A global network of people using mobile technology for social impact.
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.
On March 30th, Epidemiologic Reviews published a paper entitled “Text Messaging as a Tool for Behavior Change in Disease Prevention and Management.” Written by Heather Cole-Lewis and Trace Kershaw, the paper reviews previously published data to assess the potential for mobile phones to be used in disease management and prevention.
Comprised of data from 17 articles representing 12 studies (five of which focused on disease prevention and seven of which focused on disease management), the authors draw conclusions on the effectiveness of using mobile phones (and more specifically, text messaging on mobile phones) to change health behaviors.
In the days following the devastating earthquake in Haiti in early January 2010, aid workers arrived on the island to offer medical and technical support. With the capital, Port-au-Prince, suffering the brunt of the destruction, transporting supplies and people over destroyed roads proved difficult. Communications technologies, in an immediate post-disaster environment, are critical for aid workers to coordinate relief supplies and to deliver post-disaster care.
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.
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.
Although nonprofits in the United States has been slower to embrace mobile phones for health purposes than the rest of the world, mobiles are catching on as a way to reach diverse populations across the U.S.
“Mobile provides a fantastic channel for communication,” said Erin Edgerton, senior social media strategist at the Center for Disease Control and Prevention (CDC). “It’s always on, always with you and provides personal access to information.”
Nonprofits and government agencies are using this ubiquitous device for health purposes including monitoring, education and instant alerts and communication.
Mobile monitoring
For diabetes patients in Georgia, mobile phones have facilitated an instant connection to help and education. In several different pilot studies, participants used cell phones to document aspects of diabetes treatment ranging from glucose readings to snapping photos of the meals that they ate. Participants then sent the photos, readings, or other questions to a diabetes education center, where a diabetes educator could instantly respond to questions.
Mounting interest in the field of mHealth—the provision of health-related services via mobile communications—can be traced to the evolution of several interrelated trends. In many parts of the world, epidemics and a shortage of healthcare workers continue to present grave challenges for governments and health providers. Yet in these same places, the explosive growth of mobile communications over the past decade offers a new hope for the promotion of quality healthcare. Among those who had previously been left behind by the ‘digital divide,’ billions now have access to reliable technology. There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services—even in some of the most remote and resource-poor environments.
This report examines issues at the heart of the rapidly evolving intersection of mobile phones and healthcare. It helps the reader to understand mHealth’s scope and implementation across developing regions, the health needs to which mHealth can be applied, and the mHealth applications that promise the greatest impact on heath care initiatives. It also examines building blocks required to make mHealth more widely available through sustainable implementations. Finally, it calls for concerted action to help realize mHealth’s full potential. The report is organized into the following sections:
Google, in partnership with MTN Uganda, has launched 'Google SMS', a set of services that allows users in the country to access SMS information services. These include, for example, access to health and agriculture tips, weather information, and news and sports. Google offers these online information services aready on the web, but is now expanding them to SMS - however, at a high price per SMS.
"We seek to serve a broad base of people -- not only those who can afford to access the Internet from the convenience of their workplace or with a computer at home," said Rachel Payne, Google's country manager for Uganda, in a post on the Google blog.
Claim Mobile is a platform designed to support a
project that subsidizes healthcare by reimbursing health service
providers in Uganda for treatment of patients with sexually
transmitted infections. As with many development projects, the
Uganda Output-Based Aid (OBA) project involves a number of
stakeholders: the service providers, the project implementers,
the financiers, and the Ugandan government. Design of an appropriate solution requires meeting the various and conflicting requirements of all of these stakeholders. In this paper we detail
the rapid design and testing of a pilot implementation of a
mobile and web-based system for processing claims forms, based
on two prior field visits to Uganda. Based on a comparative
device study, semi-structured interviews, health clinic surveys,
and a brief deployment, we affirm the selection of the mobile
phone as a platform from the health clinic perspective, and
further suggest that effective design for development requires
more than addressing requirements of the the “users” of the
mobile phones but also all the other stakeholders involved, who
may have conflicting requirements.
Reported by Leigh Jaschke and Melissa Loudon.
