In Malawi, problems as symptoms

When I started out in development I had no idea what I’d be able to do to help solve some of the huge, complex problems out there. But that lack of certainty – and an absence of obvious answers – turned out to be a far better starting point than I ever imagined. 

After a trip to Zambia in 1993 to help build a school, I knew immediately that my work in IT and finance in Jersey wasn’t the right career for me and that I wanted to spend the rest of my working life doing something more meaningful. But that was all I knew. At that stage I didn’t have a skill set that was particularly useful to international development, so there was no obvious quick and easy way in. Instead I set out on an extended period of learning, one where I spent as much time as I could living with, working with, and supporting the communities and causes I wanted to help – everything from a few weeks helping build a local hospital in Uganda to a year working in rural conservation in Nigeria.

The work was often hard and emotionally challenging, but in a way I was fortunate. That decade of learning turned out to be critical, and included a spell at university learning development and the art of social anthropology. The technology piece didn’t return until much later, and I’m grateful for that. If mobile phones and the Internet been around in 1993 I’d probably have jumped straight into ICT4D and bypassed all the context – and been far the poorer for it.

not-the-tech-tweet

I write this as I sit on a flight from Malawi where I’ve spent a week assessing a teacher absenteeism system as part of my work with CARE. What turned out as a trip to unpick a piece of software turned into one dominated by everything but. Food insecurity, climate change, economics and the politics of education were the real issues, teacher absenteeism just a symptom. The visit reminded me why I got into development – not because of technology, but because of the people, and the very real challenges they face in their lives.

From afar you’d be forgiven for thinking that teachers not showing up for work were just lazy and, although that might be the case for some, for the vast majority the reasons were far more complex than that. It was only after sitting down and speaking to many of them that you realise how teacher absenteeism isn’t the real problem after all, and a technology looking to solve a problem might be looking at totally the wrong thing.

Anyone hoping to make use of today’s vast toolbox of technologies to solve a problem in international development might be better off keeping it closed at first, and taking time to better understand the context of the problem they’re trying to solve. Unfortunately, the availability of technology makes it far too easy to skip that learning step (hence the high rate of failure) and I consider my wider knowledge of development issues to be a far greater asset to those I work with than my programming or technical skills. There’s a dedicated Students page on the kiwanja website promoting the merits of this very approach.

For the children: Food aid distribution at a school in Malawi

With 20% of the country facing severe food insecurity due to an excessive drought, the Malawian Government declared a state of emergency half-way through our trip. We saw piles of food aid at primary schools to feed the children, many of who had little chance of getting it anywhere else, and heard of classes with ratios of 250 students to one teacher, and others with little to no materials and even less hope of getting any any time soon. Many teachers felt undervalued, demotivated and underpaid, struggling as much as the students they were trying to teach. Somehow, the enormity of these challenges – and how they connected and intertwined – only seem real when you come face-to-face with them. Time in the field beats any amount of time in front of a computer screen.

This trip was a stark reminder of something I already knew – the value of local knowledge, local reality and local perspective on any development effort, regardless of what we assume the problem, or solution, to be.

Mapping medicine availability via SMS

Medicine stock-outs are a potentially lethal problem in a number of African countries, yet governments insist they don’t occur. What could be more powerful than a map which contradicts this claim?

Last week activists in Kenya, Uganda, Malawi and Zambia started surveying clinics in their respective countries, checking stock levels of essential medicines, including:

  • First-line anti-malarials
  • Zinc 20mg tablet
  • Penicilin
  • First-line ARVs
  • Metronidazole 200mg tablet
  • Ciproflaxicin
  • Amoxicillin suspension
  • Ceftriaxone
  • Cotrimoxazole suspension
  • ORS – Diarrhea

Each of these are seen as essential in varying degrees to fighting disease and illness, and are widely used when available.

Armed with the data, activists report their results via structured, coded SMS – “x,y,z” – where the first number represents their country code (Kenya, Malawi, Uganda or Zambia), the second their district or city, and the third the medicine which they found to be out of stock.  These messages are received by a phone connected to a computer running FrontlineSMS, which then runs an automatic script which validates the data before it is sent over the internet to a Ushahidi-powered website.

From there the results are automatically displayed on a map, below (click to visit the live site).

Stockouts map

As of today, there have been over 250 stock-outs of these essential medicines.

Since the data is automatically populated, the map represents an almost real-time picture of stock-outs in the four target countries. After a successful launch and a week piloting the service, the “stock-out hub number” will now be distributed to medicine users throughout each country so that anyone with a mobile phone can send in a stock-out report. Unlike reports from official, known data collectors, these messages will firstly be checked by staff at Health Action International (HAI Africa) before being posted up on the map.

Stockouts Team

The technological portion of the campaign was implemented by Michael Ballard and Claudio Midolo, both Open Society Fellows from the Department of Design + Technology at Parsons the New School for Design in New York.  Ndesanjo Macha also helped in getting FrontlineSMS up and running in Uganda and Malawi.

For further background information and up-to-date news, visit the “Stop Stock-Outs” website.

FrontlineSMS, media, and the Malawi elections

It doesn’t quite make the headlines in the same way as elections in Nigeria, the DRC or Zimbabwe, but today the people of Malawi are awaiting the results of a general election which many are saying is too close to call. A peaceful and orderly outcome is crucial. Malawi has one of the fastest growing economies in the world (although it is starting from near-bottom, admittedly) and continued stability is vital if progress is to continue.

Access to balanced and unbiased election information is often a key problem at crucial times like these. The logistical challenges of running nationwide elections is often compounded by a lack of election-specific knowledge among local media, which can often lead to misreporting, misinformation and – in worse-case scenarios – civil unrest. The availability of ICT tools for local journalists can also be problematic, compounding the problem yet further.

Malawi elections, courtesy http://www.flickr.com/photos/malawielectionspix/

The African Elections Project (AEP) Malawi focuses on developing the capacity of the media through the use of ICTs, and mobile-enabled AEP Malawi team members are working across the country, using voice and SMS to stay in touch with a central newsroom based in Blantyre. This newsroom is equipped with a copy of FrontlineSMS, which is helping manage incoming and outgoing SMS to and from newsroom members, and helping auto-manage and disseminate news via SMS to subscribers.

FrontlineSMS is free software that turns a laptop and a mobile phone into a central communications hub. Once installed, the program enables users to send and receive text messages with large groups of people through mobile phones.

To receive regular election updates and certified results from the Malawi Electoral Commission, log on to www.africanelections.org/malawi. Malawians can text “subscribe” to +265 884 583 980 or email their mobile number to malawi@africanelections.org.

Updates are also available on Twitter by following @malawivotes2009

The African Elections Project (AEP) Malawi is co-ordinated by the International Institute for ICT Journalism working hand in hand with key partners, with funding from the Open Society Initiative for Southern Africa (OSISA) and Open Society Initiative for West Africa (OSIWA).

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”.