Part 2 of 2 of a short “Bringing mHealth back to earth” series
From the start of our projects to the finish, it’s people who determine what FrontlineSMS:Medic does, when we do it, and why. The tech tools we use exist to serve patients, community health workers, and healthcare professionals – not the other way around. This mindset is critical for a number of reasons. I’ll explain.
We strongly believe that projects should start when clinics ‘pull’ them to a site, as opposed to having projects ‘pushed’ onto healthcare providers. Ken Banks included the (very important) push/pull differentiation in his “Development best practices for beginners” series. Clinics are not just convenient places to pilot technology innovations. Healthcare providers should demand programs they need, and we should be ready to respond. Local staff should determine how the tech will be used, and we should be flexible and helpful in working through use cases and functionality.
Andre Blackman posted this video of our SMS training at Pulse + Signal:
You’ll notice that I’m not in any of the shots. It wasn’t my place to train the community health workers – (1) I don’t lead their other training sessions, and (2) I don’t speak Chichewa well. I’ll work one-on-one with those who need individual attention – although, the CHWs do self-organize into pairs, and those who need help will find it from others. We made it clear that local staff were running the show.
A quick and straightforward example of being responsive: On the first day of training, one of the CHWs was struggling to see the small letters on the cell phone…
So, we created handouts of blown-up number pads, which everyone ended up using.
Our work involves technology, but the focus is on the people. A bag full of cell phones without community health workers using them to serve patients is… just… heavy.
“mHealth” is intimidating. I’ve written about this before – most of FrontlineSMS:Medic‘s partners cautiously approach us. After we work together to get projects up and running, I consistently hear, “We never thought this technology would be – much less work – here.”
With this post, I’m hoping to dispel some mHealth myths and start to dissolve the perception of mHealth programs as unattainable for small and large clinics (with or without technical know-how). Below, you’ll find pictures and prices for all the technology we’re using for the Partners in Health project in Malawi. Here’s the key: except for FrontlineSMS, all of the following tools were already being used locally.
Left: FrontlineSMS running on an Acer netbook with modem attached Right: with Motorola V3 RAZR attached
FrontlineSMS is free software, and incredibly easy to use. The Acer netbook cost $200, and the modem was $150. You can get the phone and data cable for $20 or less.
We needed mobile phones. This is how Hope Phones and the generosity of phone donors helped out, in a big way. We got these RAZRs for $15 each, and we’ve used models that cost as little as $6.50, which work just fine.
Solar panels are useful if electricity’s scarce, and we almost always implement sharing systems. We’ve found that 3-4 community health workers can share a panel, given efficient charging rates. The product pictured cost $20, and we’re testing $7 panels right now. Of course, we’re buying local SIM cards (cost less than $2 each). The last piece of the puzzle is cell network coverage. Luckily, we’re not building any towers; coverage is good and always improving.
That’s it. Really. As Home Depot used to say, “You can do it. We can help.”
Of course, people make this work and give the tools value. My next post (part 2 of 2) will focus on implementation and training (both FrontlineSMS training and SMS workshops with the community health workers) and I’ll include videos.
Henry leading SMS training
I’m happy to answer any questions – just leave a comment.
Hello from Neno! Here, I’ve drawn out the use case we’ll be focusing on for the Partners in Health pilot at Neno District Hospital. There is a lot of potential for the FrontlineSMS:Medic system to be used to track patients in a number of programs: e.g. ART, pre-ART (HIV-positive patients not yet on antiretroviral therapy), TB, PMTCT, Kaposi’s sarcoma, chronic care.
So, we have: touchscreens in the hospital for patient registration and clinical data entry, electronic medical records following patients and creating alerts, and cellphone-wielding village health workers tracking remote patients. I think it’s exciting, and we’ll be structuring the outcomes assessment this week.
We’re training 130-150 village health workers next week. In the picture above, the VHWs had gathered for a training session on multi-drug-resistant TB. You can see me in the back, watching intently.
I’m excited about this pilot for a number of reasons. First, PIH is well known for stellar communty-based care including their village health worker (VHW) training and support. We’ll pilot the system with 150 VHWs. Second, we’ll be running FrontlineForms, which will allow for structured data collection. Finally, Baobab Health Partnership implemented their revolutionary eVCT touchscreens for clinician-patient interactions within the clinic. With the upcoming FrontlineSMS-OpenMRS integration, it will be feasible to create a continuum of data from these touchscreens to cellphone-wielding VHWs in remote villages.
