Health

A mobile phone text messaging service and a new webportal are bridging the information gap on diabetes in Kenya, where the disease annually kills more people than HIV/AIDS

By P-B Halberg, International Media Support (IMS), and Sandra Sudhoff, CartONG A new project aims to improve diabetes awareness and reliable communication about the disease throughout Kenya through mobile phone technology and a webportal.

Patient's Rights: Cambodian Vaccine Clinic Builds Local Reporting System Using FrontlineSMS

Patient's Rights: Cambodian Vaccine Clinic Builds Local Reporting System Using FrontlineSMS

In the spring of 2012 the Institut Pasteur du Cambodge of Phnom Penh (IPC), Cambodia conducted a pilot study on a text message-based pharmacovigilance tool. Don't know what pharmacovigilance is? Not to worry, neither did I! According to the World Health Organization, "Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem." The IPC used FrontlineSMS as a tool to follow up with patients after they received vaccinations.

VNI Service Award Finalist Pierre Omadjela uses FrontlineSMS to Raise Malaria Prevention Awareness in the Democratic Republic of the Congo

VNI Service Award Finalist Pierre Omadjela uses FrontlineSMS to Raise Malaria Prevention Awareness in the Democratic Republic of the Congo

Congratulations to Pierre Omadjela for being recognized as a finalist for Cisco’s VNI Service Awards for his work in healthcare awareness using FrontlineSMS! The World Health Organization estimates 80,000 citizens of the Democratic Republic of Congo (DRC) died in 2010 from Malaria. The mosquito-transmitted disease is responsible for 40% of the mortality in Congolese children under five, and in a country where a quarter of the population lack access to healthcare facilities, promoting prevention has proven to be more effective than only treating infected patients. The President’s Malaria Initiative, launched in 2005 through USAID, provides malaria prevention and treatment in five provinces, which make up 26% of the DRC’s health zones.

Health Information for Remote & Rural Eastern Indonesia

Health Information for Remote & Rural Eastern Indonesia

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.

A project with teeth: improving dental health outcomes in the Gambia using FrontlineSMS

A project with teeth: improving dental health outcomes in the Gambia using FrontlineSMS

'As part of our Masters program at Drexel University School of Public Health, we were afforded the opportunity to work on addressing public health concerns in the Gambia for six weeks in summer 2012. We would be working on a community-based masters thesis. Our project focuses on advancing mobile health concerns by improving dental health practices using SMS messaging, as well as enhancingvaccine inventory control at village trekking sites. Health workers could manage referrals, follow-up treatment, and reminders to patients using SMS.

A Day Well Spent at FrontlineSMS

A Day Well Spent at FrontlineSMS

Given the incredible growth in mobile usage in the last decade, it comes as no surprise that many organisations are embracing the use of mobile technology to expand their reach and engage with communities. This has come with its fair share of challenges, given some of the limitations of technology such as poor mobile connectivity in some areas, SMS has become the more reliable and inexpensive option.

FrontlineSMSat7: Your Health is in Your Hands

In the fifth of our seven blog posts celebrating the month that FrontlineSMS turns 7, Sila Kisoso, our Community Support Manager, shares her first inspiring encounter with FrontlineSMS - at her previous role with the Innovations for Poverty Action Water, Sanitation and Hygiene (IPA-WASH) Benefits Project in rural Kenya. 

Data-mining our download records - what download registration did, and didn't tell us about our users

By Kavita Rajah and Laura Walker Hudson FrontlineSMS software is used in such a wide variety of sectors that often people are surprised to hear that the inspiration for FrontlineSMS originally came specifically from conservation work. Throughout 2003 and 2004, FrontlineSMS Founder Ken Banks was working to find ways to help authorities engage and communicate with communities in wildlife conservation in South Africa, without relying on the Internet. Ken realised he needed a system that could send, receive, and organize text messages through a mobile device and a laptop without needing the Internet, and from that the original concept of FrontlineSMS was born. The software was developed in the summer of 2005 and made available online that October.

Six years on, despite the very context-specific inspiration for the software, FrontlineSMS has now been downloaded nearly 27,000 times and is in use in over 80 countries, in 22 different areas of social change work. Until the recent release of FrontlineSMS Version 2, users were asked to fill in a form telling us who they were and how they were planning to use FrontlineSMS before being given a download link. Following up on this data gives us the links with users that lead to our case studies and FrontlineSMS in Action blog posts. We recently analyzed the whole dataset to learn more about how, why and where people seek to use our software. What we were able to glean from it was interesting. Among other fun facts:

  • The top 3 sectors in which FrontlineSMS is being used most are Education, Health and Civil Society
  • The country that has downloaded FrontlineSMS the most is the United States, followed by Kenya and then, India - we think that a lot of downloads from North America and Europe are intended for use elsewhere
  • Africa accounts for 35% of all downloads - more than any other continent. 25% of downloads are from Asia, and 17% from North America.

Interestingly, some geographic regions have large numbers of downloads in certain sectors. For example, West Africa has the highest number of downloads in Election Monitoring and Engineering, while Europe has the highest number in Arts and Culture. Asia has the highest number of downloads in the Media sector.

However, the limitations of this dataset got us thinking about how we gather information on our users.

