ChatSalud Aims to Empower Rural Nicaraguans to Advocate for their Sexual and Reproductive Health.
Guest post from FrontlineSMS user Lauren Spigel, and Nishant Kishore Co-Founders of ChatSalud
In Nicaragua, sex is embarrassing. Yet in a country where approximately 50 percent of the population is below the age of 18, and where 1 in 3 adolescent girls will become pregnant before they reach the age of 18, it’s clear that people are having sex—they’re just not talking about it due to pena—a wonderfully ambiguous word located somewhere between shame, embarrassment, and awkwardness.
When the only way to access reliable sexual and reproductive health information is through a face-to-face consultation with the community doctor or nurse, it’s not surprising that most people opt to get their sexual health information from “la calle”—or rather, from friends and family who may not have complete or accurate information. Rural populations are hesitant to consult with a doctor due to the perception that the community will find out and think of them as promiscuous, unfaithful, or diseased. As a result, misinformation about sexual health is rampant, especially among youth.
The ChatSalud team is comprised of Nicaraguans from various institutions, as well as Peace Corps Volunteers who are living and working in rural Nicaragua, in places ranging from the northern-most mountains all the way to the Río San Juan. From these collective experiences, certain realities have become abundantly clear to us: 1) there is a high rate of young girls getting pregnant; 2) women are at high-risk for developing preventable diseases, such as cervical cancer, due to cultural barriers to getting screened; 3) sexually transmitted infections often go untreated; 4) and lastly, more people have access to cell phones than to indoor plumbing.
Accordingly, ChatSalud aims to provide rural text-based education in order to empower Nicaraguans to advocate for their sexual and reproductive health, which will lead to positive behavior change such as increased condom usage, more testing for HIV and other STIs, and learning to use cell phones to access and share information regarding their sexual and reproductive health.
ChatSalud will work as a “ping-pong” system, which is designed to be interactive in nature so that the user can customize their experience with the platform, deciding which information to read and which to skip, based on a series of menus and coded themes. Our “ping-pong” system is modeled after FHI 360’s Mobile for Reproductive Health project in Kenya and Tanzania, though ChatSalud will differ in that it will cover a wider range of themes, ranging from HIVaids, sexually transmitted infections, reproductive health, and safer sexual practices.
The user will initiate the interaction with ChatSalud after viewing an advertisement such as a poster, radio spot, or television ad, or through talking with friends and family that have used the system. The user will send “info” to ChatSalud and will automatically receive an initial menu that will include the four umbrella themes: HIVaids, sexually transmitted infections, reproductive health, and safer sexual practices. From there, the user can choose which theme to learn about. All of the themes are coded by number in the ChatSalud system. The coded automatic responses will give rural Nicaraguans low-tech, text-based access to a plethora of information—essentially a sexual and reproductive health encyclopedia at their fingertips.
ChatSalud is quickly becoming a national-level mobile health platform. While we used a modem for initial tests with limited users, the modem began experiencing a lag time of upwards of 45 minutes. Since we are expecting a high volume of SMS traffic, the throughput required will be significantly more than could be provided by a modem.
Obviously a new system was needed.
While still in development, the new system, which will utilize FrontlineSMS Version 2 mounted on servers and remote browser-based access, will bring together resources provided by several local stakeholders. CIES, the Nicaraguan School of Public Health, will donate and maintain their servers, which will house the FrontlineSMS version 2 software. Meanwhile, a local tech firm, GüeGüe, will provide technical support and assistance to secure and maintain a VPN between the software housed at CIES and the local telecommunications network. The VPN will provide key links to both Claro and Movistar, the local telecommunications providers, and from there, connect to users nation-wide. While the old system could only send and receive six text messages per minute, this new system will have the ability to handle millions of text messages per day, ensuring a smooth and instantaneous interaction between ChatSalud and its users.
