A global network of people using mobile technology for social impact.
Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations.
We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.
The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.
This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per
patient even though their case loads have risen threefold. It has helped integrate the local-level
primary health service provision of HAART with the kind of centralised data capture and analysis
that could potentially support a national HAART rollout.
Femi Soremekun, managing director of Nigeria-based Biofem Pharmaceuticals, is all too familiar with the fight against counterfeit drugs. In late 2008, a distributor notified him that he suspected that one of Biofem’s products, Glucophage, was being counterfeited. After checking batch and inventory numbers, Soremekun reassured him there was no evidence of such activity. It was only after more allegations surfaced that he sent a sample to French manufacturer Merck & Co. to be analyzed. Turns out the claims were correct. “I was very shocked,” Soremekun says. “[The counterfeiters] got into my market, counterfeited my product, and I wasn’t even aware of it. I was losing sales.”
It was around this time that Soremekun learned about Sproxil, a start-up company that is part of a consortium that includes Nigeria’s pharmaceutical industry association and the country’s regulating agency. The group explores technology-based strategies to tackle drug counterfeiting. On the sidelines of the consortium, Biofem and Sproxil discussed implementing a drug-certification process in order to restore Biofem customers’ confidence in Glucophage. Following a successful five-month trial in Nigeria involving about one million units of Biofem’s product, the company has seen sales pick up again. “We ended up being called the guinea pig,” Soremekun jokes.
This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.
The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.
The major thematic areas include:
The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.
Over four and a half billion people live in the developing world and require access to services in the financial, agricultural, business, government and healthcare sectors. Due to constraints of the existing infrastructure (power, communications, etc), it is often difficult to deliver these services to remote areas in a timely and efficient manner.
The CAM framework has found success as a flexible platform for quickly developing and deploying high-impact applications for these environments. Many of the applications built with CAM have relied on a model where a field worker with a mobile phone regularly returns from a disconnected environment to one with connectivity. In this connected state, the phone and a centralized server can exchange information and get the collected data backed up on reliable media.
We propose extending CAM’s networking model to enable continual operation in disconnected environments. Using a set of heterogeneous paths made available through social and geographic relationships naturally present among workers, we describe a system for asynchronously routing data in a best-effort manner.
Results of proof-of-concept testing for an mHealth solution for reproductive health in Uttar Pradesh, India. The text messaging tool based on FrontlineSMS, is a family planning service that relies on the Standard Day Method system of birth control. This method of birth control depends on the woman's fertility cycles to avoid pregnancy. Women can text the date of their menses and user receives their fertility status. Additionally, women can receive information about other family planning options, and support. Presented are observations on the appropriatenss of the technology from focus group discussions. The authors share the input given by target users in the product and service design. Women tested the solution to give insight on feasibility and design.
This paper provides an overview of the implications of this trend for the delivery of healthcare services and population health. In addition to addressing how mobile phones are changing the way health professionals communicate with their patients, a summary is provided of current and projected technologic capabilities of mobile phones that have the potential to render them an increasingly indispensable personal health device. Finally, the health risks of mobile phone use are addressed, as are several unresolved technical and policy-related issues unique to mobile phones. Because these issues may influence how well and how quickly mobile phones are integrated into health care, and how well they serve the needs of the entire population, they deserve the attention of both the healthcare and public health community.
A how-to guide on using and implementing RapidSMS for mobile data collection and communication.
Ths manual give an overview for how to implement and use RapidSMS in a mobile data collection project. RapidSMS is a SMS framework for data collection, group coordination, and complex SMS workflows. The tutorial outlines when and when not to use RapidSMS, guides the user through project steps and milestones, outlines factors for a successful implementation, and provides worksheets for project planning. Example training materials are included.
The aim of this paper is to encourage reflection and discussion around the
potential of mHealth in developing countries and to consider how early experiences
can inform the way forward. Toward this aim, I synthesize many reviews and
presentations from the eight years I have been studying the evolution of mobile
phones and health in developing countries. I include observations and discussions
that are now shaping the creation of mHealth as a field, to highlight the ingredients
we need to move from a series of pilot projects and isolated business opportunities
to a full-scale maximization of health-related benefits.