Gathering data about how FrontlineSMS is used is critical for us on a number of fronts - it helps us to improve the software, enables us to report to our donors and the public about the impact of our work, and helps inspire others to use SMS in their work in new and more powerful ways. Although the download data was useful, it could only give us a snapshot of a user's intention at the time they downloaded FrontlineSMS - it was difficult to link this with data about actual use, from the statistics-gathering module in version 1.6 or later, or from our annual user survey, and many users didn't go on to use FrontlineSMS as they'd intended. The most informative element of the form was a freetext section which allowed users to give us potentially quite a bit of information about our plans - but is hard to parse and analyze and often included hardly any data. The only way for users to download anonymously was to give false or junk information on the form.

When we came to plan the release of the new software, we thought very differently. Version 2 of the software is a one-click download that asks users to register when they install. Information collected in this way is sent back to us over the web, when the system sees the internet - we'll be adding support for registration via SMS later. We are committed to allowing users to maintain their anonymity, as we know many are activists (if you are one of these people, you should read our Data Integrity Guide!). You will always be able to opt-out of in-app registration - although it means we get fewer registration records, we know we can trust the data we get. In future, we'll also be building better ways for users to keep in touch with us and each other, and share information about what they're doing with FrontlineSMS, using the website.

We'll keep analyzing the data and posting updates here - in the meantime you can read the analysis of our 2010 and 2011 user surveys here.

Data Collected via FrontlineSMS is used by Ministry of Agriculture in Cambodia

In this guest post new FrontlineSMS user, Sophie Baron, shares how she is currently using FrontlineSMS in a pilot study to monitor and contain the spread of animal diseases in Cambodia. This pilot was initiated by Dr. Flavie Goutard and Dr. Sebastien Le Bel from the Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD) and the Institut Pasteur du Cambodge (IPC). It is now providing valuable information to the Cambodian Ministry of Agriculture Forestry and Fisheries, through their National Veterinary Research Institute (NaVRI) at the Department of Animal Health and Production. In this post Sophie explains how the pilot has been set-up to overcome communications challenges, and discusses how FrontlineSMS is helping enable successful tracking and containment of animal diseases. By Sophie Baron

Infectious animal diseases are a major threat for the agricultural community in Cambodia. If levels of animal diseases are not monitored and contained effectively, this can have a negative impact on farmer’s livelihoods. I am working through the CIRAD, alongside IPC and NaVRI, to implement a targeted monitoring and surveillance system for animals. A pilot study is currently being implemented in two rural Cambodian provinces - Kampong Cham and Takeo. The sample for this pilot study is made up of 10 villages from each of 3 districts in both provinces; making a total of 60 villages. From each of the 60 villages, we asked the village chief and a selected village animal health worker (VAHW) to report the number of dead cattle, chickens, ducks and pigs in their village on a weekly basis. They were also asked to report the number of cattle infected by Foot and Mouth Disease (FMD) and Hemorrhagic Septicemia (HS); and the number of cattle that died from these infections.

The data reported via SMS by village chiefs and VAHWs helps to provide a more accurate baseline of animal mortality, and serves to alert NaVRI when mortality is higher than usual. If the reports being sent indicate that mortality is high, someone from NaVRI is sent to the relevant village to take samples from the animals, which are used to diagnose the condition. Based on this diagnosis appropriate actions are taken which curb the potential for an outbreak. Receiving regular data via SMS - and being able to manage this data within FrontlineSMS - helps enable NaVRI to adopt more timely and effective response mechanisms to breakouts of animal diseases.

When we were designing the pilot study, there were some interesting challenges that we had to consider. The pilot was targeting rural areas where access to internet is slow, so we had to build a solution that was accessible. Luckily, most people have mobile phones in these rural areas, but there is also a low usage rate of SMS in Cambodia. This is partly because phones do not support Khmer characters – which is the official language in Cambodia - making texting very difficult, and in some cases impossible. In addition, a phone call costs approximately the same as an SMS in Cambodia, thus reducing the incentive to communicate via SMS.

However, the high access to mobile phones means that SMS still offers a viable solution and enables effective data collection; we just had to be aware to design our use of SMS to suit the context. To get around the language challenge, we implemented a numbering system so that users just had to submit reports via SMS using numerical values as opposed to sending fully written text messages. We went to the villages and offered personal training to those who would be submitting reports via SMS, and further explained and documented the numbering system. In order to incentivize people to send their SMS reports the cost of SMS is reimbursed. On a monthly basis, VAHWs and village chiefs are given sufficient mobile top-up to be able to send SMS reports throughout the month.

The way we have designed the pilot seems to be working well. In the first few weeks, there was a 90% rate of response from the VAHWs. We have experienced some initial errors in the report format, but Ms. Kunthy Nguon, research assistant at IPC was able to call to follow up and clarify any incorrect reports, and to inform those reporting of the correct way to structure the content.

Since the pilot has proved efficient in helping us to receive timely and accurate reports so far, I have recently installed FrontlineSMS at NaVRI, where reports will continue to be monitored. The pilot started in February 2012 and will continue as a pilot study until June 2012. Following this point, we will evaluate the success of our use of FrontlineSMS and we will be looking for funding to continue the project from June 2012 and to expand into additional provinces.

Under the supervision of Dr. Arnaud Tarantola, head of the Epidemiology and Public Health unit at IPC, we are also currently reviewing ways that FrontlineSMS can be used in some other IPC projects, for tasks such as monitoring success of patient vaccination and collecting patient feedback. It has been really valuable to investigate the different potential uses of FrontlineSMS across public and animal healthcare, and we hope to expand use of the software moving forward. Sophie Baron is a veterinarian doing a Masters in Public Health, and specializing on epidemiologic surveillance of human and animal diseases. Thanks to a Fondation Pierre Ledoux scholarship, Sophie is doing a six month internship based at Institut Pasteur du Cambodge (IPC) as part of her studies.

