Over the past couple years, I’ve had the privilege of co-managing World Vision’s Speed Evidence Project, which seeks to improve information management in the immediate aftermath of a disaster. After most disasters, reliable field data is significant challenge - what we can find is normally incomplete and/or inaccurate.
In the aftermath of devastating Typhoon Haiyan, we're working with networks of aid agencies to support the international response any way we can - but we know that the first and most important responders are already in the Philippines.
People say a picture speaks a thousand words, and this was the motivation behind our FrontlineSMS user photo competition, which opened towards the end of April. We are always keen to see the many innovative ways FrontlineSMS users have been using our software around the world. Photography is an excellent medium to show how FrontlineSMS is being used to in a variety of exciting and innovative ways, and it was great to receive photos and see projects in action!
We are pleased to announce that the winner of the FrontlineSMS Photo Competition is Molave Development Foundation, Inc. Based in the Philippines, Molave Development Foundation runs the valuable Safe Motherhood project, which was recently featured in our National Geographic blog series Mobile Message. The project aims to reduce mother and infant mortality rates by providing education and support to expectant mothers via SMS. Molave sent us lots of great photos of their work including midwives training on FrontlineSMS and expectant mothers receiving messages from FrontlineSMS. To see these photos visit our FrontlineSMS Facebook page here.
Many thanks to everyone who sent in there photos. Although the competition is now over we are still always looking for high resolution images of FrontlineSMS in action so please send along any photos you would like to share with us to firstname.lastname@example.org
Meanwhile, as worthy winners of our recent photo competition we will be sending Molave Development Foundation some of our brand new FrontlineSMS T-shirts as competition prizes!
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.
Although I've only been writing about the social mobile long tail for a couple of years, the thinking behind it has developed over a fifteen year period where, working on and off in a number of African countries, I've witnessed at first hand the incredible contribution that some of the smallest and under-resourced NGOs make in solving some of the most pressing social and environmental problems. Most of these NGOs are hardly known outside the communities where they operate, and many fail to raise even the smallest amounts of funding in an environment where they compete with some of the biggest and smartest charities on the planet.
Long tail NGOs are generally small, extremely dedicated, run low-cost high-impact interventions, work on local issues with relatively modest numbers of local people, and are staffed by community members who have first-hand experience of the problems they're trying to solve. What they lack in tools, resources and funds they more than make up with a deep understanding of the local landscape - not just geographically, but also the language, culture and daily challenges of the people.
After fifteen years it should come as no surprise to hear that most of my work today is aimed at empowering the long tail, as it has been since kiwanja.net came into being in 2003, followed by FrontlineSMS a little later in 2005. Of course, a single local NGO with a piece of software isn't going to solve a wider national healthcare problem, but how about a hundred of them? Or a thousand? The default position for many people working in ICT4D is to build centralised solutions to local problems - things that 'integrate' and 'scale'. With little local ownership and engagement, many of these top-down approaches fail to appreciate the culture of technology and its users. Technology can be fixed, tweaked, scaled and integrated - building relationships with the users is much harder and takes a lot longer. Trust has to be won. And it takes even longer to get back if it's lost.
My belief is that users don't want access to tools - they want to be given the tools. There's a subtle but significant difference. They want to have their own system, something which works with them to solve their problem. They want to see it, to have it there with them, not in some 'cloud'. This may sound petty - people wanting something of their own - but I believe that this is one way that works.
Here's a video from Lynman Bacolor, a FrontlineSMS user in the Philippines, talking about how he uses the software in his health outreach work. What you see here is a very simple technology doing something which, to him, is significant.
In short, Lynman's solution works because it was his problem, not someone elses. And it worked because he solved it. And going by the video he's happy and proud, as he should be. Local ownership? You bet. o/
Now, just imagine what a thousand Lynman's could achieve with a low cost laptop each, FrontlineSMS and a modest text messaging budget?