I begin by reviewing the strategic priorities within global health, where mobile
telephony can have the greatest impact, along with organic health-related uses of
mobile phones, and examples of formal mHealth interventions. I then demonstrate
the potential for mobile phones to become an extension and an integral
component of eHealth, describing how information and communication technology
(ICT) can be used in health care, as well as mHealth, as a subset of mServices:
using mobile devices to deliver services such as banking and health. I also show
how trends and interests are converging among key stakeholders within the
mHealth ecosystem, thus forming a foundation on which we can scale up and sustain
more and better mHealth activities. Finally, I present some tactical guidance
for a way forward that will further the objectives of both public health and business,
particularly in outreach efforts to emerging markets, the bottom of the pyramid,
and the next billion mobile phone subscribers.
Baseline under five child mortality in Sauri, Kenya as of 2005 was estimated to be 148 deaths per 1000 live births. By 2008, the rate had dropped to 81 deaths per 1000 live births due to Millennium Village Project (MVP) interventions. A review of child deaths revealed that among other causes, such as malaria, acute febrile illnesses, diarrheal illnesses and HIV, malnutrition contributed to more than 50% of all child deaths. Community health workers (CHWs) led several interventions, namely community-based management of acute malnutrition, home-based testing for malaria and diarrheal illnesses and immediate dispersal of appropriate treatments.
To support these interventions, MVP ran a pilot project where CHWs were equipped with mobile phones to use SMS text messages to register patients and send in their data with the goal of improving child health and empowering community health workers. This report seeks to detail the methods used, illustrate early results and initial findings of the ChildCount mHealth platform that CHWs have now been using since early July of 2009.
Presented here is an overview of the operational needs of NGOs and CBOs and the role information systems can play to increase their accountability and efficiency. Information systems need to fit the diverse operational needs of NGOs and CBOs, which include coordinating activities, training and monitoring staff, documenting results, accounting, reporting, decision making and learning, acquiring external information and encouraging community participation.
Unfortunately, there are gaps in information systems that impede the ability of NGOs to embrace ICT. To name a few, the lack of open, accessible, cross-platform mobile development tools, limited opportunities and resources provided to local small software companies to engage with NGOs, and the lack of long distance networking technologies to reach remote locations.
Two examples of technologies that were applied successfully are shared: Self Help MIS, an application to monitor activities of small microfinance organizations and credit groups and DigitalICS, an application for data collection used by agricultural cooperatives. The author stresses that ICTs should be viewed as a tool to allow local change agents to be more effective and accountable and shows how computing is able to support local organizations by inspiring innovation, implementation and dissemination of projects, and measuring impact.
The Praekelt Foundation was founded in 2007 as the nonprofit/NGO offshoot of Praekelt Consulting. The NGO now runs three programs that work to better the lives of people living in poverty in South Africa. Each of those programs (Young Africa Live, SocialTXT, and TXTalert) use mobiles to achieve that goal.
Young Africa Life: The goal is to engage young Africans with a mobile-based community where they can find access to information about HIV/AIDS, relationships, sex, and gender.
SocialTXT: The goal is to engage people living in poverty about social issues by maximizing unused space on "Please Call Me" messages.
TXTalert: The goal is to use SMS reminders to increase kept appointment rates at clinics, encourage regular medication for chronic illnesses, and allow patients a free way to contact clinics if they have a problem.
Young Africa Live is a mobile portal where users can access information about HIV/AIDS while also reading entertainment-orientated blog posts.
SocialTXT takes advantage of the unused space in "Please Call Me Messages" to post informative social messages, such as the contact number for the National AIDS Helpline.
TXTalert uses SMS reminders to encourage patients with chronic illnesses to take their medication and follow-up with their clinic appointments.
The target audience for all three programs are people living in poverty in South Africa. Young people are a particular target audience of Praekelt's programs.
