Posts from — June 2009

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

If we were to have a mantra on the FrontlineSMS project, it would be this: “Focus on the users, and all else will follow”.

From the very beginning we’ve been unashamedly focused on servicing the needs of our growing NGO user base. Much of the advanced functionality you see in the software today has been requested by users over the course of the last four years, and much of the feature request list we’re working through today is based on feedback received since the major MacArthur-funded re-launch last summer. Our focus on the user is beginning to pay off, with well over 500 members actively engaged online. Although we’re excited with our progress, we’re far from complacent and there’s much more we need to, and can, do.

With growing numbers of these users actively engaging online, others have started contributing their own stories on how they’re applying the software in their social change work. All that remains now is the creation of the second part of the community puzzle – this time for developers.

With invaluable support from our friends at the Open Society Institute (OSI) and the Free Software Foundation, last autumn we finally solved some lengthy and complex licensing work with the FrontlineSMS code. With a number of educational establishments, NGOs and individual developers keen to begin work, we pushed the code out on SourceForge, posted a community blog entry a little later, and got on with improving functionality and providing continued frontline technical support to the NGO user base.

Although some early partners have already started working with the code, we’ve been holding back on an official announcement until we have everything in place – IRC, mailing lists, documentation and processes, for example – and the code is in the best possible shape for people to work with.

Earlier last month we started working with Aspiration Tech in San Francisco, who will be responsible for helping build the community. Our own developers, a number of users, and other volunteer programmers are all incredibly excited to be working with Aspiration, who are experts in the field. We’ll make an announcement once we’re good to go.

Although there is considerable buzz and excitement around mobile technology and source code at the moment, we’ve been firm believers that the users come first. Without them you have no project, no community. Only now, after increasing numbers of this first community – the users – begin to apply the software in exciting and innovative ways, is everyone ready – developers included – to tackle the second.

This is the eighth in our series of FrontlineSMS guest posts. Here, Mike Blyth – Computer Systems Coordinator at Serving in Mission (SIM) – discusses their use of the software among missions operating in central Nigeria

Jos, Nigeria has been in the news recently because of riots in November that killed hundreds of people. This was the second such episode since 2001, and the situation remains tense. Besides this, violent crime has increased rapidly in the past four years, with frequent robberies by armed gangs of up to 20 or more men.

Part of our response as a group of missions in Jos has been to strengthen our communications network, and FrontlineSMS has become a key part of that network. The mobile phone is the basic means of communication in Jos, where there are few if any functioning land lines, and where Internet access is still expensive and spotty. During the November crisis, we noticed that voice calls on the mobile network rarely connected, probably because of congestion, while SMS messages got through well.

Our response

It was shortly after that we started experimenting with FrontlineSMS, and we have so far developed a system with a number of features.

First, anyone can text the system and receive a response with the current status message. In a crisis, this could contain warnings, instructions, announcements and so on. Besides this ‘on demand’ capability, we keep one list of users who receive broadcast alerts.

Anyone can join this “text alerts” group by sending the request as a text message to the system. We ask people to send the message “JOIN” followed by their name. At this point, FrontlineSMS cannot automatically include the name when the phone number is added to a group (only the number is added), but we hope that feature will be included in the future.

We maintain other user lists such as compound security leaders, crisis management teams, and so on. Anyone can broadcast a message to the crisis management team by prefixing a text message with a code that causes FrontlineSMS to forward the message to all team members.

Finally, we use FrontlineSMS to send outgoing SMS messages through the Internet when it is available. They’re sent via Clickatell, which routes them to the actual SMS network. Clickatell is very fast and inexpensive. We can send about 80 messages per minute this way, far more than is currently possible if we were to send messages directly via the mobile phone network.

Real life examples

Fortunately, we have not had actual rioting since we set up the system. However, there have been times when it has been very useful to send warnings and to raise the alert level. Here are some actual examples:

• @Alerts: Jos is tense, please avoid downtown today
• @Security: X and Y have been robbed tonight & report the robbers took their Toyota Land cruiser and muttered something about Hillcrest on the way out
• @Alerts 20Feb 655pm. Serious rioting reported in Bauchi. No problems in Jos. Obey curfew, avoid areas that could be troublesome
• 22 Feb 8am. *** Rioting on Friday Bauchi, churches & mosques burned. Now controlled. Keep on alert. Report signif news this num or ur security rep
• SecGrp: Some rumors are going around about unrest planned for Friday, …. Email or txt me if you know more. –Mike

Effectiveness

The system has worked quite well. The most serious limitations to date have been problems with the modem and Internet, which have had a tendency to lock up, failing to receive messages, and have to be re-initialized manually. In addition, message delivery is sometimes delayed for hours, occasionally more than a day. This is a fault of the local network and has nothing to do with FrontlineSMS or Clickatell.

In summary, FrontlineSMS has served us very well as a way to communicate quickly by SMS. We would recommend it to others in similar situations.

Mike Blyth
Computer Systems Coordinator
Serving in Mission (SIM)
www.sim.org

Fortunately for us, many of the day-to-day technologies which drive large chunks of our on-line lives quietly tick away in the background, only reminding us of our total dependence on them when something breaks or goes wrong. We take the complex ecosystem which drives much of this for granted.

Last month I was invited to speak at a conference at Georgia Tech and give my perspective on building social mobile tools that work in the opposite, resource-challenged environments, a reality for the majority of people in the world today. My short ten minute talk is available above, courtesy of Georgia Tech, along with a PDF of the slides.

The motivation behind the Computing at The Margins Symposium grew out of a research agenda at the university aimed at “understanding the technology needs of under-served communities, both domestically and abroad, and driving the creation of innovative technology to serve and empower these communities”.

Figuring out how we build useful, appropriate mobile tools for grassroots NGOs is crucial if we’re not to create a digital divide within the digital divide. Additional posts and video on my thinking behind this “Social Mobile Long Tail” are available here.