One of the biggest challenges that public health systems face is reaching last-mile communities. And, for as large as that problem is in direct service provision - it can be even harder to stay in contact for researchers. Read how FrontlineSMS is currently involved in combating HIV spread in Thailand…
By P-B Halberg, International Media Support (IMS), and Sandra Sudhoff, CartONG A new project aims to improve diabetes awareness and reliable communication about the disease throughout Kenya through mobile phone technology and a webportal.
In the spring of 2012 the Institut Pasteur du Cambodge of Phnom Penh (IPC), Cambodia conducted a pilot study on a text message-based pharmacovigilance tool. Don't know what pharmacovigilance is? Not to worry, neither did I! According to the World Health Organization, "Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem." The IPC used FrontlineSMS as a tool to follow up with patients after they received vaccinations.
Congratulations to Pierre Omadjela for being recognized as a finalist for Cisco’s VNI Service Awards for his work in healthcare awareness using FrontlineSMS! The World Health Organization estimates 80,000 citizens of the Democratic Republic of Congo (DRC) died in 2010 from Malaria. The mosquito-transmitted disease is responsible for 40% of the mortality in Congolese children under five, and in a country where a quarter of the population lack access to healthcare facilities, promoting prevention has proven to be more effective than only treating infected patients. The President’s Malaria Initiative, launched in 2005 through USAID, provides malaria prevention and treatment in five provinces, which make up 26% of the DRC’s health zones.
The landscape of NTT is largely rugged and infertile with a short and intense wet season. In this environment subsistence farming, the predominant livelihood, is marginal with many communities experiencing periods of hunger through the dry season. The provision of services to the rural population is difficult because there the few roads are generally of poor quality and frequently impassible in the wet season due to flooding or landslides. For many accessing health services requires walking long distances and the use of public transport where available. It is not uncommon for people in need of emergency care to be carried by a group of villagers to a point where road transport is available.
'As part of our Masters program at Drexel University School of Public Health, we were afforded the opportunity to work on addressing public health concerns in the Gambia for six weeks in summer 2012. We would be working on a community-based masters thesis. Our project focuses on advancing mobile health concerns by improving dental health practices using SMS messaging, as well as enhancingvaccine inventory control at village trekking sites. Health workers could manage referrals, follow-up treatment, and reminders to patients using SMS.
The Rockefeller Foundation recently launched a new website, Capacity to Innovate.org, which examines lessons from a number of organizations including Ushahidi and Internews, and encapsulates them in three short reports which are well worth a read. FrontlineSMS is featured in the 'Learning From Experimentation' report, available from the website. Here's an excerpt, but we really recommend the whole report as a very readable and thought-provoking set of examples.
FrontlineSMS was featured in an article from DevEx this week, as part of a piece on the trends to watch in international development for 2012. You can find an extract of the article below, and the full piece can be found here.
"As the world adjusts to seven billion people, and begins its creep toward eight billion, doing more with less will become increasingly important. Continuing economic stagnation and budgetary concerns in OECD countries will also put stress on existing commitments of foreign assistance and hamper new initiatives. Greater efficiency and effectiveness in development is paramount. Below are three trends to watch in the coming year that can help improve development outcomes.
1) mHealth and mGovernance
Applying mobile phone technology to global health challenges has huge potential to improve health outcomes. In previous blogs I’ve given a few examples of how mHealth is making a difference: in remote areas of Afghanistan, health workers are getting training through SMS; in South Africa, Project Masiluleke sends text messages with important information about HIV; in South Asia pregnant women are receiving important maternal health information also via text messages. Here are few more instances: FrontlineSMS, a free online text messaging system that sends texts between groups of people and online mapping systems like Google Earth, allows health workers in Cambodia to report cases of malaria in real time. This has permitted the government to track outbreaks and allocate resources more effectively. Previously, it took up to a month for cases to be registered."
To read the full article please visit the DevEx website here.
One of the major strengths of FrontlineSMS is the wealth of knowledge and experience existent in our vibrant community of users. In order to enable our community to share lessons learned from deploying FrontlineSMS, we are in the process of building up a collection of in-depth user case studies. Acting as a guide for those who aim to use FrontlineSMS in their own programs, these case studies can be used by practitioners as well as be passed on to managers, donors and others seeking to learn more about using mobiles for social change.