Young Africa Live: The site had rapid pickup among users, and exceeded the expected number of users. The Praekelt Foundation was able to get many resources from NGOs to populate the site with static content, and the bloggers have been well-received by readers.
SocialTXT: The program had a large effect on the number of users calling the National AIDS Helpline, and they were able to incorporate in regional languages in order to make the project more inclusive.
TXTalert: The appointment reminders dropped missed appointment rates at a Johannesburg hospital from 30% to 4%.
Young Africa Live: The portal is only accessible to users who use Vodacom as a service provider. Thus not all mobile users in South Africa can access the information. Also, the site's rapid popularity created a need for more content.
TXTalert: The system currently only runs in Johannesburg because it is dependent on clinics and hospitals having electronic patient databases, which many rural clinics do not have.
System Description
EMIT is an application that allows facilitators to capture field data on cellphones and submit it via GPRS to a centralised database. Surveys are customised and data is monitored, verified and prepared for analysis in real time. Read more here.
From Pilot to National
The pilot was performed with the Community Media Trust (CMT), who used EMIT as a monitoring and evaluation (M&E) tool to capture information on their HIV prevention and treatment literacy sessions in clinics, their training programme and open day events held in public spaces in communities where they work. CMT had been struggling with long turnaround times:
EMIT is an application that allows facilitators to capture field data on cellphones and submit it via GPRS to a centralised database. Surveys are customised and data is monitored, verified and prepared for analysis in real time.
A national roll-out of EMIT as a mobile-based data monitoring and evaluation (M&E) system revealed a clear trend of lower costs, greater accuracy and a faster turnaround time on reporting. With proper training and widespread buy-in, fieldworkers used EMIT with successfully and managers found it an efficient and effective monitoring tool.
Field workers in mobile health.
Training was easier than expected as the fieldworkers were already competent cell-phone users.
The data capturing system allowed for real-time access where CMT management could see submissions in real time and make follow up calls to the clinics to ensure their fieldworkers were in fact on duty.
A few organisations had ill-defined organisational processes, making it hard to implement a solution that had little existing foundation. In specific cases it was important to analyse existing processes and re-engineer processes that were redundant. This was done by having workshops and interviews with relevant parties to try and come up with a better defined process that could not only be auditable by funders but logical to the M&E manager. This was very successful as it allowed Cell-Life to analyse organisations and customize the technology accordingly.
In terms of the sector, there is a great need for broad-based IT skills as training is still required at most of the partner NGOs. For this reason, training has become a core part of the EMIT product offering.
The lack of network coverage in certain rural areas meant that data capturers had to go to areas with network coverage in order to send their collected forms.
There are challenges involved in the provision of cellphones. Clear policies for cellphone usage are necessary to try and reduce loss. In the near future, the EMIT application will be compatible with all Java enabled cell-phones, meaning that most facilitators will be able to use their personal cellphones, minimizing the cost of providing handsets and the management thereof.
During the last FailFaire (well, actually the first one to date) we were reminded by a guest rather sternly that NGOs often forget who their users are and, more importantly, what the needs of these users are. When we, collectively as a field, implement mobile deployments with constituents or groups, do we tend to forget user needs and capabilities, getting too enchanted with the tech (and ourselves) and then fail when, not surprisingly, there isn't any uptake? We have seen many a project fail for precisely this reason. Our grouchy attendee had a point even if he did not deliver it very gracefully.
To this end, we are reposting here a recent report from Zambia. Project Mwana is UNICEF Innovation project that is "working with the Zambian Ministry of Health, UNICEF Zambia, the Malawi Ministry of Health, UNICEF Malawi and many implementing and technical partners to find appropriate, scalable and impactful ways that mobile technologies can strengthen health services for mothers and infants in rural health clinics."
As part of a "Mobile Telemedicine" initiative undertaken by the Millennium Villages Project in Ghana, I have been researching and documenting existing software platforms that enable and support remote consultation activities.
