I understand that you can get rich off iPhone applications. Projected revenue for Apple’s App Store in 2011 is $2.91 billion, and 70% goes to app developers. I know we’re overwhelmed by stories of big money in tech startups (see Facebook’s $50 billion valuation and the box office success of The Social Network). That said, I’d like to deliver a message to Millennials – you can innovate with a different purpose. There are new and exciting platforms for social impact. More than 5 billion people now own mobile phones. 50% of people on the African continent use mobile devices, and they will soon be ubiquitous. 90% of the world’s population is covered by a mobile signal. This technology is spreading faster than anything we’ve ever seen. This past Sunday marked the 30th year in the fight against HIV/AIDS. Millennials won’t remember the first diagnosis, but we do know the stakes have escalated. Our moral circle has expanded, and we are taking action locally and globally. Ever-expanding tech infrastructure provides opportunities to tackle seemingly intractable problems. In 2007, I met community health workers in rural Malawi who were walking 45 miles every week to hand-deliver updates on HIV-positive patients in their remote villages. We bridged that gap with text messaging, using 100 cell phones and open source software. In six months, the number of patients treated for tuberculosis doubled, emergency care was provided for the first time, and the health workers saved thousands of hours of travel time. The success of that pilot launched a nonprofit mobile technology company, Medic Mobile. Today 3,000 health workers across 12 countries use our tools to improve healthcare for 500,000 people. We often use SMS, or text messaging, because it is the lowest common denominator and it reaches the last mile. This week, we’re announcing the first SIM card application for healthcare, which will run on 80% of the world’s phones – from $15 handsets to Android smartphones to tablets. Knowing that over 1 billion people never see a healthcare worker, we’re building applications to support patients, health workers, doctors and public health officials using technology that’s quickly finding its way into everyone’s hands. The first SIM app, Kuvela (which means “to listen” in Chichewa), will let community health workers track vital drug stocks and provide real-time reports on disease. If you’re looking for whiz-bang tech to get you excited about social impact, examples abound. Dr. Aydogan Ozcan and his team of graduate students at UCLA have built a $20 camera phone add-on that uses a new imaging technique to auto-diagnose malaria, tuberculosis and sexually transmitted diseases using MMS (multimedia messaging). Rob Munro, a computational linguist at Stanford University, is harnessing artificial intelligence and natural language processing to classify symptoms reported by health workers and patients for disease surveillance. These are some of the smartest people on earth, and they’ve chosen to innovate for the public good. Justin Timberlake, playing Sean Parker in The Social Network, scoffed at a million dollars and set the revenue bar at a billion dollars. I’m looking forward to the next blockbuster movie about our generation, where the most memorable line will be, “You know what’s cool? Improving the lives of a billion people.”
Note: I owe this blog a few posts on Colombia and the Democratic Republic of Congo, but wanted to start here. I’m committing to blogging more, inspired by friends and colleagues.
Within the first few minutes of conversation on an airplane or at social gatherings, I’m asked, “So, what do you do?” My usual reply over the last few years has been, “I co-founded a nonprofit.” I explain more if they’re curious, about 10% of the time. I’m now realizing that’s bad framing, for a few reasons.
Medic Mobile team members
1. Stop defining the venture by what it’s not.
“What does your venture do?”
“It doesn’t make a ton of money.”
“Okay, but what does it do?”
If we’re going to use one word to describe what we are, it shouldn’t include ‘non.’ ‘Nonprofit’ implies tax-exempt status, not a specific approach or goal.
2. We have a lot in common with Google, Twitter, Facebook, etc.
This first hit me when Medic Mobile was starting up and I was at Stanford and in the Bay Area. We approach social impact and growth the same way innovative companies approach revenue and growth. We move quickly, and expect to be the best at what we do. I’m fortunate to work alongside talented, committed individuals.
We plan for everything to go brilliantly, and learn quickly when it doesn’t. We are obsessed with scaling. (For impact ventures, sometimes scaling means reaching tremendous depth, serving a targeted community/population. In other cases, it means aggressively partnering and releasing innovation to replicate and implement broadly.)
Our goal? Create and implement mobile tools that help health workers save more lives, on a massive scale. We’re not just a nonprofit.