Faster Channels of Communication: A Radio and SMS Initiative in NE Kenya

Infoasaid has recently shared some news about an initiative with Save the Children in Wajir, Kenya, which is using FrontlineSMS to communicate with field workers and community representatives. Meanwhile, the radio is being used to share information about health, education and food security.

The objective of Infoasaid - a consortium of Internews and the BBC World Service Trust - is to improve how aid agencies communicate with disaster-affected communities. The emphasis is on the need to deliver information, as aid itself, through the most appropriate channels. You can read more about Infoasaid's work on their website http://infoasaid.org/

The article is republished below with permission, or read the original post here.

Infoasaid has helped Save the Children to improve its two-way communication with half a million drought-affected people in Northeast Kenya.

The project uses mobile telecommunications and community radio to establish new and faster channels of communication between the aid agency and remote rural communities.It was launched in Wajir County, close to the Somali border, in the fourth quarter of 2011 and will run during the first six months of 2012.

Save the Children runs vital health, nutrition and food security projects in Wajir County, a semi-arid region which has been devastated by three years of drought and serious food shortages. Its operational centres in Wajir and Habaswein will use SMS messages to exchange information with health workers, relief committee members and community representatives in outlying areas.

Save the Children will also sponsor special programmes on Wajir Community Radio, the local radio station. The radio station broadcasts in Somali, the main language spoken by local people. It commands a large and loyal audience within 150 km radius of Wajir town.

Most people in Northeast Kenya are semi-nomadic pastoralists. They depend on their herds of camels, cows, sheep and goats to feed their families and generate a small cash income. Infoasaid therefore set up weekly radio programmes that will inform local people about the latest animal prices and market trends in the area’s two main livestock markets; Wajir and Habaswein.

It also helped Save the Children to design a weekly magazine programme on Wajir Community Radio. This will focus on key issues related to the aid agency’s emergency aid programmes in the area. The radio programmes, which include a phone-in segment, will focus on issues such as health, education and food security and alternative livelihoods.

The mobile phone element of the project will establish FrontlineSMS hubs at the Save the Children offices in Wajir and Habaswein. FrontlineSMS is free open source software that turns an ordinary computer into a text messaging exchange.It will enable Save the Children to broadcast SMS messages simultaneously from the computer to a variety of different contact groups in the field.

Each message is drafted on the computer, which then uses the FrontlineSMS software to send it by SMS to a large group of recipients.In this way, the same short message can be sent rapidly to a group of 50 or more people through a simple operation that takes less than two minutes to perform.

Previously, Save the Children staff would have had to telephone or visit each of the targeted individuals personally to deliver the same message. That process could have taken several days to complete

The FrontlineSMS hubs in Wajir and Habaswein will not only send out vital information. They will also capture and record incoming messages from people in the field. Each incoming message will be evaluated immediately and passed on to the appropriate person for a timely response.

Infoasaid supplied 240 basic mobile handsets and solar chargers to facilitate the establishment of these two SMS messaging networks. The equipment is being distributed to collaborators and community representatives in every location where Save the Children provides local services.

To read the original article please click here.

Get the Word Out: Using SMS to Support Harm Reduction for Vulnerable Women

Guest post from FrontlineSMS user Gordon Gow, University of Alberta Here at the University of Alberta we are using FrontlineSMS to support graduate student research in communication and technology. Among its range of activities, the Mobile Applications for Research Support (MARS) Lab provides access to FrontlineSMS and mobile phones to allow students and community groups to set up and run pilot projects using text messaging.

UniAlberta2
UniAlberta2

Among our projects, the MARS Lab is providing support for “Get the Word Out” program operated in partnership with Edmonton’s Centre to End All Sexual Exploitation (CEASE). CEASE works through partnerships to create and pursue strategies to address sexual exploitation and the harms created by prostitution. Their work includes public education, client support, bursaries, counselling, trauma recovery and emergency poverty relief for individuals working to heal and rebuild their lives after experiencing exploitation.

“Get the Word Out” is a harm reduction service that uses FrontlineSMS to enable women involved in prostitution to anonymously report incidents or concerns about violence or crime that is affecting them or may affect others. The program also offers an network for these women to share thoughts or provide peer-based social support using anonymous text messages. FrontlineSMS is set up to auto-forward incoming text messages to a distribution group that includes frontline support agencies and clients who have chosen to subscribe to the service. The auto-forwarding process removes the callerID from the text and preserves only the contents, ensuring anonymity of the issuer. Text messages are also forwarded to a set of email addresses provided by the frontline agencies, as well as a protected Twitter account.

The MARS Lab is also involved in other projects using FrontlineSMS.  For example, it is working in collaboration with Simon Fraser University to pioneering the use of FrontlineSMS in combination with Ushahidi to explore the use of social media in campus health and safety.  This project is using FrontlineSMS to receive text messages from students and staff at both the University of Alberta and Simon Fraser University to report health and safety concerns on campus. The goal of the project is to better understand how text messaging can provide a low cost, low barrier means of reporting to encourage the campus community to help mitigate risks to health and safety on a university campus.

Furthermore, in early 2012 the MARS Lab will be launching a pilot project in partnership with LIRNEasia and the Sri Lanka Department of Agriculture to explore the use of text messaging to support Agricultural Extension Services in the Dambulla and Matale districts. This pilot will involve deployments of FrontlineSMS at three agricultural information centres and is also expected to include a deployment of FrontlineSMS:Radio with a local radio station to support audience interaction for one of the live agriculture talk shows.