Village health workers
I’ll be blogging here as the project unfolds. I won’t be alone in Malawi – FrontlineSMS:Medic’s Medical Director, Lucky Gunasekara, will be setting up projects with VillageReach and the Clinton HIV/AIDS Initiative a bus-ride away. Keep tabs on @bikobiko and www.bikobiko.com for updates from Lucky. Isaac Holeman (our Clinical Programs Director, @isaacholeman, www.isaacholeman.org) is headed to St. Gabriel’s Hospital in Namitete this August – home of the Mobiles in Malawi pilot.
After working with PIH, I’m joining Lucky in Cameroon to pilot new applications for FrontlineSMS:Medic with the Global Viral Forecasting Initiative. Needless to say, we’re excited about the summer.
The Hope Phones campaign launched last Monday – 8 days ago. Thanks to you (colleagues, friends, family, acquaintances, bloggers, Facebookers, and tweeps) we’ve collected over 700 phones. What impact will this make?
In short, we’ll be able to provide up to 1,400 cell phones for healthcare workers in Malawi, Burundi, Uganda, Honduras, Bangladesh, and Lesotho. Once all 700 phones are processed by our recycling partner, I’ll give you a full breakdown of the phones’ values and which clinics will benefit.
Every phone matters. Each one will give another ~50 families a connection to clinicians and clinic resources. Malawi’s average family size was 5.5 in 2006 — in a little over 1 week, what would have been trash could pull another 385,000 people into FrontlineSMS:Medic programs. Phone donors are doing more good than they know – check out a recent post on TrackerNews: “Phone Riff: Hope Phones, Healthy Texting, Conflict Minerals, Ecological Intelligence, Blue Sweaters and Doing the Right Thing.”
Clinics benefiting thanks to Hope Phones donors
There’s still a lot of work to do, and the Hope Phones campaign isn’t going anywhere. In the 8 days since Hope Phones launched, Americans have discarded more than 3.5 million phones. If we recycle just 0.5% of next week’s phones through Hope Phones, we could provide tools enabling better healthcare for 9.9 million people.
You can help. Just spread the word, and toss your old phones in the mail — one email to friends and family, one tweet, one conversation with a coworker on a lunch break. Check out the map below to track Hope Phones collection sites and partners. Email email@example.com to get involved. If you’d like to start up a program at your school or workplace, we’d love to hear form you.
Hope Phones collection centers (click to view)
Thank you to everyone who helped launch this campaign.
FrontlineSMS:Medic today launched www.HopePhones.org and Hope Phones, a nationwide mobile phone collection campaign supporting mHealth programs at medical clinics in over 30 countries. The campaign will make use of old cell phones in the US to provide phones for clinics and healthcare workers in the developing world.
Cell phones are valuable tools in the battle to reduce disease and illness. The field of mHealth – the provision and coordination of health-related services via mobile communications – is blossoming in response to a global shortage of healthcare workers and the demonstrated impact made by simple, mobile tools.
Hope Phones will make use of the nearly 450,000 cell phones discarded every day in the US. HopePhones.org allows donors to print a free shipping label and send their old phone in to The Wireless Source, a global leader in wireless device recycling. The phone’s value allows FrontlineSMS:Medic to purchase usable, recycled cell phones for healthcare workers.
Hope Phones lets you give your old cell phone new life on the frontline of global health. Just one, old blackberry will allow FrontlineSMS:Medic to purchase 3-5 cell phones for healthcare workers, bringing another 250 families onto the health grid via SMS.
FrontlineSMS:Medic is an nonprofit organization advancing rural healthcare networks in the developing world through the implementation of sustainable, appropriate technologies delivered through mobile phones. Its first pilot project distributed cell phones to community health workers in 100 rural villages in Malawi, saving thousands of dollars in travel and hospital costs and doubling the number of patients treated for tuberculosis in the catchment area. Stories about FrontlineSMS: Medic projects have been featured in CNN, Discovery Channel news, the BBC, The Guardian, PC World and Reuters.
