On this year’s International Women’s Day, we recognize the important work our alumni and partners are doing to empower women and girls across the world.

At TechChange, there are few areas we see this empowerment happening than in the field of family planning and reproductive health. As we’ve seen in our mHealth online course and community, many organizations are doing fantastic work in this area including the UN Foundation and MAMA, D-Tree International, FHI 360, Jhpiego, John Snow Inc., and more.

We’re hoping to further explore the issue of gender in global development programs and technology in our upcoming online course on Gender.

Use the coupon code, IWD2015, by this Friday, March 13, to get $50 off any TechChange open online course such as mHealth, Mobiles for International Development, Gender, and more.

 

 

PreMAND field workers testing data collection tablets in Navrongo, Ghana (Photo: N. Smith)

Mira Gupta, one of the star alumna of our courses on Mapping for International Development and Technology for Monitoring & Evaluation (M&E), is a Senior Research Specialist at the University of Michigan Medical School (UMMS). Last October, USAID awarded UMMS $1.44 million to assess maternal and neonatal mortality in northern Ghana. This 36-month project, “Preventing Maternal and Neonatal Mortality in Rural Northern Ghana” (also referred to as PreMAND: Preventing Maternal and Neonatal Deaths) will help USAID, the Ghana Health Service, and the Ghana Ministry of Health design interventions to prevent maternal and neonatal mortality by investigating the social, cultural and behavioral determinants of such deaths across four districts in northern Ghana. For this project, UMMS will be partnering with the Navrongo Health Research Centre and Development Seed.

Project Regions and Districts

Project Regions and Districts

We sat down with Mira to learn more about this project and how her TechChange trainings in digital mapping and technology for M&E gave her the skills and background she needed to develop her team’s project in Ghana.

1. What interested you in taking the Mapping for International Development and the Tech for M&E online courses?
I was in the process of trying to learn everything I could about our GIS options when I heard about TechChange’s Mapping for International Development course. It provided a fantastic introduction to the range of approaches being used on international development projects and the variety of organizations working in that space. The course material helped me identify which types of visualizations would be most appropriate for my team’s research. I especially benefited from the many sectors represented in the TechChange sessions because while I was trying to create a project for the Health sector, I actually learn best through a Democracy and Governance framework given my previous background in this field. TechChange provided access to mapping specialists in both areas through its instructors and other class participants.

Just as I heard of the mapping course right as I needed it, the same thing happened again with the Technology for M&E course, which I took a year later. By that point, the PreMAND project had just been awarded and I learned that I would be responsible for the evaluation components. I was excited to take the TechChange course because I knew it would provide a great overview of the many different tools being used, and that I would benefit immensely from the participation of classmates working on projects in similar settings. As expected, the content presented was incredibly valuable in informing our project approach in terms of our field data collection, methods of analysis, and presentation of findings.

2. How did the mapping component of this USAID-funded project come together?

The Three Project Phases: Research will inform the visualisations, which will inform programming

The Three Project Phases: Research will inform the Visualisations, which will inform Programming

While working on a maternal and neonatal health qualitative study a couple of years ago, I sensed that there were themes and patterns in the data that were difficult to verify since the locations of the respondents had not been geocoded. Some of the variables indicated 50/50 probabilities of any particular outcome, which seemed to suggest that there was no pattern whatsoever when viewed as a large dataset. Because my background is in Democracy and Governance, I used election maps to illustrate to my research team that once geocoded there might in fact be very distinct geographical trends in the data, drawing parallels to the locational breakdown of political party support in the United States.

I was in the process of researching mapping resources when I first heard about the TechChange’s Mapping for International Development course, and through the course I met some of the mapping experts that ultimately served as key resources in the development of our project strategy. The course gave me the necessary base knowledge to effectively liaise between our health researchers and the mapping experts to determine the best approach to meet our data visualization needs. We were extremely fortunate to have USAID-Ghana release a call for outside-the-box submissions under its Innovate for Health mechanism, right as we were developing our program concept.

3. What are the biggest challenges you anticipate in undertaking this project?
For the visualization component, generating the base layer maps will be more difficult than we originally anticipated. The various pieces of data we need are spread throughout different government sources such as the Ghana Statistical Service, the Lands Commission, and the Ministry of Roads and Highways. We will need to consult with each of these groups (and likely many others), to explore whether or not they will allow their data to be used by our project. It will require some agility on our part, as we need to stay flexible enough so that we collect any outstanding geographic data we may need through our team of field workers. While there are many moving pieces at the moment, it’s exciting for us to think that we’re building what may be the most comprehensive geographic base layer map of the region, as an initial step in developing our health indicator analysis tool.

