Posts from — February 2009
Today 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.
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.
February 23, 2009 48 Comments
In this – the third in our series of FrontlineSMS guest posts – Grégory Rebattu, Télécoms Sans Frontières (TSF)’s Niger Representative, and Oisín Walton, Head of TSF Communications and International Relations, talk us through their thoughts on the software, and its potential for emergency relief in Niger.
“I work for Télécoms Sans Frontières (TSF), the leading NGO specialising in the deployment of telecommunications in emergencies, and head-up TSF’s base here in Niger. In emergencies, telecommunication networks are often seriously damaged or destroyed. Some humanitarian crises also strike in areas with no existing communication facilities. Today, TSF plays a key role in strengthening coordination and communication by deploying telecommunications centres within 48 hours of an emergency. These centres offer broadband Internet access, voice communications, fax lines and all the IT equipment needed for a field office.
Our base in Niger is more involved in longer term projects particularly in strengthening food crisis prevention systems. Niger is ranked 174th out of 177 nations on the United Nations Development Programme’s Human Development list – making it one of the least developed countries on Earth. The living conditions in the Sahel desert are extremely harsh and recurrent drought leads to almost permanent food insecurity. Less than 12% of the territory is cultivable – so the widely reported current food crisis hits Niger particularly hard.
Telecommunication networks are also very much in their infancy, although GSM coverage is now on the rise and bringing infinite new opportunities for the humanitarian and development sectors. In particular, we believe that text messaging – used in conjunction with cutting-edge tools such as FrontlineSMS – are particularly powerful, enabling the collection and dissemination of data quickly and easily with very low running costs. Over the past few weeks we have been working closely with the FrontlineSMS team, putting the software through its paces and assessing its suitability in our work. We have been particularly excited by the new “FrontlineSMS Forms” data collection functionality which we helped test and which is being released next week.
Crucially from our perspective, FrontlineSMS is extremely user-friendly, allowing partner organisations on the ground to rapidly deploy a data collection and dissemination system from scratch. This simplicity is crucial for organizations which may lack technical skills, and users can be up and running in a matter of minutes with the minimum of mouse clicks. The intuitive nature of the software also means that little technical support is required once they’re up and running.
I have already presented the application to a group of NGOs and UN agencies who are very excited. These organizations – who work in a wide range of sectors including health, nutrition and agriculture – immediately saw the immense potential of FrontlineSMS and how it might enhance their capacity to save lives and develop local economy, not to mention their capacity to improve the security of their own staff.
On that note, our first FrontlineSMS initiative is about to launch, and will provide an SMS security alert forwarding service to Niger’s NGO community. This will allow aid workers to instantly warn the community about security issues in real time.
Concretely, we see other immediate applications for FrontlineSMS in Niger. These include the use of the new Forms feature for data collection for the National Health System which collects and monitors the number of cases per pathology in health structures. FrontlineSMS could also be used to collect market prices, and even to disseminate those prices to small farmers.
We are also planning to test its interoperability with satellite phones which will allow us and our partner organizations to extend its usage into areas not covered by mobile networks. We also plan to use it in our responses to sudden-onset emergencies where mobile networks are often disrupted.
Summing up, FrontlineSMS is a fabulous tool and one which presents huge opportunities to non-technical NGO users. Saying that, don’t be fooled by its simplicity – as well as standard incoming and outgoing group messaging, it has plenty of advanced and extremely powerful functionality. From our testing and evaluation, and our discussions with partner organizations, it looks like FrontlineSMS has infinite applications in the humanitarian world, and this is great news for those we are trying to help.
As we often say here, it’s now no longer a question of technology, it’s a question of imagination!”
Grégory Rebattu, Niger Representative
Oisín Walton, Head of Communications & International Relations
Télécoms Sans Frontières
February 16, 2009 71 Comments
In this, the second of a series of guest posts on how FrontlineSMS is being used around the world, Dr. Mohammad Akbar and Kenneth Adam – Director and Business Advisor respectively at Media Support Partnership Afghanistan (MSPA) – talk about their current and planned uses of the platform, and the impact it is having on their work
“A recent special edition of a radio programme for young people in Afghanistan was devoted to one topic – the shocking recent acid attack on girls attending school by violent extremists allied to the Taliban. The impact on the audience was recorded in some 300 phone calls from listeners – a record for the long running programme “Straight Talk”, produced by a team of young broadcasters from Media Support Partnership Afghanistan (MSPA).
