Featured image credit: Andy Miah Creative Commons License

Today we had the opportunity to chat with Steve Ollis of D-tree International, who will be a guest expert for our Mobile Phones for Public Health course. Below, he discusses his experience working in the mHealth field!

Can you tell us about your background and experience in mHealth?

I came into mHealth and global health in a somewhat non-traditional way. I actually started off as an accountant and management consultant with BearingPoint, working with various US government military branches on their accounting systems. I moved into IT consulting with a focus on program management for the next six years, working at progressively smaller companies, bringing web applications to state and federal agencies and addressing issues like help desk, user training and support, and change management needed to introduce and sustain new applications in large organizations.

My career in mHealth and global health started with a few short volunteers stints in Kenya and South Africa followed by a position with the Clinton HIV/AIDS Initiative (now Clinton Health Access Initiative) for two years in Tanzania, working in pediatric HIV, commodities, lab systems and Prevention of Mother to Child (PMTCT) programs.

With this exposure to the global health world and my background in information technology, I was intrigued by the possibility of working in the mHealth space and joined D-tree International in Tanzania six years ago. I have been fortunate to work on cutting edge mobile decision support tools focusing on design, development, deployment and support. I have seen projects grow from 1-2 facility to over a hundred facilities, and 5-10 community health workers to thousands of health workers. Over the years I have also seen a dramatic price drop for Android phones from $650 t0 $80. I have worked in Tanzania, Benin, Malawi, Kenya, Sri Lanka and India as part of small and large teams, and have worked at both the community health worker and Ministry of Health levels.

How is mHealth incorporated to your work currently?

D-tree International is a health NGO that uses mobile technology to improve the care provided by frontline health workers. We are working at the government, donor, implementing partner and ground levels to develop applications and systems that support decision makers at all levels, from the community health worker and nurse level to health systems supervisors. We focus on providing mobile decision support tools to health workers, and creating health systems to provide them adequate support. We use mobile technology to improve health outcomes by developing supervisory applications, dashboards, mobile money integration for transport, vital events tracking, and point of care diagnostics.

Why do you think mHealth is important / what impact can learning about the use of mobile phones for public health have on development projects?

It is amazing to think about how we can do things more effectively and efficiently using mobile devices, including data collection, applications, closed user groups and telemedicine. At a higher level it is useful to think about how these innovations can be introduced, scaled and supported in order to create significant impact and change.

What are your thoughts on the future of mHealth, and where you think this field is heading?

We’ll see continuing availability of smartphones at all levels of society and the prices will come down further. The price of data and sms will also be reduced and connectivity will increase at greater bandwidth. These forces will allow for increasingly complex mHealth systems to be developed where data, images and video may be able to be shared even in the most remote areas. Point of care diagnostics will continue to evolve, where the prices and power requirements for certain tests will drop to a point that they become more feasible to deploy at the community level. Mobile money, vouchers and mobile insurance will also play a role as the health workers and clients become more familiar with their use in their day to day lives. Power and lack of unique identifiers will remain significant challenges, but innovative solutions should be available soon in areas where we work.

We believe mHealth skills have the potential to make a huge impact in your work. Why do you think taking this class is important, and who would you recommend it to (public health professionals, field workers, etc etc).

This course provides a great overview of different types of mobile technologies and mHealth projects in addition to providing a unique opportunity to connect with a community of implementers and experts in the field. It will also provide some guidance around processes and structures required to include a successful mHealth component to a project. I am a firm believer in the potential of mHealth to radically transform the current state of healthcare. Everyone from policy makers to healthcare workers need to think about how we can use these tools to save lives and help people live healthier, happier lives.

Any advice for someone who wants to make a career in mHealth?

There are many opportunities available for people from all backgrounds. There is a need for people not only with health and technology skills, but also with sociology, anthropology, finance and business, project management and analytics skills. I think it’s important to be conversant in the technology, but to keep exploring these other areas which are critical to the work we are all doing to introduce and support game changing innovation in health systems for the good of the communities we serve.

About Steve
Steve is D-tree’s Chief Operating Officer with over 20 years experience in management consulting, information technology and public health. Steve holds a Bachelor’s degree in Finance from The American University and a Master’s in Business Administration in Information Systems and Finance from the University of Maryland. He is also a certified Project Management Professional. Prior to joining D-tree, Steve worked for the Clinton HIV/AIDS Initiative in Tanzania directing programs in Pediatrics, Prevention of Mother to Child Transmission of HIV, and Rural Care and Treatment.

SteveOllis

Technology has been known to facilitate anonymous harassment online, but in India a non-profit organization is using mobile apps to fight harassment on the streets. I came across Safecity in my Mobile Phones for International Development course, and since I plan to return to India and pursue my career in promoting gender equality, the case study of Safecity reducing gender-based violence (GBV) caught my attention.