The organization uses FrontlineSMS, a free, open-source software program that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and cell phones. Their pilot implementation model places a laptop running FrontlineSMS in a central clinic and distributes cell phones to healthcare workers to coordinate care with patients in peripheral villages. Their programs currently serve 1.2 million patients in Malawi and Uganda. Future development of the FrontlineSMS:Medic platform will encompass electronic medical records and diagnostics at the point of care.
Coupled with free, open-source software, the hardware provided through Hope Phones will scale mHealth initiatives, connecting thousands of clinics worldwide to remote healthcare workers and patients. The campaign was designed in partnership with Wieden+Kennedy – the global advertising agency of the year in 2007 and the creator of Nike’s “Just Do It” campaign – with support from kiwanja.net and The William and Flora Hewlett Foundation.
In Bushenyi, Uganda, I worked with two ART clinics to set up FrontlineSMS:Medic programs. The SMS programs will focus mainly on supporting ART monitors and RPMs (Resident Parish Mobilizers) working within the communities. The clinics will use the system to enable patient tracking, emergency care services, symptom reporting, and adherence reporting. The following is a video of Dr. Elioda Tumwesigye, introducing the project:
Selected notes from the first two days of my 10-day trip:
2-hour all-encompassing FrontlineSMS training session with ART coordinator, community nurses, and data managers included…
Connecting the GSM modem
Checking for new messages
Sending one-off messages to contacts
Sending group messages
Managing contacts and groups
Enabling emails via auto-forwarding
Auto-replies via keyword (e.g. drug information)
Auto top-up system (“ID#_units”)
Elly, Arthur, and Joham interacting with FrontlineSMS for the first time
An important component of that training session — group worked together as one person used FrontlineSMS to, for example, add a new contact and set that contact up to receive SMS credit upon request.
During a meeting with 30+ clinicians at KCRC, I talked about the St. Gabriel’s pilot, introduced FrontlineSMS + the handsets, and talked through use cases with the staff. One nurse asked if we could recruit participants for clinical trials (and monitor trials) via SMS. That may work well, with CHWs in the field relaying study info, CHWs texting back mobile #s of interested community members, and those contacts being added to an SMS info distribution list. A few sheets of paper were passed around the group during the presentation, for staff to make note of ideas for use within the ART + community-based care programs.
More often than I expected, a very simple question arose, “What should we be talking about?” The easiest response is that it depends – on who “we” are and what we’re doing. I heard three broad options, each of which is tied to different factions I’ve encountered throughout my brief but focused mobile tech sprint, of late:
Talk about what works, right NOW. This is what interests NGOs and clinics working on the ground. They want to know what they can do, today, to impact operations and better serve beneficiaries (e.g. treat patients and support community health workers). For the most part, this group doesn’t know exactly what tech’s available, and they doubt they can afford it. I’ve heard from numerous clinics, “We knew mobile technology initiatives existed, but we never expected them to come – or work – here.”
Talk about where the technology is going, and what it’s going to take to get there. I turn to others for this information. Tech junkies rule this domain, and rightly so. They should be the ones leading the charge to construct and control tech advancements (e.g. WiMAX). This conversation excites and is clearly best suited for techies. End users are less interested.
Talk about theory and long-term convergence of best practices and competing technologies. Tech experts and NGOs with case studies can offer bits and pieces, but this conversation lends itself to policy experts, economists, and fortune tellers. If we can find technology and implementation strategies that scale horizontally, outputs of these conversations may be less prescriptive and more descriptive – with organizations choosing and mixing available technologies at their liking. Erik Hersman of White African and Ushahidi wrote about this idea a little while ago.
Obviously, there’s some crossover. But it may be useful to keep in mind how we fit into these discussions.
Those who know me will understand why I’m most passionate about the first discussion. We don’t have great means by which to connect “on-the-grounders” with tools they can use. The clinics and service providers I talk to certainly feel disconnected from what they perceive to be immense, unattainable opportunity to utilize mobile tools. Their perception of value may be accurate and real, but the barriers to entry need not be.
With support from The Children’s AIDS Fund, I will be working with Dr. Elioda Tumweisgwe to set up FrontlineSMS:Medic programs at Bushenyi Medican Center and Kabwohe Clinical Research Center in the western rural district of Bushenyi. Dr. Tumweisgwe is the Chairman of the Uganda Parliament’s HIV Committee.
Over 200 CHWs will be involved in the two programs for the clinics, which collectively serve 800,000 people in 29 subcounties and 2,304 villages.