It's great to see the diverse range of projects which the University of Alberta is supporting in their use of FrontlineSMS! This post was originally shared on the FrontlineSMS Community Forum. You can see the full original post and connect with Gordon on our forum here.

Using SMS to Help People with HIV in Rural Kenya

Guest post by Ben Parfitt, Ugunja Research Team

Africa has undergone a mobile revolution, and it is spreading. The health sector is capitalizing on the resulting plethora of new opportunities. Doctors, nurses, health workers and pharmacists often rely on their mobile phones, using them as a reference tool, accessing information otherwise unavailable to them. Among this rapid change, a coordinated movement is beginning to engage people living with HIV, en mass, through FrontlineSMS.

Cleopa Otieno, KenTel National Coordinator, works with a network of 42 telecenters throughout Kenya, providing technical solutions to help communities reach out. KenTel has helped introduce FrontlineSMS to many health centers in Kenya. “Health centers are of great interest,” Cleopa explains. “Last year we began to focus on sending text messages to help people living with HIV.”

St Paul’s health center in Ugunja, western Kenya, formed part of a pilot study, to investigate the effectiveness of using SMS to support those living with HIV. In this rural town near the Ugandan border, nine out of ten residents regularly use a mobile phone, according to our recent survey. And of those, over 72% ranked mobile telephony as the most important technology they use to get information and to communicate.

The pilot study involved sending a course of SMS messages to 268 people living with HIV up to three times a week. Trial messages included: “Wash hands with soap and safe water before handling food, eating and after visiting the toilet. Wash fruits and vegetables with safe clean water before eating them.” It was hoped that such advice would help prevent infection and illness among those most vulnerable.

Important lessons were learned through this pilot study. It was revealed that patients knew how to act, but many were not aware of the underlying reasons for doing so. Yet it also became clear that too much was being communicated in too short a time frame and they soon became overwhelmed. The patients wanted to know why this information mattered and they wanted clear, practical solutions dealt out in small, manageable chunks.

It also became clear that technology couldn’t substitute the face-to-face community meetings which penetrate many corners of life in Ugunja. We learned that FrontlineSMS is to be used in addition to, not instead of, such personal that are so ingrained into everyday life.

The health center is now preparing to roll out the initiative to all of its 450 people living with HIV. Many different people – staff and volunteers – are helping prepare for this roll out. Three students, from the Radboud University Nijmegen in the Netherlands, have helped lay the foundations for this roll out, compiling a digital database from which to send mass messages using the FrontlineSMS service. They have also supplied a laptop for the health centre to use, along with basic IT training.

St.Paul’s nutritionist, Isaac Masinde, is one of three healthcare workers managing content. He is working with FrontlineSMS to deliver nutritional interventions, especially for people living with HIV who become undernourished. “It is important to remind them of the most effective times to eat and to take their food by prescription dosage," Isaac explains. “We advise them on dietary measures to be taken to improve their BMI. I can see that this is picking up gradually.”

This may be just the beginning of using technology to help support people living with HIV. “We want to make further use of an interactive voice recognition system, allowing patients to call the health centers, listen and leave questions,” explains Cleopa. By using a range of communications tools it is hoped that the health center can reach and help support as many people as possible.

Ben Parfitt worked in rural Kenya as part of the Ugunja Research Team this summer. Kindly supported by the ICT4D Collective at Royal Holloway, University of London and by the Royal Geographical Society’s Gumby Award. Visit www.ugunja.wordpress.com to follow the team’s progress.

Innovation in practice: Family planning via SMS

Florence Scialom, FrontlineSMS Community Support Coordinator, speaks with Esha Kalra, Georgetown University’s Institute for Reproductive Health (IRH) Programme Associate

It is difficult to bring an innovative idea to life, without first proving its potential in practice; there is a need to demonstrate on a small scale that something actually works before it can make a big difference. FrontlineSMS can be used as a tool in this process - as a free and easy to use software it can be used to test a concept before an investment is made in any costly software development.

Georgetown University’s Institute for Reproductive Health (IRH) is a global organisation dedicated to improving reproductive health worldwide, and they have been able to test the value of their latest m-health initiative using FrontlineSMS. This m-health service, called CycleTel™, empowers women by providing accessible reproductive health information via SMS. I recently spoke with Esha Kalra, India-based IRH Programme Associate, to find out more about CycleTel, and the value IRH gained through using FrontlineSMS.

As IRH explains, “CycleTel facilitates use of the Standard Days Method® (SDM), a fertility awareness-based method of family planning based on a woman’s menstrual cycle. Appropriate for women who usually have menstrual cycles between 26 and 32 days long, SDM identifies days 8 through 19 as the fertile days. To prevent pregnancy, the couple avoids unprotected sex on these days.” By making this fertility information accessible via SMS, CycleTel empowers women to have more control over their reproductive health. “We found the process straight forward and easy to explain to women who participated in testing the service,” Esha told me, explaining her experience of managing one of CycleTel’s testing phases.

IRH used FrontlineSMS to support two phases of manual testing of the CycleTel concept, in Lucknow and New Delhi, both in India. For the first phase in Lucknow, 30 women were selected to participate in the trial, and in the second phase in New Delhi the number of participants rose to 90 women. Esha was responsible for managing a number of the study’s components, including operating FrontlineSMS during the second phase in New Delhi. Esha explained to me that she very quickly picked up the variety of FrontlineSMS functionalities which could serve the needs of the project. “I do not come from a technical background, but I found messages easy to organise and send, using the group and key word functionality. In addition, the data we collected was easy to manage because we were able to regularly export it from FrontlineSMS,” Esha explained.

