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!

A glimpse into social mobile's long tail

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.

Watch this video on the FrontlineSMS Community pages

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?