In order to gain governmental support, one of the major barriers we had to overcome was to figure out how to make the system 100% anonymous. Normally, when a user communicates with ChatSalud, their personal phone number is displayed along with their message. While we cannot use cell phone numbers and maintain anonymity, an identifying feature was still necessary to allow us to analyze our user interactions. We were lucky to connect with developer Alex Galonsky, who generously donated his time to help us modify the program. Alex’s solution was to hash the phone numbers of users as they come in to effectively create a “digital fingerprint” of each user without allowing system operators to view user phone numbers directly on the main interface. This allows us to provide basic anonymity to all users while still monitoring and evaluating the project’s effectiveness. This will also ensure confidentiality if we use the platform to open up direct communication between users and health workers in the future.
We are almost ready to launch ChatSalud. Before we can do so, we must secure funding to cover our SMS expenses. In spite of this remaining hurdle, with each passing week, we are gaining more and more momentum from local stakeholders. With our system in place and nearly ready to go, we hope to launch ChatSalud in the next couple months and start making an impact in the lives of Nicaraguans.
Happy 2013: user survey, the release of Version 2.2, and other news!
Here’s our first newsletter of 2013, posted here for your reading pleasure!
How are we doing? Help us get better: the 2013 user survey is OUT NOW
The development and growth of FrontlineSMS has been driven by feedback we receive from our active user community. Each year we give our users the opportunity to share their use and vision of FrontlineSMS through our annual user survey. This year is no different! We would like to hear from you through our 2013 User Survey – tell us how you’re using the software, how we can make it better, and help us show how FrontlineSMS is making a difference. The survey takes less then 10 minutes!
FrontlineSMS Version 2.2 now available for download from our website
Since version 2 of FrontlineSMS launched in June, we’ve been busy refining the software, fixing bugs, and adding new features in response to user demand.
Today’s release includes a number of new features: three new Activities, which let you set up auto-forward to SMS, Subscription services which add and remove contacts from groups, and web connections including a custom integration with Crowdmap and Ushahidi. We’ve also improved the way Keywords work, so that you can use multiple words separated by commas for the same action, allowing for spelling mistakes, multiple languages, and other variations.
For users experimenting with running FrontineSMS across networks, or just needing a bit of extra security, we’ve added basic authentication. You can now require a password to get into FrontlineSMS.
Users upgrading to Version 2.2 from other v2 releases can do so seamlessly without changes to the database or activities. What are you waiting for? Go download it!
Looking back: happy 7th birthday, FrontlineSMS!
In October 2012, we celebrated seven years of FrontlineSMS with a series of blog posts from the team about the users who really stick in their minds. Many users contributed very special photos which you can see on our Flickr page. We always want those photos because we think they’re awesome, so if you didn’t get yours in follow the link to the blog posts and send them in now!
Looking forward: Introducing Our Services
In December, we formally launched our social entreprise, which has been offering premium support services to our users since 2011. In the coming years, this work and other soon-to-be-announced developments will support the sustainable growth of FrontlineSMS for many years to come. You can read more about our services on our website, and get in touch with our team at email@example.com. We look forward to hearing from you!
News from the Community \o/
Here at FrontlineSMS we pride ourselves on our active and global user community. There have now been over 38,000 downloads of our software, and our online community forum has over 2,900 members regularly interacting with us and each other about their use of FrontlineSMS. Below you will find the latest news for and about our buzzing user community.
Call for Volunteer Translators
We are adding functionality to FrontlineSMS all the time, so we’re always looking for volunteers to help us translate the interface into our priority languages: French, Arabic, Spanish, Russian and Mandarin… and practically any other language out there! For more information on this, and to register your interest in helping out please email firstname.lastname@example.org.
