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa

Abstract

Background. Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, Short Message Service (SMS) printers were deployed to address this gap, the majority using the global data service platform (GDSP) to simplify deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization. Objectives. The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa. Materials and Methods. A costing analysis for the 2020 calendar year was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: (i) months active (based on internet protocol data), (ii) signal, and (iii) battery strength. Results. There were 4,450,116 results delivered to printers that were situated at 2,232 primary healthcare facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength ≥60% and a battery strength of ≥6 volts. Conclusions. Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.