Mobile meets health on the margins

The timing of this article could not have been better, given the discussions last week on the merits of mobile-based “cloud computing” and the clarification of our position a couple of days later. Despite advances in mobile devices and data connectivity, the need for mobile tools to also be able to work in less than optimal conditions is still as strong and as relevant as ever, as this use of FrontlineSMS by Telecoms Sans Frontiers in Nicaragua shows us all too well.

TSF – No Bugs In This Software That Fights Disease
(re-printed with the kind permission of SatNews.com)
November 5th, 2009

“Since the beginning of October, Nicaragua is facing a huge rise of dengue cases, which has become a major public health concern in the country. The Health Ministry of the Central American nation (Minsa) has a crisis unit (SILAIS) which currently focuses its activities in response to both the dengue and H1N1 plagues. An Internet monitoring system has previously been set up to control the health situation in the country; nevertheless access to computer is often difficult in some regions where only few health centers are equipped.

TSF and FrontlineSMS TrainingDue to this serious situation, and the necessity to improve the collection of information, TSF, in collaboration with PATH (an international non-profit organisation that aims at enabling communities worldwide to break longstanding cycle of poor health) is reinforcing SILAIS’ capacities in Information and Communications Technologies.

In order to monitor the spread of the dengue in Managua and to conduct mobile health actions, TSF has been implementing for the first time a very innovative system based on a widespread, cheap and solid technology, GSM.

To set up the program, TSF uses FrontlineSMS software. Developed by a TSF partner NGO, FrontlineSMS is free, open source 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. Thus, GSM technology is used to reach as many geographical zones as possible to control health issues in those areas. The server in SILAIS is connected with the 32 health units in Managua.

Each health unit has been delivered a mobile phone by TSF, so that they can send different kinds of information through SMS to the server. Hospital and health centers fill in predefined forms from their mobile phones and send them by SMS to SILAIS. Designed by PATH and the SILAIS, those forms provide data about the classic and hemorrhagic dengue cases, about the H1N1 2009 ones and the need for medicines when the stock nearly runs out. Once the forms received, the server stores information and puts them in databases in order to facilitate statistical analysis, on Excel format for example.

TSF provides two-way communication to health units enabling SILAIS to receive a daily report and gather messages from the health units and will have an updated situation in each center. At the meanwhile, SILAIS will also be able to communicate important information to them through SMS (such as an alert or a warning about coming meetings for example) or give them automatic answers to predefined questions sent by the health units.

Image courtesy Telecoms Sans Frontiers

By providing communication links between health structures and the SILAIS, TSF will allow the Health Ministry to have more accurate information about the diseases spread within Managua and quickly survey and assess the needs in affected areas. TSF helps health professionals use advanced methodologies such as smart phones and open-source software. Mobile devices are great tools to track and transmit crucial data in order to detect an epidemic threat at an appropriate time. Through this program, TSF participates in strengthening health systems in Nicaragua.

Following the installation of the system, on October 24th, TSF organized training for all the beneficiaries of the project. The health units and SILAIS staff were trained on the application’s functionalities and available services”.

For a related article on FrontlineForms, the FrontlineSMS data collection tool used by TSF for the project, go here.

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?