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.
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.
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.
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.
By Kavita Rajah, FrontlineSMS Community Support Assistant Stop Stockouts is currently using FrontlineSMS in their campaign to increase access to medicines in public health institutions in Uganda and Kenya. Recently we’ve spoken with Denis Kibira, National Coordinator for the Stop Stockouts Campaign in Uganda, about how FrontlineSMS software has helped to achieve campaign objectives.
When a pharmacy or health center runs out of a medicine, this is referred to as a ‘stock-out’. Stock-outs often include medicines that are used to treat common but serious diseases such as malaria, pneumonia, diarrhea, HIV, TB, diabetes and hypertension – all of which are among the highest causes of death in Africa. In African countries such as Uganda and Kenya, stock-outs can frequently occur and it can be weeks or months before the stock is replenished. Patients needing these medicines are then forced to travel long distances in search of alternate sources, pay high prices for medicines from the private sector or they are forced to do without – ultimately facing life or death circumstances.
The Stop Stockouts campaign lobbies African governments to meet their obligations to provide essential medicines by increasing the national budgetary allocation for the purchase of these medicines and by ensuring efficiency and transparency in the procurement, supply, and distribution of medicines. The campaign is an initiative of Health Action International (HAI) Africa, Oxfam, and a number of African partners – with the support of the Open Society Institute (OSI).
Stop Stockouts was introduced to FrontlineSMS by OSI, who promoted FrontlineSMS as a very useful tool for advocacy and quick monitoring of medicine availability. Since then, Stop Stockouts has been using FrontlineSMS to aid in campaign communications. They use FrontlineSMS to send information to members, to remind partners about meetings and to update stakeholders on advocacy events.
Stop Stockouts also use FrontlineSMS in their monitoring activities such as ‘Pill Checks’; where researchers visit public health institutions to check on the availability of essential medicines. Researchers send an SMS containing the results to a common server, and the incoming data is managed via FrontlineSMS. These results are then reflected in an online map of the country, produced using mapping tool Ushahidi, and showing areas where medication is out of stock. This map provides real time evidence about the stock-out situation on a national level and serves as a compelling lobbying tool to the relevant authorities. The visual mapping of these ‘pill checks’ have increased visibility of the Stop Stockouts campaign which has contributed to the success of the campaign.
Stop Stockouts state that FrontlineSMS has greatly improved their communications. Denis explains “it has reduced the turnaround time in which we get and respond to issues in the communities where we work, and the "pill check" map has added impact to our advocacy and technical reports.” Denis says that the online mapping system using FrontlineSMS and Ushahidi is especially powerful because it comes from the people. He asserts that using FrontlineSMS as part of their campaign communications has helped to reach at least 1,000 people every year. The results have been very impactful that governments are also currently using SMS to collect its own data and monitor facilities. Additionally, there has also been an increased demand for use of technology for monitoring government activities as well as new relationships for information sharing with other NGOs in different countries.
Stop Stockouts are also currently exploring using FrontlineSMS in their complaints and compliments desk which is a feedback mechanism for communities in which health service delivery, in particular human rights violations, can be reported.
We look forward to staying in touch with Denis and the rest of the Stop Stockouts team as they continue to make powerful use of FrontlineSMS software. o/
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.
ReliefWeb have recently reported on FrontlineSMS being used to help to contain the spread of malaria in Cambodia. This story has also received coverage from IRIN, the news service of the United Nations Office for the Coordination of Humanitarian Affairs. The FrontlineSMS blog featured a guest post about this use of our software, too, which you can read here. Below is an extract from the ReliefWeb coverage:
"TA REACH, 6 September 2011 - Cambodian efforts to contain the spread of malaria have been strengthened by a pilot project using text messaging and web-based technology.
"My work is definitely easier," said Sophana Pich, 41, one of 184 village malaria workers (VMWs) now trained in three provinces (Kampot, Siem Reap and Kampong Cham) since the project launch earlier this year.
She typically diagnoses five to six cases of the often deadly virus each month during the rainy season between May and October.
"Before, it would take a month before this information was reported to the district health level. Now it's instantaneous," the mother-of-three said from her home in Ta Reach, a village of 200 households in Kampot Province, about 150km southwest of Phnom Penh.
