White Ribbon Alliance for Safe Motherhood: Mum's Tattoo Parlour at Glastonbury Festival

Our twenty-sixth guest post comes from the lovely James at the White Ribbon Alliance, who piloted FrontlineSMS in campaigning in a particularly innovative and fun bit of awareness-raising - offering free transfer tattoos at Glastonbury Festival... The White Ribbon Alliance for Safe Motherhood is a coalition of individuals and organisations that campaign to make pregnancy and childbirth safe for all women and newborns. With members in 148 countries, I had thought for a while that FrontlineSMS could be a very useful tool for many of our members, so was keen to "road-test" the software when the opportunity presented itself.

Glastonbury Festival seemed like a great opportunity to do so. For the second year running, we were running a campaign to raise awareness of Maternal Health - by offering people the ultimate way to show how much they love their mum - by coming to our "tattoo parlour" and having a classic "mum" heart tattoo.

In the first year, we were taken aback by the amazing response and the vast number of people that got a tattoo and signed up to be part of our movement. However, this left us with thousands of people's handwritten contact details to type up onto the computer for our mailing lists, which made it really difficult for us to get back to them quickly and simply.

So, this year, I downloaded FrontlineSMS, bought an old electric pink Sony Ericsson phone and USB cable from the Queensway Computer Market (for any London dwellers, this is a veritable Aladdin's cave of old phones, computers and parts), and a SIM card, so that people could text us their email addresses instead.

I had a couple of hiccups setting up FrontlineSMS with the phone - firstly, drivers weren't available for, or didn't work with, Windows 7 - which meant that computer that I'd been putting off upgrading from Windows XP was suddenly my least favourite machine in the office no more - and then the first set of drivers that I downloaded for the phone didn't allow FrontlineSMS to see the handset.

However, a quick search for the phone's model number on FrontlineSMS's forums turned up a link for alternative drivers, which linked the phone up and meant it could send and receive texts perfectly.

Not wanting to risk taking a laptop to the muddy fields of Somerset, I anxiously left the computer in the office running FrontlineSMS with my fingers crossed that it wouldn't crash and that no-one turned it off whilst I was at the festival.

Happily though, when I returned, everything was still running - and a couple of minutes later, I had exported all the email addresses into a nice .csv file ready to be imported into our mailing list server! Unfortunately, we still had thousands of handwritten signups to transcribe. Whilst I don't think we'll ever eliminate this, FrontlineSMS seems like a really effective way to reduce the use of paper, offer easier ways for people to ask for more information about our campaigns, and for us to get back in contact with them.

Perhaps more importantly, it proved itself a reliable tool that I think has the potential to be really useful to our members around the world - and we look forward to introducing them to it and hearing their thoughts and ideas of how they might use it for their own work in support of Maternal Health.

Jaalaka: Connecting the HIV/AIDS Community through Technology

In the twenty-fourth in our series of guest blog posts, we'll hear about how FrontlineSMS is helping Karnataka Health Promotion Trust, and a team of students from the University of Southern California, to build a network of people living with HIV/AIDS in India.

“Jaalaka” means “network” in Sanskrit. In Hubli-Dharwad, FrontlineSMS technology is being used to connect members of the HIV/AIDS population in a widespread rural network to improve service delivery and social support.

Hubli-Dharwad, a peri-urban district in Karnataka, India, has experienced a significant HIV/AIDS endemic. Most of the infections occur amongst the rural female sex-worker population. There is a significant lack of knowledge about STI prevention and treatment amongst these sex workers, which has contributed to the growth in the rate of infections. The Karnataka Health Promotion Trust (KHPT), a government organization that funds and administers public health programs in Hubli-Dharwad, spearheads several programs to combat the spread of HIV/AIDS and other STIs. In order to target the high risk population of female sex workers, KHPT formed a partnership with the Bhoruka Charitable Trust (BCT), a local NGO aimed at promoting health and livelihoods among female sex workers. Since the Hubli-Dharwad region includes over 372 rural villages, BCT employs both professional Outreach Workers as well as volunteer Peer Educators (whom are also female sex workers) to travel to distant villages to educate female sex workers about the risk of HIV/AIDS and to promote safer sex practices.

