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Two Guides You Must Read Before Using Mobile Technology for Behavior Change

Photo Credit: Larissa Frei

As the desire to utilize mobile phones in international health projects has increased in the last few years, organizations continually ask a similar question, “We want to use mobile phones. Now what?” But the decision to introduce or start a mhealth project needs to come after answering many questions before “now what?” especially when dealing with behavior change communication projects. Enter Abt Associates, FrontlineSMS, and Text to Change. Two guides have recently been released to help organizations assess whether or not mobiles are the right tool, and if they are, the process moving forward. One is from Abt Associates and is entitled mBCC Field Guide: A Resource for Developing Mobile Behavior Change Communication Programs. The other one was created in collaboration between FrontlineSMS and Text to Change and is entitled Communications for change: How to use text messaging as an effective behavior change campaigning tool.

mHealth is a sexy term these days but it is not always the best approach to creating behavior change. Simply using mobile devices will not instantly make your project/program better. But when designed and implemented with the end user in mind, they can be a cheaper and more direct tool to pass information along in order to change behaviors.

Reason for the Guides

Abt and FrontlineSMS/Text to Change saw the need to have a guide that can lead practitioners through the necessary steps in order to see if and how a mobile solution could be used in the field. Each guide clearly shows the need to analyze on how a mobile intervention would fit into a program. They both do a great job pointing out that every situation is different and that a mhealth intervention must fit into the context and infrastructure of the region. But they are structured in very different ways and have noticeably different lengths (50 pages vs 7 pages). The Frontline/Text to Change guide is structured more like a checklist and mostly focused on text message interventions. The mBCC guide is longer and walks the reader thoroughly through the assessment process. But the guides show how to strategically think about behavior change communication projects.

The mBCC Field Guide

Abt Associates broke down the guide into 6 chapters with each chapter focusing on a specific topic. Each chapter lays out the necessary research and design that must be conducted in order to successfully utilize mobiles for behavior change. The chapters are in order of how one should follow the process (even though you can pick and choose chapters if you have already completed a chapter before reading). The chapters include Situation Analysis, Audience Segmentation, Behavior Change Objectives, Message Development, Tools & Technologies, and Monitoring and Evaluation. Each chapter also includes tools in the form of Excel templates that can be utilized to complete the assessment discussed in the chapter. With a high level of detail along with the structured worksheets, this guide is designed for those who are new to mhealth and are seeking a step-by-step walk through from the start.

Frontline/Text to Change

As mentioned before, the FrontlineSMS and Text to Change guide is more of a checklist of things to research and discuss before designing and implementing a mobile-based behavior change project. With a DOs and DON’Ts list, it covers context, content, developing campaigns, and monitoring and evaluation. This skeleton format is a quick read and is probably better suited for an organization that either has worked with mobile devices before or is somewhat knowledgeable about mhealth.

Both are very useful guides for the intended audiences. With mhealth still only mostly being used in pilot projects, we need to find answers to what changes behavior. The greater number of projects that use mobile devices for behavior change communication (when they are deemed most appropriate) means more data and evidence will be produced in order to show the true impact of mobile devices. These guides give the necessary direction to organizations to start leveraging mobile devices in health projects and discover what does and does not work along with why, which is the most important question of all.

As an ending note, the mBCC Field Guide was presented by Gael O’Sullivan, Stephen Rahaim, and Shalu Umapathy from Abt Associates during the latest mHealth Working Group meeting. They explained that the guide needed to be a “living document,” and they requested feedback about it from mhealth practitioners, especially those in the field. Please visit their website (http://www.mbccfieldguide.com/) in order to provide any feedback. To provide feedback to FrontlineSMS and Text to Change, please find used the contact information here and here.

March 21, 2012/by actualize

Mobile Money, Originally posted on the GBI Portal

Recent Innovations in Money Mobile: Moving Past the M-PESA Model

Photo Credit: TechCentral

Within the last month, there have been multiple new examples of mobile phones being leveraged to expand financial services in developing nations. With the popularity and quick success of M-PESA in Kenya, there was a push to copy the model in other developing countries. But it has been realized that the M-PESA model cannot be simply duplicated. The new mobile money products and services need to focus on solving a customer’s pain (or perceived pain) within the regional context (competition, policy environment, culture, infrastructure, etc). The examples below show how innovation in the market is occurring to meet the needs of customers. Mobile Network Operators (MNOs) are seeing the benefits of providing an expanded set of value-added services to differentiate themselves in the market. In a recent TECHTalk at USAID with Pamela Riley from Abt Associates, she explained that MNOs are most focused on increasing and keeping their customers. With greater competition in the mobile network market, the ability to create more value to a MNO’s service keeps the customers from jumping from one provider to another (usually easier because one MNO’s SIM card can be easily switched out for another’s). The MNOs’ desire to increase revenue creates an incentive for them to implement innovative solutions based on the needs of their customers but also within the region’s entire context.