There are also a handful of challenges related to evaluation. The primary purpose of our project is to provide new information to clarify the roles of social and cultural factors in determining maternal and neonatal deaths, and shed light on a valuable set of drivers which up until now have been unclear. We are currently in the process of finalizing our M&E framework, which has been a complex process because our project doesn’t fit the mold that most performance indicators are designed for. As a result we’ve been carefully drafting our own custom indicators through which we’ll measure our project’s progress and impact.

One of our most interesting evaluation challenges has been the development of our Environmental Mitigation and Monitoring Plan, which is traditionally intended as a tool for implementing partners to take stock of the impacts their work could have on the natural environment. In our case, we’re using it as a tool to think through our ethical approach to the potential impact of our project on the social and cultural landscape, given the challenges associated with collecting very sensitive health information and the need for data privacy. It’s pushing our team to think through every step of our project from the perspective of our various stakeholders, and has yielded many valuable insights that have strengthened our program approach.

4. What are the tools that you became familiar with in Mapping for International Development and M&E and plan on using in this project and how will you apply them to your project?
I came into Mapping for International Development knowing very little about the resources available in that space. Several of the tools that I became familiar with through the class, such as OpenStreetMap, MapBox and QGIS were highly applicable to our project in Ghana. After participating in the session led by Democracy International and Development Seed, I reached out to those instructors for their input on how I could best translate my project concept into actionable steps.

The visualizations I hoped to create were complex enough that I soon realized it would make the most sense for our research team to work directly with a mapping firm. We were so impressed by the technical feedback and past projects of Development Seed that we established a formal partnership with them and worked together to refine the vision for the project that was ultimately funded. TechChange’s training gave me the knowledge I needed to select the right partner and understand how best to combine our research goals with the available mapping resources to maximize our project’s impact.

Programs used on the PreMAND project

Programs used on the PreMAND project

In Technology for M&E I learned about the capabilities of different devices, survey apps—those able to capture geodata were of particular interest to me—and even project management tools. There were many helpful conversations both in the class sessions as well as in the participant-led threads around the data collection process, data privacy, and the ways in which project findings can be best communicated to a variety of stakeholder groups. What I found to be most relevant and applicable to our Ghana project were the conversations surrounding human-centered design, and the use of rich qualitative data. I gained a lot from the session led by Marc Maxson of GlobalGiving, who discussed which forms of data are the richest and easiest to interpret. The University of Michigan and our partner the Navrongo Health Research Centre already excel in qualitative data collection techniques, but the conversations throughout the TechChange M&E course inspired some new ideas as to how we might incorporate multimedia such as video and photographs in our qualitative data collection process to make our project deliverables that much more substantive.

5. What is your advice for researchers working to integrate more data visualization and mapping in their research and project interventions?
My advice would be to focus on the end user of your data and identify their needs and interests early in the process. That clarity can then be used to inform 1) what content will be most useful, and 2) what presentation format(s) will be most effective. It’s important to do some form of a needs assessment and let stakeholder feedback guide the project’s design.

In the case of our Ghana project, we are implementing a two-prong approach to our visualizations because both the government representatives and our donor will find an interactive web application most useful, while local community members in the rural North will benefit more from group discussions centered around printed maps.

Feedback loop with two stakeholder groups: the government of Ghana and local communities

Feedback loop with two stakeholder groups: the government of Ghana and local communities

It is common to sometimes present health indicator data solely as points on a map, but we are designing our visualizations to be much more detailed with background layers including health facilities, schools, compounds and roads so that those viewing the health indicator data can orient themselves a bit better to the local context. Had our end-users only been the leaders of those individual communities such detailed maps may not have been necessary. Similarly, the visualizations for one stakeholder group might incorporate a lot of words or even narrative stories based on their level of education, while for other stakeholders, those visualizations will be more image-based and we’ll orient them to the maps through presentations in their local communities.

About Mira Gupta

Mira Gupta

Mira Gupta is a Senior Research Specialist at the University of Michigan Medical School (UMMS), where she focuses on program design, strategy and evaluation. She has developed successful international aid projects in 18 countries, including 13 in Africa. Mira began her career in the Democracy and Governance sector where she worked for organizations such as IFES, the National Democratic Institute, and the Carter Center. She also developed projects in the Economic Risk and Conflict Mitigation sectors before transitioning into Global Health. Her research on the effects of local power dynamics on health-seeking behavior in northern Ghana is published the current edition of Global Public Health.

