The Mobile Minute is here to bring you coverage on the rise of smartphone sales around the world, a crop insurance plan in Kenya that uses mobiles to process claims and distribute money, the effect of the 2010 U.S. elections on PBS' mobile web and app usage rates, a pilot in Zambia that uses SMS to rapidly transmit HIV test results between rural clinics and hospitals, and mGive's new mobile donation options.
In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector.
At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here.
Patients can pay service providers directly for health care services delivered.
Service providers can use mobile transfer platforms to reward patients with monetary or airtime incentives for treatment compliance.
At the district, regional, and national levels, governments and organizations can improve management of funds and introduce better checks and balances by using mobile money platforms. Some uses include:
Mobile phones are being tried and tested in myriad ways in health care. They are used for data collection and disease surveillance, for ensuring treatment compliance, for managing health information systems and point-of-care support, for health promotion and disease prevention, and for delivering emergency medical services. Clearly, m-health, as this growing field is dubbed, is here to stay.
At the same time, achieving scale and sustainability in most m-health projects has been a challenge. One of the key aspects of beginning to think about ways to integrate m-health into health systems in a sustainable way is to establish financial systems to pay for health services and to ensure financial accountability within programs.
The Vodafone Americas Foundation and the mHealth Alliance are announcing a call for entries for the annual Vodafone Americas Foundation Wireless Innovation Project mHealth Alliance Award, a competition to identify and support promising wireless-related technologies to address critical social issues around the globe. Proposals will be accepted from September 27, 2010 through December 15, 2010, with the final winners announced in April 2011.
The Mobile Minute is back with the latest mobile news. McKesson Foundation's president is interviewed about its $1.5 million grant for m-health research, Zimbabwe begins to roll out per-second mobile billing, NTEN shows non-profits in the United States seven ways to incorporate mobile donations, Apple publishes its guidelines for submissions to the app store, and Twitter releases new figures about their mobile access numbers.
Today's Mobile Minute brings you coverage on using SMS to access social networks in Nigeria, Organizing for America's new iPhone app that aids political canvassers, HTC's development of a dual GSM and CDMA phone, a pilot project that uses SMS to send information to pregnant women in Peru, and a Pew Research Center report on U.S. adults' mobile phone usage habits.
Karen G. Cheng, Francisco Ernesto and Khai N. Truong
Publication Type:
Journal article
Publication Date:
1 Apr 2008
Abstract:
Handheld computers have untapped potential to improve HIV/AIDS programs in sub-Saharan Africa, particularly in the collection of survey data. We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior.
Participants were asked about their HIV/AIDSrelated knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition. These results suggest that using handheld computers in data collection in sub-Saharan Africa may lead to biased reports of HIV/AIDS-related risk behaviors.
Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., Fu, L., Ossman, J.
Publication Type:
Report/White paper
Publication Date:
1 May 2010
Abstract:
This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.
The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.
The major thematic areas include:
Treatment Compliance
Data Collection and Disease Surveillance
Health Information Systems and Point of Care Support
Health Promotion and Disease Prevention
Emergency Medical Response
The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.
Today's Mobile Minute covers how mobiles are improving students' performance in a North Carolina school, personal data theft from a malicious Android app, a $100 million USAID grant for health services in Malawi, the effect of mobile applications on the East African economy, and the release of Opera's "State of the Mobile Web."
A how-to guide on using and implementing RapidSMS for mobile data collection and communication.
Ths manual give an overview for how to implement and use RapidSMS in a mobile data collection project. RapidSMS is a SMS framework for data collection, group coordination, and complex SMS workflows. The tutorial outlines when and when not to use RapidSMS, guides the user through project steps and milestones, outlines factors for a successful implementation, and provides worksheets for project planning. Example training materials are included.
Today's Mobile Minute covers the mobile gender gap, mobiles in the classroom that allow deaf children to learn alongside hearing children, a study about mobile over-sharing, mobile credits on cell phones during disasters, post-Haiti disaster management with ICTs, and a 90-second interview with Patricia Mechael about mobile health.
The Child Africa International School in Kabale, Uganda encourages the use of SMS at school in order to foster communication between hearing and non-hearing students, as described in "Deaf Children are Being Heard in Africa." (Hat tip Textually.org)
According to a Webroot Study of 1,645 social network users, 55% of people polled said "they worry over loss of privacy incurred from using geolocation data" on mobile phones."
"Disaster Response 2.0: Learning from Haiti" looks at how ICTs were used after the January 2010 earthquake in Haiti, covering mobile donations, Ushahidi, and how ICTs can help during emergencies.