How Safecity Works
Safecity is a non-profit organization in India that offers a platform for individuals to anonymously share their stories of sexual violence or abuse. This crowdsourced self-reported data is then displayed on a map of India to show hot spots and patterns of violence in various parts of the country. Safecity collects this data through its website, social media platforms, and via email, text or phone to increases awareness of the various kinds of GBV, ranging from catcalling to groping to rape. It also allows Indian individuals, law enforcement agencies, neighborhoods, businesses, and the society at large to access this data and to use it to take precautions and devise solutions.

Safecity reports
Safecity reports

Why Safecity Works
As one of the founders of Safecity put it, the three main reasons that rape and other sexual harassments are underreported in India is because people are afraid to report it, the police manipulate the data, or because victims are deterred by the delayed justice system. This, along with the cultural stigma attached to talking about sexual harassments, makes anonymity for victims very important. Allowing for anonymous reporting, Safecity has collected over 4000 stories from over 50 cities in India and Nepal since it launched in December 2012.

How Safecity is Using Mobile Apps
Along with collecting and visualizing data, Safecity promotes a variety of phone applications to help sexual minorities feel safe in public spaces:

GeoSure (provides personalized travel safety content via mobile)
Nirbhaya: Be Fearless (emergency app that sends a distress call or emergency message to a specified contact or group)
SafeTrac (allows automatic monitoring and tracking of your journey)

Safecity also promotes services like Taxshe, a safe all-female driver service, and KravMaga Chennai, a self-defense teaching service.

Challenges and Looking Ahead
As with many ICT4D solutions, access to the technology remains an important barrier. Safecity and its advertised applications, products and services seem to only reach a very specific target audience (urban populations with access to modern technology), leaving behind illiterate populations from rural areas with no access to technology. With their missed dial facility, Safecity is hoping to reach out to women with limited access to technology by recording their reports of abuse and harassment over the phone and suggesting appropriate interventions.

I look forward to seeing how Safecity uses this form of community engagement and crowdsourced data to not just report, but reduce GBV in India. This course introduced me to a new and unique way to address the pervasive issue of GBV in India and I look forward to utilizing the tools and lessons learned in making India a gender equitable country one step at a time.

Interested in learning about other ways mobile tools are helping communities address different problems? Join us in our upcoming Mobiles for International Development online course that begins on May 11.

Author Bio

Nikita Setia Headshot

Nikita Setia is a M.A. candidate at the Elliott School of International Affairs in the International Affairs Program, concentrating in development. She previously earned her B.B.A in Economics, International Business, and Management at Northwood University in Midland, Michigan.

Photo credit: myAgro

The current financial model of banks cannot address what development experts call the “triple whammy” of poor peoples’ lives – they struggle with low savings, uncertainty of cash flows, and the inability to access formal financial instruments. Small farm holders in the developing world face similar struggles as they often have to purchase seeds and fertilizers in one large payment to improve their harvest. MyAgro, provides an innovative alternative to farmers, eliminating the need for banks and placing financial decision-making in the hands of small farm holders.

MyAgro helps farmers purchase agricultural tools on layaway via an SMS platform and a network of local vendors. Anushka Ratnayake started myAgro in 2011 as a pilot program in Mali and soon expanded it to Senegal. MyAgro’s success can be attributed to their approach of using a mobile phone platform to adapt current pro-poor financial methods to addressing the financing problem in the agricultural sector.

How does myAgro work?
MyAgro works much like someone going to top up their phone for additional talk time at their local store. Participating farmers purchase scratch-off cards (ranging from $.50 to $10) with a unique pin number. This pin number is sent to myAgro and is recorded in their database under the farmer’s profile. An SMS is sent back to the farmer notifying them of how much they have saved towards their goal (to purchase fertilizer, seeds, or agricultural training). Once this amount is reached, the farmer receives the tools or service they have purchased from myAgro.

Why does myAgro’s model work?
MyAgro’s model gives rural farmers access to key financial services including cash-flow management and savings, through this approach:

  1. Reliability
    Without the credit and collateral that banks require when opening a savings account, poor people have responded by forming rotating savings and credit funds (ROSCAs) within their communities. This has been replicated worldwide, helping families manage scarcities. However, this informal tool does not provide the accountability, reliability and privacy that banks would offer. MyAgro builds on the success of ROSCAs, where people save through small incremental amounts over the long-term, but with the security and reliability of a formal mobile platform.
  2. Convenience
    MyAgro clients don’t have to travel long distances to access banks, which is especially useful for rural farmers living in remote areas where bank branches do not exist. MyAgro also increases inclusion by making the system easy to use, especially for those who are illiterate. Getting the basic use out of myAgro only requires the farmer to SMS the numbers located on the card they purchased. In addition, no physical cash is involved. In mobile cash transfer platforms such as the successful M-PESA program, some local vendors run out of cash when a customer wants to conduct a transaction, myAgro only relies on digital transactions – a successful approach within cash-strapped countries.
  3. Flexibility
    By allowing farmers to choose how much to save on a given day, myAgro takes into account the variety of shocks that vulnerable populations experience, such as illness in the family or natural disasters. The mobile platform allows them to use their small-scale savings for large-scale purchases.

