A massive thank you to Rohan Fisher, a researcher at Charles Darwin University who is currently focusing on open-source applications for mobile mapping and health data visualisation in remote and developing country contexts, for his contribution to the FrontlineSMS blog! The use of personal mobile phones has increased rapidly, even in remote parts of Eastern Indonesia, revolutionising the way people communicate. I work in a small regional university in Northern Australia (Charles Darwin University) very close to the Eastern Indonesian province of Nusa Tenngara Timur (NTT).
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.
For the last few years we have been working with local health departments building capacity in collecting and mapping health information. Through this work we found that whilst SMS was already an important tool health data reporting at some clinics and districts office its use was fairly ad-hoc and unstructured. It was clear that FrontlineSMS could play a useful role for improving the effectiveness of SMS for the delivery of health services. Key in our decision to use FrontlineSMS to support health information activities in this region was the fact that it does not require an internet connection; it was free, efficient, and simple to use, enabling easy implementation at districts and clinic levels.
Also important was the bottom-up implementation philosophy of FrontlineSMS. In Indonesia over the last decade there has been rapid decentralisation of governance at the district level. This increased regional autonomy allows for most planning and budgeting decisions to be made at the local level. FrontlineSMS fits well into this paradigm, allowing an implementation that supports local programs and priorities. Health workers in this region are generally over-worked and under-resourced so FrontlineSMS is promoted to them as a simple tool that makes their work easier. Through building capacity in the use of this tool, without stipulating what it should be used for, we are developing local ownership and engagement.
We have recently delivered training in West Timor, Sumba and Flores to 11 districts. A total of 40 mobile phones and modems were provided for use at the clinic and district level, with an additional 60 mobile phones given to midwifes for further trials in West Timor. All the participants in the training could see immediate benefits from FrontlineSMS particularly to support programs monitoring pregnant women. Currently rates of maternal mortality in this region are very high. In an effort to tackle this, SMS is being used to assure women are provided with trained assistance during their pregnancy and birth. This has been done through health officers monitoring SMS requests to a mobile phone 24 hours-a-day, seven days a week. FrontlineSMS is now providing a way to conduct this around-the-clock service in a more efficient way. It was also clear from the training that participants could see a wide range of potential applications. FrontlineSMS is now, for example, also being trailed for monitoring Rabies cases in Eastern Flores.
Key to the delivery of this project is our partnership with a local Indonesian NGO (Amaryllis). Amaryllis has assisted with the development of training materials, the on ground training and will conduct follow-up research assessing the sustainability, successes and difficulties in the implementation of FrontlineSMS. The results of this assessment will form the basis of a workshop later in the year to discuss the ongoing use of FrontlineSMS.
The project is funded by AUSAID (Australian Aid) through their public sector linkages program. You can find out more about this project and download the Indonesian Language FrontlineSMS training material here.