In summer of 2009, a group of University of Southern California (USC) students, along with financial and logistical support from the Deshpande Foundation, helped launch a pilot program with FrontlineSMS software to improve BCT’s data collection and service delivery. Currently, BCT employs two uses of the Frontline Forms program. Peer Educators make contact with rural female sex workers in the field and complete a Referral Slips via Frontline Forms and the information is immediately sent to the BCT headquarters. The Outreach Workers in the field also completes Daily Reports through Frontline Forms and sends it to the headquarters. By using FrontlineSMS technology as opposed to paper forms, BCT is able to expedite the exchange of information with its staff members in various remote rural areas throughout the district.

As of today, BCT has implemented the program with 37 Peer Educators and 10 Outreach Workers. Both BCT and KHPT have been extremely pleased with the results and are eager to expand the program. Currently, a new team of USC students will be working during the summer of 2010 to troubleshoot technical issues and develop new uses of FrontlineSMS for BCT and other HIV/AIDS advocacy organizations in Hubli-Dharwad.

For more information, check out the USC team's page about the project.

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.

Outreach, health and SMS in Ukraine

Earlier this year, IATP Ukraine launched three pilot projects using FrontlineSMS. In this, the thirteenth in our series of FrontlineSMS guest posts, Yuriy Selyverstov - the Dnipropetrovsk Representative from the Internet Access and Training Program (IATP) - describes two of the projects Tamarisk, a Ukrainian NGO,  plays the key role of resource center for local third sector organisations in the Dnipropetrovsk region. It organises and conducts training for NGOs, and hosts joint round table events for mass media, local authorities and other NGO representatives. Because of this it is important that Tamarisk be able to inform their target audiences about upcoming events. E-mail lists, a web portal for local NGOs, phone calls, and personal contacts have been traditionally used for this purpose.

In March this year, Tamarisk - in co-operation with the IATP program - launched a pilot project that uses FrontlineSMS to disseminate information to target audiences via SMS. By June there were over a hundred NGO subscribers with additional numbers being added regularly. Subscribers are organised into several groups depending on the field of their activities, and since the start of the project over 300 messages have been sent. The effectiveness of SMS sending is well illustrated by the International Renaissance Foundation, who held a presentation at the Tamarisk offices in April. About 60% of the participants found out about the event via SMS.

The following conclusions were drawn after the first three months of using FrontlineSMS:

• Almost all SMS messages were read compared to e-mail, which is not checked regularly by many NGOs
• Bulk SMS sending saves time in comparison to phone calls or personal contact
• SMS did not exclude other traditional tools for disseminating information, but complimented them very effectively

Tamarisk now plans to increase the use of FrontlineSMS in its work.

In the second project, "Doroga Zhizni" (Road of Life) applied FrontlineSMS in the field of HIV/AIDS and tuberculosis transmission prevention and treatment. The target audience are injecting drug users and former prison inmates.  "Doroga Zhizni" is part of the all-Ukrainian "Network of People Living with HIV/AIDS".

For two months starting in March 2009, a pilot group of users with mixed HIV/TB diagnosis received scheduled text messages twice a day reminding them to take their pills. After the two months were up, feedback was collected from the group asking their opinion about the effectiveness of the service. In total, 90% of the group replied that SMS effectively helped them not to forget to take their pills, and that they wanted to receive SMS in the future. Only 10% said SMS was not helpful. Overall, 50% of the group noted positive psychological benefits - the messages made them feel that they were not alone and that somebody cared about them. The project concluded that FrontlineSMS was effective in improving patient adherence to prescribed treatment.

“Doroga Zhizhi” now plan to recommend using SMS reminders with all of its clients, starting this summer. To make this scaling possible they plan to request additional funding from their donor to cover the cost of the messages.