Global FrontlineSMS Team Continues to Grow
We’re delighted to welcome three new team members in our cozy Kenya office. In November 2012, Joram Tayo joined FrontlineSMS as our Finance Officer and in January 2013 Okal Otieno joined as a developer. Joram joins FrontlineSMS from five years at CHF in Kenya, and we’re delighted to welcome him to the team. Okal has been a FrontlineSMS fan for a while now and interned for us last year. Its great to have him as part of the developer team. Finally, Alex Pitkin will be joining us as Business Analyst and Product Manager for six months while taking time out from his glamorous roles at Team Rubber and Delib in London and Bristol, UK. Delighted to have him on board. \o/
Meet the rest of the FrontlineSMS team at http://www.frontlinesms.com/about-us/the-team/
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FrontlineSMS is built and distributed for free by a non-profit US Foundation. If you are a fan and would like to support us, please feel free to make a donation to FrontlineSMS. Your donation will be highly appreciated!
Thanks for reading our latest newsletter – we hope you’ve enjoyed it and we’d love to hear what you think. Let us know your views, your requests for future newsletters and any other comments at email@example.com.
The FrontlineSMS Team
A Few Words About Problem Solving
As anyone who knows me will tell you, I’m a bit obsessed with words. Not just words themselves, but how we use them, what that shows us about how we think, and what it means when their definitions creep. It’s a side effect of having been trained as a lawyer and a journalist, I think. Or at least, that’s what I blame it on. Either way, it’s gotten me thinking about something. We have to change the way we talk about solving problems.
Let me explain. We, at FrontlineSMS, are very lucky to have a lot of friends,users, and partners who are trying to fundamentally change the way that we, as a world, operate. Many of these friends, over the years, have been recognized for their incredible work using just about every buzzword out there, from innovators to entrepreneurs to technologists to… you get the point. While I join the rest of the world in applauding the work they do, I worry about what it means that we lionize people who understand something we should all realize: problems are almost never solved and one solution almost never works for everyone. Somehow, acknowledging a state of constant change has became synonymous with a sprawling new vocabulary that tries to categorize people who solve problems.
I’m all for recognizing those who catalyze change- I’m just also concerned that by celebrating them as unique, we externalize what they do and, in some small way, absolve ourselves of responsibility for pushing change in our own contexts. Lots of people have recognized the extreme diversity of problem solvers- I’ve found them everywhere.
One of the common things that I notice in almost all of the people who are changing the world is that they recognize the evolving nature of problems and the contexts in which they happen. I’ve found these people in government, non-profits, and, of course, business. Entrepreneurs were, prior to a few years ago, people who made businesses. They were not vanguards or innovators or harbingers of the brave new future, they were people who made their business in, well, business. There wasn’t an ‘entrepreneurial’ way of looking at the world, there were just people who identified market opportunities and worked within growing investment markets and business models to meet them. The thing is, all that really describes is problem solving with a profit motive, and people have been solving problems with varying degrees of profit motive for… as long as we’ve been around. The way we use these terms loses the forest for the trees.
More important than the use of the words, though, is what it says about how we think. So let me be clear about some of my core assumptions and what I think they mean:
1.) Things are now, and have always been, changing. Technological evolution, scientific breakthroughs, climate change, urbanization, and globalization (to name a few), shift the circumstances in which we live and make decisions, requiring us to constantly reconsider the way that we solve problems, provide services, share knowledge, and act as collectives. What has changed beyond precedent, though, is the rate of change. Things are invented, distributed, contextualized, fragmented, broken, and reinvented so quickly now that the only thing that is constant is change. The only stable assumption is instability.
2.) Humans are inherently path-dependent creatures. From the very beginning of learning how to solve problems, we find a solution, learn it, and then stop looking for more solutions to that problem, until it doesn’t work anymore. In the meantime, though, everything around the problem changes and by the time we’re seeking a new solution, so much of the context has changed that we struggle to understand the larger concepts (i.e.- having to explain the whole Internet in order to show someone how to pay a bill online). The difficulty of teaching people new habits is one of the largest obstacles to the development and deployment of new systems to solve problems.
