Tuberculosis management among migrants using Near Field Communication technology

Updated: Mar 8, 2021

A year ago, I visited western Thailand with American Refugee Committee at Alight , a nonprofit organization working to improve lives of refugees, displaced persons and migrants, to design a program for migrants who have tuberculosis. The program is funded by TB Reach Wave 6, and works to address challenges related to lack of consistent care and access to tuberculosis medications, particularly an issue because migrants in Thailand often move around for work and lose touch with the health system. If a TB patient loses touch with the health system before the 6-9 months of treatment is complete, there is a large risk that a tuberculosis case will worsen and become drug resistant, and also spread to other people that the patient comes into contact with.

Through an initial design visit, the American Refugee Committee team and I spoke with migrant patients and health volunteers and discovered key challenges to tuberculosis care among migrants:

  • It was difficult for health volunteers to track patient care for those who move away or travel across the Myanmar border, especially using the traditional paper-based system

  • Patients and caretakers do not fully understand tuberculosis treatment and the medication regimen, including the length of treatment and side effects

  • Patients were hesitant to visit the health facility, because there was a language barrier between the Myanmar migrants and the health worker and potential for discrimination

Recognizing the unique characteristics of migrant patient movement and the need for long term care for tuberculosis treatment, we designed a solution which addresses these challenges using Near Field Communication (NFC) technology and a Mobile application. In the program, the Migrant Liaison Officer is a supervisor who uses a mobile application to enroll a patient into a 6-month program (with the patient’s consent) and to supervise Migrant Health Volunteers to make sure he/she is meeting with patients. The Migrant Health Volunteer visits the patient regularly at home, and guided by a mobile app with decision support, administers tuberculosis medications and evaluates patient side effects. After a visit, the health volunteer taps an NFC tag onto the back of the mobile phone, which stores the patient information from the mobile application onto the NFC tag, and leaves the NFC tag with the patient. The patient holds onto the NFC tag and brings the tag with him/her to any future visit with the program. This way, even as the migrant patient moves across low connectivity settings within and even outside of the patient’s district, the patient’s data is available during the visit. With this solution, any health volunteer in the program can read the NFC tag and pull up the latest patient information to continue the continuity of patient care.

We chose Near Field Communication as a critical part of the solution for several reasons:

1. Supports patient movement. A large challenge in managing migrant patients is loss to follow up. Patients often move away or transfer out of the system and therefore default on treatment. The NFC and mobile application system provides a way to track patients who transfer out of the program, and also enables users to transfer complete patient records from one district to another using NFC scanning.

2. Allows for multiple health workers to access a case. Often with digital health programs, it is difficult to share data across health workers for a variety of technical reasons, which therefore limits continuity of care if more than one health worker needs to visit a patient. With access to the latest patient information on the NFC token, data sharing across health workers is easier to maintain, and we can support multiple health volunteer – patient relationships. Additionally, though data are shared among assigned health workers for patients care, the confidentiality and security of these data are maintained through different usernames and passwords.

3. Facilitate patient record retrieval. Similar to QR codes, the NFC token contains a unique identifier that can be used to retrieve the patient record. This is useful in settings where health workers interact with a large number of patients and where it thus would be difficult to retrieve a record from a complete list, or even through a search function that might fail due to differences in spelling or typos. We have seen from many other programs that identifying clients using names or typed ID numbers is extremely problematic and can lead to duplicate registrations of up to 50% of clients. It is therefore important to have a truly unique ID to identify a client.

4. Works in low connectivity settings. With very low, or no, connectivity in some villages in Thailand, NFC provides a solution to lack of connectivity, since it can work in such settings. Health volunteers with the program’s mobile application can read the NFC token offline and pull up the latest information to continue care; they do not need to rely on connectivity to view the latest patient record since it is always stored on the NFC token.

5. Solution is client centered. The NFC token stores client data, so the client can carry the data with him/her to any patient visit and is empowered to own the data when moving across locations. This is different than other forms of identification such as biometrics and QR codes which does not store client information directly, but instead acts as an identifier to pull a record from a mobile application.

6. Language-independent. The NFC token is language-independent, which means that a mobile application can display information from the NFC token in whichever language the user selects for the application. This helps to solve the problem of client movement to an area with a foreign language, because if the client moves to a different area, the NFC could be read by the health worker in the health worker’s own language.

7. Data is secure. The NFC token is encrypted, and therefore, information on the NFC token can only be accessed from a phone with the compatible program mobile application. If the NFC token is lost, it cannot be picked up and read by another system, and is only available for the authorized health workers within the program. Since the program works with vulnerable migrant populations, this was a critical component for selecting this solution.