This audience response provides an example of what is possible given the enormous growth in mobile phones in Afghanistan, well over 6 million and rising at over 100,000 a month. Young people in the troubled south often feel isolated and bored, trapped in a conflict which shows no sign of going away. Development activities have largely been suspended because of insecurity. They want to hear and view programmes on issues important to them, and to contribute to the debate, and with 84% of households possessing working radios and 38% TVs, there is great potential in this approach.
MSPA will be using FrontlineSMS as one of the tools in a new project as part of a British Government-funded media initiative to engage with young people specifically in conflict affected regions though interactive radio programming, tied in with a national competition for young people to produce short video films on their mobile phones. FrontlineSMS will play a key role in the competitive process of selecting the individuals to be given the new mobile phones and trained in their use. This project is planned to start in April 2009. Initial trials using the software are underway, with a view to collecting information on listeners’ views on a variety of topics and feeding these back to them with the help of FrontlineSMS. This will allow active dialogue on issues as varied as the activities of NATO forces in the country and whether Afghans should bear arms, to commenting on education and health services.
Another important application this year will be in the run up to the Presidential Election in September. The media is key to informing the population about the rights of voters, and about the policy of different candidates. FrontlineSMS could be used to elicit the views of listeners in different categories and feed back the results to listeners, prolonging the debate and in so doing capturing the interest of people who are actively engaged in the debate”.
Dr. Akbar, MSPA Director
Kenneth Adam, MSPA Business Adviser
Media Support Partnership Afghanistan (MSPA)
February 11, 2009 58 Comments
I’ve been meaning to finish this post for a while now – it’s been sitting in “draft” mode for the past couple of months. It took a talk by Nathan Wolfe at TED last week – live-blogged by good friends Erik Hersman and Ethan Zuckerman – which finally got me thinking again. Nathan’s talk on bush meat, primates and conservation in Africa drove Erik to make an impassioned call to action:
It really challenged me to think about local communities in Africa and their needs, and I’m thinking hard on what would it really take to replace this type of activity… Please, join me in thinking about this
Now, I’m no expert on primate conservation, bush meat hunting or conservation more broadly, but I did spend the best part of a year trying to understand it. Cercopan is a small NGO based in Calabar, southern Nigeria, which aims to “conserve Nigeria’s primates through sustainable rainforest conservation, community partnerships, education, primate rehabilitation and research”. I arrived there in late 2001 keen to understand what primate conservation really looked like – i.e. on the ground.
I wasn’t the only arrival that December day. A small baby chimpanzee had been confiscated (pictured) from a local market and was waiting to be collected from Lekki, a conservation and education centre in Lagos run by the Nigerian Conservation Foundation. Primate rescue was to be a theme of my time in Nigeria, as was a sense that a large part of the ‘conservation effort’ was really damage limitation and control. Rehabilitating orphaned primates was often the easier part – even though it was hugely challenging and distressing. Changing perceptions, overcoming local politics and trying to shift cultural mindsets turns out to be much harder. Not only that, it takes considerably longer, time that increasing numbers of species simply don’t have.
Primate conservation, bush meat hunting and deforestation are all inextricably linked. Tackling one without trying to address the others simply doesn’t work. In its simplest form, the whole thing goes something like this.
Loggers enter the forest and either blanket cut or selectively cut trees. Paths and roads are opened up into areas which were previously difficult or impossible to access. Loggers need to eat, and many actively hunt for bush meat while working in the forest. Local hunters join in. As more trees are cut and more roads laid, hunters are able to penetrate deeper into the forest, reducing wildlife populations – primates included – yet further
If I were to summarise what I learnt about these complex issues from my time in southern Nigeria, I would break it down into the following categories.