How is mobile telemedicine defined? According to the the Rockefeller Foundation,
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status or for educational purposes. It includes consultative, diagnostic, and treatment services.
Mobile health information technology (mHealth) typically refers to portable devices with the capability to create, store, retrieve, and transmit data in real time between end users for the purpose of improving patient safety and quality of care.
Many mobile projects struggle with scale and impact. While a mobile health project may run well with a small number of patients in one hospital, expanding the scope of a project until it is large enough to have real impact takes money, time, and widespread support of key stakeholders in a given community. ChildCount is well on its way to show scale and, so we hope, significant health impacts using mobile technology for patient support.
In a little over eight months, ChildCount has enrolled nearly 10,000 children under five in their catchment area into the ChildCount health monitoring system – an acceptance rate of more than 95%.
ChildCount's goals are to:
ChildCount is a health monitoring system that targets pregnant women and children under five. ChildCount provides mobile phones to community health workers who then use SMS to manage data about patients, including health information, immunization records and disease symptoms.
The target audience is children under five and pregnant women in specific communities that are part of the Millennium Villages project in Africa.
The project especially credits close relations with local community health workers as a key to its success. Also, RapidSMS and the Django platform allowed ChildCount to quickly update its services once the initial project changed into a larger-reaching plan. The project was able to get a more than 95% participation rate in the initial pilot.
One challenge was adapting the program to target all the children in the catchment area, not just the ones who are at-risk. Another, major challenge, is developing the project into a sustainable model so that ChildCount can continue on without reliance on outside grants.
The Vodafone Americas Foundation is announcing the last call for nominations for the second annual Wireless Innovation Project, a competition to identify and reward the most promising advances in wireless related technologies that can be used to solve critical problems around the globe. Proposals will be accepted through February 1, 2010, with the final winners announced on April 19, 2010 at the annual Global Philanthropy Forum in Redwood City, California.
Two of the fastest-growing and popular mobile data collection tools have recently seen some exciting upgrades in newly released versions.
Open Data Kit recently released v1.1 of ODK Collect. Open Data Kit (ODK) is a suite of tools to help organizations collect, aggregate and visualize their data. ODK Collect is powerful phone-based replacement for paper forms. Collect is built on the Android platform and can collect a variety of form data types: text, location, photos, video, audio, and barcodes. ODK Collect can be downloaded in the Android marketplace or here. The developers also have a demo video that describes the new features of the release. Open Data Kit is a member of the Open Mobile Consortium of which MobileAtive.org is a founding member.
Some of the new features of ODK Collect include barcode scanning, image/audio/video capture and playback, editing of saved forms, and device metadata (phone number, IMEI, IMSI) support. GPS acquisition and form processing is a faster, and the developers added review data entry. The user interface has been field tested and reworked to make training and use much easier. ODK Collect also supports question grouping, repeats, constraints, complex logic, and multiple languages.
ODK is currently deployed for HIV counseling with AMPATH in Kenya, user feedback gathering for Grameen's AppLab in Uganda, war crime documentation with the Berkeley Human Rights Center in the Central African Republic, and forest monitoring with the Brazilian Forest Service.
Meanwhile, our friends over at Datadyne have released version 2.0 of their popular mobile data collection platform EpiSurveyor. For some of the very cool GPS features of that, see the video below. EpiSurveyor is a free, user-friendly mobile-phone-and-web-based data collection system. Version 2.0 has many new features such as GPS (users with GPS-enabled phones (like the Nokia E71) can automatically create a "GPS stamp" for every record collected AND automatically see the results on a Google map, all within EpiSurveyor.org), advanced logic, including skip logic; numeric range limits for data entry; and a much better user interface for the web-backend.
EpiSurveyor is used by organizations around the world. One organization, TulaSalud in Guatemala, uses EpiSurveyor for maternal health. The video below (en Espanol) explains how the organization is using the tool.
Video informativo de TulaSalud, sobre la aplicación del sistema de monitoreo epidemiológico aplicado con la tecnología de EpiSurveyor, el cual pretende tener a tiempo real el reporte epidemiológico de las comlunidades.