There are close to 3,000 VMSs in 1,500 villages across Cambodia, described by many as the "foot soldiers" in the country's fight against malaria.
As part of a larger US$22.5 million malaria containment effort launched by the government in 2009 and funded by the Bill & Melinda Gates Foundation, the volunteers receive three days of training in the early diagnosis of malaria and treatment.
In addition, they are given a bicycle, a pair of boots, a bag, a flashlight and a cooler box for medicines, as well as a small travel allowance.
Under the pilot scheme now under way, they are also given mobile phones.
Using FrontlineSMS - an open-source software enabling users to send and receive text messages with groups of people - VMSs can now report in real time all malaria cases in their villages to the Malaria Information and Alert System in Phnom Penh with a simple text message, including the patient's name, age, location and type of virus."
To read the full article visit ReliefWeb.
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!
span style="font-weight: normal;">Guest post by Will Chester, TechChange
“TJ said his body feels like it's on fire! Hurry!” Shouts like this one echoed through the halls of George Mason University as ten School for Conflict Analysis and Resolution (S-CAR) students participated in a simulated malaria outbreak as part of their Technology for Peacebuilding course facilitated by TechChange. The goal of the simulation was to provide students hands-on experience using FrontlineSMS software.
TechChange staff built the simulation around an existing case study of a FrontlineSMS implementation currently underway to track the spread of malaria in Cambodia. The staff sought to mimic many challenges present in the field in order to get students to think critically about both the great advantages and limitations of using technology like FrontlineSMS in crisis response.
Students were given a basic overview of malaria symptoms and risk factors and then the class was broken into three groups. Each group was equipped with a computer running FrontlineSMS using a GSM modem, which allowed them to send and receive text messages. Groups were responsible for engaging three sick residents, performing an assessment of each resident's situation, and deciding on an overall treatment plan specifying which patients should receive medication (and in what order) based on information the group was able to collect from those residents or a public health worker in the field.
The three residents were spread out on a different floor from the groups and were instructed to convey varying degrees of sickness and proximity to water (a known risk-factor for malaria transmission) to the groups. All residents in the simulation had access to cell phones.
- Resident One – High risk – Resident One lived near a water source, complained of a fever and a headache, but was unwilling to provide information to the health workers. He was only marginally literate, but would take medicine if it was administered to him directly.
- Resident Two – Medium to high risk - Resident Two lived near a water source, complained of a fever, but not of a headache. He was willing to share information with the health workers, and would take medicine only if the health worker observed him taking it.
- Resident Three – Low risk – Resident Three did not live near a water source, did not have a fever or a headache, but had severe gastrointestinal (GI) pain. He was very communicative and would take any medicine administered to him.
Under ideal circumstances groups would administer medication to Resident One and Two, but not Resident Three. This variation was built into the simulation to challenge the groups to think critically about their responses rather than simply medicating as many residents as possible. This is especially important for diseases like Malaria that have drug-resistant strains, and in situations where the treatment itself can be harmful or where medicine might be in short supply.
Text messaged reports from the field began rolling in as groups developed surveys and strategies to determine the health status of each resident. Groups also communicated with their public health worker to assess their progress and alert them to any information they received from the residents directly.
Groups quickly recognized their need for a set of guidelines and best practices for their use of FrontlineSMS. One group decided to focus on preventive education and sent welcome texts to the residents encouraging them to abide by good health and sanitation practices. Another group sought to streamline their communications by introducing a numeric scale for fever and pain that shortened the text messages and made them easier to process.
In the end, Resident One received medication from only one group, meaning two groups’ approaches were unable to treat the highest risk patient effectively. All three groups successfully treated Resident Two, but also decided to treat Resident Three, the lowest-risk resident. Although none of the groups reached the optimal solution for the simulation, they all gained valuable experience with FrontlineSMS and the complexities of program design.
Simulations are great platforms for learning tech – After the simulation, students expressed that they greatly enjoyed the activity because it was a practical, hands-on, and interactive way to learn about FrontlineSMS. They all appreciated learning how to use the software in a fun engaging and intense manner such as this.
Technology does not obviate need for good program design – All of the groups were able to leverage FrontlineSMS to enhance their programs, rather than relying too heavily on the technology alone. Students did a great job following up with residents after sending text messages and ensuring that FrontlineSMS was used to streamline communications, but not replace the human element of their program.