A notable step taken by IRH to get staff accustomed with FrontlineSMS was to create a project manual ahead of using the software. This manual drew content in part from information in the FrontlineSMS help files, but it was tailored by IRH to suit CycleTel’s programme needs. Esha described the value of this, stating that, “it really helped to have everything documented before the start of project; the manual laid out how to use FrontlineSMS to meet our project requirements and made project management much easier.” It was this forward planning on the part of IRH, combined with ease of use of FrontlineSMS that led the project to its initial success.

There have been positive proof-of-concept results from this test phase – with the majority of test users saying that they would like to continue to use the service and would recommend it to a friend. The formative research using FrontlineSMS, and especially the feedback from test users, was absolutely essential to determine the potential scope of the CycleTel service. As a result of CycleTel’s formative research results, IRH decided to pursue customised software development to automate the service. For IRH, being able to test CycleTel using FrontlineSMS proved to be a critical step in the iterative process they are now taking from concept to scale.

IRH are currently working with us to produce a full case study on their use of FrontlineSMS, so keep an eye on our blog for further details on this coming soon!

Malaria Diagnosis in Real-Time via SMS

Re-posted from the Malaria Consortium blog, with permission from Steve Mellor, Malaria Consortium Systems Manager Malaria Consortium, with the support of the Bill & Melinda Gates Foundation-funded CONTAINMENT Project, is pioneering a Day 3 positive alert system in Ta Sanh district, western Cambodia, using mobile phone and web-based technology (including FrontlineSMS) to facilitate response in real-time. CONTAINMENT’s Sonny Inbaraj reports.

Effective containment of multi-drug resistant falciparum malaria depends on timely acquisition of information on new cases, their location and frequency. This is to plan interventions and focus attention on specific locations to prevent an upsurge in transmission.

Response in western Cambodia’s Ta Sanh district involves combining the process of positive diagnoses through microscopy of Day 3 positives at the Ta Sanh health centre from blood slides sent by Village Malaria Workers, to an alert system using mobile phone and web-based technology to help pinpoint potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to be present.

The proportion of patients who still carry malaria parasites on the third day of treatment is currently the best measure available of slow parasite clearance and can be used as a warning system for confirmation of artemisinin resistance.

In Ta Sanh, the Village Malaria Workers or VMWs play a crucial role in the early detection and treatment of the killer falciparum malaria. In September 2010 the USAID-funded Cambodia Malaria Prevention and Control Project (MCC), implemented by University Research Co., LLC (URC), trained these VMWs to prepare blood slides from those who tested positive for falciparum malaria from rapid diagnostic tests. They were also trained to carry out a three-day directly observed treatment (DOT) of the Pf cases with the co-formulated ACT dihydroartemisinin – piperaquine.

Chou Khea, a 21-year-old Village Malaria Worker, trained by MCC in Ta Sanh district’s remote Ou Nonoung village tells CONTAINMENT how she carries out DOT.

“Immediately after a villager tests positive for falciparum malaria in a rapid diagnostic test (RDT), I prepare the blood slides. Then I give the drugs, which the villager has to take in front of me,” says Khea.

“On Day 2 and Day 3, I’ll go to the villager’s house and make sure that the drugs are again taken in my presence,” she adds. “After 72 hours from the first intake of the anti-malaria drugs, I’ll be at the villager’s house again to take his or her blood sample for preparing another blood slide.”

Chou Khea then takes the Day Zero and Day 3 slides, together with the used RDT, to the Ta Sanh Health Centre 30-kilometres away from her village.

“I usually take a motor-dop (motorcycle taxi) to the health centre. But most of the motor-dop drivers are reluctant to use the track to health centre in the rainy season because of the slippery mud. Also many of them are scared of the wild animals and land-mines in the area,” she tells CONTAINMENT with concern. “I hope to have my own motorcycle soon, so that I’ll be able to transport the slides and RDTs faster,” she adds with a smile.

At the Ta Sanh Health Centre, the Day 3 slides are examined by a microscopist and if asexual malaria parasites are seen they are graded as positive. The microscopist immediately sends out an SMS on a mobile phone, using a dedicated number, to a database indicating the village code and the sex of the patient.

Malaria Consortium pioneered the use of this alert system in Ta Sanh, with support from Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the World Health Organization’s Malaria Containment Project funded by the Bill & Melinda Gates Foundation.

Malaria Consortium’s Information Systems Manager Steve Mellor explains the use of cellular text messaging (SMS) as a viable tool to send alerts and map Day 3 positives in real-time on Goggle Earth.

“We use FrontlineSMS, an open-source software, that enables users to send and receive text messages with groups of people through mobile phones,” Mellor tells CONTAINMENT.

“FrontlineSMS interfaces with an MS Access database system that was developed to host the SMS data and to provide validation on the data received and to send an automatic reply to the sender containing any validation errors found, or to confirm that the data has been accepted,” he adds.

In the Access database, a script interfaces with Goggle Earth and maps out the locations of the Day 3 positives based on the village code. The mapping on Goggle Earth is essential as it gives a clear visualisation of the terrain and helps CNM, WHO and the USAID-funded Cambodia Malaria Prevention and Control Project (MCC) to plan coordinated interventions in terms of case follow-up on Day Zero and Day 3 and carry out epidemiological and entomological investigations.