The latest of these case studies is out today, and is based on Georgetown University’s Institute for Reproductive Health (IRH) using FrontlineSMS to provide a rapid prototype of a new mHealth service. This service — called CycleTel™ — empowers women by providing them with accessible reproductive health information through SMS. You can find a guest blog post about this project here, and you can find out more and read the full case study here.
Each of the case studies is produced in partnership with an organization using our software to enable positive social change. The case studies provide analysis of the need for FrontlineSMS in different contexts, show the preparation required for using our software, demonstrate lessons learned by different users and the impact FrontlineSMS can have towards enabling positive social change.
The new case study we have made available today accompanies another case study released last year in partnership with Plan International, which is based upon their use of FrontlineSMS to track incidences of violence against children in Benin. Both case studies are available on our newly styled Case Studies webpage. Previously this webpage showed the wealth of guest blog posts we have from FrontlineSMS users, and these are still linked to directly from the same webpage. However, moving forward, this webpage will also be used to house the small but growing library of more in-depth FrontlineSMS case studies.
If you are using FrontlineSMS for your work and think your program would make a great case study, then please do feel free to get in touch. If you would like to share ideas and feedback on our newly released case study, please visit our community forum here to share your views. Your input is always welcome!
We would like to take this opportunity to thank Georgetown University’s Institute for Reproductive Health (IRH) and Plan International for working on these case studies with us. In addition, many thanks goes to Tim Howe for his ongoing website support, Jessica Lo for her graphic design work, and to FrontlineSMS Hero Megan Goldshine for her graphic design support, too!
This post is the latest in the FrontlineSMS Mobile Message series with National Geographic. To read a summary of the Mobile Message series click here.
In this installment of our special “Mobile Message” series, Irma F. Saligumba – Health Research and Projects Coordinator at Molave Development Foundation – talks about a project in the Philippines which aims to reduce mother and infant mortality rates, and provide education and support to expectant mothers, all through their mobile phones.
“Ma’am, I already gave birth. Thank you for the messages you sent”. This was the SMS message I received from Meriam. She is one of the 100 pregnant women who registered in November 2010 for the pilot implementation of the Mobile e-health System for Safe Motherhood Program, run by Molave Development Foundation Inc.
This program aims to support the Philippine Government in reaching towards the United Nation’s Millennium Development Goals to reduce maternal mortality ratio by three quarters by 2015.
As the Health Research and Projects Coordinator of Molave Development Foundation, Inc., I spearheaded a study on the effectiveness of using mobile phones to reach out to pregnant women to improve their maternal health.
We chose the town of Roxas, located on Mindoro Island about 400 kilometers south of Manila, for the research. Its population is about 50,000 spread across 20 villages; its Health Center has 2 physicians, 1 nurse and 8 midwives. To supplement the lack of health staff, there are 140 village health volunteers (VHV) who are trained to do most of the legwork for the midwives, and disseminate information on primary health care, maternal and child health, family planning and nutrition.
I was introduced to Meriam during a visit to her upland village. Like most of the mothers in our program, Meriam is in her mid-20′s, has some years of high school education, is unemployed, and her husband doesn’t have a regular job. Subsistence farming provides additional income, and their average monthly salary is about $150. The only means of telecommunication in their area is through mobile phones. She shares one with her husband.
In the Philippines, where nearly 40% of the population lives below the poverty line, the equity gap is stark and wide. However, the ownership of a mobile phone is one of the few things that has crossed the income divide, making telecommunication relatively affordable and more accessible in this country of 7,100 islands. There are 70 million Filipinos who have mobile phones, compared to only 7 million installed fixed phone lines.
This is the basis for developing a program that uses text messaging to inform and educate pregnant mothers on safe motherhood. Aside from its mass appeal, mobile phones provide the advantage of two-way communication. Mothers are not just passive participants receiving information, but can also ask questions or communicate their concerns if they need to.
We are using FrontlineSMS as our communications platform because it is easy to use for health workers’ with low technical know-how, it works without an Internet connection and provides a way to send SMS through pre-paid SIM cards, thus making it a low cost option. It is also vitally important that the software allows for data storage, and we have created a database of the mothers and the health workers on our on-site computer.
Prior to implementing our pilot project, we conducted various training sessions for the Health Center staff. First we provided a Basic PC Literacy Course which covered use of mouse and keyboard, familiarization with computer symbols and commands, basic computing using word processing and spreadsheets, and how to use the Internet. When they gained sufficient confidence, we then moved on to training basic FrontlineSMS skills (for the PC and mobile phone) to show staff how to use key functionality. Five health personnel were also trained on advanced FrontlineSMS, including administration, management and troubleshooting.