As this was TechChange's first live-action FrontlineSMS simulation there were many lessons learned, which we are looking forward to incorporating into future simulations (Read about our Ushahidi Afghanistan Election Monitoring Simulation). Free lesson plans will be available on the TechChange website in the coming weeks. TechChange is excited to design and deliver more simulations as part of workshops or courses to organizations and universities. For more information visit http://techchange.org/
TechChange also has three online certificate courses this fall for those who want to learn more about FrontlineSMS and other tech strategies and tools:
In this installment of our special “Mobile Message” series, Irma F. Saligumba – Health Research and Projects Coordinator at Molave Development Foundation – talks about a project in the Philippines which aims to reduce mother and infant mortality rates, and provide education and support to expectant mothers, all through their mobile phones.
“Ma’am, I already gave birth. Thank you for the messages you sent”. This was the SMS message I received from Meriam. She is one of the 100 pregnant women who registered in November 2010 for the pilot implementation of the Mobile e-health System for Safe Motherhood Program, run by Molave Development Foundation Inc.
This program aims to support the Philippine Government in reaching towards the United Nation’s Millennium Development Goals to reduce maternal mortality ratio by three quarters by 2015.
As the Health Research and Projects Coordinator of Molave Development Foundation, Inc., I spearheaded a study on the effectiveness of using mobile phones to reach out to pregnant women to improve their maternal health.
We chose the town of Roxas, located on Mindoro Island about 400 kilometers south of Manila, for the research. Its population is about 50,000 spread across 20 villages; its Health Center has 2 physicians, 1 nurse and 8 midwives. To supplement the lack of health staff, there are 140 village health volunteers (VHV) who are trained to do most of the legwork for the midwives, and disseminate information on primary health care, maternal and child health, family planning and nutrition.
I was introduced to Meriam during a visit to her upland village. Like most of the mothers in our program, Meriam is in her mid-20′s, has some years of high school education, is unemployed, and her husband doesn’t have a regular job. Subsistence farming provides additional income, and their average monthly salary is about $150. The only means of telecommunication in their area is through mobile phones. She shares one with her husband.
In the Philippines, where nearly 40% of the population lives below the poverty line, the equity gap is stark and wide. However, the ownership of a mobile phone is one of the few things that has crossed the income divide, making telecommunication relatively affordable and more accessible in this country of 7,100 islands. There are 70 million Filipinos who have mobile phones, compared to only 7 million installed fixed phone lines.
This is the basis for developing a program that uses text messaging to inform and educate pregnant mothers on safe motherhood. Aside from its mass appeal, mobile phones provide the advantage of two-way communication. Mothers are not just passive participants receiving information, but can also ask questions or communicate their concerns if they need to.
We are using FrontlineSMS as our communications platform because it is easy to use for health workers’ with low technical know-how, it works without an Internet connection and provides a way to send SMS through pre-paid SIM cards, thus making it a low cost option. It is also vitally important that the software allows for data storage, and we have created a database of the mothers and the health workers on our on-site computer.
Prior to implementing our pilot project, we conducted various training sessions for the Health Center staff. First we provided a Basic PC Literacy Course which covered use of mouse and keyboard, familiarization with computer symbols and commands, basic computing using word processing and spreadsheets, and how to use the Internet. When they gained sufficient confidence, we then moved on to training basic FrontlineSMS skills (for the PC and mobile phone) to show staff how to use key functionality. Five health personnel were also trained on advanced FrontlineSMS, including administration, management and troubleshooting.
Meanwhile, village health volunteers were trained on how to use the mobile phone for data entry of pre- and post-natal registration, in order to register pregnant women and new mothers in the program.
With the system in place, we started sending out the messages to participants who had already registered during pre-natal checkups at the Health Center. We also worked to reach out to new pregnant women. Posters and brochures were distributed giving instructions on how to register, by sending in an SMS.
Every day for three months, these women received messages on introduction to safe pregnancy and delivery, baby’s phases of development, tips on preparing for labor, common pregnancy problems, benefits of facility-based childbirth, breastfeeding, neonatal care, and child immunization. Through this program we sent a total number of 11,100 text messages or 111 for each of the 100 women registered.
