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.

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?

FrontlineSMS takes on rural healthcare in Malawi

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”.