In just three years, myAgro has managed to address a debilitating financial problem in farming communities in the developing world by providing a reliable and accessible savings tool and allowing farmers to managing their cash flows on their own terms. I look forward to seeing how myAgro expands its current 6,000 farmer membership while also collaborating with other mobile technology platforms to continue providing information and financial services to the benefit of the poor.

Interested in learning more about other ways mobile phones are empowering people in the developing world? Join us in our upcoming course, Mobile for International Development that begins on May 11.

About author 

Ana Tamargo

Ana Tamargo is a development professional and recent graduate from the Elliott School of International Affairs, George Washington University. She recently received a master’s degree in International Development Studies. During this time, Ana completed TechChange’s “Mobile Phones for International Development” course in order to advance her knowledge in using innovative information and communication technologies to facilitate programming and data collection within the local context. She has worked at international NGOs such as Pact, World Cocoa Foundation, and the Rainforest Alliance and has expertise in program advancement, evaluation and research in the fields of sustainable natural resource management, rural poverty alleviation, and bottom-up development. Ana is eager to continue findings ways to incorporate mobile phone technology in helpingempower and provide services to vulnerable populations.

By Samita Thapa and Kendra Keith

When we interviewed Nobel Peace Prize winner, Muhammad Yunus, at the 2013 mHealth Summit, he said that mobile phones are the “Aladdin’s lamp for healthcare”, a statement that still rings true today. Two years after that interview, we take a look at how digital health is beginning to expand beyond mobile phones. Mobile phones – especially smartphones – have been revolutionary in health care, especially in developing countries. With budding industries like add-ons to smartphones and wearable tech, the mHealth landscape is evolving.

Here are 5 digital health tools that extend beyond the mobile phone:

1. Pre cancer screening phone attachment

OscanPhoto source: Cellphone Beat

In areas of the world with high amounts of tobacco consumption and limited access to affordable dental care, oral cancer is a major concern. Oral cancer can be prevented with early detection and to equip rural health workers, the OScan team at Stanford university has developed a screening tool that mounts on a camera phone and conducts screenings for oral lesions. The data can then be transmitted to dentists and oral surgeons for assessment. OScan is in the process of conducting field tests with grants from Stanford, Vodafone Americas Foundation, and previously received funding from the mHealth Alliance.

2. STD testing smartphone attachment

Columbia University researchers have created a dongle (an attachment with a specific software) that can plug into Androids or iPhones and conduct tests for HIV and syphilis in about 15 minutes. The attachment costs $34 to manufacture, unlike the current method of conducting these tests in labs which can cost nearly $18,000. The dongle was recently tested in Rwanda on 96 patients and is still under development to improve its accuracy before doing a bigger trial run.

3. Ultrasound attachment for smartphones

Photo source: MobiSante

Seeing how an infant is developing during pregnancy allows any dangers to mother and baby to be addressed at an early stage, and is important to reducing mortalities related to pregnancy and birth. Urban hospitals may be equipped to provide ultrasound services to pregnant women, but it is difficult to extend these services to rural communities. To make ultrasound imaging accessible to everyone, MobiSante, Inc, an imaging technology company has developed a “smartphone based ultrasound device that allows health workers to perform ultrasounds anywhere and share the images via secure Wi-Fi, cellular networks, or USB.” With this attachment, the benefits of ultrasound services can be put in the hands of community health workers in even the most remote clinics.

4. Sensory patch for remote patient monitoring

Wendy Taylor with Smart band-aidPhoto source: Mashable

USAID recently launched the ‘Grand Challenge’ calling for innovative approaches in the fight against the ongoing Ebola crisis. One of the two innovations unveiled at SXSW ‘15 is the multisense memory patch or Smart Band-Aid. It’s a flexible patch that takes a patient’s baseline vitals and measures the changes from the baseline remotely. The vitals can be measured from outside the hot zone, or area containing active ebola cases, as the patch uses a USB cable to transmit data (the final version will use Bluetooth). With 7 – 10 hours of battery life, it costs $100 and is disposable. Wendy Taylor, Director of the USAID Center for Accelerating Innovation (pictured above), calls the smart band-aid a game changer!

