Interoperable Technologies in International Development: Access to FrontlineSMS

By Ashley Mannes FrontlineSMS was recently included in an academic paper, written by Ashley Mannes, of Georgetown University, USA, and titled ‘Interoperable Technologies in International Development: Access to FrontlineSMS.’  In the below guest post, Ashley introduces the main themes of her paper and what compelled her to write about FrontlineSMS:

"When I first got the opportunity to travel to different parts of the world, I began to understand and appreciate the beauty and unique qualities of the cultures that unite our global community. My interest in development flourished during my master’s degree program in Communication, Culture, and Technology at Georgetown University. The program helped me to realize that a great opportunity is provided by today’s technologies; to communicate with and connect to cultures and climates that once seemed so distant. In this manner, I discovered the work of organizations like FrontlineSMS that are using technology to help people to connect and communicate across the world.

I actually came across FrontlineSMS by chance, as I was preparing to write a paper on Networks and International Development. I knew I wanted to explore how open lines of communication and access to technology were helping NGOs connect with local communities in order to give them a more global voice, and it was when I began searching for organizations with this type of a mission that I discovered FrontlineSMS.  Through my research I saw how technology was positively impacting local NGOs and communities around the world due to FrontlineSMS’ work.  Therefore, it seemed ideal to focus on FrontlineSMS as the case study for my paper.

I chose the title Interoperable Technologies in International Development: Access to FrontlineSMS to tie together ideas of access to technology and economic development. My paper explores the “bottom billion”, an idea proposed by Paul Collier that addresses the specific needs of the populations of least developed nations that have been left out of the discussion, and the struggle to prosper in today’s economic climate. I suggest that in order for these countries to rise from the “bottom”, they must build upon their own bonding capital and reciprocity in order to use the communication networks that are available to them.

In this sense, struggling nations must focus on the local connections that they have in order to expand their voices to a more global platform. I stress that new technologies, such as mobile phones, are fostering much more crosscutting communication; these new technologies have the ability and potential to aid development goals and economic activities. However, in order to take advantage of these new technologies, these networks must be interoperable and open.

FrontlineSMS is utilizing both the technology of mobile phones and the networks of communities to spread information, communicate, and affect lasting change. I focused on two case studies in particular to demonstrate how FrontlineSMS can be flexible and accessible technology, used by NGOs to accomplish both their local and global missions. In Pakistan, for example, the global NGO, the International Organisation for Migration is using FrontlineSMS software to send mass text messages of health and sanitation information to countless displaced refugees who need this information to remain safe and healthy during natural disasters. The ability of these NGOs to access this technology and reach out to local Pakistani citizens through text messages is a huge step for development, and one that allows for an open line of communication with those who may need it most.

The second case study I looked at focused on the response to the HIV/AIDS epidemic in the Hubli-Dharwad district of India. Here FrontlineSMS was utilized to connect a network of development groups to the local sex-workers infected by, or at-risk of contracting, HIV/AIDS. The FrontlineSMS data collection tool FrontlineForms allowed field workers to quickly collect important information on their mobile phones and export it to their headquarters to be gathered and documented for further development purposes. Interoperable technologies have helped development practitioners collect more information faster and more easily.

It has become clear that openness and flexibility are necessary components of technologies that can help to successfully promote development. Access to technologies that harness the network capability of a common mobile phone can provide the needed link and physical line of communication to isolated communities.  Interoperable technologies can be used to network a group of development practitioners or to distribute mass amounts of information and assistance to a local community. They can be used to collect information in the field or to simply communicate between individuals.

Regardless of the manner in which the technology is utilized, the accessibility of this technology can help to open up a path of communication between the local and global, ultimately building social capital at the local level and cultivating a more global sense of capital and reciprocity through working together and expanding these development networks. I enjoyed exploring how FrontlineSMS is helping communities and NGOs to interact, and hope that I have done justice to this in my paper."

Read Ashley’s paper here - Interoperable Technologies in International Development.