Members at the Clinton Global Initiative are asked to make a commitment to action. This year, our commitment at FrontlineSMS:Medic centers around the deployment of three mobile health tools: PatientView, a lightweight patient records system that can be used anywhere there is a mobile signal; Surveys, a new tool that allows users to collect structured information by SMS; and the OpenMRS messaging module, a new messaging platform for the open-source medical records system OpenMRS.
Ideal for hard-to-reach hospitals and clinics, PatientView organizes text messages and mobile forms to create searchable patient and health worker profiles.The module creates a new user interface within FrontlineSMS – one screen where staff at a central computer can view all relevant data relevant. Health workers can sort, update, and add new records from the central computer. The plug-in also introduces login security, new search features, simpler messaging to patients’ health workers, and an upcoming ‘flag’ system to alert clinical staff to certain information, and new reporting capabilities. Watch the demo video here.
The Surveys module was developed to efficiently and accurately send structured information via plain text SMS available on the lowest-common-denominator handsets in low-resource settings. It provides a simple syntax and enables structured data collection with the robustness and scalability of SMS through plain text, yes/no, multiple choice, and checklist responses. Use cases include dynamic stock reporting and resource mapping, landmine victim care tracking, and maternal health vital event reporting. We are collaborating with Google to enable Surveys to update information about health facilities in Resource Finder, a tool Google has developed to help disseminate updated information about which services various health facilities offer in a disaster area. Surveys will allow relief workers to update a given facility’s available bed status, which types of specialists are on staff, etc, all via SMS.
Google's Resource Finder
The OpenMRS Messaging Module
FrontlineSMS:Medic has built a messaging platform for OpenMRS, a web-based, open-source medical records system. This messaging module will allow large clinics to extend patient records outside clinic walls, e.g. giving remote health workers the ability to update patients’ records via SMS, allowing clinicians to set appointment reminders, messaging CHWs about patient test results and treatment instructions, etc. Learn more about the messaging module here.
FrontlineSMS:Medic aims to implement three national-scale and over ten regional-scale programs by the end of 2012. Target countries include Malawi, Kenya, Mali, Bangladesh, Haiti and Colombia. Through these deployments, we expect to increase our number of end users to at least 15,000 health workers.
The need is loud and clear – large gaps exist in health systems. The disconnect between health centers and peripheral communities means that adherence rates suffer, clinicians are unaware of patient statuses, immobile patients cannot receive emergency care, remote health workers lack support, new illnesses are not identified, and drug stock-outs are too common. We believe that FrontlineSMS:Medic’s tools can help create health systems that are connected, coordinated, and save more lives.
The magnitude of certain problems is fully evident and inexcusable. Each year, 350,000 women and girls die every year from pregnancy-related causes, and over 100 million lack access to family planning. My generation has had access to these staggering statistics for years. As global citizens, we must now choose to act.
I was honored to join heads of UN agencies and government officials, as well as corporate and nonprofit leaders at last week’s Women Deliver event, “Accelerating Action on the MDGs: Delivering for Women, Girls, and Babies.” The theme threading the event’s discussions was clear - low-hanging impact exists, and if we want to increase access to proven interventions, we need to get creative.
We know lives are saved by skilled birth attendants and quality postnatal care. Still, distance between women and health clinics is a large gap in health systems and a threat to maternal and newborn health. In many places, we now have mobile tools that can bridge that gap before, during, and after childbirth. Decentralized community health workers and traditional birth attendants are with expecting mothers; in an ideal world, 100% of these remote health workers would be able to communicate with the nearest health facility through means other than walking or bicycling. Simple voice calls and smart text messaging systems can increase access to emergency transport as well as obstetric and neonatal care.
We also know that women want access to family planning. Once a decision has been made to provide family planning for large, distributed populations, commodity levels must be closely monitored to ensure access. Usually, this means staff on motorcycles deliver stock reports when they have a reason to visit a central office. Reports aren’t delivered or go missing in stacks of paper. Women walk miles to the clinic to be turned away due to stock shortages.
With booming mobile infrastructure and suite of tools at our disposal – text messaging, data networks, voice, flashing systems, radio, etc. – that lack of coordination can and should end. In the next few years, people at every level of the health system, from patients to policymakers, should have access to real-time information regarding stockouts. Everyone with a mobile phone can play a role; routine reporting from paid health staff layered with less structured citizen reporting can identify and verify bright spots and trouble spots.