5. Data Collection Necklace for Infant Vaccinations

Khushi BabyPhoto source: Khushi Baby

Developed to address the challenge rural clinicians and parents face in documenting children’s vaccination records, Khushi Baby stores children’s medical history in a digital necklace. After winning the Thorne Prize for Social Innovation in Health in 2014, this Yale University classroom project has become an organization and has conducted a successful field test in the village of Mada Daag, India. When vaccinations are administered, the healthcare worker can scan the necklace with their Khushi Baby app on their smartphone to transfer vaccination data to the necklace. The data is also automatically uploaded to the cloud once the healthcare worker returns to the clinic. Parents then receive automatic voice calls reminding them about vaccination clinics and during their next visit, the healthcare worker simply scans the necklace of the baby to see which vaccines are due.

As amazing as mobile phones and these new attachments and wearables are in global health, these new technologies also raise important issues. For example, when it comes to wearables, battery life can be an issue. Erica Kochi, a senior advisor at UNICEF noted that internet connectivity has beat electricity to many rural parts of the world, so access to electricity may still be minimal or non-existent in parts of the world where wearable tech can help. While finding better ways to collect more data is vital in healthcare, data privacy and security is increasingly becoming an important concern as we are realizing that there is too much data to manage.

The overall issue of practicality is another concern. Are these innovative solutions practical, cost-effective, and cost-saving? These are the conversations we will be having in our upcoming mHealth online course. We will be discussing new mHealth approaches like the ones mentioned in this post among others. We have a great group enrolled already and will be hearing from guest experts from organizations like Medic Mobile, National Institutes of Health (NIH), D-Tree International, PATH, and more!

Last week, tens of thousands of participants and over 2,000 exhibitors gathered at the annual Mobile World Congress (MWC) in Barcelona to launch and share the latest advances in mobile technology, wearables, virtual reality, gadgets, robotics, the Internet of Things (IoT), devices, 5G, and more.

Similar to last year, we decided to take a look at how announcements from MWC15 will impact the developing world.

1. Facebook and Google continue to spearhead ambitious initiatives to get more people across the world online.

As we shared last year, Facebook and Google continue to lead in efforts to get the next billion people around the world online.

In his keynote address, Facebook CEO Mark Zuckerberg advocated for free basic internet services to propel mobile growth in emerging markets. Since launching Internet.org at last year’s MWC, the initiative has now reached Colombia, India, Zambia, Kenya, Tanzania, and Ghana.

Separately, Google has been experimenting with several initiatives in its connectivity strategy, including Project Loon or “floating cell towers” project, Google Fiber, and Project Titan – its drone extension of Project Loon.

Google Loon Project

Google Loon Project

Photo credit: SiliconKarne

2. Digital identity and privacy is becoming more significant for mobile consumers

When addressing the audience, GSMA Director General Anne Bouverot discussed the growing importance of digital identity.

“I think digital identity is the new frontier. This is an area where we think we need better services to access services: healthcare, payments, social networks, whatever we’re accessing on the Internet. We want to access them and prove who we are, but we don’t want to necessarily give our mobile numbers and be spammed after that. We haven’t completely found this balance yet, so stay tuned for deployment in mobile connectivity and digital identity in the year to come.” – Anne Bouverot

With mobile security concerns on the rise, this year’s Mobile World Congress also introduced smartphones with privacy in mind. For example, Brazilian phone maker Sikur introduced the GranitePhone which has encryption features designed to ease the privacy concerns of smartphone users.

Sikur GranitePhone

Sikur GranitePhone

Photo credit: Cnet

3. mHealth focus shifting to wearables
Wearable technology was a hot trend at MWC15, especially in the form of fitness trackers, smartwatches, and smartbands. For example, HTC made its big launch of the HTC Grip in partnership with Under Armour and featuring built-in GPS capabilities.

What’s ahead?

Though MWC15 covered many types of emerging technologies beyond mobile including 5G, connected devices, the internet of things, virtual reality, and other topics, the theme of the immense potential of the world’s connectivity resonated throughout the week.

According to Jimmy Wales, Founder of Wikipedia, who attend this year’s Mobile World Congress,

Technology is making real and useable internet access available to tens of millions across Africa today and if we think forward 20 years and even 10 years, we’re going to have massive connectivity to the real internet for hundreds of millions of people and this going to have an incredible impact on politics in these places, on society, on trade, and opportunities for all kinds of people.” – Jimmy Wales

What news on MWC15’s impact on developing countries did we miss? Let us know in the comments and/or tweet us @TechChange.

Interested in how MWC15 announcements are impacting Mobiles for International Development and mHealth? Register for these courses now!

What does TechChange have in common with Alicia Keys, Bollywood actor Aamir Khan, and Doctors Without Borders? We are all in Aid & International Development Forum’s ‘Top 100 Accounts to Follow on Twitter in 2015!’

AIDF released their list of the most active and followed accounts in humanitarian aid and development on March 3, 2015 and we are excited to be listed as number 57 on the list as one of the top three Mobile for Development (#M4D) twitter accounts.