As part of our 'deconstructing mobile' series, we have been looking closely at the claims that have been made about mobile technology for a more realistic assessment of mobiles in social development that is based on data, rather than hype. Unlike more recent reporting on the topic, the Financial Times has an interesting article that questions whether mobile tech can actually "fill the gap left by underdeveloped healthcare system,' particularly in Africa.
As has been reported, the challenges in delivering health care in many African countries are stark. As the Financial Times points, out, there is 'an acute shortage of resources and trained staff means that more than 50 percent of the region’s population is estimated to lack access to modern healthcare facilities."
In the context of the rapid growth of mobile phone penetration in developing countries, mobile telephony is currently considered to be particularly important for development. Yet, until recently, very little systematic evidence was available that shed light on the developmental impacts of mobile telecommunication.
The Information and Communication Technology for Development (ICT4D) program of the International Development Research Centre (IDRC), Canada, has played a critical role in filling some of the research gaps through its partnerships with several key actors in this area.
The objective of this paper is to evaluate the case of mobile phones as a tool in solving development problems drawing from the evidence of IDRC supported projects. IDRC has supported around 20 projects that cut across several themes such as livelihoods, poverty reduction, health, education, the environment and disasters. The projects will be analyzed by theme in order to provide a thematic overview as well as a comparative analysis of the development role of mobile phones. In exploring the evidence from completed projects as well as the foci of new projects, the paper summarizes and critically assesses the key findings and suggests possible avenues for future research.
Here are some mobile events for the month of October that we thought are noteworthy and of interest to the MobileActive.org community. If you know of others, please mail us at info at MobileActive dot org.
The first Mobile Web Conference in Africa is a two-day event in Johannesburg that focuses on some of these key questions: How will the mobile industry evolve to a point where the vast majority of people have access to the mobile web and the content they want to view? How can societal and economic problems be tackled by the development of the capabilities of the mobile device?
PopTech explores major trends shaping our future, the social impact of new technologies, and new approaches to addressing the world’s most significant challenges. Several PopTech Fellows are part of the MobileActive.org community, including Deb Levine from Isis.inc, a leader in using mobile phones for sexual health education.
Providing effective health care in poor countries is an essential component to economic development and poverty reduction. Unfortunately donors supporting this endeavor often find that resources given are not matched by desired gains.
The output-based aid (OBA) model of financing seeks to address this by paying healthcare providers directly for services rendered instead of paying for the service provision up front. However, the program management is information intensive, necessitating much paperwork to track and reimburse payment claims. Smartphones (mobile phones with advanced features) have the potential to alleviate this burden.
Based on recent work in Uganda we have identified some of the constraints and realities of the context in which these devices could improve the quality and speed of payment claims. In collaboration with Marie Stopes International and Microcare, we propose to deploy a number of smartphones for use in the Uganda OBA project, with dual goals of reducing claim processing time and improving communication between the health care providers and the management agency running the OBA project.
With the continued expansion of mobile technology around the globe, and the persistent lack of universal Internet connectivity, the use of mobile phones in public health presents a new opportunity to improve health services delivery. This intersection of mobile technology and public health, known as m-health, offers four distinct applications for international development, including drug adherence and remote monitoring, remote dissemination of information, data collection and disease outbreak surveillance, and diagnostic treatment and support.
Several programs have addressed these m-health applications, but those that are most effective utilize open-source coding, are not reliant upon the Internet, and have great potential for scalability.
This report explores the ways in which non-
governmental organizations (NGOs) and
other groups deploy and use mobile
technology in their work to help solve some
of the world’s greatest problems. This study
is not meant to be exhaustive or definitive,
but rather to provide a view into how a
number of organizations are using mobile
technology to achieve social impact. The authors
selected case studies that enabled an
exploration of significant innovations,
opportunities, and emerging trends, as well
as the obstacles, in the use of mobile
technology to advance social goals.
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