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Tanzanian farmers report improved yields via SMS

“Nearly 90 percent of Tanzania's residents live in rural areas, work primarily in the agricultural sector, and lack access to information, technology and markets,” Technoserve state on their website. Technoserve is an organisation which focuses its work in Tanzania on supporting farmers, cooperatives and suppliers in order to help develop rural industries. Whilst working towards these country-wide goals, keeping track of their impact is essential. Here, FrontlineSMS Community Support Coordinator, Florence Scialom, speaks with James Hangaya, Monitoring and Evaluation Analyst at Technoserve Tanzania, about how he is using FrontlineSMS to help collect the data he needs for monitoring Technoserve's Coffee Initiative project in Tanzania.

** This post has also been shared by Technoserve, and reported on by AllAfrica. **

Training for farmers is a key to Technoserve’s strategy in Tanzania, and forms a large part of their Coffee Initiative project. Training sessions help small-scale coffee farmers produce better quality coffee, thus helping them to secure higher prices in the international marketplace. “Sessions are based on different topics, and include practical lessons on, for example, how much fertilizer should be used to produce the best yield,” explains James. The farmer trainers hold multiple sessions on agricultural best practices, helping farmers to use their equipment and run their farming practice more efficiently.

One of the key steps in monitoring and evaluating the success of training is to measure the changes in farmers’ behaviour. “We train approximately 12,000 farmers every year” James tells me, “and there are nearly 60 farmer trainers across the country at the moment, running courses for groups of 15 to 20 farmers at a time.” There is certainly a lot of data to keep track of, and this is where FrontlineSMS proves very helpful Technoserve's work.

After experiencing the challenges of monitoring and evaluating their training programmes using extensive paper surveys, James and the Technoserve Tanzania team decided that there must be a more efficient way. This is when they came across FrontlineSMS data collection tool, FrontlineForms. Using this tool Technoserve farmer trainers are now able to conduct all post-training evaluation via SMS.

James explains how they manage this process: “Each farmer that attends a training session is allocated an individual ID. When filling out FrontlineForms, the farmer trainers use this ID to identify which individual farmer they are collecting data on. They answer set survey questions about farmer behaviour, using a pre-defined scale of 1-10 to indicate responses. They then send them back to me in the office to analyse the data.” This gives Technoserve Tanzania the data they need, to indicate whether the training has had an impact on the way the farmers manage their crops.

In addition, farmer trainers are provided with scales to measure a sample number of farmer’s harvest weights. These weights are compared with the farmer’s previous yield, and show how much farmers are able to produce before and after Technoserve training courses. Collecting these kind of direct indicators of impact is key to monitoring the success of the Coffee Initiative training sessions, and FrontlineForms is allowing this data collection process to be done much more quickly, and at a lower cost to Technoserve Tanzania.

The transition from paper to SMS has made a great difference to work flows, as James explains; “it saves us so much time and money, because our field staff no longer have to travel from the field to deliver paper survey results to our office, which can be a journey of more than 1,000 kilometres.”

This use of SMS technology makes the data collection process more efficient in error detection, too. As James says, “If I had picked up a potential error or if there was any data missing in a paper report then I would have to send it all the way back to the field to check whether the data needed to be edited; now I am able to this much more quickly and simply, via SMS.” These efficiency savings help to demonstrate the value of using FrontlineForms as a data collection tool.

Technoserve Tanzania plan to continue using FrontlineSMS for monitoring and evaluation, and are looking at ways to optimise and extend the ways they use the software, too. “In future we are looking to use FrontlineSMS to register farmers for training sessions and track their attendance. This will allow us to provide real-time reporting from the field,” explains James.

As Technoserve get accustomed to using SMS in their day to day work flows it is clear they are finding out more and more ways for it to help them make their work quicker, easier, and more efficient. James summed up this fact well by saying, “my boss agreed that we should change to FrontlineSMS for all the things that it can do for our work!”

You can find out more about what FrontlineSMS can be used for here, download the software for free here, and access FrontlineForms here.

