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.

FrontlineSMS: Now with Forms

It’s been a hectic few months, but we’re finally there. Today we’re excited to announce the release of the new FrontlineForms, an SMS-driven data collection tool which seamlessly integrates into our existing and growing FrontlineSMS platform.

Sure, data collection tools already exist, but many require mobile internet access to function, degrees in Linux to get running, or PDAs or the kinds of phones that just aren’t available to the masses in most developing countries. FrontlineForms runs on most high- and low-end Java-enabled phones, can be downloaded directly onto a handset over-the-air, doesn’t require internet access beyond installation, and utilises the already-proven simple user interface of FrontlineSMS. In short, FrontlineForms compliments our existing focus on empowering the social mobile long tail with an entry-level, usable data collection tool.

According to my thinking, tools for the long tail need – among other things – to run on readily available hardware wherever possible, and be simple to install and easy to use. These innocent little criteria can create huge challenges, though. Writing an application which runs on all desktops (Windows, Mac and the various flavours of Linux), that interfaces locally with the widest range of phones and modems, and connects remotely with a data collection tool which runs on as many Java-enabled handsets as possible is a huge technical challenge. Many other mobile solutions concentrate on one desktop operating system, or a small family of mobile phones (sometimes just a single phone), which is all fine if you want to concentrate on users higher up the long tail. With our focus on grassroots NGOs, we don’t.

FrontlineSMS Forms Editor

So, this is how it works. Using the new FrontlineSMS Forms Editor (above), users are able to create a form visually on their computer by dragging-and-dropping field types, giving them names and setting other parameters along the way. The form is then encoded and sent via SMS to any number of handsets running the FrontlineForms client, a small program which runs on a wide range of Java-enabled handsets. Once these handsets receive a new form, the Java client interprets the data, saves the form layout and displays a mobile version ready for the fieldworker to complete (see below).

FrontlineForms Client

The FrontlineForms client can hold many different forms at the same time, all selectable from a drop-down menu. As requirements change new forms can be built and distributed by simply texting them to the recipients handset through FrontlineSMS – they don’t need to travel to the office to be added. Once out in the field the user simply inputs their data, and once complete multiple forms are combined and compressed, ready to be sent back to the FrontlineSMS hub, again as SMS. If at any time users find themselves working out of range of a mobile signal, the data is usefully held in “offline” mode until connectivity is restored.

The addition of data collection functionality to FrontlineSMS is a significant step forward for the software. From today, non-profit organisations in the developing world can experiment with anything from simple two-way group messaging campaigns to prototyping SMS-based information services, or start collecting data in the field, all through a single software application. The modular nature of FrontlineSMS means that users are able to deactivate functionality they do not need, but then easily reactivate it as they grow into SMS services. Future “modules” will include mapping functionality – powered by Ushahidi – and multimedia messaging (due later this year) allowing the transmission of pictures, audio, video and text. More specialist applications, including those being developed independently by the FrontlineSMS:Medic team, will also appear as optional modules.

According to Dr. Luis Sarmenta of the Next Billion Network and MIT Media Lab – whose students worked on pre-release versions of the tool as part of their own projects:

“Data collection from the field is one of the most common needs we see among projects in the developing world today, and enabling people to use mobile phones instead of paper would empower a lot of groups and people out there to do their work more efficiently, more effectively, and with broader reach. FrontlineForms seeks to provide this profoundly useful capability while remaining true to the goal of ease-of-use that has been the key to FrontlineSMS’ success and value”

Télécoms Sans Frontières (TSF) were equally positive after spending several days putting the entire platform through its paces as part of a wider evaluation exercise. According to Grégory Rebattu, TSF’s Niger Representative:

“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”

FrontlineSMS Icon - Photo by Erik Hersman (White African), Kenya, 2008

Today’s release of FrontlineForms gives many new and existing FrontlineSMS users access to entry-level data collection tools for the very first time. Those that find it valuable, and those whose data collection needs grow, can then move onto more scalable and powerful solutions such as those developed by DataDyne, an organisation we’ve been in contact with over the years and whose work is making a considerable impact in parts of the developing world. What FrontlineForms aims to do, over-and-above anything else, is give grassroots NGOs the opportunity to try out mobile data collection with the minimum of fuss, the minimum need for high-level technical expertise or equipment, and the minimum of funding.

These are exciting times for the FrontlineSMS community. The software has been allowed to develop organically, based very much on the needs of  users in the field, and it continues to power increasing numbers of social change projects around the world. If 2009 doesn’t turn out to be the “Year of Mobile” everyone is talking about, we’ll sure be doing our best to make it the “Year of the FrontlineSMS user”.  \o/

(Further details on today’s FrontlineForms launch can be found on the official Press Release. A special thanks goes to Tess Conner for her work on media and PR, to MIT and Télécoms Sans Frontières for their feedback, to the team at Masabi for their commitment and contribution to the project, to members of the FrontlineSMS Communiity for their ideas and enthusiasm, and to members of the wider social mobile community for their continued support and encouragement. You know who you are)