As we hoped, we received messages back from the mothers. Some expressed appreciation for the messages. Others raised serious questions regarding their pregnancy. An expectant mother named Jane inquired if using the computer is bad for the baby. Jocelyn asked what she should be feeling if the baby is due for birth. At 7-months pregnant, Rebecca wanted to know if it is normal to have swollen and painful vagina.
These questions were forwarded to their respective midwives for advice because they were better aware of their patients’ pregnancy status. The midwife’s response was sent by the system to the mother. In the case of Rebecca, she was advised to go to the hospital for evaluation. She even went as far as Manila to have better care, and she ended up staying there until she gave birth because her condition was too serious for traveling.
We are now looking into expanding the Safe Motherhood Program in other parts of the country. Our initial assessment shows that the program has influenced the parent’s decision to use a health facility instead of their home for childbirth. The system also facilitated the prompt recording of new pregnant women and post-natal reporting. This data helps midwives prepare and plan for the pre- and post-natal care activities in the village. This more efficient and interactive information management system can ultimately contribute to improved maternal care, and thus decreased mortality levels.
Mothers involved say they will recommend the Safe Motherhood Program to others. They feel assured that someone is concerned about their welfare and that there is someone they can go to if they have questions. This gives them a feeling that they are important because someone cares, and that feeling of being important strengthens their desire to take care of not only their health, but also their babies.
Irma F. Saligumba has been the Health Research and Projects Coordinator of Molave Development Foundation, Inc. since 2007, and is Lead Researcher of Pan-Asian Collaboration for evidence-based e-Health Adoption and Application (PANACeA) Network with member countries in Central, South and Southeast Asia.
Prior to her involvement at MDFI, she spent 4 years in Attapeu, Laos as provincial health trainer of Health Unlimited. She also served as Training Specialist for 4 years at Philippine Rural Reconstruction Movement focusing on leadership-building, gender and development, and advocacy. She is a registered nurse and earned her masters in Public Health at the University of the Philippines.
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.
FrontlineSMS:Medic is now Medic Mobile. From the start, FrontlineSMS:Medic implemented and extended FrontlineSMS to bridge gaps in healthcare delivery systems. After a successful pilot, the FrontlineSMS software and community acted as a launchpad for an organization that uses open source software to support health services across the globe. The launch of a new name, Medic Mobile, reflects the growth and trajectory of that organization. Medic Mobile will continue to be one of the most emphatic champions of FrontlineSMS – contributing code, user experiences, and peer-reviewed research back to the community. Here, Isaac Holeman and Josh Nesbit, co-Founders of FrontlineSMS:Medic, walk us through the history of the project, and where they see Medic Mobile heading in the future.
The FrontlineSMS:Medic Story
FrontlineSMS:Medic was preceded by two independent projects, Mobiles in Malawi and MobilizeMRS. Josh Nesbit initiated Mobiles in Malawi in the summer of 2007, working at a rural Malawian hospital that serves 250,000 patients spread 100 miles in every direction. To reach remote patients, the hospital trained volunteer community health workers (CHWs) like Dickson Mtanga, a subsistence farmer. Dickson had to walk 35 miles to submit hand-written reports on 25 HIV-positive patients in his community. The hospital needed a simple means of communication, and in the summer of 2008 Josh returned to the hospital with mobile phones and a laptop running FrontlineSMS to provide it.
MobilizeMRS was born with a focus on electronic medical records, and the notion that the technology could be extended to engage CHWs in structured data collection. Isaac Holeman discovered Mobiles in Malawi and contacted Josh online, and in late 2008 they decided to join forces. Isaac brought the key characteristics of MobilizeMRS with him – a commitment to extending OpenMRS, the initiative to formalize their projects as a venture, insistence that the venture should have a distinct brand and leadership authority, and commitment to developing innovative software.
In February of 2009, Josh, Isaac, and a group of students from Stanford and Lewis & Clark founded FrontlineSMS:Medic together. The mission was to help health workers communicate, coordinate patient care, and provide diagnostics using low-cost, appropriate technology.
In six months, the pilot in Malawi using FrontlineSMS saved hospital staff 1200 hours of follow-up time and over $3,000 in motorbike fuel. Over 100 patients started tuberculosis treatment after their symptoms were noticed by CHWs and reported by text message. The SMS network brought the Home-Based Care unit to the homes of 130 patients who would not have otherwise received care, and texting saved 21 antiretroviral therapy (ART) monitors 900 hours of travel time, eliminating the need to hand deliver paper reports. You can read more about this pilot in the Journal of Technology and Health Care publication.