“TechnoServe makes a commitment to businesses and industries, working in the field with entrepreneurs and other industry stakeholders to build enterprises able to thrive on their own and generate continuing benefits for the rural poor.” You can read more about their work on their website: www.technoserve.org

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UN uses FrontlineSMS to help manage aid response in East Africa

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em>By Lisa LaRochelle, FrontlineSMS Project Assistant FrontlineSMS is being used for social change in many different ways across the world. Common use case examples include election monitoring, provision of health information, and agricultural support –  these kinds of use cases have direct positive impact on people’s lives. Yet here at FrontlineSMS we have seen increasing numbers using FrontlineSMS for organisational management, which has indirect benefits for people which are

far harder to measure and demonstrate; helping organisations to work more efficiently, communicate more easily with their staff, and move information around more swiftly. Examples include using FrontlineSMS for monitoring and evaluation, data collection, and internal communication. It is this latter kind of FrontlineSMS use case that we recently discussed with Sanjay Rane, Information Management Officer at the United Nations Office for Coordination of Humanitarian Affairs (OCHA) in Kenya.

Mobile phone penetration is high in Kenya, and the UN OCHA staff members that Sanjay works with all have their own mobile phones. The convenience and accessibility of SMS appealed to the team, and FrontlineSMS is a low-overhead way of managing text messages to and from groups. “For the last couple of months we have been using FrontlineSMS as an in-house communication tool,” Sanjay explains “and it has certainly helped foster better information sharing among the OCHA Kenya team.”

SMS offers an immediacy and intimacy that can be seen as unique from other methods of communication. People always have their mobiles close to them, and generally read messages quickly. This has certainly shown to be the case in OCHA’s experience. They have found that using SMS helped them to reach staff, especially during an emergency occurring in off hours, when most of the staff do not check their emails. OCHA Kenya can use the tool to send out urgent updates to the team.

One of the major benefits of using FrontlineSMS is the ability to manage SMS more easily than using a simple phone handset. When trying to send out messages using a handset, Sanjay found it difficult and time consuming to add and delete people’s contact information, send messages to multiple contacts at the same time, and maintain groups of contacts. FrontlineSMS offers a simpler solution: the ability to sort contacts into groups so that, for example, an emergency alert text can be sent out to a large group of staff at once. It is also possible to set up key words and automatic replies with FrontlineSMS, so the system can automatically send people important advice and information.

The OCHA Kenya team had such success with their experience that they decided to implement FrontlineSMS to facilitate communication with a larger group of humanitarian partners in Kenya, as a preparedness tool for the referendum in 2010. They are now exploring the possibility of using SMS to help coordinate with agencies responding to the current East Africa drought. This is an indication that FrontlineSMS is enabling improved communications management in a way that was otherwise not possible.

It was the capacity to manage data in combination with the popularity and simplicity of SMS which led Sanjay to FrontlineSMS. “At OCHA Kenya, using SMS for internal communication is very popular, as it is a familiar communications tool. We have found it really valuable to use SMS for communicating with colleagues on important humanitarian developments in Kenya,” Rane says. Organisational management, although behind the scenes, can provide huge social benefits by enabling those working for NGOs and INGOs to communicate more effectively and do their challenging jobs more efficiently

Announcing the "Mobile Message"

Over the past year or so, it's become increasingly clear to us that we need to take the "mobile message" out of its technology silo and make it more available - and accessible - to a wider audience. This was the thinking behind our regular series on PC World, and is the thinking behind a new series we're launching today in collaboration with National Geographic.

The "Mobile Message" is aimed at a broad audience, but most importantly people who would never likely visit a mobile-specific site. Recent talks at Communicate - aimed at conservationists - and Nat Geo Live! - aimed at the general public - have convinced us even more that we need to stop just talking among ourselves and take the message out to more mainstream, broader audiences.

According to the first "Mobile Message" posted today:

"Over the next few months we will delve into the human stories behind the growth of mobile technology in the developing world. We'll take a closer look at the background and thinking behind FrontlineSMS, and hear from a number of users applying it to very real social and environmental problems in their communities. We will also hear thoughts and insights from other key mobile innovators in the field, from anthropologists to technologists to local innovators."