Although large-scale logging is a significant problem – often carried out by larger (almost always foreign) companies – many poor local people are ‘recruited’ to help in the destruction. Equipped with chainsaws supplied by their employers, they enter community forests and national parks and selectively cut high-worth trees. Roads and paths are cut to remove the logs, which are sometimes cut into large planks before being shipped off. Forestry officials, many of whom haven’t been paid for months, stamp the trees as coming from a legitimate source. I will never forget the haunting sound of distant chainsaws as I walked through those forests.
Speaking with the locals in Calabar, many find it inconceivable that people would ever eat primates. In many communities it’s simply taboo, but sadly the same can’t be said for killing them. As outsiders come in search of work, and as main roads open up alongside the fringes of rainforest, hunters from these communities will go in, track down wildlife – primates included – and sell them at the side of the the road. Bush meat is in great demand (see below), and it’s a brisk trade. If a mother is killed then the infant will be sold as a pet – a double bounty for the hunter. Some of these orphans are incredibly young, and barely alive if they are lucky enough to be rescued, as this picture distressingly shows.
The many Nigerians I met believed that bush meat was much better for you than ‘farmed’ meat, and given the choice they’d rather eat something from the forest than a farm. This is a major challenge for conservation groups trying to ween people off bush meat and more towards livestock of various descriptions (see below). As a case in point, some Nigerians living in London appear to be willing to pay significant amounts of money for illegally imported bush meat, despite the availability of almost any other kind of meat from legal, local sources such as London supermarkets (see this interesting story reported by the International Primate Protection League).
Conservation groups on the ground spend huge amounts of time on education and alternative livelihoods and farming programmes. In the 1990′s there was considerable focus on the potential for “grasscutters” – a widely-distributed cane rat found in West and Central Africa – and how farming and breeding these could help reduce or replace reliance on bush meat for protein. I’m not sure how many of these projects were successful, although some research has been carried out and there has been some success by individuals in Ghana. From my own observations, keeping livestock of any kind (other than chickens or turkeys, which need little looking after) turned out to be a foreign concept to many people, and efforts to promote it largely failed.
Speak with the hunters in almost any rural community and there is almost universal recognition that the wildlife is on the decline. Many fondly speak of overnight hunting expeditions with their fathers, and how they’d return the next morning with a healthy ‘catch’. Evidence of distant permanent overnight camps highlight today’s reality – longer trips, days in length, but ones which still don’t guarantee a single kill. Urban dwellers rarely see this reality. Ask them about conservation and wildlife, and their reaction is one of “the monkeys will never finish” (Nigerians often use the term “finish” to describe extinction). Nigerians clearly have much to learn from each other.
It would have been great to have ended my time in Nigeria with a solution to some of these problems, and even better to be able to outline a few of them in this post. But I didn’t, and I don’t.
What I can contribute is this, though…
Things you can do
Firstly, take a little time to try and understand the problems – plural. It frustrates me to read blanket condemnation in the western media of local people in African countries cutting down forests and daring to kill cute chimpanzees. Yes, it’s sad and its destructive. I’ve seen at first hand the pain and distress of an orphaned primate who’s had to have an arm broken to release the grip on its dead mother, or the look in the eyes of exhausted parents struggling to put a decent meal on the table for their children. The problems are complex, but they’re human and animal.
Secondly, join a local organisation working with local communities on the ground. If you’re interested in African primates in particular, a good place to start out is the Pan African Sanctuary Alliance (PASA), an organisation committed to the conservation and care of African primates through the support of in-situ sanctuaries.
Thirdly, if you’re the volunteering kind, check out the University of Wisconsin’s Primate Info Net, but bear in mind that volunteering is really only productive if the local organisation can’t find, or afford, a local version of you among the communities in which they work. If that’s the case, be sure you have a transferrable skill so you can train a local person to replace you when you leave. Sustainability isn’t always financial – it also has a human element to it, too.
Finally, find out about alternative conservation/human strategies such as direct conservation payments – different models do exist. Just as primate species are different, so must be the conservation strategies to help protect them. One size rarely fits all, and this is true whether you’re an elephant, a forest, a primate or a local villager.