There are a number of major things that have happened in the last hundred years that make this even more complicated, such as the doubling of human life expectancy (meaning that we have to solve problems over a much longer span and a lot more changes to try to process) and the exponential growth in information and human connectedness (increasing the amount of information we need to process, the number of problems we encounter, and the complexity of the contexts in which they exist). Human nature is increasingly ill-suited to navigate the reality that it is creating.
More fundamentally, though, we need to break the cognitive habit of developing path dependency, at least to the degree possible. It’s only by building fluid problem solving habits and institutions that are inclusive of multiple approaches across diverse contexts that we’ll be able to manage the incredible complexity that our changing, collective problems create.
3.) Institutions and markets are the systems that we’ve developed to solve problems. The problem is, though, that they have grown at very different rates. Institutions and governments have the dual responsibility of supporting (and regulating) markets, while establishing and enforcing protections for individuals. Conversely, markets now evolve at a rate that institutions aren’t structurally designed to manage, let alone bridge the growing gap between businesses and people.
In most countries, governments institutions are, very intentionally, charged with controlling the rate of change of everything from cultural norms, business practices, currency, etc. in an effort to make sure that it results in the collective good. We have given governments and organizations the responsibility for identifying our needs and teaching us, collectively, the habits and behaviors that meet them. Obviously, success varies, but most institutions have not built the learning processes or internal mechanisms necessary to keep pace with the accelerating environment around them.
There is no question that there’s a need to change the way we solve problems, but that doesn’t necessarily require a profit motive. You do not have to be an entrepreneur to fix a system, you have to understand the problem it solves, the context of that problem, and the ways that new approaches can improve that solution.
There is an emerging term for people who are focused on new ideas within organizations: intrapreneur. The term refers to people who bring new ways of doing things (although, more commonly, just new ideas) to an existing organization. In my opinion, the term acts to the detriment of the ideas it intends to support- but more on that in the conclusion.
It is imperative now, more than ever, that we explicitly begin building flexibility into institutional and governance mechanisms. Likely, this will mean creating institutional processes capable of continuously generating new paths to the same outcome and finding ways to consolidate their outputs into a single process. And while market viability matters, it’s important that we don’t confuse managing change with being motivated by profit.
4.) There is a quote by William Gibson, given new life by Tim O’Reilly: “The future’s here. It’s just not evenly distributed yet.” I’ve always loved this quote for how it captures the challenge of the spreading future, but it speaks to a vision that I struggle with.
There is no one future. And we don’t appear to be getting closer to one future, at least not in how we communicate with information and each other. The world around us is fragmenting, not coalescing. There are more countries (and governments), technologies, and types of infrastructure than ever before. The ways that we publicly and privately invest in infrastructure, business practices, and regulatory reform is driving a more variable, not uniform, landscape for human interaction. In order to manage the wide range of challenges posed by this fragmentation, we will all have to become better at managing complexity, contextualized design, and constant change. We must fundamentally change how we see problems- they are not ever solved, they are just waiting for a better solution.
The increasing use of words like “entrepreneurialism,” and “innovation,” is a sign of the creeping cultural recognition of the importance of system improvement. At the same time, entrepreneurialism implies a profit motive that artificially limits and externalizes the motivations and approaches that attract people to solving problems. Markets will likely continue to be better at recognizing opportunities, supporting solutions, and compensating growth, but it will take all of us to build institutions and governments capable of supporting that growth. That will probably require us to change the way that we think, learn, and interact. It will certainly require us to take responsibility for changing our own habits and contexts for the better. I’m not suggesting that everyone is an entrepreneur, then the word would lose meaning. In a world where we will all have to learn to identify opportunities and participate in problem solving, thank goodness everyone isn’t.