“All this happens in real-time and alert text messages are sent out simultaneously to the operational district malaria supervisor, the provincial health department, CNM and the administrators of the database,” Mellor points out.

There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases. Malaria Consortium and CNM are also in direct talks with Mobitel, one of Cambodia’s main telecommunication carriers.

“We are in negotiations with Mobitel for a free number and also free SIM cards to be distributed to health centre staff and village malaria workers,” Mellor reveals. “After all, this is for a public good.”

Besides plans to map all Day Zero cases, Malaria Consortium is also exploring the possibility of sending alert messages in Khmer script.

“This will be a breakthrough and we hope this will help facilitate a quick response mechanism from CNM and other partners,” says Mellor.

Texting for life in Pakistan: the International Organisation of Migration

The International Organisation for Migration, an intergovernmental organisation working to support people to return to their homes after being displaced by disaster of conflict, have been using FrontlineSMS in Pakistan for some months. Below, the twenty-eighth FrontlineSMS guest post is an operational update from Maria Ahmed and Isabel Leigh, in the Mass Communication Team.

October 15th is Global Handwashing Day, and in Pakistan, the IOM have been sending messages about hygiene and sanitation as part of their response to the devastating floods that hit Pakistan in recent months, affecting approximately 20 million people according to the UN's Office for the Coordination of Humanitarian Aid (OCHA).

IOM are leading the  communication response on behalf of the UN 'Cluster System' of humanitarian responders, and have developed over 50 Public Service Announcements (PSAs) in Pashto, Sindhi and Punjabi on topics including  prevention of diarrohea and malaria, water purification methods, mother and child health during the fasting month of Ramadan, child protection issues, treating snake bites, setting up durable shelters and fire safety in camps.

IOM first started using FrontlineSMS in the North in 2009, to mirror humanitarian messages sent out using radio broadcasts with informational texts. People in Northern Pakistan, nearly 3 million of whom were displaced by conflict in 2009, use cell phones extensively amongst family members, often texting in Urdu ( the national language) using the English script. Using FrontlineSMS has saved IOM over $15,000 compared to the  costs they would have paid to develop an organised, mass texting system using a commercial supplier. Supported by Zong, the Pakistani subsidiary of China Mobile, IOM is sending free, bulk, informational messages to affectees and humanitarian workers across Pakistan to enhance informational outreach.

In the South, people are used to using mobiles for voice calls, but send far fewer text messages. So IOM are partnering with Zong, who have donated a million free phone calls through 100 cell phones to IOM to enable a free phone service for flood victims to get vital information, seek help and access relief services offered by the Government and aid agencies. IOM hope to continue to expand the service to reach more handsets in Sindh, Punjab and KP, and from January onwards, in Balochistan, Gilgit Baltistan and Pakistan Administered Kashmir.

White Ribbon Alliance for Safe Motherhood: Mum's Tattoo Parlour at Glastonbury Festival

Our twenty-sixth guest post comes from the lovely James at the White Ribbon Alliance, who piloted FrontlineSMS in campaigning in a particularly innovative and fun bit of awareness-raising - offering free transfer tattoos at Glastonbury Festival... The White Ribbon Alliance for Safe Motherhood is a coalition of individuals and organisations that campaign to make pregnancy and childbirth safe for all women and newborns. With members in 148 countries, I had thought for a while that FrontlineSMS could be a very useful tool for many of our members, so was keen to "road-test" the software when the opportunity presented itself.

Glastonbury Festival seemed like a great opportunity to do so. For the second year running, we were running a campaign to raise awareness of Maternal Health - by offering people the ultimate way to show how much they love their mum - by coming to our "tattoo parlour" and having a classic "mum" heart tattoo.

In the first year, we were taken aback by the amazing response and the vast number of people that got a tattoo and signed up to be part of our movement. However, this left us with thousands of people's handwritten contact details to type up onto the computer for our mailing lists, which made it really difficult for us to get back to them quickly and simply.

So, this year, I downloaded FrontlineSMS, bought an old electric pink Sony Ericsson phone and USB cable from the Queensway Computer Market (for any London dwellers, this is a veritable Aladdin's cave of old phones, computers and parts), and a SIM card, so that people could text us their email addresses instead.

I had a couple of hiccups setting up FrontlineSMS with the phone - firstly, drivers weren't available for, or didn't work with, Windows 7 - which meant that computer that I'd been putting off upgrading from Windows XP was suddenly my least favourite machine in the office no more - and then the first set of drivers that I downloaded for the phone didn't allow FrontlineSMS to see the handset.

However, a quick search for the phone's model number on FrontlineSMS's forums turned up a link for alternative drivers, which linked the phone up and meant it could send and receive texts perfectly.

Not wanting to risk taking a laptop to the muddy fields of Somerset, I anxiously left the computer in the office running FrontlineSMS with my fingers crossed that it wouldn't crash and that no-one turned it off whilst I was at the festival.

Happily though, when I returned, everything was still running - and a couple of minutes later, I had exported all the email addresses into a nice .csv file ready to be imported into our mailing list server! Unfortunately, we still had thousands of handwritten signups to transcribe. Whilst I don't think we'll ever eliminate this, FrontlineSMS seems like a really effective way to reduce the use of paper, offer easier ways for people to ask for more information about our campaigns, and for us to get back in contact with them.