TechChange also ranked among the top three Mobile for Development (M4D) accounts, next to @mHealthSummit and @GSMAm4d. Nine other M4D twitter accounts also made AIDF’s top 100 list, showing the growth of this sector.

We are equally excited to see some of our partner organizations including the World Bank, Oxfam International, USAID’s Global Development Lab, and more make the list!
See the complete list here.

If you don’t already, follow us @TechChange to get the latest updates on technology for social change, social enterprise, edtech, global development, exclusive deals for our followers, and more.

GIZ Nepal participants Pushpa Pandey, Valerie Alvarez, and top TechChange student Bikesh Bajracharya with TechChange Communications Associate Samita Thapa, (and TechChange cubebots).

In our most recent mHealth online course, twelve participants from GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit) Nepal enrolled in the course to support its mHealth pilot for adolescent sexual and reproductive health. This holiday season, I was fortunate enough to return to my native home of Nepal to meet these TechChange alumni in person at the Nepali-German Health Sector Support Programme (HSSP) at their new office in Sanepa, Nepal. Since the September 2014 mHealth pilot launch, more than 150,000 adolescents have used their interactive service.

Nepal’s National Health Education, Information and Communication Center (NHEICC) developed a National Adolescent Sexual and Reproductive Health Communication Strategy (2011 – 2015) that stressed strongly the use of modern methods of communication in its implementation. GIZ, Health for Life (H4L), and the UN Population Fund partnered under NHEICC’s leadership to initiate this SMS based mHealth project – the first in Nepal. The SMS messages and interactive package focus on delaying marriage and pregnancy, healthy timing and spacing of babies, health and hygiene, and addressing gender based violence. The local mobile services provider, Nepal Telecom and NCELL, distributed the interactive SMS package that includes an encyclopedia, role model stories, quizzes, and a hotline for further questions.

Mr Khaga Raj Adhikari, Minister, Ministry of Health and Population launching ‘m4ASRH’ (Mobile for Adolescent Sexual & Reproductive Health) on 18 September 2014.

Mr Khaga Raj Adhikari, Minister, Ministry of Health and Population launching ‘m4ASRH’ (Mobile for Adolescent Sexual & Reproductive Health) on 18 September 2014.

Since Pushpa had shared the status of the GIZ mHealth pilot in Nepal as her final project for the mHealth online course the day before we met, it was especially great to catch up with her in person! She expressed that this mHealth course was much more engaging and fun to complete than other online courses she has tried out. Bikesh, the top user in our course with over 400 tech points, is new to the GIZ team and very excited to apply what he has learned in the mHealth course to his work in Nepal. Valerie recently arrived in Nepal and very new to the GIZ-team, was also excited to learn how much the other participants were engaging and that she can still access all course material for four more months.

All three GIZ Nepal participants shared their astonishment on how many tech points Bikesh was able to stack up in the course and also the fantastic course facilitation by Kendra. They also admitted that hearing Pushpa present in the mHealth course gave them insights that they weren’t aware of even though they work at the same office. While taking a technological approach to development projects in a country like Nepal can be challenging, it is an even bigger challenge to get the government’s buy in. It was exciting to learn that despite some hurdles, this mHealth pilot was an initiative supported by the government of Nepal.

We are excited for the future of mHealth in Nepal and wish GIZ all the best in their continued success! We are also excited to welcome six more participants from GIZ Nepal in our upcoming Technology for Monitoring and Evaluation course in January to better measure the impact of this mHealth pilot! It is wonderful to see how GIZ is committed to mHealth and M&E through their investment in technology capacity building in Nepal.

This feedback on mhealth concerns a field mission I undertook in July 2014. I visited one of Handicap International Federation’s HIV and disability projects being implemented in the region of Ziguinchor in the South of Senegal. Like many other organisations represented by colleagues in TechChange’s mHealth course, Handicap International is strongly exploring how mHealth can best fit in and with what we can offer not only to our primary focus on people with different impairments (our main targets), but also to various communities confronted with different issues, be they related to development, relief or emergency settings..

I realised that our project was provided with two android phones from CommCare to collect data as a “pilot activity” (not initially designed in our project, but rather as an add-on to our M&E system and tools). The project M&E officer in charge was supposed to learn about how it works and two project community mobilizers were supposed to collect specific information to feed into the beneficiary and activities database.

What happened with this pilot was quite interesting. Given that there was no specific planning or budget assigned to this seemingly exciting additional activity, and after discussions with CommCare, they graciously provided the project with two phones and basic training to the staff. Project staffs started the process of collecting data, but it didn’t work because there was the phones had no credit. So, they added credit and restarted the process of collecting data. Data were entered and things seemed to be on the right track. Knowing this, the M&E specialist in charge wanted to synchronise the system to see how data looked like. It didn’t work. After another brainstorming, the team learned that they had to set other aspects on the phones so that data can reach to the other end. Furthermore, given that this was an “extra activity”, problem-solving was not that fluid with CommCare as it was not the priority of neither party. And barriers continued, to the point that no one really bothered with whether the phones were useful to the project, to the beneficiaries, to the staff, nor to the system.