Don’t Call It A Comeback: 5 Reasons SMS Is Here To Stay
SMS remains the most popular two-way communications platform on the planet. In most cases, it’s inexpensive, casual, and discreet for users. It also represents one of the more profitable features offered by mobile network operators. And while SMS does face an increasingly fractured market, largely from the growth of messaging apps, it’s not going anywhere anytime soon. Here are 5 reasons why:
1) SMS is growing, not shrinking
Indeed, SMS is continuing to grow at an incredible rate globally. In 2011, more than 7.8 trillion SMS were sent worldwide. That vastly outpaces every other messaging platform combined. Over-the-top (OTT) messaging (instant messaging platforms like WhatsApp, iMessenger, BlackBerry Messenger, etc., also known as application-to-person) represent 3.5 trillion messages, combined. Multimedia messaging service (MMS) adds another 200 billion. The rate at which SMS are sent is increasing, and is expected to increase each year at least through 2016, according to several research firms.
2) SMS is a major revenue driver for mobile network operators worldwide
SMS represents 63.5% of mobile messaging revenue globally. And it represents somewhere around 10% of an average operator’s revenue streams. I have a hard time believing MNOs won’t think of ways to add value to SMS, or reduce the cost enough that it still makes sense for consumers.
In fact, there are multiple examples of them taking this step. For instance, SMS sent via first delivery attempt mechanism can potentially save money on 80%-90% of text messages. Clever bundling can also drive revenue: here in the United States, we bundle SMS with our calling plans, meaning there’s no ceiling to how many messages a given subscriber sends in a month on his or her plan. What’s the disincentive to use SMS?
3) SMS is platform agnostic and highly reliable
I can (and do) use iMessage with friends who also have iPhones. But what about friends who have Android-based mobiles? Colleagues whose businesses use BlackBerry devices? My mother, who uses a feature phone? To reach them, SMS is the most reliable option. This is due to the simple reason that it’s hard-coded into the global mobile infrastructure, requiring distribution across all phones and carriers.
What’s more is that I find iMessage and other chat applications to be unreliable. SMS, on the other hand, works even in extremely resource-limited conditions, including lack of internet access and even moments of cell tower traffic congestion. For example, in emergencies, texts have a higher chance of reaching people than other forms of communication. This level of low-resource ubiquity is unmatched in the global communications infrastructure.
4) Increasing use in business, government and non-profit sectors
SMS is seeing a dramatic increase as a tool for businesses, governments and non-profits to interact with large populations. For example, Detroit recently introduced a Text-My-Bus program that allows people using public transport to learn when the next bus is arriving at a given stop. Businesses are increasingly looking to SMS as an opportunity for advertising special prices or events to clients. UPS, for example, uses SMS to notify clients as to the progress of their package deliveries. And non-profits are increasingly participating in text-to-donate programs, where donors can send a brief message to a short phone number and a small donation is added to a cell phone bill. Most famously, the American Red Cross raised more than $43 million with its text-to-donate campaign following the 2010 earthquake in Haiti.
I suspect they choose SMS over a messaging service largely because user adoption rates are so high – see my previous point about SMS being platform agnostic. With so many mobile phones in circulation, there’s only one global messaging platform at the moment. For people wanting to reach a large audience via a convenient messaging feature, SMS is the only real option. As these services gain more traction, people will continue to interact with them via SMS.
5) Chat Is Attempting To Emulate SMS Success
Many analysts see built-in messenger apps, such as iMessage, WhatsApp, Mxit and others as a threat to SMS. These apps operate on a users’ data plan, rather than through the SMS protocol. The argument follows that in cases where data plans are cheaper than SMS plans, users will choose the least cost route, thus supplanting SMS as the most popular platform. To be fair, we’ve seen this happen in a few places. Hong Kong, Australia, and Finland have seen drops in SMS usage. In the US, SMS usage leveled off in 2011 for the first time. But a dip in usage does not translate to an evaporation of an entire platform. Indeed, SMS is still the most popular platform in the US, despite the relative ubiquity of iMessage, Blackberry Messenger and Facebook chat.