This guest post is by Sara Buzadzhi a past participant in TC309 Mobile Phones for Public Health. Can’t wait for June 3? Sign up for TC105 Mobiles for International Development launching on March 4th, which will feature a week on public health.

While the use of various mHealth applications and text-messaging services are
surging in both high and low-income countries, Russia has been somewhat behind
the curve in adopting these solutions to address health issues. The Russian NGO I
work for, the Health and Development Foundation, has been striving to change that,
introducing the country’s first national mHealth programs.

This January, HDF launched a new nationwide program for clients considering and
undergoing infertility treatment. This initiative, IVF/ART School uses an innovative
-combination of traditional and mHealth approaches. The target audience, women
and their families, will be reached through a multi-tiered approach including offline
seminars with reproductive health specialists at clinics; social networks, a program
site, and regular, interactive webinars online; and text messages to participants’
mobile phones. This comprehensive approach will enable us to maintain a strong
connection with our target audience, each component informing and reinforcing
program messages, and provide them with multiple chances for interaction with
peers and experts.

Why IVF?

The demographic situation in Russia has been a point of concern for the government
and the general population since birth rates began to decline in the last decade of
the 20th century. Population increases in the last several years have injected some
optimism into the discussion, but state and public organizations are still eager to
do what they can to promote population growth (including monetary incentives for
pregnant women and mothers).

Against this background, the need for easy access to assisted reproductive
technology treatment for couples dealing with infertility issues is clear. In fact, the
Russian government recently announced that infertility treatment would be covered
under the free state insurance starting in 2013.

But while financial support is important, it is also vital that women and couples
seeking treatment, or considering seeking treatment, are well informed as to their
options, and are receiving the emotional support that can greatly influence the
success of infertility treatment. That is where the IVF/ART School can play a key
role; program participants will receive expert, unbiased information and support
from several sources, including their peer group, increasing the likelihood that they
will maintain treatment until reaching a successful outcome.

Text4baby Russia

t4babyHDF’s first national mHealth program was Text4baby Russia, a nationwide maternal
and child health text messaging program that will celebrate its one-year anniversary
this February. Through this program, new and expectant mothers receive
information on caring for their health and the health of their children through free
text messages to their mobile phones. Subscribers receive 1-2 texts per week on topics like nutrition, safety, substance abuse prevention, legal rights, breastfeeding, and more.

Text4baby Russia (SMSmame in Russian) is based on the successful U.S. program
text4baby, but was significantly adapted by HDF and its government and medical
community partners to ensure that the messages meet the specific cultural and
socio-economic needs of its Russian target audience. HDF is currently piloting a
webinar series to address text message topics in greater depth, and plans to launch
the series in early 2013.

We would be happy to hear from any organizations/individuals working in similar
areas, as we have found international collaboration and knowledge sharing (in
forums like the TechChange course we attended, Mobile Phones for Public Health)
to be very helpful in developing and disseminating our work. Follow HDF and their projects on Twitter: @HealthDevtFound @Text4babyRussia @IVFSchoolRussia

This is a guest post by TechChange alumna Julia Nagel.

If you’re interested in learning with TechChange, check out our next course on Mobile Phones for Public Health. Class starts June 3. Apply now

In December 2012, I traveled with the Center for Strategic and International Studies (CSIS) to Zambia and Malawi to shoot videos on women’s health. Armed with three cameras – a Panasonic HMC, a Canon Rebel T3i, and a Canon 5d Mark II – we sought to capture the voices of African women on issues that affect their lives and the lives of countless women in their country: maternal mortality, cervical cancer, and family planning. Why three cameras you might ask? My fellow videographer and I both agreed that while the Panasonic HMC is a highly versatile camera, its look does not compare to that of a nice DSLR.

With the DSLR cameras, colors are more saturated, images are more vivid, and you get a nice crisp focus on your subject (if you’re able to manage how sensitive that camera’s focus ring is) that nicely blurs the background. The DSLR does have two major downfalls though. One, it does not operate well in low light (a major problem during Malawi’s rainy season). Two, there’s no good way to capture audio. Thus, the
Panasonic was used for every shoot alongside the DSLRs.

 

In this video, Joyce Banda – the first female President of Malawi – talks about the importance of women’s health and empowerment, particularly in Africa and in her country. The interview was both inspiring to shoot and to edit. The two cameras we used in this video are the Panasonic HMC for the wide shot, and the Cannon 5d Mark II for the tight shot. The video was edited in Final Cut Pro and the cameras were matched in Final Cut using an incredibly helpful program called Plural Eyes. To read
more about the interview, please visit: www.SmartGlobalHealth.org/JoyceBanda. Also, stay tuned to www.SmartGlobalHealth.org for the additional videos that will be released from our trip, due out in February.