You can read the rest of the introductory post on the National Geographic website here.

Mobile Design. Sans Frontieres.

Although I find myself intrigued by the convergence of computer science, human computer interaction (HCI) design and international development, it's not often that I find myself in a room of experts. They're just not places I tend to mix, most likely because I have no professional IT qualifications, let alone a computer science degree, and I've done most of my own software design off-the-cuff, much to the dismay of people who hoped there was a robust process behind it. Last August I got my first taste of the very real challenges that the computer science world faces when it comes up against the equally real challenges of international development. The meeting - convened at UC Berkeley - was an eye-opener for me to say the least, and as I left I blogged about how thankful I was that it wasn't me who had to come up with the answers. You can read that post here.

A little later in the year I was invited to speak at the First International Workshop on Expressive Interactions for Sustainability and Empowerment, held at one of Vodafone's London offices. The topic of conversation was similar, but here the focus was on how to build mobile tools that work in difficult, challenging, 'foreign' environments. Following my talk I was invited by the Editor of Interfaces, John Knight, to contribute an article to the next edition of their magazine.

For the article I teamed up with Joel Selanikio, co-founder of DataDyne.org and the creator of the EpiSurveyor mobile data collection tool. It made sense working with Joel for a number of reasons. Not only have I known and admired him and his work for some time, but Joel is first and foremost a paediatrician. For him - like me - understanding the problem takes priority over the technology, consideration of which should always come last. FrontlineSMS and EpiSurveyor have both evolved from time spent in the field - observing, experiencing and understanding before designing, developing and building.

You can read our thoughts on the process - "Ten things you might want to know before building for mobile" - in the current edition of Interfaces magazine (PDF, 2.5Mb).

For further posts on the subject see the "Mobile applications development" section of this blog, which includes a 10 minute video on the topic.

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.

Due 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.

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: Peacebuilding in Afghanistan

In this, the second of a series of guest posts on how FrontlineSMS is being used around the world, Dr. Mohammad Akbar and Kenneth Adam - Director and Business Advisor respectively at Media Support Partnership Afghanistan (MSPA) - talk about their current and planned uses of the platform, and the impact it is having on their work "A recent special edition of a radio programme for young people in Afghanistan was devoted to one topic – the shocking recent acid attack on girls attending school by violent extremists allied to the Taliban. The impact on the audience was recorded in some 300 phone calls from listeners – a record for the long running programme "Straight Talk", produced by a team of young broadcasters from Media Support Partnership Afghanistan (MSPA).

This audience response provides an example of what is possible given the enormous growth in mobile phones in Afghanistan, well over 6 million and rising at over 100,000 a month. Young people in the troubled south often feel isolated and bored, trapped in a conflict which shows no sign of going away. Development activities have largely been suspended because of insecurity. They want to hear and view programmes on issues important to them, and to contribute to the debate, and with 84% of households possessing working radios and 38% TVs, there is great potential in this approach.

MSPA will be using FrontlineSMS as one of the tools in a new project as part of a British Government-funded media initiative to engage with young people specifically in conflict affected regions though interactive radio programming, tied in with a national competition for young people to produce short video films on their mobile phones. FrontlineSMS will play a key role in the competitive process of selecting the individuals to be given the new mobile phones and trained in their use. This project is planned to start in April 2009. Initial trials using the software are underway, with a view to collecting information on listeners’ views on a variety of topics and feeding these back to them with the help of FrontlineSMS. This will allow active dialogue on issues as varied as the activities of NATO forces in the country and whether Afghans should bear arms, to commenting on education and health services.

Another important application this year will be in the run up to the Presidential Election  in September. The media is key to informing the population about the rights of voters, and about the policy of different candidates. FrontlineSMS could be used to elicit the views of listeners in different categories and feed back the results to listeners, prolonging the debate and in so doing capturing the interest of people who are actively engaged in the debate".