Portio Research takes this argument a step further, suggesting that messaging apps may only be an addition to an increasingly fragmented market, rather than being an SMS killer:
“Does a boost to one messaging type have to equate to a usage drop in another? Does it have to mean cannibalisation of SMS? What about synergy? Side by side traffic growth? And what of the other messaging mediums of MMS, mobile e-mail and mobile IM? After all, while messaging users love to communicate seamlessly, popular modes of communications do vary – and maybe OTT isn’t a replacement, but rather just one more segment of the messaging mix.”
At FrontlineSMS, we’d agree – multi-channel engagement doesn’t mean the end of SMS. It means a boom in mobile messaging across the board, including for SMS.
In an increasingly device-rich society, with wild differences in access to infrastructure and technologies of all kinds between the very poor and even the moderately well-off, multi-channel communications are critical if service providers and businesses are to engage effectively with everyone in a community, all of the time. Each platform and channel of communication has trade offs, and as we’ve argued elsewhere, your choice of platform not only presents opportunities – to sharing video, or messaging more cheaply across cell data – but can close doors to those without the kit or the credit to access them. Multi-channel approaches, such as the Praekelt Foundation’s Young Africa Live, which combines SMS with feature- and smart-phone apps and a website, offer the broadest possible number of options for individuals to engage with its message. Despite the brevity of the format, SMS has a valuable place in this spectrum, both as a lowest-common-denominator technology, and as a communications platform that often works when all others fail.
In a multi-channel world, where successful engagement and data capture are increasingly critical, and as businesses focus more and more on reaching previously difficult markets in low- and middle-income countries, who can afford to discount the world’s most accessible, most widespread, digital communications medium?
Star FM in Zimbabwe ensure Young People are the Stars
Republished from the FrontlineSMS:Radio blog:
Star FM in Bulawayo, Zimbabwe was established in October 2000 to address a specific need for a platform to allow young people living in the Bulawayo Metropolitan Province to discuss issues affecting them. The founders also realized that there was no radio station targeted at youth in the country. Although Star FM does not have a license to broadcast, they distribute audio content on CDs, over the Internet and via satellite. Amy O’Donnell and Emily Cholette from FrontlineSMS:Radio recently spoke to Star FM’s Director, Philani Ncube, about how the station is expanding opportunities for youth participation.
Check out an excerpt below or read the post in full here.
As with other community radio models, the Star FM community owns, manages and determines the content for programs – and in this case it is a community of young people. It is important for Bulawayo Youth Broadcasting to encourage youth participation because, as Philani explained, “They are the future leaders. The youth are encouraged to participate as they know that these issues affect them directly.”
Young people are engaged with the station in varying degrees, with some taking very active roles like presenting programs and being interviewed on the day’s topic or participating in roadshows. Philani shared the ways Star FM is looking to expand options for listeners to respond to content they hear: “We do not have phone in programs since we do not broadcast live, but the audience give feedback using our Facebook page and most recently through SMS coming into FrontlineSMS.”
High mobile penetration in Bulawayo presents Star FM with an opportunity to open new channels for participation, and Philani shared some of his ideas: “SMS is very important for Star FM to reach the youth since we are not live on air.” Being asynchronous means opinions can be gathered in an ongoing way and presenters can incorporate messages into the content they develop. Philani and the other presenters have recently started using FrontlineSMS to involve the youth audience on the discussions covered in the show. “It seems to be a better method of reaching quite a huge number of youth in the community with limited channels of communication.” Philani explained. “Further, it will benefit the radio station as the listeners will get timely updates of the station’s activities so as they become more engaged, we can expand our followers.
To read this post in full click here
More photos and information can be found on Star FM’s Facebook page.
To learn more about uses of SMS with radio, visit the FrontlineSMS:Radio website
With thanks to Emily Cholette for initial research into this great use case!