 

If you’re interested in mapping in crisis zones, consider taking our course Tech Tools and Skills for Emergency Management that runs from September 3rd – September 28th. 

Cross-posted from Greg Maly’s blog, Multitracked. He is currently working on a mapping based research project run by the University of Denver in New Delhi, India.

This past May we published a blog piece outlining some of the basic lessons learned from TechWeek at Korbel. One of the main takeaways was that technology solutions, though a potentially powerful set of tools, are only 10% tech and 90% people power.

This includes not only putting people in the drivers seat for the use of these tools over time, but also at the onset of any project when considering the need, or gap, they are intended to fill. A few months later, these lessons have become ever more salient as my team from the University of Denver works on the design of a maternal and child health monitoring system for the community of Jasola – a high risk population that borders the Yamuna river in New Delhi, India, and consequently suffers from high child and maternal mortality rates.

Keeping the importance of local ownership in mind from the onset of our project, and working with our local counterparts in the region – a Gender Resource Center (GRC) staffed by women who both live and work in the community – we began by holding a series of focus group discussions with the primary stakeholders in the region: young mothers and pregnant women, doctors who run small health clinics, and community health workers. In each meeting a number of grievances arose, from a lack of resources and shortage of doctors relative to the size of the population in the region, to the difficulties of maintaining effective communication between doctors and patients. As an example of the effectiveness community driven conversations, through these focus group sessions we learned that knowing the location of pregnant mothers was one of the greatest obstacles to routine checkups. This we could work with relatively quickly.

A simple fix was the breakdown of the community into the separate Mohallas, or neighborhoods, which are already well known to community members, but haven’t made it into any form of visual representation. A few afternoons of community mapping using handheld Garmin GPS units and an OSM update quickly fixed the problem and moved the conversation forward a few steps, allowing new ideas to unfold – many of which came from the GRC staff themselves.

Like many health projects around the world, this one has a long way to go. The problems are greater than any solution of this scale can begin to truly address. However, small wins like these slowly begin to even the playing field as communities become empowered to address problems one a time, and with sustainable solutions that do not require a large number of additional resources. In this case, we’re happy to report that community members are on board, including some young mothers who have joined the conversation. Updated maps are being connected with a system that will aim to track mothers from conception through to birth. And though our DU team is set to return home in just two weeks time, I can already tell that the community members see the benefit of this project, and are ready to push it forward with or without us for the long haul. Who knows – there might even be a tablet involved. Stay tuned.

 

 

Text to Change’s Chief Technology Officer, Marcus Wagenaar, sat down with me yesterday to discuss new projects on the horizon and innovations in the mHealth field.  Text to Change is an international NGO which uses technology for social change, or as Marcus puts it, “not just a tech company.”  Instead, outreach is where Text to Change works. As the knowledge bearers about mHealth systems and needs, they help design, conceptualize, manage and analyze outreach and projects with their implementing partners to address gaps in healthcare systems and information.

I asked Marcus to talk a bit about some of his favorite projects:

m4rh

Mobiles for Reproductive Health (m4rh), in collaboration with FHI, uses SMS and web based software to send targeted messages about reproductive health.  The user gets their first message and is given 1-3 options for response, such as “if you want more information about condoms, text back 001.” They are then inside a tree of responses win which they can navigate back and forth and discover new information.  The project has been running in Kenya and Tanzania for over a year with pilots in Ghana and Rwanda underway. FHI provides the content and updates, Text to Change runs the IT backend in each country, all from Kampala.

m4rh is one of Marcus’ favorites because it’s “inherently scalable, once it’s set up anyone can access it for free by texting the first keyword to get the main menu” and it’s the “perfect example of Text to -Change because it provides people with information to make informed choices about their lives. In situations where information is lacking or inaccurate around sensitive issues of reproductive health, m4rh allows people to access information that can give them more control over their lives.  They still make their own decisions but at least they have all necessary information to make an informed choice.”

As example of its popularity; in May 2012 more than 40 thousand people have accessed the M4RH information service in Kenya alone. The specific information people access in the system is analyzed. Also, SMS surveys amongst users are carried out to enable deeper analysis of behavioral patterns. By combining this information various things can be deduced. Examples are: which contraceptives are popular in which age groups, what are the differences in male and female use of the system, are the choices people make influenced by the system, etc. These research results or not yet in the public domain but have been shared at various mHealth conferences and we hope to be able to share the results with a wider audience in the near future.