[Mobile Minute Disclaimer: The Mobile Minute is a quick round-up of interesting stories that have come across our RSS and Twitter feeds to keep you informed of the rapid pace of innovation. Read them and enjoy them, but know that we have not deeply investigated these news items. For more in-depth information about the ever-growing field of mobile tech for social change, check out our blog-posts, white papers and research, how-tos, and case studies.]
Healthcare agents in Bamako Coura, Mali, are providing better care to children with the help of mobile phones. Healthcare agents with Pesinet, a non-profit organization based in Mali, perform weekly checkups on children and then send the results to a doctor for evaluation through a Java application.
Anne Roos-Weil, founder of Pesinet, says:
In Sub-Sahara Africa you have a very, very high child mortality rate. […] In Mali, where our project is based, one child out of five dies before the age of five. What we realized is that they’re mostly dying because they don’t go to the doctor or the healthcare center early enough.
To prevent child mortality from benign diseases through regular home screenings
To create an insurance plan so that health problems do not bankrupt families
Brief description of the project:
Pesinet is a mobile healthcare service currently deployed in Bamako Coura, Mali. Parents sign up for a healthcare worker to visit their children weekly for a regular checkup. The agents collect data via mobile phone, and send it to a doctor at a healthcare center, who reviews the information for changes. The parents pay the equivalent of one Euro a month, which covers visits to the doctor in case of emergency, and provides half-price medication in case the child needs medical care.
Target audience:
The target audience is parents of children under five in Bamako, Mali (for the current pilot; later it will expand to all parents of children under five who live in areas with high under-5 mortality rates in Mali).
Length of Project (in months) :
10
Status:
Ongoing
Anticipated launch date:
Total cost of project:
$ 12,000
What worked well? :
In a survey conducted by the Malian Ministry of Health, 96% of the mothers enrolled in the program reported satisfaction with Pesinet, 99% wished to recommend the service to family and friends, and 97% of the families found the service to be "very affordable."
What did not work? What were the challenges?:
The program's challenges are:
Breaking through the trust barrier - Pesinet found it difficult to promote the service rapidly in areas where there is little awareness of the value of prevention, as this involves a significant cultural shift.
The organization's desire to be financially self-sustaining has meant slow growth (compared to subsidized programs); the paying approach inevitably led to slower adoption than if the service were free of charge.
The aim of this paper is to encourage reflection and discussion around the potential of mHealth in developing countries and to consider how early experiences can inform the way forward. Toward this aim, I synthesize many reviews and presentations from the eight years I have been studying the evolution of mobile phones and health in developing countries. I include observations and discussions that are now shaping the creation of mHealth as a field, to highlight the ingredients we need to move from a series of pilot projects and isolated business opportunities to a full-scale maximization of health-related benefits.
I begin by reviewing the strategic priorities within global health, where mobile telephony can have the greatest impact, along with organic health-related uses of mobile phones, and examples of formal mHealth interventions. I then demonstrate the potential for mobile phones to become an extension and an integral component of eHealth, describing how information and communication technology (ICT) can be used in health care, as well as mHealth, as a subset of mServices: using mobile devices to deliver services such as banking and health. I also show how trends and interests are converging among key stakeholders within the mHealth ecosystem, thus forming a foundation on which we can scale up and sustain more and better mHealth activities. Finally, I present some tactical guidance for a way forward that will further the objectives of both public health and business, particularly in outreach efforts to emerging markets, the bottom of the pyramid, and the next billion mobile phone subscribers.
Pesinet is a not-for-profit international organization delivering a simple prevention and early-care system for countries lacking medical resources ,with the objective of driving a systemic change in the healthcare situation of low-income countries and reducing child mortality.
Pesinet was designed to offset the weaknesses of existing public healthcare systems and provide affordable healthcare services to help prevent, detect and treat diseases in time thanks to the periodic and cost-efficient monitoring of key health data.
Baseline under five child mortality in Sauri, Kenya as of 2005 was estimated to be 148 deaths per 1000 live births. By 2008, the rate had dropped to 81 deaths per 1000 live births due to Millennium Village Project (MVP) interventions. A review of child deaths revealed that among other causes, such as malaria, acute febrile illnesses, diarrheal illnesses and HIV, malnutrition contributed to more than 50% of all child deaths. Community health workers (CHWs) led several interventions, namely community-based management of acute malnutrition, home-based testing for malaria and diarrheal illnesses and immediate dispersal of appropriate treatments.