After the 2010 earthquake in Haiti, Josh reached out to FrontlineSMS users on the ground and connected with mobile operators. Soon after, FrontlineSMS:Medic helped coordinate The 4636 Project, an effort to create an emergency communications channel. Working with the Office of Innovation at the US Department of State, technology providers, Digicel, and Voila, a system was created to process text messages expressing urgent needs from the ground. Using crowd-sourced translation, categorization, and geo-tagging, reports were created for first responders within 5 minutes of receiving an SMS. Over 80,000 messages were received in the first five weeks of operation, focusing relief efforts for thousands of Haitians.
In less than one year, FrontlineSMS:Medic expanded from 75 to 1,500 end users linked to clinics serving approximately 3.5 million patients. Growing from the first pilot at a single hospital in Malawi, they established programs in 40% of Malawi’s district hospitals and implemented projects in nine other countries, including Honduras, Haiti, Uganda, Mali, Kenya, South Africa, Cameroon, India and Bangladesh.
A growing toolkit
In 2010, the FrontlineSMS:Medic team expanded and began creating new mobile tools. Software developers built on the FrontlineSMS platform to create a lightweight patient records system, PatientView, and a text-based information collection module, TextForms.
Developed by volunteers in less than two days, the initial 4636 system combined a number of technology platforms. Most recently, FrontlineSMS:Medic developers worked on a messaging module for OpenMRS, a project that had been in the works since the MobilizeMRS days prior to FrontlineSMS:Medic. It became clear to the team that building upon and implementing various open source tools was the best way to serve users and achieve impact.
FrontlineSMS acts as a catalyst for new projects – incubating ideas, teams, and software for legal systems, education, financial services, radio, and other fields. The model replicates FrontlineSMS:Medic’s sector-specific approach and builds on a community of users innovating every day
Medic Mobile continues FrontlineSMS:Medic’s team, values, and mission – using mobile tools to create connected, coordinated health systems that save more lives.
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.
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.
The timing of this article could not have been better, given the discussions last week on the merits of mobile-based "cloud computing" and the clarification of our position a couple of days later. Despite advances in mobile devices and data connectivity, the need for mobile tools to also be able to work in less than optimal conditions is still as strong and as relevant as ever, as this use of FrontlineSMS by Telecoms Sans Frontiers in Nicaragua shows us all too well. "TSF - No Bugs In This Software That Fights Disease" (re-printed with the kind permission of SatNews.com) November 5th, 2009
"Since the beginning of October, Nicaragua is facing a huge rise of dengue cases, which has become a major public health concern in the country. The Health Ministry of the Central American nation (Minsa) has a crisis unit (SILAIS) which currently focuses its activities in response to both the dengue and H1N1 plagues. An Internet monitoring system has previously been set up to control the health situation in the country; nevertheless access to computer is often difficult in some regions where only few health centers are equipped.
Due to this serious situation, and the necessity to improve the collection of information, TSF, in collaboration with PATH (an international non-profit organisation that aims at enabling communities worldwide to break longstanding cycle of poor health) is reinforcing SILAIS’ capacities in Information and Communications Technologies.
In order to monitor the spread of the dengue in Managua and to conduct mobile health actions, TSF has been implementing for the first time a very innovative system based on a widespread, cheap and solid technology, GSM.
To set up the program, TSF uses FrontlineSMS software. Developed by a TSF partner NGO, FrontlineSMS is free, open source software that turns a laptop and a mobile phone into a central communications hub. Once installed, the program enables users to send and receive text messages with large groups of people through mobile phones. Thus, GSM technology is used to reach as many geographical zones as possible to control health issues in those areas. The server in SILAIS is connected with the 32 health units in Managua.
Each health unit has been delivered a mobile phone by TSF, so that they can send different kinds of information through SMS to the server. Hospital and health centers fill in predefined forms from their mobile phones and send them by SMS to SILAIS. Designed by PATH and the SILAIS, those forms provide data about the classic and hemorrhagic dengue cases, about the H1N1 2009 ones and the need for medicines when the stock nearly runs out. Once the forms received, the server stores information and puts them in databases in order to facilitate statistical analysis, on Excel format for example.