Meanwhile, village health volunteers were trained on how to use the mobile phone for data entry of pre- and post-natal registration, in order to register pregnant women and new mothers in the program.
With the system in place, we started sending out the messages to participants who had already registered during pre-natal checkups at the Health Center. We also worked to reach out to new pregnant women. Posters and brochures were distributed giving instructions on how to register, by sending in an SMS.
Every day for three months, these women received messages on introduction to safe pregnancy and delivery, baby’s phases of development, tips on preparing for labor, common pregnancy problems, benefits of facility-based childbirth, breastfeeding, neonatal care, and child immunization. Through this program we sent a total number of 11,100 text messages or 111 for each of the 100 women registered.
As we hoped, we received messages back from the mothers. Some expressed appreciation for the messages. Others raised serious questions regarding their pregnancy. An expectant mother named Jane inquired if using the computer is bad for the baby. Jocelyn asked what she should be feeling if the baby is due for birth. At 7-months pregnant, Rebecca wanted to know if it is normal to have swollen and painful vagina.
These questions were forwarded to their respective midwives for advice because they were better aware of their patients’ pregnancy status. The midwife’s response was sent by the system to the mother. In the case of Rebecca, she was advised to go to the hospital for evaluation. She even went as far as Manila to have better care, and she ended up staying there until she gave birth because her condition was too serious for traveling.
We are now looking into expanding the Safe Motherhood Program in other parts of the country. Our initial assessment shows that the program has influenced the parent’s decision to use a health facility instead of their home for childbirth. The system also facilitated the prompt recording of new pregnant women and post-natal reporting. This data helps midwives prepare and plan for the pre- and post-natal care activities in the village. This more efficient and interactive information management system can ultimately contribute to improved maternal care, and thus decreased mortality levels.
Mothers involved say they will recommend the Safe Motherhood Program to others. They feel assured that someone is concerned about their welfare and that there is someone they can go to if they have questions. This gives them a feeling that they are important because someone cares, and that feeling of being important strengthens their desire to take care of not only their health, but also their babies.
Irma F. Saligumba has been the Health Research and Projects Coordinator of Molave Development Foundation, Inc. since 2007, and is Lead Researcher of Pan-Asian Collaboration for evidence-based e-Health Adoption and Application (PANACeA) Network with member countries in Central, South and Southeast Asia.
Prior to her involvement at MDFI, she spent 4 years in Attapeu, Laos as provincial health trainer of Health Unlimited. She also served as Training Specialist for 4 years at Philippine Rural Reconstruction Movement focusing on leadership-building, gender and development, and advocacy. She is a registered nurse and earned her masters in Public Health at the University of the Philippines.
Re-posted from the Malaria Consortium blog, with permission from Steve Mellor, Malaria Consortium Systems Manager Malaria Consortium, with the support of the Bill & Melinda Gates Foundation-funded CONTAINMENT Project, is pioneering a Day 3 positive alert system in Ta Sanh district, western Cambodia, using mobile phone and web-based technology (including FrontlineSMS) to facilitate response in real-time. CONTAINMENT’s Sonny Inbaraj reports.
Effective containment of multi-drug resistant falciparum malaria depends on timely acquisition of information on new cases, their location and frequency. This is to plan interventions and focus attention on specific locations to prevent an upsurge in transmission.
Response in western Cambodia’s Ta Sanh district involves combining the process of positive diagnoses through microscopy of Day 3 positives at the Ta Sanh health centre from blood slides sent by Village Malaria Workers, to an alert system using mobile phone and web-based technology to help pinpoint potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to be present.
The proportion of patients who still carry malaria parasites on the third day of treatment is currently the best measure available of slow parasite clearance and can be used as a warning system for confirmation of artemisinin resistance.
In Ta Sanh, the Village Malaria Workers or VMWs play a crucial role in the early detection and treatment of the killer falciparum malaria. In September 2010 the USAID-funded Cambodia Malaria Prevention and Control Project (MCC), implemented by University Research Co., LLC (URC), trained these VMWs to prepare blood slides from those who tested positive for falciparum malaria from rapid diagnostic tests. They were also trained to carry out a three-day directly observed treatment (DOT) of the Pf cases with the co-formulated ACT dihydroartemisinin – piperaquine.