Dr. Akbar, MSPA Director Kenneth Adam, MSPA Business Adviser Media Support Partnership Afghanistan (MSPA) www.mspa.org.af

The "long tail" revisited

Four years ago was a very lonely time. Not for me personally, understand, but in the social mobile space. The wider non-profit world was just beginning to take a serious interest in what the technology had to offer, and in 2004 I'd just co-authored one of the earlier reports - funded by the Vodafone Group Foundation - on the use of mobile technology for conservation and development. To give some context, these were the days when it was widely believed that "poor people in developing countries" would never be able to afford a phone, and the days when concrete case studies on the application of mobile technology for positive social and environmental change were few and far between. Most evidence was anecdotal. A revised report would look very different today, but with one exception - many of the conclusions would likely still stand. If that's the case, how far have we really come?

Four years ago this week I came up with the concept of a laptop-based group messaging hub. The software I ended up developing is better known today as FrontlineSMS ("ProjectSMS" was the working title for the first few months). When I eventually got the resources together to write the first version in the summer of 2005, there was zero chance of reinventing any wheels. The "social mobile applications" shop was quite literally bare. After extensive research for a project I had been working on with South Africa National Parks (SANParks), there were simply no appropriate technology mobile solutions they could easily pick up and run with. The situation seemed crazy, and I had a hunch that SANParks were not alone in their need for an appropriate, portable, GSM-based communications tool. The rest is history, as they say.

Things are not quite so lonely today and 2008 - for me, at least - goes down as the year things really began to change. For what seemed like an age, FrontlineSMS was one of the few appropriate technology-based mobile tools aimed at - and openly and freely available to - the grassroots non-profit community. For a while it was the only one. It was also likely the first to be developed specifically with the NGO sector in mind - most other solutions were commercial offerings which found their way into the hands of NGOs, quite often the larger international variety with the funds, expertise and resources to use them. The frustration for me was that - until last year, at least - many of the emerging 'non-profit' mobile solutions seemed to be following that same model.

Enter "The Social Mobile Long Tail", my attempt at mapping out the social mobile applications space (you can read the original post, which explains the thinking in detail, here).

The basic rationale behind it was this. The majority of emerging mobile solutions, platforms or tools (call them what you will) were settling in the red area, and as such were technically and financially out-of-reach of many grassroots NGOs, many of whom sit in the green space. Tools at the higher end of the graph are generally more complex, server-based systems aimed a multinational NGOs or government departments. Tools in the lower end are simple, low-cost, appropriate and easily replicable solutions. My experiences working with NGOs in Africa over the past fifteen years has strongly influenced and steered the focus of my work towards the long tail, and I would have it no other way.

But let's just destroy a few myths for a minute. There are many out there. Here's my top three (feel free to add to these in the comments section below).

Firstly, wherever your tool sits on the graph, there is no right or wrong place for it. It's all about the context of the user. There is just as much a need for $1 million server-based, high bandwidth solutions as there are for free, SMS-only tools. In your typical scenario, national governments would likely go for the former, and grassroots NGOs for the latter, but not always. Both are valid, and tools shouldn't ever be described as "being better" than another because of it. This is a big mistake. We need there to be solutions all along the tail so that the users have a healthy applications ecosystem to dip into, whoever and wherever they may be. If you're trying to park a car into a small space, a Mini is much better than a Rolls Royce.

Secondly, let's not get all hooked up on scale. Just because a tool in the long tail might not run an international mobile campaign does not make it irrelevant. Just as a long tail solution might likely never run a higher-end project, expensive and technically complex solutions would likely fail to downscale enough to run a small communications network for farmers from a small NGO office with no mains electricity, for example.

Thirdly, we don't yet have any complete, polished mobile tools. I would argue that everything that we see in the social mobile applications ecosystem today is "work in progress", and it will likely stay that way for a very long time. Speaking with my FrontlineSMS hat on, I'd say we're probably only about 40% there with that solution right now. There is much to do, and the mobile technical landscape never stands still. Our challenge is how we all move with it, how we stay relevant, and how we all work together to share technical resources and know-how. A fragmented mobile landscape is a problem for all of us.