Below are a few recent examples of innovation in the mobile money space:

Mobile Banking

RedCloud Technology recently completed Bolivia’s first mobile money platform. The product, Nube Roja, was created from a $1.2 million investment from BlueOrchard, CONFIE (Corporación de Fomento a Iniciativas Económicas S.L.), PROFIN (Fundación para el Desarrollo Productivo y Financiero), Iceni Mobile, and RedCloud. The goal of the product is to provide access to financial services to roughly 6.5 million people in Bolivia who do not have a bank account. A pilot of the service will begin in the near future with customers being able to cash in, cash out, top up their airtime, transfer money person-to-person, and send remittances.

A newly formed partnership between First National Bank (FNB) and retail store PEP allows customers in South Africa to use FNB’s eWallet for banking services at the retail store. As long as the individual has a bar-coded South African ID, he/she can deposit, withdraw, send, make payments, and purchase goods at any PEP store in South Africa. In the past, only FNB customers could use the product. But with this partnership, FNB is looking to reach the unbanked in the country. Partnering with PEP expands FNB financial services to 1,200 stores and gives greater access to those who have a mobile phone.

As a part of a strategy to expand financial services further into the rural areas of Mexico, the National Savings Bank and Financial Services (Bansefi) is going to use mobile technologies through the implementation of the Program of Technical Assistance to Rural Microfinance (Patmir). Their goal is to have over 15% of their new partners and customers be served with low-cost mobile technology. Bansefi will be hiring a consulting firm to provide technical assistance with the implementation of new technologies, innovations, and best practices.

Money Transfer Services

In partnership with one of the leading MNOs in India (BSNL), the Indian Post Office has begun its own mobile money service. The service allows money be transferred via text message and utilizes the physical post offices to act as cash in/cash out locations. It works by the sender providing the post office with the receiver’s information (number and address) along with the amount to be sent. Once the cash is deposited, both the sender and receiver are text messaged a unique code by the Post Office. In order to withdraw the money, the receiver shows the code to the Post Office. There is a service charge of 5% and is available to individuals across all networks.

Airtel has plans to establish mobile money transfer services in Kenya and Tanzania as it has already done in Uganda. The goal of the new services, as stated by Michael Okwiri, Vice President of Corporate Communivation at Airtel Africa, is eventually create a cross-border money transfer service between the three countries.

Western Union and Telma, a Malagasy telecomm company, have partnered to start an international mobile money transfer service. The new service allows citizens to transfer money via their mobile phones by using Western Union’s international transfer service. By combining Telma’s mobile money service (MVola) and Western Union’s service, individuals can receive money transfers from abroad via their mobile phone. The transfer will go directly into their MVola account. At this point, it is only a one-way service as Malagasy citizens can not send transfers outside the country. MVola, like other mobile money services, allows customers to purchase goods, make payments, and deposit/withdraw money.

ATM

As a part of Airtel’s new mobile money platform in Uganda, customers will be able to process transactions at ATMs. This includes paying bills, accessing their bank accounts, and withdrawing Airtel money using ATMs located country-wide. This service was made possible via partnerships with banks which include Standard Chartered, Post Bank, KCB, and Diamond Trust Centenary Bank.

Credit-Worthiness

A Cambridge start-up has created software in order to help determine an individual’s credit risk by looking at how the person uses their mobile phone. Cignifi has received $2 million in funding after piloting the product last year in Brazil. The software looks at multiple data points in order to further understand one’s lifestyle. It creates a score similar to the FICO score used in the United States. Since many developing countries do not have credit bureaus or limited ones, it is more difficult to calculate the credit risk of an individual person. This is innovative way to understand the riskiness of an potential borrower.

February 8, 2012/by actualize

Agriculture, Health, Mobile, Originally posted on the GBI Portal

‘Smart’ Use of Smartphones for Health Services: A Case of TB in Nigeria

Photo Credit: Leah Ekbladh

Using smartphones to collect tuberculosis (TB) data within the health sector of Nigeria has eliminated the use of printed forms; minimized human error in data entry; reduced the lag time of availability of data for policymakers and managers; and helped pinpoint ways to improve delivery of TB care, reported Leah Ekbladh.