Chou Khea, a 21-year-old Village Malaria Worker, trained by MCC in Ta Sanh district’s remote Ou Nonoung village tells CONTAINMENT how she carries out DOT.
“Immediately after a villager tests positive for falciparum malaria in a rapid diagnostic test (RDT), I prepare the blood slides. Then I give the drugs, which the villager has to take in front of me,” says Khea.
“On Day 2 and Day 3, I’ll go to the villager’s house and make sure that the drugs are again taken in my presence,” she adds. “After 72 hours from the first intake of the anti-malaria drugs, I’ll be at the villager’s house again to take his or her blood sample for preparing another blood slide.”
Chou Khea then takes the Day Zero and Day 3 slides, together with the used RDT, to the Ta Sanh Health Centre 30-kilometres away from her village.
“I usually take a motor-dop (motorcycle taxi) to the health centre. But most of the motor-dop drivers are reluctant to use the track to health centre in the rainy season because of the slippery mud. Also many of them are scared of the wild animals and land-mines in the area,” she tells CONTAINMENT with concern. “I hope to have my own motorcycle soon, so that I’ll be able to transport the slides and RDTs faster,” she adds with a smile.
At the Ta Sanh Health Centre, the Day 3 slides are examined by a microscopist and if asexual malaria parasites are seen they are graded as positive. The microscopist immediately sends out an SMS on a mobile phone, using a dedicated number, to a database indicating the village code and the sex of the patient.
Malaria Consortium pioneered the use of this alert system in Ta Sanh, with support from Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the World Health Organization’s Malaria Containment Project funded by the Bill & Melinda Gates Foundation.
Malaria Consortium’s Information Systems Manager Steve Mellor explains the use of cellular text messaging (SMS) as a viable tool to send alerts and map Day 3 positives in real-time on Goggle Earth.
“We use FrontlineSMS, an open-source software, that enables users to send and receive text messages with groups of people through mobile phones,” Mellor tells CONTAINMENT.
“FrontlineSMS interfaces with an MS Access database system that was developed to host the SMS data and to provide validation on the data received and to send an automatic reply to the sender containing any validation errors found, or to confirm that the data has been accepted,” he adds.
In the Access database, a script interfaces with Goggle Earth and maps out the locations of the Day 3 positives based on the village code. The mapping on Goggle Earth is essential as it gives a clear visualisation of the terrain and helps CNM, WHO and the USAID-funded Cambodia Malaria Prevention and Control Project (MCC) to plan coordinated interventions in terms of case follow-up on Day Zero and Day 3 and carry out epidemiological and entomological investigations.
“All this happens in real-time and alert text messages are sent out simultaneously to the operational district malaria supervisor, the provincial health department, CNM and the administrators of the database,” Mellor points out.
There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases. Malaria Consortium and CNM are also in direct talks with Mobitel, one of Cambodia’s main telecommunication carriers.
“We are in negotiations with Mobitel for a free number and also free SIM cards to be distributed to health centre staff and village malaria workers,” Mellor reveals. “After all, this is for a public good.”
Besides plans to map all Day Zero cases, Malaria Consortium is also exploring the possibility of sending alert messages in Khmer script.
“This will be a breakthrough and we hope this will help facilitate a quick response mechanism from CNM and other partners,” says Mellor.
The timing of this article could not have been better, given the discussions last week on the merits of mobile-based "cloud computing" and the clarification of our position a couple of days later. Despite advances in mobile devices and data connectivity, the need for mobile tools to also be able to work in less than optimal conditions is still as strong and as relevant as ever, as this use of FrontlineSMS by Telecoms Sans Frontiers in Nicaragua shows us all too well. "TSF - No Bugs In This Software That Fights Disease" (re-printed with the kind permission of SatNews.com) November 5th, 2009
"Since the beginning of October, Nicaragua is facing a huge rise of dengue cases, which has become a major public health concern in the country. The Health Ministry of the Central American nation (Minsa) has a crisis unit (SILAIS) which currently focuses its activities in response to both the dengue and H1N1 plagues. An Internet monitoring system has previously been set up to control the health situation in the country; nevertheless access to computer is often difficult in some regions where only few health centers are equipped.
Due to this serious situation, and the necessity to improve the collection of information, TSF, in collaboration with PATH (an international non-profit organisation that aims at enabling communities worldwide to break longstanding cycle of poor health) is reinforcing SILAIS’ capacities in Information and Communications Technologies.