To support these interventions, MVP ran a pilot project where CHWs were equipped with mobile phones to use SMS text messages to register patients and send in their data with the goal of improving child health and empowering community health workers. This report seeks to detail the methods used, illustrate early results and initial findings of the ChildCount mHealth platform that CHWs have now been using since early July of 2009.
Presented here is an overview of the operational needs of NGOs and CBOs and the role information systems can play to increase their accountability and efficiency. Information systems need to fit the diverse operational needs of NGOs and CBOs, which include coordinating activities, training and monitoring staff, documenting results, accounting, reporting, decision making and learning, acquiring external information and encouraging community participation.
Unfortunately, there are gaps in information systems that impede the ability of NGOs to embrace ICT. To name a few, the lack of open, accessible, cross-platform mobile development tools, limited opportunities and resources provided to local small software companies to engage with NGOs, and the lack of long distance networking technologies to reach remote locations.
Two examples of technologies that were applied successfully are shared: Self Help MIS, an application to monitor activities of small microfinance organizations and credit groups and DigitalICS, an application for data collection used by agricultural cooperatives. The author stresses that ICTs should be viewed as a tool to allow local change agents to be more effective and accountable and shows how computing is able to support local organizations by inspiring innovation, implementation and dissemination of projects, and measuring impact.
An overview of the components, approaches and techniques used to build mobile phone-accessible applications that use SMS text messages as a conduit for data collection and service delivery. SMS-based applications represent a paradigm shift allowing innovative new approaches to monitoring and data collection fundamentally changing the way we can approach the delivery of critical health, economic and social services in resource-poor settings. SMS has the potential to fill significant connectivity and service gaps, particularly for the world’s poor, until data networks and phones that can support them become more ubiquitous.
This guest post was written by Nicolas di Tada, Director of Platform Engineering at InSTEDD. He writes about an ingeniousway for health workers to accurately transmit semi-structured data via mobile. His post is reprinted here with permission.
During August 2009, we went on a number of field trips to health centers in remote areas of Thailand and Cambodia. The idea was to conduct a few usability tests on Geochat syntax alternatives that we were exploring. Our goal was to simplify the interaction between health workers and the system to ultimately allow them to report disease cases in a semi-structured way.
The case information always originates at the local health center level - this is where the patient comes and gets diagnosed. Most of the case reports are made through phone calls to the district level (the higher administrative level). Case details get lost when the district level summarizes the information by disease and reports the quantity of each to the provincial level.
We had another great Technology Salon today, this time on Cloud-based SMS applications that showcased four interesting applications -- ChildCount+, Jokko, Happy Pill, and Patatat. And, in big news of the day, Matt Berg succeeded in breaking the Tech Salon cardinal rule of no slideshow presentations (and I am making it public knowledge in case someone needs ammunition in the future).
The rapid adoption of mobile technology by end users has also resulted in a corresponding proliferation of pilot projects around the world. A number of projects discussed in this Salon have cross-over potentials not just across borders, but even across sectors. Here are some notes and links to applications, all in the interest of wider dissemination beyond the group that was at the Salon.
This guest-post is by Arturo Morosoff who completed recently a project with D-Tree International and BRAC Tanzania to provide videos on mobile phones to assist Community Health Workers (CHWs) for health education. It is posted here with permission.
I recently completed a five week volunteer project working with Irene Joseph and Gayo Mhila of D-Tree International to provide videos on mobile phones to Community Health Volunteers with BRAC Tanzania in the Mbagala district of Dar Es Salaam.
A bit about me: I have no formal training in ICT or public health. My background is in technology and business and I live and work in the San Francisco Bay Area in California. I was on a two month trip in Tanzania and volunteered to help D-Tree with this project. As such, the project needed to be completed in a short time and we began with modest goals.
Among BRAC’s programs to help alleviate poverty is its health program, which relies on an all-female team of Community Health Volunteers (CHVs) to conduct monthly home visits to provide health education and support. Each CHV visits 150 – 200 homes each month, asking health related questions and providing healthcare information. In Tanzania, D-Tree has been collaborating with BRAC to provide the CHVs with a mobile phone-based tool called Commcare, to help improve the effectiveness of their home-based programs. About a year ago there was discussion with the CHVs of providing them with health education videos suitable for use on phones to provide additional support for their home visits.
Catholic Relief Services' maternal and neo-natal health monitoring program in Uttar Pradesh, India is incorporating mobiles into its work. The pilot project, which launched in June 2009, uses mobiles to increase volunteers' ability to share and gather health information.