This spring, UNICEF Malawi and the UNICEF Innovations Team deployed RapidSMS to monitor child growth and nutrition. We wrote about it previously here.
Now there is a detailed report (pdf), evaluating the effort (pdf). The report, released on June 16th, was issued by Columbia University's School of Public Policy and Affairs (SIPA), UNICEF Malawi, UNICEF's Innovations team, and Mobile Development Solutions (MDS).
The report details the findings of the deployment, and outlines recommendations for the future use of SMS in Malawi. Raymond Short of Mobile Development Solutions says that,
“while there have been innumerable ICT development applications introduced recently, there have not been many independent studies of their efficiency”.
In Uganda, medical clinics keep track of patient and medical payment records on paper. They then carry these often error-ridden forms to a management agency, where the information is manually entered into a database to receive reimbursements for the care provide. The process is tedious, time-consuming and leads to errors that can be costly for the local clinics. Melissa Ho, a Ph.D. candidate at the University of California Berkeley School of Information in the United States, believes that a mobile phone can make the process more efficient and accurate, saving money and resources for local clinics.
Take a low-cost ultrasound probe, a Windows mobile phone, and the skills of two scientists at Washington University in St Louis in the United States, and you get the world's first mobile-phone ultrasound instrument.
USB-based ultrasound probes have been around since 2005, offering a much cheaper and more portable alternative to larger ultrasound machines. Probes provide increasingly high-quality imaging for a tenth of the cost. A typical, portable ultrasound device costs around $20,000, while USB probes sell for around $2,000 right now - and the price is declining. Probes are ideally suited for first-responders and for primary care in developing countries, for example.
The small probes are connected to a phone with a USB cord that have been, typically, connected to a laptop for displaying the images. But carrying around laptops for transmitting images is not an option in many clinics in developing countries for lack of consistent electricity, heat, and lack of Internet access.
Using mobile phones has enormous potential for increasing access to healthcare for poor people aroundd the world, and for improving clinical outcomes. Now a new association, the mHealth Alliance, has been launched to support this emerging field and increase the scale and impact of the many small prokects around the world.
So new, the Alliance has so far no website, press release, or organization yet, it was announced to the BBC as part of the GSMA World Congress in Barcelona. The mHealth Alliance is currently under the auspices of three foundations, the UN and Rockefeller Foundations in the United States, and the UK-based Vodafone Group Foundation.
Deploying mobiles in health care in developing countries is not only promising for health outcomes, it is also a hot and potentially lucrative business area. There is enormous interest by NGOs, donors, telcoms, mobile vendors, researchers, and governments in the the use of mobile phones for increasing healthcare for the poorest people in the world.
The Vodafone Americas Foundation has a new Wireless Innovation Challenge to promote innovation and increase implementation of advanced wireless related technology for a better world. The foundation is providing $600,000 in awards to support projects "of
exceptional promise." The Challenge is open to projects from universities and nonprofit organizations based in the United States.
Projects must demonstrate a multi-disciplinary approach that uses innovation in wireless related technology to address a critical global issue in one or more of the following areas: access to communication, education, economic development, environment, or health. The
technology should have the potential for replication and large scale impact. Teams should have a business plan or a basic framework for financial sustainability and rollout. Submissions deadline is February 2, 2009.
On day two of the MobileActive ’08 conference, I attended The Humanitarian Technology Challenge: In Search of Innovative Solutions presented by Claire Thwaites, who heads the technology partnership between Vodaphone and the UN Foundation.
Thwaites said that their goal is to find technology solutions to humanitarian challenges. The IEEE lists five key challenges which Thwaites presented:
Reliable Electricity
Needs: Power availability for electronic devices, including low power stationary facilities, rugged mobile power supplies for emergency settings, mechanical transducers, passive generation devices that charge as you walk. Renewable energy hubs are preferred, as well as the use of intermediate field offices as data relay points.