A few lessons learned from this minuscule pilot trying to use mobile technologies for data collection (and arguably for other aspects of project management and global development):

  1. If rationales are well thought through at project inception, it would be important to include planning, budget and dedicated human resources for the utilisation of mHealth within a project.

  2. Having “free phones” may not be the best incentive to projects when it is not tied to any specific performance indicators associated to bigger project goals.

  3. Excitement about mHealth is insufficient; there needs to also be interest combined with strong planning and field testing, coupled with systematic follow-up from the mHealth provider. This aligns with what mHealth guest speaker Ray Brunsting told us in the course about the importance of a project preparation phase that regularly iterates and progressively constructs what is needed so that the mobile mechanism works smoothly thereafter.

  4. Careful, regular, and frequent feedback is needed especially when getting an mHealth program is in its initial phases.

But this experiment didn’t deter us to pursue our desire to use mHealth and mainstream disability. We decided to partner with AMREF (France) which has tremendous experience in using mHealth. This project will start shortly and is going to use mHealth in the context of maternal and child health in Senegal. It will bring the expertise of two different organisations for the benefit of mothers and children, through a specific project, planning and budget, and through disability lens.

All this to say that using mobile phones to promote public health is not that straightforward. However, when we attempt to consider lessons learned and good practices from others, it tends to work better. So thanks so much to TechChange, all participants in the mHealth online course, as well as from our great speakers and facilitators for sharing all the mHealth wisdom

Interested in learning more about mHealth pilot programs and successfully scaled projects across the world? Register now for our mHealth online course which runs from November 17 – December 12, 2014.

About Muriel Mac-Seing

Muriel Mac-Seing

Muriel Mac-Seing is an alumna of TechChange’s Spring 2014 mHealth: Mobile Phones for Public Health online course. For the past 12 years, Muriel Mac-Seing has dedicated her work to community health development in Sub-Sahara Africa and South and South-East Asia, in the areas of HIV and AIDS, sexual and reproductive health, gender-based violence and disability. Currently, she is the HIV and AIDS/Protection Technical Advisor to Handicap International Federation supporting country missions and national programmes to include disability for universal access to HIV and AIDS and protection services for all. She co-chaired the HIV and Disability Task Group of the International Disability and Development Consortium (IDDC) from 2010 to 2012. Since May 2014, she is also a member of the Human Rights Reference Group at the Global Fund to Fight AIDS, Tuberculosis and Malaria. Trained as a nurse, she served an underprivileged and multiethnic clientele in the regions of Montréal, Canada.

 

According to GSMA’s Digital Entrepreneurship in Kenya 2014 report, 99% of internet subscribers in Kenya access the internet through mobile devices. Kenya has been the leader in mobile banking, with apps like M-PESA, Zoona, and others. When taking TechChange’s Mobile Phones for Public Health online course with a group of 10 colleagues at PATH, I was curious to learn what mHealth looked like in Kenya and learn what lessons I can apply to my mHealth programs in Bihar, India. As part of my final project for the course, I asked Debjeet Sen, one of my colleagues at PATH based in Kisumu, Kenya, to share his views on the state of mHealth interventions in Kenya.

Like other developing countries, mHealth in Kenya primarily focuses on two core areas:

1. Data collection, where mobile devices replace and/or complement traditional paper-based tools;

2. Behaviour change, where mobile devices are used to disseminate key messages and good practices among communities.

And like any low-resource setting, there are inherent challenges in rolling out mHealth interventions, so it is important to be cognizant of them and develop appropriate counter-strategies.

mHealth training for CHWs in Kenya photo 1Community health workers (CHWs) during a mHealth training in Kenya

Here are a few challenges that Debjeet sees mHealth interventions face in Kenya:

  1. Multiple mHealth interventions have remained at the pilot stage

Many mHealth interventions in Kenya have not yet been integrated into larger health and information technology systems due to the absence of a clear scale-up strategy in the pilot project design and a lack of consensus on common software and hardware requirements. Different projects use different handsets with different operating systems for different mobile platforms. Aligning individual mHealth projects with regional and national management information systems (MIS) is necessary, but may not necessarily happen, as mHealth projects often function autonomously. Wherever possible, it is important to integrate mHealth data streams with existing MIS platforms in order to prevent duplication and mixing of data.

  1. Many mHealth projects rely on the use of smartphones

Smartphones can be expensive and beyond the purchasing power of Kenyan government institutions and individuals. Most people continue to rely on low-end phones, which are cheap and widely available.