There have been many positive blog posts calling 2009 the "Year of Mobile". I think they could be right. I also think 2009 is going to be the "Year of the Searcher" (see my earlier blog post). As I argued back then, let's never forget it's the users of our tools who we answer to. Social change happens on the ground, often through them, and not online.

For the first time in four years things don't feel quite so lonely. I for one am hugely honoured to be working in a space alongside some of the most dedicated and talented people in the mobile and development fields, all of whom are trying to apply a range of practical solutions - all the way along the "social mobile long tail" - to some of the most pressing problems in the world today. We have a great opportunity in front of us if we stick together, remain focussed, and do not lose sight of the big picture.

After all, we don't want to be reading blog posts in twelve months time calling 2010 the "Year of Mobile", do we?

Mobiles for media empowerment

Today, all eyes are on the United States with one of the most anticipated Presidential elections in decades. Amidst the excitement lurks the ever-present concern over potential election day chaos, and fears of a repeat of what happened in Florida eight years ago. Once again, mobile technology is also being touted as one way of smoothing election day progress and how it's reported, as it has been in almost every election around the world in recent years. The proposed use of Twitter is perhaps the one key addition in USA'08.

In the coming months three West African countries also go to the polls - Ghana, Guinea and Cote d'Ivoire. Sadly, access to balanced and unbiased election information is often a key problem in these countries. 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. Availability of ICT tools for local journalists can also be problematic, compounding the problem yet further.

To address some of these challenges, the International Institute for ICT Journalism, in partnership with the Open Society Initiative for West Africa (OSIWA), are embarking on the "West African Elections Information and Knowledge Project".

The project seeks to strengthen the role of the media in election reporting through the training of senior editors, journalists and reporters; developing and disseminating an 'Election Reporting Guide for the Media'; the use of text messaging in election coverage and monitoring with FrontlineSMS; and the creation of a Knowledge Online Portal.

The use of mobile technology in election monitoring may be nothing new, although promoting the use of text messaging specifically as a media enabler represents something of a departure from its usual use by official election monitor groups. The choice of FrontlineSMS is also significant. The software has already been successfully implemented in Nigeria to enable what is widely believed to be Africa's first citizen election monitoring project, and it was used in the last Philippine elections to help organise official monitoring teams around the country. In recent weeks it has also been lined up to help register 135,000 overseas Filipino workers in advance of the upcoming 2010 elections.

Further details on the West African election project are available via the Africa Election Portal website, and updates will also be posted on the kiwanja.net blog as the project moves forward.

SMS-powered rural healthcare in-a-box

A few months ago Josh Nesbit, a Senior in the Human Biology Program at Stanford University, travelled to east Africa where he spent the best part of his summer introducing FrontlineSMS into a rural hospital in Malawi.

St. Gabriel’s Hospital, where Josh worked, is located in Namitete. It 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, and with just two doctors and a handful of clinical officers, St. Gabriel’s Hospital is also strikingly understaffed.

With woefully inadequate communications exacerbating the problem, Josh - with the help of the Haas Center for Public Service at Stanford University and the Donald A. Strauss Foundation - implemented kiwanja's FrontlineSMS software to connect the hospital with its community health workers (CHW). Now, 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. The "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. According to Josh, FrontlineSMS has essentially 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).

Since returning to Stanford, Josh has continued his work, speaking at a number of conferences and workshops and producing a user manual - "Building an SMS Network into a Rural Healthcare System" (available here as a PDF, 7Mb). According to Josh, the guide "provides an inexpensive way to create an SMS communications network to enable healthcare field workers as they serve communities and their patients".

Not only has FrontlineSMS enabled a significant improvement in healthcare delivery for St. Gabriel's, the project is infinitely scalable and replicable. Coming in at just $2000, Josh has clearly demonstrated what is possible with just three basic ingredients - a single laptop, one hundred recycled mobile phones, and local ownership and engagement. Now, with his step-by-step user guide and the minimum of investment in time and money, rural hospitals the developing world over can easily implement their own SMS communications network.