FrontlineSMS:Medic is a nonprofit using mobile technology to create health systems that save more lives. The FrontlineSMS:Medic team and I are focused on low-hanging impact, and scaling what works now. At a time when questions of accountability abound, we develop and deploy tools that enable local action and produce good data as a byproduct. We are building tools that become solutions when people on the ground use them to tackle specific problems. At the Clinton Global Initiative, we committed to scaling new mobile health tools to support more than 15,000 health workers and the patients they serve.
Today, our team is planning a project with One Heart World-Wide in Nepal to increase access to emergency obstetric care and increase the percentage of births attended by skilled birth attendants. In Mali, we are designing systems for reproductive health commodity and maternal health event monitoring. We are moving quickly to deploy tools where they can make an impact. It is time to act, together.
I’d love to see implementers and tool-providers shift away from data collection and towards creating local action. Here’s my reasoning:
1. Especially in the case of mobile technology, data can be a byproduct of action – e.g. clinicians and community health workers can use mobile phones to coordinate patient care, use identifiers, and produce a longitudinal record of care that can be aggregated with other records, analyzed, visualized, etc.
2. These systems involve people. Imagine someone tells you, “Please report, because we need data.” Now imagine they say, instead, “We need information.” Or, “We need to know.” Finally, “We need to act.” Which framing builds the greatest incentive for participation?
3. It takes action to achieve impact. Yes, large data sets that inform policy are important — reiterating my first point, I’d argue we’ll have that data anyway due to the nature of the technology. At the end of the day, for a situation to change, someone needs to do something differently. Our programs should reflect that reality.
Local actors want change through action. Policymakers want data to inform decisions. Luckily, technology can deliver both.
Sometimes, people just pull through for one another. Less than one month ago, I flashed the designers’ bat signal with a meager attempt to draw out some use cases for FrontlineSMS:Medic. A team of talented artists stepped up to the plate and hit a home run:
They’re a wonderful team, and this is high-impact volunteering. As a nonprofit start-up, seemingly small tools/resources really matter. A nifty poster version of the graphic will be featured at the upcoming Global Health Information Forum in Bangkok and the art will immediately have a home in our team’s presentations.
More than a few times, I’ve been asked for a visual representation of FrontlineSMS:Medic‘s use cases. I can always flip through photographs and tell stories, but there is demand for a more graphic and ‘networked’ explanation. I took half an hour today to sketch out a few – many others were left out – in an experiment.
I’m looking for some feedback – in your eyes (whether or not you’re familiar with FrontlineSMS:Medic), is this helpful?
Pop!Tech has published the presentations from this year’s Social Innovation Fellows, and I thought I’d share the 5-minute talk on FrontlineSMS:Medic and the Hope Phones campaign. The fellowship program challenged us to rethink our presentations, impact models, financial sustainability, and media strategy — making sure we left with a ‘way forward’ and a community of support.
I’m behind on blogging, so this is an attempt to catch up by combination. Maybe the alliteration in the title makes up for the randomness of this post… maybe not!
Last week I found out who will be joining me in Camden for the PopTech Social Innovation Fellows Program, and they’re an inspiring bunch. I’m ready for light-bulb moments, humbling conversations, and challenges posited by the faculty.
During my most recent journey through Malawi, Kenya (unexpected), and Cameroon, I was accompanied by a small music collection I threw on my iPhone before catching the first flight. I was consistently up until 2AM charging cell phones, making SMS training materials, and salvaging internet connectivity — tunes kept me company. Here are my admittedly eclectic ‘mHealth field work’ albums from the summer:
Finally, I’m looking forward to exploring a new town. I found an apartment and office space in Washington, D.C. and will be here for a year, maybe longer. Feel free to email me at firstname.lastname@example.org, reach out on Twitter (@joshnesbit), or leave a comment here if you’d like to grab coffee. My office is at 910 17th NW between I and K.
The Medic Mobile software development team, led by Dieterich Lawson, just posted videos of a new software plugin, PatientView.
The PatientView plugin creates a new user interface within FrontlineSMS – one screen where staff at a central computer can view all data relevant to an individual patient. Users will also be able to sort through, update, and add new records from the central computer. This plugin is designed to manage patient information at small health centers, some of which will move on to a robust medical records system in the future, others of which will prefer to use FrontlineSMS to send data to a medical records system at the nearest large hospital.