The program uses SMSs to allow ASHAs (Accredited Social Health Activists who are local volunteers) to report statistics on maternal and neo-natal health metrics. According to O.P. Singh, who gave a presentation on the program as part of the SHOPS/mHealh Alliance online conference, several problems in the current system led to the adoption of mobiles: the existing paper system was difficult to use, workers at village and block levels had limited access to information from headquarters, and the paper system was slow. The organization hoped that incorporating mobile phones would give the volunteers a better sense of the health landscape, since they would have access to real time information and be able to instantly share their results. During the presentation, Singh illustrated the system with the following graph:
To increase communication flow and collect data via community health workers
To teach local health workers to incorporate technology into their work
To more accurately track births and deaths
Brief description of the project:
Catholic Relief Service's "Texting with a Purpose" gave mobile phones to community health workers (ASHAs) in the Uttar Pradesh region of India in order to track live births and deaths. The ASHAs filled out mobile forms and submitted them via SMS to a central database in order to better monitor maternal and neonatal health in the region.
Target audience:
The target audiences are:
36 volunteer accredited social health activists
Pregnant women and newborns in Uttar Pradesh, India
Length of Project (in months) :
10
Status:
Ongoing
Anticipated launch date:
What worked well? :
The project has raised the level of reported births to almost 100%. Because the data is compiled instantly, less children are missed than under the old system. The Catholic Relief Service has also seen that the ASHAs view the SMS system as a viable plan for the future or reporting on maternal/neonatal health and that they are working hard to master the system.
What did not work? What were the challenges?:
So far, 65% of the ASHAs still need support from family members or the Catholic Relief Services staff in order to manage the SMS texting; reasons for this include a lack of familiarity with mobile technology and low literacy. Another challenge is the coded SMS system; it has to be filled out very precisely, which can lead to errors.
Catholic Relief Services carries out the commitment of the Bishops of the United States to assist the poor and vulnerable overseas. We act to promote human development by responding to major emergencies, fighting disease and poverty, and nurturing peaceful and just societies; and we work with local, national and international Catholic institutions and structures, as well as other organizations, to assist people on the basis of need, not creed, race or nationality.
Many mobile projects struggle with scale and impact. While a mobile health project may run well with a small number of patients in one hospital, expanding the scope of a project until it is large enough to have real impact takes money, time, and widespread support of key stakeholders in a given community. ChildCount is well on its way to show scale and, so we hope, significant health impacts using mobile technology for patient support.
In a little over eight months, ChildCount has enrolled nearly 10,000 children under five in their catchment area into the ChildCount health monitoring system – an acceptance rate of more than 95%.
Register every child under five in a community into the ChildCount database
Screen those children for signs of malnutrition every 90 days
Monitor the children for the three major causes of death in children under five (malaria, diarrhea, and pneumonia)
Group all children into age groups to streamline the immunization process
Record all local child births and deaths.
Brief description of the project:
ChildCount is a health monitoring system that targets pregnant women and children under five. ChildCount provides mobile phones to community health workers who then use SMS to manage data about patients, including health information, immunization records and disease symptoms.
Target audience:
The target audience is children under five and pregnant women in specific communities that are part of the Millennium Villages project in Africa.
Length of Project (in months) :
8
Status:
Ongoing
Anticipated launch date:
Total cost of project:
$ 25,000
What worked well? :
The project especially credits close relations with local community health workers as a key to its success. Also, RapidSMS and the Django platform allowed ChildCount to quickly update its services once the initial project changed into a larger-reaching plan. The project was able to get a more than 95% participation rate in the initial pilot.
What did not work? What were the challenges?:
One challenge was adapting the program to target all the children in the catchment area, not just the ones who are at-risk. Another, major challenge, is developing the project into a sustainable model so that ChildCount can continue on without reliance on outside grants.
The Millennium Villages project is led and executed by the communities on the ground in Africa. Throughout the continent, more than 400,000 people are leading this bold initiative, giving their time, skills, and resources to make the project a success and one that is relevant to local conditions. Because Millennium Villages are an investment toward a sustainable end to extreme poverty, Millennium Village communities strengthen their local governments and institutions and certify the preparation and implementation of the interventions in their community. This is necessary to ensure that their development will become sustainable and self-sufficient.
The Millennium Village project is based on the findings of the UN Millennium Project and is led by the science, policy and planning teams at The Earth Institute, Millennium Promise and the United Nations Development Programme.
The Vodafone Americas Foundation is announcing the last call for nominations for the second annual Wireless Innovation Project, a competition to identify and reward the most promising advances in wireless related technologies that can be used to solve critical problems around the globe. Proposals will be accepted through February 1, 2010, with the final winners announced on April 19, 2010 at the annual Global Philanthropy Forum in Redwood City, California.