Ekbladh, who is a Senior Associate at Abt Associates was giving a talk hosted by the Global Health Council on the topic “Quality TB Care: Using Smartphone Technology for Data-driven Improvements in Nigeria” as part of the Health Systems 20/20 presentation series on Tuesday January 10. Her talk focused on TB quality improvement activity in Nigeria, the Abt Associates’ approach to quality improvement (QI), the before and after picture of supportive supervision (SS) system, next steps, and lessons learned.

TB Situation in Nigeria and the Health System

According to Leah, with Nigeria ranking 10^th among the 22 high TB burden countries in the world, the country’s TB situation could be improved. Before the HS2020 and the National TB Program’s joint intervention, the TB supervision system was largely paper-based. Results of data collected from health facilities were not available immediately for feedback and quality improvement; each state had its own paper-based system with different design of the forms and different items; data were compiled quarterly at State levels; and data entry and analysis was time consuming and prone to a lot of human error.

With support through Health Systems 20/20, the USAID flagship project for strengthening health systems worldwide, the need to strengthen the Supportive Supervision (SS) system to improve performance and treatment outcomes with Nigeria’s health sector was identified. The activity by Abt Associates aimed to shift away from the long paper-based checklists that do not support timely QI at the health facilities, towards supervision that concentrates on performance of clinical tasks, resolution of problems experienced by the health workers, and increased feedback from supervisors.

Photo Credit: Leah Ekbladh

The Activity: The Role of Information and Communication Tools

The project believes that when the new information and communication technologies (ICTs) are smartly and strategically integrated into existing development processes, they can help streamline, transform and improve services. And with the strong in-country leadership support from Nigeria to explore new and innovative ways of improving quality through SS system, the activity took off smoothly with a pilot in 4 local government areas (LGA) in 4 states.

Tools Used: Beginning with what was available at the time, and also based on the usability of the features, Personal Digital Assistants (PDAs) were used in combination with Pendragon software to help in creating forms, connecting the forms to the users, distributing the forms, and uploading the forms to a database. After a year of piloting, it was realized that the market for the PALM PDAs was declining with the increasing use of smartphones in Nigeria. Also, EpiSurveyor software from Datadyne was recommended due to its ease of use and its ability to calculate and populate the forms for data collection.

Outputs

Rapid Results Indicators (RRI): RRI form was created with the most critical items that sum up the key elements that are needed for quality data collection, analysis, use and QI for supervision. This was done through repeated iteration resulting in a consolidated checklist that streamlines and integrates the numerous checklist that exists on the paper-based system. The checklist (RRI) loaded into the smartphones, are programmed to do automatic calculations of critical indicators by reducing human error.

Training and Capacity Building: Thirty (30) out of 50 supervisors have been trained on the use of the smartphone technologies and data managers are also trained on the use and improvement of the database. (It should be noted that these people are the existing public servants of the ministry of health in Nigeria). Six rounds of data collection have been done with one using smartphones and five with PDAs.

Database: Through the system, a web-based database to house the data collected and to more easily aggregate and report information to the national level has been developed and launched. The database provides online data aggregation for analysis and dissemination, and quality control system of the data including online government approval data being published and used.

When data is uploaded, supervisors gets notified or alerted for review either on their phone through SMS or email. Updates are communicated back to the officer for review and publication.

Impact of the Activity

With the pilot activity, supervisors have reported the ease of use of the tool in data collection as well as for review and editing of submitted data. Some reported a reduction of working hours from 3 hours with paper-based system to 30-45minutes with the smartphone technology. Supervisors have indicated that the system is enabling them to monitor and assess performance of the TB health delivery system, identify problems and opportunities, and many cases take immediate action for improvement. For example, the rate of drug stock-outs has significantly decreased, and external quality control is easily obtained for quality service with far less delay.

Photo Credit: Leah Ekbadh

Lessons Learned and Steps Forward

It was discovered that careful selection of technologies (information communication technologies) for international development activities is key for success; suitable technologies in combination with human resources (socio-technical) is critical; and steps must be taken to roll-out projects incrementally and then plan for scale-up.

In terms of scaling, a total coverage of Lagos and Abia is expected soon with the training of additional 50 supervisors and full integration of the database on schedule. The project also expects to leverage other funding sources to expand further and also involve the private sector in Nigeria.

Visit Abt Associates international health programs for more information on their activities and the Health Systems 20/20 presentation series site for information on the upcoming events and also access the audio recording of the talk.

January 17, 2012/by actualize

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