IATP is funded by the United States Agency for International Development (USAID) and implemented by IREX, an international nonprofit organisation that delivers cross-cutting programs to strengthen civil society, education, and media independence in more than 50 countries

Yuriy Selyverstov Dnipropetrovsk Representative Internet Access and Training Program (IATP) www.ua.iatp.net

Where compliance is king

This is the ninth in our series of FrontlineSMS guest posts. In this latest post Aurelio Gomes, who works out of Universidade Catolica de Mocambique, explains their use of the software in monitoring and improving anti-retroviral treatment (ART) compliance among rural communities in Mozambique

Thanks to the US President’s Emergency Program for AIDS Relief (PEPFAR), increasing numbers of HIV-infected people living in poor countries have been given access to anti-retroviral therapy (ART). Successful treatment of HIV depends upon ART recipients maintaining a compliance rate of 95% or higher to prevent the emergence of drug resistance. The commonly used first-line regimen has a low genetic barrier to resistance when dosing is below recommended levels. Not only does widespread resistance lead to a need for costly second-line regimens, but it also threatens to reverse ART survival gains. Worst still, resistant HIV may also be transmitted to others, severely limiting treatment options.

As ART therapy becomes more widely prescribed in Sub-Saharan Africa, suitable systems to ensure patient compliance have to be designed and implemented to maximize ART effectiveness. This is especially necessary in rural areas of Africa. Mozambique exemplifies this situation since 80% of the total Mozambican population are rural. Patients are difficult to locate because formal postal addresses don’t exist in these areas. As in many parts of sub-Saharan Africa, residents are not connected to the electricity grid, and lack regular phone service or access to clean water. Stigma and discrimination increase the challenge of ensuring compliance, as HIV- positive individuals are often very concerned about their privacy.

Following initial technical assistance from our partners at Inveneo, we have been successfully using FrontlineSMS for several months to facilitate communication between the HIV treatment centers and the community health care workers (CHWs) deployed in remote rural areas. These CHWs are armed with mobile phones, enabling communication to flow more quickly and accurately, leading to an improvement in health care delivery.

Our FrontlineSMS-driven communication system is helping us maintain a 95% and higher compliance of ARV therapy, crucial for the patient, the success of our programme and efforts to reduce the chances of development of drug-resistant strains of the virus.

Aurelio Gomes Project Coordinator Universidade Catolica de Mocambique www.ucm.ac.mz

Sitcoms+SMS: Tackling HIV/AIDS in the DRC

In this, the first of a series of guest posts on how FrontlineSMS is being used around the world, Becky McLaughlin - Marketing Director at Rien que la Vérité - talks about their current use of the platform, and the impact it has had on their work "Based in the Democratic Republic of Congo, Rien que la Vérité was born in 2006 when some of the finest musicians in the Congo united to produce a CD of songs speaking against the spread of HIV/AIDS. Since 2006, the Rien que la Vérité platform has produced 14 music videos, a documentary, and an all-day stadium concert. In its present incarnation, Rien que la Vérité is touching the lives of the people of the Congo through their television screens as they follow the lives of a Kinois family on a locally-produced TV drama.

Rien que la Vérité - the TV series - launched nationally on November 30th, 2008 and first implemented FrontlineSMS in the airing of its second episode on December 14th. Each episode broadcast is accompanied by short talk-show segments during which a host introduces music clips, talks to well-known musicians and actors, and interviews representatives from local NGOs and organizations whose message dovetails with a theme introduced in the show.

During the December 14th show, the audience was invited to participate by sending an SMS with the name of their favorite character. The responses were collected using FrontlineSMS. This simple first step allowed Rien que la Vérité to test the software and to begin an exploration of our audience's perceptions and preferences. As the show continues we plan to introduce more simple polls that will help tailor the show to the audience's tastes, and give viewers a sense of ownership of the program.

This, however, is the most basic use we foresee. We are now launching a drive to support fan clubs, so that people who watch the show can find each other, meet, and talk about the show and the topics it introduces - a process that will begin to normalize conversation about HIV/AIDS. We'll use FrontlineSMS to collect contact information from interested fans, then broadcast messages with times and locations for local club gatherings. We also intend to use FrontlineSMS in our research for measuring the impact the show has on our target audience. We'll send out questions via SMS to fans before and after each show, measuring any changes in attitude, knowledge, or self-reported practices due to exposure to the show's messaging.

FrontlineSMS will be a critical tool in our goal to entertain and educate. Like its television format, Rien que la Vérité's future development must remain grassroots, and FrontlineSMS is an excellent vehicle for this."

Becky McLaughlin Marketing Director Rien que la Vérité www.abcd-laverite.com

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".