Medical Male Circumcision

The Medical Male Circumcision project, in partnership with Jhpiego in Tanzania and potentially Uganda, is a service hat sends information, similar to m4rh, as well as supporting patient recovery.  Individuals in the beneficiary population get messages regarding where they can receive Medical Male Circumcision and why it’s important, such as “Male circumcision can reduce the risk of female-to-male HIV transmission by 60%”.  After surgery, patients receive messages as soon as the surgery is complete regarding what to expect during their recovery. The Medical Male Circumcision project provides a Virtual Nurse who advises patients: “Make sure that you do not have sex for the first two days,” for example, or later on in the recovery “if your urine is discolored, visit the clinic.” The messages are “specific but lighthearted” with quiz questions every week to engage the patients and to assess how much they know about Medical Male Circumcision. Messages are meant to be encouraging and a “positive way to ensure recovery,” reduce stress, and “decrease health costs overall” by addressing concerns before they become serious health issues.

Text to Change monitors how many people they reach with their messages, how often they are reached, and how much it costs to reach a person. Researchers were able to show a statistically significant association between those men who texted in to the toll-free number asking where male circumcision was available and those who actually followed through and got circumcised. This is a good example of providing people with information to help them making informed decisions about their own health.

Data Collection

The data collection project is in the pilot phase with the Center for Disease Control in Tanzania within the mHealth Alliance. The project targets mothers after they have delivered and will speed up data collection about Vertical or Mother-to-Child-Transmission (MTCT) of HIV.  Currently, midwives and nurses fill in registers for mothers and babies to track their data by hand.  The individual patient data is rarely analyzed and often inaccessible to researchers and government representatives so that today there is no reliable number for the transmission rate for MTCT in Tanzania.  This Data Collection tool pilots a new form for tracking MTCT data, where healthcare workers take data from the standard register, write it on a worksheet and then copy it line by line and send it to a central location using SMS.  The data collected will allow the CDC to calculate the transmission rate for the first time in Tanzania and will enable impact evaluation of interventions that aim to lower the number of Mother to Child Transmission of HI, which is part of the Millennium Development Goals.

I also asked Marcus to give a window into exciting innovations in the pipeline:

FormHub              

FormHub is an Open Source initiative by Columbia University.  Text to Change is working with Columbia to develop and use their platform in the field. Text to Change is currently implementing this technology with one of their partners. The partner will conduct a survey in Uganda’s Luwero District, interviewing 1000s of teachers and students in secondary school about physical abuse, sexual abuse, living conditions, and emotional and physical wellbeing of children.  This is the first ever large-scale survey about these sensitive issues performed in Uganda. The partner designs the survey questions, Text to Change enables easy data collection using mobile technology and the formhub platform. Using cheap Android phones, 60 trained Ugandans will carry out the survey using FormHub.

Marcus also wants to use FormHub to automate data gathering in health and medical setting in remote clinics because it’s simple to use for the designer, data collector and data analist and it’s open source.  Many more interesting projects to come!

Vusion

Vusion is a new SMS open source platform development by Text to Change. The backend is based on the Vumi system developed by the Praekelt Foundation.  Marcus sees Vusion as the next big thing in SMS messaging, and here’s why:

  • Vusion is focused on providing a scalable enterprise messaging platform
  • It can connects to multiple telecom companies and aggregators in multiple countries and multiple shortcodes
  • Once Vusion is set up, you won’t need a programmer to design campaigns or access data so it’s easy for non-technical project managers to use without programming skills
  • An API enables access to SMS data from external applications, which enables easy development of for example; advanced real-time data visualizations, website-widgets, twitter integration, etc.
  • Vusion has different access levels and enables organizations to implement and manage multiple SMS programs in parallel from one central platform.

Programmer? You can download Vusion from github and see what the skeleton looks like.

Some of the cost implications of SMS projects are annual dedicated shortcode fees and aggregator costs.  Vusion reduces this by enabling shortcode sharing. Users can use the same shortcode for small projects to share infrastructure and still be in full control over their campagins and projects  This is the approach Text to Change has been pioneering for years but Vusion will make it easier for organizations to be more involved in their own campaigns by having full access to their projects and the associated data.

Vusion was launched with an extensive demo on the 15th of June in Amsterdam. There is no recording of real-live demo but an accompanying presentation is available on slideshare.

Interested in learning about Mobiles for International Development? Check out our upcoming course, mHealth: Mobile Phones for Public Health, starting in November.