TSF provides two-way communication to health units enabling SILAIS to receive a daily report and gather messages from the health units and will have an updated situation in each center. At the meanwhile, SILAIS will also be able to communicate important information to them through SMS (such as an alert or a warning about coming meetings for example) or give them automatic answers to predefined questions sent by the health units.
By providing communication links between health structures and the SILAIS, TSF will allow the Health Ministry to have more accurate information about the diseases spread within Managua and quickly survey and assess the needs in affected areas. TSF helps health professionals use advanced methodologies such as smart phones and open-source software. Mobile devices are great tools to track and transmit crucial data in order to detect an epidemic threat at an appropriate time. Through this program, TSF participates in strengthening health systems in Nicaragua.
Following the installation of the system, on October 24th, TSF organized training for all the beneficiaries of the project. The health units and SILAIS staff were trained on the application’s functionalities and available services".
For a related article on FrontlineForms, the FrontlineSMS data collection tool used by TSF for the project, go here.
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.
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".
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
This is the ninth in our series of FrontlineSMS guest posts. In this latest post Aurelio Gomes, who works out of Universidade Catolica de Mocambique, explains their use of the software in monitoring and improving anti-retroviral treatment (ART) compliance among rural communities in Mozambique
Thanks to the US President’s Emergency Program for AIDS Relief (PEPFAR), increasing numbers of HIV-infected people living in poor countries have been given access to anti-retroviral therapy (ART). Successful treatment of HIV depends upon ART recipients maintaining a compliance rate of 95% or higher to prevent the emergence of drug resistance. The commonly used first-line regimen has a low genetic barrier to resistance when dosing is below recommended levels. Not only does widespread resistance lead to a need for costly second-line regimens, but it also threatens to reverse ART survival gains. Worst still, resistant HIV may also be transmitted to others, severely limiting treatment options.
As ART therapy becomes more widely prescribed in Sub-Saharan Africa, suitable systems to ensure patient compliance have to be designed and implemented to maximize ART effectiveness. This is especially necessary in rural areas of Africa. Mozambique exemplifies this situation since 80% of the total Mozambican population are rural. Patients are difficult to locate because formal postal addresses don’t exist in these areas. As in many parts of sub-Saharan Africa, residents are not connected to the electricity grid, and lack regular phone service or access to clean water. Stigma and discrimination increase the challenge of ensuring compliance, as HIV- positive individuals are often very concerned about their privacy.
Following initial technical assistance from our partners at Inveneo, we have been successfully using FrontlineSMS for several months to facilitate communication between the HIV treatment centers and the community health care workers (CHWs) deployed in remote rural areas. These CHWs are armed with mobile phones, enabling communication to flow more quickly and accurately, leading to an improvement in health care delivery.
Our FrontlineSMS-driven communication system is helping us maintain a 95% and higher compliance of ARV therapy, crucial for the patient, the success of our programme and efforts to reduce the chances of development of drug-resistant strains of the virus.
Aurelio Gomes Project Coordinator Universidade Catolica de Mocambique www.ucm.ac.mz
In this, the first of a series of guest posts on how FrontlineSMS is being used around the world, Becky McLaughlin - Marketing Director at Rien que la Vérité - talks about their current use of the platform, and the impact it has had on their work "Based in the Democratic Republic of Congo, Rien que la Vérité was born in 2006 when some of the finest musicians in the Congo united to produce a CD of songs speaking against the spread of HIV/AIDS. Since 2006, the Rien que la Vérité platform has produced 14 music videos, a documentary, and an all-day stadium concert. In its present incarnation, Rien que la Vérité is touching the lives of the people of the Congo through their television screens as they follow the lives of a Kinois family on a locally-produced TV drama.
Rien que la Vérité - the TV series - launched nationally on November 30th, 2008 and first implemented FrontlineSMS in the airing of its second episode on December 14th. Each episode broadcast is accompanied by short talk-show segments during which a host introduces music clips, talks to well-known musicians and actors, and interviews representatives from local NGOs and organizations whose message dovetails with a theme introduced in the show.
