Safe Motherhood: Mobile healthcare in the Philippines

This post is the latest in the FrontlineSMS Mobile Message series with National Geographic. To read a summary of the Mobile Message series click here.

In this installment of our special “Mobile Message” series, Irma F. Saligumba – Health Research and Projects Coordinator at Molave Development Foundation – talks about a project in the Philippines which aims to reduce mother and infant mortality rates, and provide education and support to expectant mothers, all through their mobile phones.

“Ma’am, I already gave birth. Thank you for the messages you sent”. This was the SMS message I received from Meriam. She is one of the 100 pregnant women who registered in November 2010 for the pilot implementation of the Mobile e-health System for Safe Motherhood Program, run by Molave Development Foundation Inc.

This program aims to support the Philippine Government in reaching towards the United Nation’s Millennium Development Goals to reduce maternal mortality ratio by three quarters by 2015.

As the Health Research and Projects Coordinator of Molave Development Foundation, Inc., I spearheaded a study on the effectiveness of using mobile phones to reach out to pregnant women to improve their maternal health.

We chose the town of Roxas, located on Mindoro Island about 400 kilometers south of Manila, for the research. Its population is about 50,000 spread across 20 villages; its Health Center has 2 physicians, 1 nurse and 8 midwives. To supplement the lack of health staff, there are 140 village health volunteers (VHV) who are trained to do most of the legwork for the midwives, and disseminate information on primary health care, maternal and child health, family planning and nutrition.

I was introduced to Meriam during a visit to her upland village. Like most of the mothers in our program, Meriam is in her mid-20′s, has some years of high school education, is unemployed, and her husband doesn’t have a regular job. Subsistence farming provides additional income, and their average monthly salary is about $150. The only means of telecommunication in their area is through mobile phones. She shares one with her husband.

In the Philippines, where nearly 40% of the population lives below the poverty line, the equity gap is stark and wide. However, the ownership of a mobile phone is one of the few things that has crossed the income divide, making telecommunication relatively affordable and more accessible in this country of 7,100 islands. There are 70 million Filipinos who have mobile phones, compared to only 7 million installed fixed phone lines.

This is the basis for developing a program that uses text messaging to inform and educate pregnant mothers on safe motherhood. Aside from its mass appeal, mobile phones provide the advantage of two-way communication. Mothers are not just passive participants receiving information, but can also ask questions or communicate their concerns if they need to.

We are using FrontlineSMS as our communications platform because it is easy to use for health workers’ with low technical know-how, it works without an Internet connection and provides a way to send SMS through pre-paid SIM cards, thus making it a low cost option. It is also vitally important that the software allows for data storage, and we have created a database of the mothers and the health workers on our on-site computer.

Prior to implementing our pilot project, we conducted various training sessions for the Health Center staff. First we provided a Basic PC Literacy Course which covered use of mouse and keyboard, familiarization with computer symbols and commands, basic computing using word processing and spreadsheets, and how to use the Internet. When they gained sufficient confidence, we then moved on to training basic FrontlineSMS skills (for the PC and mobile phone) to show staff how to use key functionality. Five health personnel were also trained on advanced FrontlineSMS, including administration, management and troubleshooting.

Meanwhile, village health volunteers were trained on how to use the mobile phone for data entry of pre- and post-natal registration, in order to register pregnant women and new mothers in the program.

With the system in place, we started sending out the messages to participants who had already registered during pre-natal checkups at the Health Center. We also worked to reach out to new pregnant women. Posters and brochures were distributed giving instructions on how to register, by sending in an SMS.

Every day for three months, these women received messages on introduction to safe pregnancy and delivery, baby’s phases of development, tips on preparing for labor, common pregnancy problems, benefits of facility-based childbirth, breastfeeding, neonatal care, and child immunization. Through this program we sent a total number of 11,100 text messages or 111 for each of the 100 women registered.

As we hoped, we received messages back from the mothers. Some expressed appreciation for the messages. Others raised serious questions regarding their pregnancy. An expectant mother named Jane inquired if using the computer is bad for the baby. Jocelyn asked what she should be feeling if the baby is due for birth. At 7-months pregnant, Rebecca wanted to know if it is normal to have swollen and painful vagina.

These questions were forwarded to their respective midwives for advice because they were better aware of their patients’ pregnancy status. The midwife’s response was sent by the system to the mother. In the case of Rebecca, she was advised to go to the hospital for evaluation. She even went as far as Manila to have better care, and she ended up staying there until she gave birth because her condition was too serious for traveling.

We are now looking into expanding the Safe Motherhood Program in other parts of the country. Our initial assessment shows that the program has influenced the parent’s decision to use a health facility instead of their home for childbirth. The system also facilitated the prompt recording of new pregnant women and post-natal reporting. This data helps midwives prepare and plan for the pre- and post-natal care activities in the village. This more efficient and interactive information management system can ultimately contribute to improved maternal care, and thus decreased mortality levels.

Mothers involved say they will recommend the Safe Motherhood Program to others. They feel assured that someone is concerned about their welfare and that there is someone they can go to if they have questions. This gives them a feeling that they are important because someone cares, and that feeling of being important strengthens their desire to take care of not only their health, but also their babies.

Irma F. Saligumba has been the Health Research and Projects Coordinator of Molave Development Foundation, Inc. since 2007, and is Lead Researcher of Pan-Asian Collaboration for evidence-based e-Health Adoption and Application (PANACeA) Network with member countries in Central, South and Southeast Asia.

