Mobilising around FrontlineSMS:Medic

Today sees the launch of an exciting new initiative - FrontlineSMS:Medic - by a growing team of students mobilising around the practical application of mobile technology in global healthcare delivery. FrontlineSMS:Medic combines Josh Nesbit's pioneering work on "Mobiles in Malawi" with a mobile version of OpenMRS - an open source medical records system - and an exciting new remote diagnosis tool. In this guest blog post, Josh Nesbit and Lucky Gunasekara talk about the origins of the project, and their plans in the coming months.

Josh: I should be heading off to class, right about now. I'll go, but not without telling a story, first. A convergence of ideas and people marks the launch of FrontlineSMS:Medic and the team's embarkation on a quest to do mHealth the right way.

Many of you are familiar with the role FrontlineSMS, a donated laptop, and a bag of recycled cell phones have played in connecting community health workers (CHWs) in Malawi to a rural hospital and its resources. Text messaging is now an integral component of the hospital's infrastructure. FrontlineSMS has proven intuitively easy to use with strong user buy-in. The program is horizontally scalable, and incredibly cheap to run, matched with indisputable savings in time and costs. Enter Lucky.

Lucky: I am the bewildered South Asian guy in the photo. Back in 2008, I was sitting in an office in Tokyo reading about cellphone penetration in developing countries, wondering if mobiles couldn't also be used for boosting healthcare delivery in resource poor settings. When I wasn't wearing a suit and riding to work in a packed Tokyo subway car, I was wearing a t-shirt and khakis and working in clinics in Sri Lanka - accepting an offer to attend  Stanford Med, this year. I worked out that SMS could be used in tandem with an open source electronic medical records system called OpenMRS, allowing for continuity in patient care from the community health workers to the clinic.  Meanwhile, Josh was sweating it out in Malawi, actually learning this the hard way. Just to prove that good ideas are obvious, Isaac Holeman and Daniel Bachhuber, two students at Lewis & Clark, had the same realization and began working on a project called MobilizeMRS to get this underway.

Josh: Long story short, we're all working together now. Lucky is pictured on stage with Bill Clinton, as his CGI U commitment is announced on the group's behalf.

Lucky: The commitment is, briefly:

To build on kiwanja's CGI commitment of an Ambassadors Program within FrontlineSMS, by developing a new version of FrontlineSMS - FrontlineSMS:Medic - for use in clinics in developing countries. That Medic will have end to end of continuity of electronic medical records by fusing FrontlineSMS with OpenMRS in a modular click-to-add format. I will be taking a year off from medical school (a decision infinitely popular with my folks) to work on this system and develop new partners on the ground with Josh, and do research on a new breakthrough medical diagnostic system at UCLA, that we feel will be the "Killer App" of FrontlineSMS:Medic. More on that to come. We're also going to be fully open source with wiki user manuals and off-the-shelf healthcare packages for download, so setting up a DOTS-TB program doesn't have to be any harder than buying a song on iTunes... OK, maybe a little bit harder... but not by much.

Josh: We're planning to pull this off within a year, operating in more than 25 pilot study and partner clinics by the summer of 2010. The system will be free and so will the hardware. Check http://medic.frontlinesms.com regularly to learn more and get involved.

Building our Clinton Commitment

Those following kiwanja's work will remember last September's invitation to the Clinton Global Initiative in New York, where we proposed the "FrontlineSMS Ambassadors Programme" as our 2009/2010 Commitment. This Commitment was announced live on-stage during the ‘Poverty and Information’ workshop on the final day, and I also had the huge honour of meeting President Clinton in person, who presented me with our Commitment certificate.

Of course, now the work really starts. Since New York much has happened, including the receipt of a significant grant from the Hewlett Foundation. Portions of this funding will be used in the coming weeks to kick off the first phase of the Ambassadors Programme, which is part of wider efforts to promote the use of FrontlineSMS among the NGO community. This first initiative will be based around Josh Nesbit's innovative health-based efforts in Malawi, and Josh - who will be project managing the work - will provide updates nearer the time via his blog and Twitter feed.

Future initiatives will take in other key target areas where FrontlineSMS has shown its versatility. These include agriculture, education, conservation and human rights, among others. For regular updates feel free to subscribe to the blog RSS or FrontlineSMS Twitter feeds.

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.

A Malawian perspective on FrontlineSMS

Josh Nesbit - a Senior in the Human Biology Program at Stanford University - spent the best part of this summer working in a rural hospital in Malawi, where he also implemented FrontlineSMS. Here, Alexander Ngalande, the Home-Based Care nurse at St. Gabriel's Hospital in Namitete, talks about his experiences of the software, and how it has impacted healthcare delivery for 250,000 people (video courtesy of Josh Nesbit)

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".