Perhaps more importantly, it proved itself a reliable tool that I think has the potential to be really useful to our members around the world - and we look forward to introducing them to it and hearing their thoughts and ideas of how they might use it for their own work in support of Maternal Health.

Jaalaka: Connecting the HIV/AIDS Community through Technology

In the twenty-fourth in our series of guest blog posts, we'll hear about how FrontlineSMS is helping Karnataka Health Promotion Trust, and a team of students from the University of Southern California, to build a network of people living with HIV/AIDS in India.

“Jaalaka” means “network” in Sanskrit. In Hubli-Dharwad, FrontlineSMS technology is being used to connect members of the HIV/AIDS population in a widespread rural network to improve service delivery and social support.

Hubli-Dharwad, a peri-urban district in Karnataka, India, has experienced a significant HIV/AIDS endemic. Most of the infections occur amongst the rural female sex-worker population. There is a significant lack of knowledge about STI prevention and treatment amongst these sex workers, which has contributed to the growth in the rate of infections. The Karnataka Health Promotion Trust (KHPT), a government organization that funds and administers public health programs in Hubli-Dharwad, spearheads several programs to combat the spread of HIV/AIDS and other STIs. In order to target the high risk population of female sex workers, KHPT formed a partnership with the Bhoruka Charitable Trust (BCT), a local NGO aimed at promoting health and livelihoods among female sex workers. Since the Hubli-Dharwad region includes over 372 rural villages, BCT employs both professional Outreach Workers as well as volunteer Peer Educators (whom are also female sex workers) to travel to distant villages to educate female sex workers about the risk of HIV/AIDS and to promote safer sex practices.

In summer of 2009, a group of University of Southern California (USC) students, along with financial and logistical support from the Deshpande Foundation, helped launch a pilot program with FrontlineSMS software to improve BCT’s data collection and service delivery. Currently, BCT employs two uses of the Frontline Forms program. Peer Educators make contact with rural female sex workers in the field and complete a Referral Slips via Frontline Forms and the information is immediately sent to the BCT headquarters. The Outreach Workers in the field also completes Daily Reports through Frontline Forms and sends it to the headquarters. By using FrontlineSMS technology as opposed to paper forms, BCT is able to expedite the exchange of information with its staff members in various remote rural areas throughout the district.

As of today, BCT has implemented the program with 37 Peer Educators and 10 Outreach Workers. Both BCT and KHPT have been extremely pleased with the results and are eager to expand the program. Currently, a new team of USC students will be working during the summer of 2010 to troubleshoot technical issues and develop new uses of FrontlineSMS for BCT and other HIV/AIDS advocacy organizations in Hubli-Dharwad.

For more information, check out the USC team's page about the project.

Outreach, health and SMS in Ukraine

Earlier this year, IATP Ukraine launched three pilot projects using FrontlineSMS. In this, the thirteenth in our series of FrontlineSMS guest posts, Yuriy Selyverstov - the Dnipropetrovsk Representative from the Internet Access and Training Program (IATP) - describes two of the projects Tamarisk, a Ukrainian NGO,  plays the key role of resource center for local third sector organisations in the Dnipropetrovsk region. It organises and conducts training for NGOs, and hosts joint round table events for mass media, local authorities and other NGO representatives. Because of this it is important that Tamarisk be able to inform their target audiences about upcoming events. E-mail lists, a web portal for local NGOs, phone calls, and personal contacts have been traditionally used for this purpose.

Tamarisk NGO gathering. Photo: IREX

In March this year, Tamarisk - in co-operation with the IATP program - launched a pilot project that uses FrontlineSMS to disseminate information to target audiences via SMS. By June there were over a hundred NGO subscribers with additional numbers being added regularly. Subscribers are organised into several groups depending on the field of their activities, and since the start of the project over 300 messages have been sent. The effectiveness of SMS sending is well illustrated by the International Renaissance Foundation, who held a presentation at the Tamarisk offices in April. About 60% of the participants found out about the event via SMS.

The following conclusions were drawn after the first three months of using FrontlineSMS:

  • Almost all SMS messages were read compared to e-mail, which is not checked regularly by many NGOs
  • Bulk SMS sending saves time in comparison to phone calls or personal contact
  • SMS did not exclude other traditional tools for disseminating information, but complimented them very effectively

Tamarisk now plans to increase the use of FrontlineSMS in its work.

In the second project, "Doroga Zhizni" (Road of Life) applied FrontlineSMS in the field of HIV/AIDS and tuberculosis transmission prevention and treatment. The target audience are injecting drug users and former prison inmates.  "Doroga Zhizni" is part of the all-Ukrainian "Network of People Living with HIV/AIDS".

"Doroga Zhizhi" Manager Iryna Pryhodko. Photo: IREX

For two months starting in March 2009, a pilot group of users with mixed HIV/TB diagnosis received scheduled text messages twice a day reminding them to take their pills. After the two months were up, feedback was collected from the group asking their opinion about the effectiveness of the service. In total, 90% of the group replied that SMS effectively helped them not to forget to take their pills, and that they wanted to receive SMS in the future. Only 10% said SMS was not helpful. Overall, 50% of the group noted positive psychological benefits - the messages made them feel that they were not alone and that somebody cared about them. The project concluded that FrontlineSMS was effective in improving patient adherence to prescribed treatment.

“Doroga Zhizhi” now plan to recommend using SMS reminders with all of its clients, starting this summer. To make this scaling possible they plan to request additional funding from their donor to cover the cost of the messages.