  1. Scarcity of a reliable power source

Electricity supply in Kenya is unreliable and regular electricity is mostly available only in semi-urban and urban areas. Since graphics-enabled smartphones are highly power-intensive, any mHealth project that relies on smartphones may face challenges if users struggle to keep their phones regularly charged.

However, there are opportunities that can help tackle these mHealth challenges:

  1. Almost universal penetration of cell phones

Kenya has a very strong base for implementing mHealth projects, partly because Kenyans are familiar with the use of mobile phones for functions other than just making and receiving calls. Mobile banking app like M-PESA is used by tens of millions of Kenyans. In fact, many financial transactions in the social sector, such as paying for trainings and workshops, issuing stipends to community health workers (CHWs), and transferring conditional cash transfers are all done through M-PESA. In a way, this extensive use of M-PESA for the social sector is already (indirectly) helping improve mHealth outcomes.

  1. Incentivizing end-users such as CHWs to buy the phones

A common mistake of many mHealth projects is to provide the cell phones for the project as “giveaways.” In turn, this results in less accountability and a lack of ownership among the phone users. Asking CHWs to partially cover the cost of the phones or buy them is a good strategy to create ownership and accountability. This also has ramifications for scale-up and sustainability, as governments in low-resource countries may be unable to cover the entire cost of purchasing cell phones.

  1. Work is underway to develop a plan to coordinate mHealth activities in Kenya

There are plans to align multiple platforms, hardware, and software with a common national strategy and to ensure that data collected from these activities are facilitated to feed into national and regional MIS.

4. Simple smartphone apps.

The simpler smartphone apps have been demonstrated to assist frontline workers such as CHWs in data collection and as job aids to assist them in household visits and group and/or individual counselling.  In an environment that faces challenges in literacy rates as well as  financial and network connectivity, we cannot simply develop and run any iPhone or Android app. Sometimes, it is important to develop ways to access mHealth tools offline.

CHWs learning about mHealth in KenyaCommunity health workers explore Information for Action app during the field test

In particular, Debjeet discussed his work on the Information for Action app, an innovative app running on the Android platform designed by the Human Sciences Research Council of South Africa. The app collects information from CHW home visits and immediately turns the collected information into actionable information in the form of a key message or suggested actions that can be shared by CHWs with caregivers. It is a dynamic app because it collects information and provides contextualized key messages and suggested actions on areas of children’s development, health, nutrition, and water and sanitation. The Information for Action app also stores records of individual home visits, which can be used by CHWs to plan for future home visits, as well as uploaded into a central data server/cloud, where supervisors can monitor for quality of home visits.

Currently, a field test of the app is being carried out in Kenya and South Africa to determine its operational feasibility and acceptability among CHWs, their supervisors, and community members receiving home visits from CHWs. Debjeet would be happy to share the app after the field tests are completed.

Debjeet asserted that the TechChange mHealth course has provided him with a structured overview of mHealth, which is a contrast to the way he has generally learned about mHealth through on-the-job experiences. The TechChange course has exposed him to interesting resources, people, and mHealth projects and he wishes to use the learnings from the course in his current projects at PATH

Why learning about mHealth in Kenya is useful for India

Since working in Bihar is quite similar to working in other countries of low resource settings like Kenya, it is helpful to learn about the challenges and strategies of different countries as we develop mHealth programs in Bihar. The PATH team in Bihar provides knowledge management support to a behavior change community mobilization project called Parivartan, which means “transformation”. The knowledge management team is in the process of conceptualizing a mobile based data collection and analysis system for village health sanitation nutrition committee (VHSNC). The committee members would develop effective social mobilization strategies to influence people to attend village health sanitation nutrition day (VHSND) at local primary health centers for health and nutrition related services. We have already started collecting a lot quality assurance sampling (LQAS) data through tablets and Kenya’s mHealth lessons definitely help as the fuel to work at per PATH’s technology and healthcare innovation in low and middle income group setting.

The knowledge on mHealth in Kenya which Debjeet has shared will help my team develop its own mHealth strategy in a low-resource setting such as Bihar, India.

If you are interested in learning more about the current state of mHealth, enroll in our upcoming mHealth course, TC309: Mobile Phones for Public Health today.

Alumni bios 

Debjeet Sen

Debjeet Sen is a Senior Associate with PATH. He has managed and supported a range of early childhood development (ECD), infant and young child nutrition, prevention of mother-to-child transmission (PMTCT) of HIV, and maternal and child health projects — primarily in Kenya and Mozambique, but also in DRC, Ethiopia, India, Malawi, Namibia, Nigeria, Pakistan, Rwanda, and South Africa. His core skills include technical design and management of complex projects, monitoring and evaluation (M&E), behavior change communication (BCC), curriculum development, capacity building and training, organizational development, documentation, and technical research and writing. He is currently based in Kisumu, Kenya. You can connect with Debjeet on LinkedIn.