February 8, 2009 16 Comments
A couple of weeks ago – in “The long tail revisited” – I briefly touched on the topic of “myths in the social mobile space”. It wasn’t the major focus of the post, but as is often the case it kicked off a completely separate discussion, one which took place largely off-blog in the Twitterverse and via email. I’ve been thinking more about it since, particularly as the social mobile space continues to hot up and people begin to face tools and projects off against one another – sometimes for the right reasons, more often for the wrong.
So, here’s my current “Top Ten” myths and misconceptions in this emerging field. Feel free to add, remove, agree, disagree, debate or dismiss. In no particular order…
1. “High-end is better than low-end”
Firstly, one mobile tool should never be described as being better than the other – it’s all about the context of the user. There is just as much a need for a $1 million server-based, high bandwidth mobile-web solution as there is for a low-cost, SMS-only PC-based tool. Both are valid. Solutions are needed all the way along the “long tail“, and users need a healthy applications ecosystem to dip into, whoever and wherever they may be. Generally speaking there is no such thing as a bad tool, just an inappropriate one.
2. “Don’t bother if it doesn’t scale”
Just because a particular solution won’t ramp-up to run an international mobile campaign, or health care for an entire nation, does not make it irrelevant. Just as a long tail solution might likely never run a high-end project, expensive and technically complex solutions would likely fail to downscale enough to run a small rural communications network. Let’s not forget that a small deployment which helps just a dozen people is significant to those dozen people and their families.
3. “Centralised is better than distributed”
Not everything needs to run on a mega-server housed in the capital city, accessed through “the cloud“. Okay, storing data and even running applications – remotely – might be wonderful technologically, but it’s not so great if you have a patchy internet connection, if one at all. For most users centralised means “remote”, distributed “local”.
4. “Big is beautiful”
Sadly there’s a general tendency to take a small-scale solution that works and then try to make a really big version of it. One large instance of a tool is not necessarily better that hundreds of smaller instances. If a small clinic finds a tool to help deliver health care more effectively to two hundred people, why not simply get the same tool into a thousand clinics? Scaling a tool changes its DNA, sometimes to such an extent that everything that was originally good about it is lost. Instead, replication is what’s needed.
5. “Tools are sold as seen”
I would argue that everything we see in the social mobile applications ecosystem today is “work in progress”, and it will likely remain that way for some time. The debate around the pros and cons of different tools needs to be a constructive one – based on a work in progress mentality – and one which positively feeds back into the development cycle.
6. “Collaborate or die”
Although collaboration is a wonderful concept, it doesn’t come without its challenges – politics, ego and vested interests among them. There are moves to make the social mobile space more collaborative, but this is easier said than done. 2009 will determine whether or not true non-competitive collaboration is possible, and between who. The more meaningful collaborations will be organic, based on needs out in the field, not those formed out of convenience.
7. “Appropriate technologies are poor people’s technologies”
A criticism often aimed more broadly at the appropriate technology movement, locally-powered, simple low-tech-based responses should not be regarded as second best to their fancier high-tech ‘Western’ cousins. A cheap, low-spec handset with five days standby time is far more appropriate than an iPhone if you don’t live anywhere near a mains outlet.
8. “No news is bad news”
For every headline-grabbing mobile project, there are hundreds – if not thousands – which never make the news. Progress and adoption of tools will be slow and gradual, and project case studies will bubble up to the surface over time. No single person in the mobile space has a handle on everything that’s going on out there.
9. “Over-promotion is just hype”
Mobile tools will only be adopted when users get to hear about them, understand them and are given easy access to them. One of the biggest challenges in the social mobile space is outreach and promotion, and we need to take advantage of every opportunity to get news on available solutions – and successful deployments – right down to the grassroots. It is our moral duty to do this, as it is to help with the adoption of those tools which clearly work and improve people’s lives.
10. “Competition is healthy”
In a commercial environment – yes – but saving or improving lives should never be competitive. If there’s one thing that mobile-for-development practitioners can learn from the wider development and ICT4D community, it’s this.
February 2, 2009 40 Comments