Prior to her involvement at MDFI, she spent 4 years in Attapeu, Laos as provincial health trainer of Health Unlimited. She also served as Training Specialist for 4 years at Philippine Rural Reconstruction Movement focusing on leadership-building, gender and development, and advocacy. She is a registered nurse and earned her masters in Public Health at the University of the Philippines.

part time jobs in baltimore

Plan International case study: helping children report abuse in Benin

We're delighted to announce the publication of the first in our series of in-depth case studies of FrontlineSMS implementations, from Plan International, documenting their work in Benin to develop and pilot a Violence Against Children SMS helpline. Linda Raftree, who many of you will know as @meowtree on Twitter, has written extensively about the programme on her blog, but the case study tries to pull out a bit more of the institutional processes and the technical pitfalls they overcame in the process.

About the programme

In early 2009, Plan was working to strengthen both local and national reporting of trafficking and violence in Benin, West Africa. They were looking for a way to lower children’s and community members’ barriers to reporting, including the risk of reprisals and stigma, communications challenges, and access to places where violence could be reported. The Plan team theorised that collecting reports via SMS, which is anonymous and low-cost, would encourage reporting and allow for a better understanding of the nature and the quantity of violence that was happening.

This in turn could be used to raise awareness around the severity of the problem, advocate for the necessary resources to prevent it, and develop better and more targeted response and follow-up mechanisms. The ability to visualise the data on a map could also have an impact on decision makers and might be a tool that children and youth could use to generate dialogue and advocate an end to cultural practices that allow for violence against them.

The case study covers the training and piloting process, combining Ushahidi and FrontlineSMS, results and key learning to date, and some of the challenges they faced - such as finding appropriate modems, and getting people to SMS, rather than calling, the helpline number.

Seeking new case studies

We hope to produce many such case studies, which are aimed at staff looking to implement SMS or FrontlineSMS in their work, but also can be passed on to managers and donors to help them understand the concepts and challenges involved - if you would like to be one of them, get in touch!

To read more about the programme, download the case study here: Plan International VAC case study, [pdf 1MB].

Using SMS in disaster response - and preparedness

A couple of weeks ago I had the great pleasure, and honour, of joining a wonderful panel, including Carel Pedre, Haiti DJ and activist, and Rory Williams of Carbonsmart.com, at the 5th Digital Citizen Indaba in Grahamstown, South Africa. The brief was to talk about digital communication in the context of natural disasters and climate change. I've spent the last three years working on humanitarian policy, so it was a real treat to bring past and current preoccupations together and let them go for a little walk, arm in arm. As ever though, time ran short, so I thought I'd repost the gist of the presentation here.

Thinking through what  to say, I went back to the basics of understanding what happens in a disaster, and what local, national and international organisations, communities and individuals can do to mitigate their effects and help people recover when they happen. I came across this excellent visualisation of the phases of disaster management and response by the University of Wisconsin's Disaster Management Center, via Özge Yalçiner's thesis.

What's striking about this graphic is how little of it is taken up by what we might think of as classic disaster management - maybe a third of it - if you imagine it as a clock face, from about 8 'o' clock to midnight. Even then, the bit that generates most of the donations and media coverage lasts even less - by the time we get up to ten or eleven 'o' clock, when the slow, laborious process of recovery begins, the world's attention has usually moved on, barring major anniversaries and scandals. I think we're seeing this with Haiti right now. But fully half of the wheel is taken up with understanding and preparing for disasters before they happen. Another big slice represents the critical prediction and early warning analysis in which governments and local knowledge play an essential part.

Much of this work, all the way around the wheel, requires community participation - and quite right too. Requirements analysis and needs assessment need local knowledge and community input; reconstruction must be community-led and owned to be successful. Then follow the wheel round to between midnight and 1 'o' clock - there's a segment devoted to gathering disaster histories and experiences, both to learn and to help plan and prepare for future emergencies. Again, this is a key point of community action. Between 2 and 3 'o' clock, vulnerability analyses bring in community maps, workshops, focus group discussions, and other techniques to make sure that interventions and community support mechanisms reach the right people and places at the right moments. And last-mile disaster preparedness and early warning systems and mechanisms just won't work unless they are truly owned by the communities who have to enact them.

This will come as a surprise to none of you, given the focus of this blog, but: I think there's a significant opportunity here to use SMS to help communities to engage with these processes and get their views heard. Complaints and response systems, data-gathering, early warning and evacuation alerts all have and should be delivered using SMS, given its ubiquity in areas that are otherwise hard to reach. Two-way communication using an SMS hub running FrontlineSMS would enable you to send alerts, information about distributions, advice and even messages of support and solidarity; and more importantly, receive information about what's happening on the ground, invaluable local knowledge, and feedback on the success of programmes, and allow people to express what they are feeling. The Haiti experience has shown that this is possible in an emergency setting, and the important work of evaluating the success of those programmes is ongoing - the next step being to build on this learning to improve our understanding of best practice for SMS in emergencies. And as I write, agencies now experienced in using SMS in the fraught days after a disaster are thinking about how to maintain those links, and forge new ones, as they move into the 'recovery phase'. But many organisations are beginning to use SMS in the longer-term, more gradual process of helping people to mitigate and prepare for the risks they're exposed to - we know many are using FrontlineSMS.

We didn't get time to talk much about this on the day, but maybe we can carry on the conversation now. What do you think?

I really enjoyed the event and the thought-provoking discussions about digital activism. I'm very grateful to the DCI team for asking us to be part of the day, and to the lovely participants, who very obligingly joined in with a bit of what I like to call FrontlineSMS Pilates.

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.