IATP is funded by the United States Agency for International Development (USAID) and implemented by IREX, an international nonprofit organisation that delivers cross-cutting programs to strengthen civil society, education, and media independence in more than 50 countries

Yuriy Selyverstov Dnipropetrovsk Representative Internet Access and Training Program (IATP) www.ua.iatp.net

Mapping medicine availability via SMS

Medicine stock-outs are a potentially lethal problem in a number of African countries, yet governments insist they don't occur. What could be more powerful than a map which contradicts this claim? Last week activists in Kenya, Uganda, Malawi and Zambia started surveying clinics in their respective countries, checking stock levels of essential medicines, including:

  • First-line anti-malarials
  • Zinc 20mg tablet
  • Penicilin
  • First-line ARVs
  • Metronidazole 200mg tablet
  • Ciproflaxicin
  • Amoxicillin suspension
  • Ceftriaxone
  • Cotrimoxazole suspension
  • ORS - Diarrhea

Each of these are seen as essential in varying degrees to fighting disease and illness, and are widely used when available.

Armed with the data, activists report their results via structured, coded SMS - "x,y,z" - where the first number represents their country code (Kenya, Malawi, Uganda or Zambia), the second their district or city, and the third the medicine which they found to be out of stock.  These messages are received by a phone connected to a computer running FrontlineSMS, which then runs an automatic script which validates the data before it is sent over the internet to a Ushahidi-powered website.

From there the results are automatically displayed on a map, below (click to visit the live site).

Stockouts map

As of today, there have been over 250 stock-outs of these essential medicines.

Since the data is automatically populated, the map represents an almost real-time picture of stock-outs in the four target countries. After a successful launch and a week piloting the service, the "stock-out hub number" will now be distributed to medicine users throughout each country so that anyone with a mobile phone can send in a stock-out report. Unlike reports from official, known data collectors, these messages will firstly be checked by staff at Health Action International (HAI Africa) before being posted up on the map.

Stockouts Team

The technological portion of the campaign was implemented by Michael Ballard and Claudio Midolo, both Open Society Fellows from the Department of Design + Technology at Parsons the New School for Design in New York.  Ndesanjo Macha also helped in getting FrontlineSMS up and running in Uganda and Malawi.

For further background information and up-to-date news, visit the "Stop Stock-Outs" website.

Mobilising around FrontlineSMS:Medic

medic-logoToday sees the launch of an exciting new initiative - FrontlineSMS:Medic - by a growing team of students mobilising around the practical application of mobile technology in global healthcare delivery. FrontlineSMS:Medic combines Josh Nesbit's pioneering work on "Mobiles in Malawi" with a mobile version of OpenMRS - an open source medical records system - and an exciting new remote diagnosis tool. In this guest blog post, Josh Nesbit and Lucky Gunasekara talk about the origins of the project, and their plans in the coming months.

Josh: I should be heading off to class, right about now. I'll go, but not without telling a story, first. A convergence of ideas and people marks the launch of FrontlineSMS:Medic and the team's embarkation on a quest to do mHealth the right way.

Many of you are familiar with the role FrontlineSMS, a donated laptop, and a bag of recycled cell phones have played in connecting community health workers (CHWs) in Malawi to a rural hospital and its resources. Text messaging is now an integral component of the hospital's infrastructure. FrontlineSMS has proven intuitively easy to use with strong user buy-in. The program is horizontally scalable, and incredibly cheap to run, matched with indisputable savings in time and costs. Enter Lucky.

President Clinton introduces Lucky

Lucky: I am the bewildered South Asian guy in the photo. Back in 2008, I was sitting in an office in Tokyo reading about cellphone penetration in developing countries, wondering if mobiles couldn't also be used for boosting healthcare delivery in resource poor settings. When I wasn't wearing a suit and riding to work in a packed Tokyo subway car, I was wearing a t-shirt and khakis and working in clinics in Sri Lanka - accepting an offer to attend  Stanford Med, this year. I worked out that SMS could be used in tandem with an open source electronic medical records system called OpenMRS, allowing for continuity in patient care from the community health workers to the clinic.  Meanwhile, Josh was sweating it out in Malawi, actually learning this the hard way. Just to prove that good ideas are obvious, Isaac Holeman and Daniel Bachhuber, two students at Lewis & Clark, had the same realization and began working on a project called MobilizeMRS to get this underway.

Josh: Long story short, we're all working together now. Lucky is pictured on stage with Bill Clinton, as his CGI U commitment is announced on the group's behalf.

Lucky: The commitment is, briefly:

To build on kiwanja's CGI commitment of an Ambassadors Program within FrontlineSMS, by developing a new version of FrontlineSMS - FrontlineSMS:Medic - for use in clinics in developing countries. That Medic will have end to end of continuity of electronic medical records by fusing FrontlineSMS with OpenMRS in a modular click-to-add format. I will be taking a year off from medical school (a decision infinitely popular with my folks) to work on this system and develop new partners on the ground with Josh, and do research on a new breakthrough medical diagnostic system at UCLA, that we feel will be the "Killer App" of FrontlineSMS:Medic. More on that to come. We're also going to be fully open source with wiki user manuals and off-the-shelf healthcare packages for download, so setting up a DOTS-TB program doesn't have to be any harder than buying a song on iTunes... OK, maybe a little bit harder... but not by much.

Josh: We're planning to pull this off within a year, operating in more than 25 pilot study and partner clinics by the summer of 2010. The system will be free and so will the hardware. Check http://medic.frontlinesms.com regularly to learn more and get involved.