Data Connectivity of Rural Health District Offices
Needs: Exchange data between central health facilities and remote field offices. Two-way transmission – upload/download, data could be batched for daily transfer, also useful for emergency alerts and outbreak alerts, less expensive service and higher bandwidth needed, maps of existing connectivity
South Africa is a hotbed of mobile social innovation. From a depression-and-anxiety group helping teens via SMS, to assisting with compliance for tuberculosis medication, and the 'cellphones for HIV' programm we have described earlier, diverse health initiatives are findings ways of using mobile phones.
Technology-based interventions for prevention and treatment of HIV/AIDS took a small but important place on the agenda at the recent 17th International AIDS Conference in Mexico City, reports attendee Kate Jongbloed who runs an insightful blog on development issues. She reports for MobileActive from Mexico.
In a session entitled, “Reaching Millions: Youth, AIDS and the Digital Age,” a number of private and non-profit organizations presented their internet and mobile phone based approaches to the fight against AIDS. A full audio and video version of the panel can be found here.
In South Africa, mobile phones and HIV/AIDS are two pervsasive realities. Some 75% percent of children and adults in the country have mobile phones, and according to the National HIV Survey, 10.8% of people over two years old are living with HIV. Almost 1,000 AIDS deaths occur every day. Cell-Life, an NGO based in Cape Town, aims to address this growing AIDS epidemic by using mobile phones.
Cell-Life's "Cellphones for HIV" project continues with two new pilot projects. In one pilot, Cell-Life will collaborate with the Treatment Action Campaign (TAC) in the Western Cape to provide information to communicty trainers and the wider HIV community. In the second pilot, Cell-Life will work with Soul City, which uses television and radio dramas to discuss issues such as social norms, health, and HIV/AIDS.
The numbers should speak for themselves. In 2006, there were 9.2 million new tuberculosis (TB) cases and 1.7 million TB deaths. Of these cases, 5.3% were a tough strain of TB that is resistant to treatment (known as MDR-TB, or multiple drug resistant tuberculosis). The total cost of TB control programs in high burden countries is estimated to be about $2.3 billion in 2008. A team of students and faculty at the Massachusetts Institute of Technology has come up with an innovative response to this problem that uses mobile phones as both a reporting mechanism and incentive program.
Roberta Lamptey Nartey, a family health practitioner in Ghana, used to rely on the walkie talkies of the security guards to communicate between hospitals where she worked. Once she wanted a woman who had had a severe asthma attack transferred from the Korle Bu Polyclinic to the surgery unit of another hospital. Nartey left a message with the night nurses to transfer her patient and wrote a note in the patient's chart, but to her chagrin, the asthmatic patient never appeared in the surgery unit. "I told the security man at the Surgical Unit to send a message to the security man at the polyclinic using his walkie talkie," Nartey wrote. "The security man at the polyclinic then went to the female ward at the polyclinic to remind the nurses on the morning shift that I was waiting at the Surgery Ward." After several layers of communication, Nartey's patient finally made it to surgery.
A first of its kind program for LGBTs in Las Vegas will begin this month. SMS and website support will be provided to individuals who opt in to the program. There is a 70% smoking prevalence among gays and lesbians in Las Vegas and So Crush SMS will attempt to lower that rate by providing indivuals with quitting tips and links to resources via text message on a weekly basis. "We're very excited about this program. One element that separates our program from others is that we will be individually responding to each incoming message. Canned responses will only be used to identify the group new opt ins are place in. Once in a group, the message correspondence becomes individualized." Jonathan Holly, Program Developer
Educational Message Services and Southern Nevada Health District will be launching a new SMS program to help LGBTs in Las Vegas connect to smoking cessation programs. A first of its kind software interface will enable program administrators to publish packages of information into an SMS platform. LGBTs will be encouraged to text the program to vote for favorite male models, clubs, DJs etc, then once opted into the network, they will receive a series of logic questions and answers to determine the kind of messages they receive at weekly intervals for the duration of the program, i.e. smokers, friend of smoker, or alerts about smoke-free events in Las Vegas. The project is being funded by a grant from American Legacy, and the data collected by the SMS messaging will be researched by Dr. William Evans at University of Nevada, Reno. For information, contact Jonathan, email: jonathan@emsmail.org, or call 805-653-6000
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