99 DOTS- Self Reporting Adherence

Self-reporting adherence by dispensing pills and calling toll-free numbers

When patients dispense pills, they break through perforated flaps on the back of the envelope, revealing a hidden, unpredictable phone number.

Patients use an ordinary phone (usually their own or a relative’s) to place a free call to this number, which a computer answers, says “Thank You”, and hangs up. Important information to tell patients about calling the toll-free number: Make a free call (from a mobile or landline phone) on any one of the toll-free numbers revealed every day. Don’t add ‘0’ or ’91’ before the toll-free number. The call can be made with no balance and from any city and anytime (no roaming charges). A call for a day’s medication must be made on the same day. Make calls only from the phone (mobile/ landline) numbers given to the centre (and registered on Nikshay). Do not cut the call till you hear “Thank You”.

From this simple interaction — the combination of the patient’s registered caller ID on Nikshay and the sequence of unpredictable numbers that they call over time — healthcare workers can monitor when pills were dispensed and likely taken.

In addition to this mechanism for self-reporting adherence, 99DOTS also supplies supporting Information, Communication and Technology (ICT) tools (Nikshay, 99DOTS platform) for health workers, enabling them to efficiently monitor and respond to any missed doses.

If a patient does not call 99DOTS on any given day, they receive an escalating series of dosage reminders. First, an automated SMS message is sent. If additional doses are missed, the patient can expect a personal outreach from a health worker, either via a phone call or a home visit.

Resources:

• Nikshay 99DOTS Training Manual, 2021.
• Nikshay 99DOTS Overview Manual, 2021.

Assessment