In order to monitor the spread of the dengue in Managua and to conduct mobile health actions, TSF has been implementing for the first time a very innovative system based on a widespread, cheap and solid technology, GSM.
To set up the program, TSF uses FrontlineSMS software. Developed by a TSF partner NGO, FrontlineSMS is free, open source software that turns a laptop and a mobile phone into a central communications hub. Once installed, the program enables users to send and receive text messages with large groups of people through mobile phones. Thus, GSM technology is used to reach as many geographical zones as possible to control health issues in those areas. The server in SILAIS is connected with the 32 health units in Managua.
Each health unit has been delivered a mobile phone by TSF, so that they can send different kinds of information through SMS to the server. Hospital and health centers fill in predefined forms from their mobile phones and send them by SMS to SILAIS. Designed by PATH and the SILAIS, those forms provide data about the classic and hemorrhagic dengue cases, about the H1N1 2009 ones and the need for medicines when the stock nearly runs out. Once the forms received, the server stores information and puts them in databases in order to facilitate statistical analysis, on Excel format for example.
TSF provides two-way communication to health units enabling SILAIS to receive a daily report and gather messages from the health units and will have an updated situation in each center. At the meanwhile, SILAIS will also be able to communicate important information to them through SMS (such as an alert or a warning about coming meetings for example) or give them automatic answers to predefined questions sent by the health units.
By providing communication links between health structures and the SILAIS, TSF will allow the Health Ministry to have more accurate information about the diseases spread within Managua and quickly survey and assess the needs in affected areas. TSF helps health professionals use advanced methodologies such as smart phones and open-source software. Mobile devices are great tools to track and transmit crucial data in order to detect an epidemic threat at an appropriate time. Through this program, TSF participates in strengthening health systems in Nicaragua.
Following the installation of the system, on October 24th, TSF organized training for all the beneficiaries of the project. The health units and SILAIS staff were trained on the application’s functionalities and available services".
For a related article on FrontlineForms, the FrontlineSMS data collection tool used by TSF for the project, go here.
Although I've only been writing about the social mobile long tail for a couple of years, the thinking behind it has developed over a fifteen year period where, working on and off in a number of African countries, I've witnessed at first hand the incredible contribution that some of the smallest and under-resourced NGOs make in solving some of the most pressing social and environmental problems. Most of these NGOs are hardly known outside the communities where they operate, and many fail to raise even the smallest amounts of funding in an environment where they compete with some of the biggest and smartest charities on the planet.
Long tail NGOs are generally small, extremely dedicated, run low-cost high-impact interventions, work on local issues with relatively modest numbers of local people, and are staffed by community members who have first-hand experience of the problems they're trying to solve. What they lack in tools, resources and funds they more than make up with a deep understanding of the local landscape - not just geographically, but also the language, culture and daily challenges of the people.
After fifteen years it should come as no surprise to hear that most of my work today is aimed at empowering the long tail, as it has been since kiwanja.net came into being in 2003, followed by FrontlineSMS a little later in 2005. Of course, a single local NGO with a piece of software isn't going to solve a wider national healthcare problem, but how about a hundred of them? Or a thousand? The default position for many people working in ICT4D is to build centralised solutions to local problems - things that 'integrate' and 'scale'. With little local ownership and engagement, many of these top-down approaches fail to appreciate the culture of technology and its users. Technology can be fixed, tweaked, scaled and integrated - building relationships with the users is much harder and takes a lot longer. Trust has to be won. And it takes even longer to get back if it's lost.
My belief is that users don't want access to tools - they want to be given the tools. There's a subtle but significant difference. They want to have their own system, something which works with them to solve their problem. They want to see it, to have it there with them, not in some 'cloud'. This may sound petty - people wanting something of their own - but I believe that this is one way that works.
Here's a video from Lynman Bacolor, a FrontlineSMS user in the Philippines, talking about how he uses the software in his health outreach work. What you see here is a very simple technology doing something which, to him, is significant.
Watch this video on the FrontlineSMS Community pages
In short, Lynman's solution works because it was his problem, not someone elses. And it worked because he solved it. And going by the video he's happy and proud, as he should be. Local ownership? You bet. o/
Now, just imagine what a thousand Lynman's could achieve with a low cost laptop each, FrontlineSMS and a modest text messaging budget?