During the December 14th show, the audience was invited to participate by sending an SMS with the name of their favorite character. The responses were collected using FrontlineSMS. This simple first step allowed Rien que la Vérité to test the software and to begin an exploration of our audience's perceptions and preferences. As the show continues we plan to introduce more simple polls that will help tailor the show to the audience's tastes, and give viewers a sense of ownership of the program.
This, however, is the most basic use we foresee. We are now launching a drive to support fan clubs, so that people who watch the show can find each other, meet, and talk about the show and the topics it introduces - a process that will begin to normalize conversation about HIV/AIDS. We'll use FrontlineSMS to collect contact information from interested fans, then broadcast messages with times and locations for local club gatherings. We also intend to use FrontlineSMS in our research for measuring the impact the show has on our target audience. We'll send out questions via SMS to fans before and after each show, measuring any changes in attitude, knowledge, or self-reported practices due to exposure to the show's messaging.
FrontlineSMS will be a critical tool in our goal to entertain and educate. Like its television format, Rien que la Vérité's future development must remain grassroots, and FrontlineSMS is an excellent vehicle for this."
Becky McLaughlin Marketing Director Rien que la Vérité www.abcd-laverite.com
Today sees the official launch of the new version of FrontlineSMS. To celebrate, kiwanja.net invited Josh Nesbit - a Senior in the Human Biology Program at Stanford University - to talk about its use in east Africa where he's spending the best part of this summer introducing the system into a rural hospital in Malawi. You can read Josh's Blog here "St. Gabriel’s Hospital is no stranger to assaults on well-being spread by disease and illness. Located in Namitete, Malawi, St. Gabriel’s serves 250,000 rural Malawians spread throughout a catchment area one hundred miles in radius. With a national HIV prevalence rate of 15-20%, children orphaned by AIDS will represent as much as one tenth of the country’s population by 2010. With tuberculosis (TB), malaria, malnutrition and pneumonia ravaging immuno-compromised populations, the health system - including St. Gabriel’s Hospital - faces a disquieting burden. Malawi’s health challenges are compounded by its devastatingly low GDP per capita, by some measures the lowest in the world.
With just two doctors and a handful of clinical officers, St. Gabriel’s Hospital is strikingly understaffed. This perennial state of affairs explains the shift of primary healthcare in other, similar settings, to Community Health Workers (CHWs), trained for specified tasks. Through the hospital’s antiretroviral (ARV) treatment program - drug therapy for HIV/AIDS - over 600 volunteers have been recruited. These volunteers are spread throughout villages in the Hospital's catchment area. Some CHWs are HIV and TB drug adherence monitors, while others accompany patients during long journeys (up to a hundred miles, often by foot) to the hospital.
A few of the more inspired volunteers record their activities in notebooks, and travel to the hospital to have their good work acknowledged. The vast majority, however, remain disconnected from hospital activities, interacting with hospital staff only to pick up their drugs. It’s not that they don’t want to play a legitimate role in a community health system - there is no communication to foster such a role.
Enter FrontlineSMS. The program, developed by Ken Banks and his team at kiwanja.net, is the cornerstone of a new, text-based communications initiative at St. Gabriel’s Hospital. Funded by the Haas Center for Public Service at Stanford University and the Donald A. Strauss Foundation, I'm currently knee-deep in a pilot program.
FrontlineSMS is being used to connect the hospital with its CHWs, expanding the role of the volunteers. Drug adherence monitors are able to message the hospital, reporting how local patients are doing on their TB or HIV drug regimens. Home-Based Care volunteers are sent texts with names of patients that need to be traced, and their condition is reported. "People Living with HIV and AIDS" (PLWHA) Support Group leaders can use FrontlineSMS to communicate meeting times. Volunteers can be messaged before the hospital’s mobile testing and immunization teams arrive in their village, so they can mobilize the community. Essentially, FrontlineSMS has adopted the new role of coordinating a far-reaching community health network.
The hospital sees intense promise in the formidable duo of FrontlineSMS and the cell-phone-yielding health worker. The usefulness of a well-managed communications network is undeniable, particularly when the information is so vital. In the first hours of the pilot program, a deceased patient’s extra ARVs were secured, the Home-Based Care unit was alerted of ailing cancer patients, and a death was reported (saving the hospital a day-long motorbike trip to administer additional morphine).
Rural healthcare has found, in FrontlineSMS, a powerful protagonist".