Pratyaya Mitra

Pratyaya Mitra is a communication professional with more than 12 years of experience in corporate and social sector. Currently working as communication and documentation officer in PATH Knowledge Management team in Bihar, India. Previously, worked with UNICEF as communication consultant for C4D, advocacy-partnership. Pratyaya worked in corporate communication and as copywriter with Ogilvy and Mather. He works with wide range of communication channels such as, written, audio visual, online, social media and mobile. He plays pivotal role in advocacy, PR and social and mHealth communication strategy to meet the project goal and business development. He did his masters in communication. You can connect with Pratyaya on Linkedin, Twitter, and Facebook.

 

Before the recent Ebola outbreak, the terms “contact tracing” and “Ebola” were spoken by only a small community of public health specialists consisting of infectious disease physicians and epidemiologists. As total cases of Ebola Virus Disease reported by the Centers for Disease Control and Prevention (CDC) exceed 10,000 across Guinea, Liberia, and Sierra Leone – almost 5000 of those fatal – these terms are increasingly entering general conversation.

What is Ebola contact tracing?

Rapid contact tracing is essential to the identification and isolation of symptomatic cases of Ebola disease, interrupting secondary transmission, and slowing exponential spread of the virus. It involves identification, documentation, and monitoring of all individuals who have come in contact with a single symptomatic case. In many cases, this is an analogue process of recording data on paper case notification, contact follow-up and field report forms, transporting those to a data entry center, and entering them into an electronic database. In other cases, mobile device can be used in the field for direct data entry into an electronic database.

Contacts have been exposed and are at risk for developing Ebola disease, but have yet to show symptoms. This is where understanding a few basics about Ebola virus and disease is helpful.

  • Transmission: direct contact with the body fluids of someone, ill or deceased, with symptoms of Ebola disease; or contact with objects contaminated by their body fluids

  • Symptoms: fever, headache, diarrhea, vomiting, stomach pain, unexplained bleeding or bruising, and muscle pain developing up to 21 days after exposure to the virus

If a contact develops symptoms within the 21 days of monitoring, they are immediately isolated and contact tracing begins for this new symptomatic case.

Ebola and Contact Tracing 

Contact tracing can get complicated, so much so that the CDC has a dedicated program, the Epidemic Intelligence Service, to build US health professional capacity and expertise to do so. A single Ebola case can result in the need to trace numerous contacts. In the early outbreak stages, rapid response is most critical as contact tracing efforts are somewhat manageable. If not contained, exponential transmission can make contact tracing efforts unwieldy, as is the case in the current West Africa Ebola outbreak.

Why is it so difficult to integrate mobile phones for contact tracing?

Several challenges in contact tracing could potentially be addressed with mobile solutions. Given wide geographic spread, remote locations and limited resources, real-time data collection and monitoring with mobile phones could facilitate rapid alert of new cases and contact follow-up. These tools could reduce time lag between data collected in the field and response, and serve as a more relevant basis for assessment and prioritization of control interventions. Given that solutions are developed with the Principles for Digital Development in mind, particularly open standards, open data, and open source software, the use of mobiles could address asynchronous data collection and reporting while lowering barriers to stakeholder collaboration.

Irrespective of the integration of mobile devices, contact tracing in Guinea, Sierra Leone and Liberia presents challenges unique from those in which the methods were developed. How do you identify and quarantine an affected patient effectively in a culture where many objects – from mattresses, toilets and food, to the burden of caring for the ill– are shared? How can reliable data be collected if interviewees intentionally misdirect or misinform surveillance officers in fear of response efforts? Social behavioral change communication could address these challenges, with mobiles playing a role.

Several groups are currently working to address data related issues in the West Africa Ebola outbreak. Notably, the World Health Organization’s Harmonized Ebola Response built on the Ona platform, the Ebola Open Data Jam, and mHero, a collaborative effort partnering IntraHealth International’s iHRIS software and UNICEF’s mobile messaging platform RapidPro. Three initiatives running in parallel leave one questioning if any single effort is actually impacting harmonization?

The challenges hindering rapid integration of mobile solutions are not necessarily unique from larger challenges in implementing mobile solutions, nor aid for that matter. Do you understand the user and ecosystem, did you design for sustainability and scale, and did you leverage opportunities for collaboration? There are suggestions that the WHO and mechanisms for responding to global health challenges are outdated, positioning the West Africa Ebola outbreak as a defining moment in their reevaluation. Perhaps it will also bring new perspective to effective leverage of mobile solutions.

Are you a “healthie”, “techie” or someone in-between interested in the use of technology in global health? Then don’t miss your chance to join course facilitator Kendra Keith and the next cohort of TC309: Mobiles for Public Health starting November 17th, 2014!