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Agriculture, Health, Infectious Diseases, Maternal & Child Health, Mobile, Originally posted on the GBI Portal

Tanzania tracks malaria prevention with mobile phones

Photo Credit: medatanzania.org

In Tanzania, a new voucher program started in late July that provides discounted insecticide treated bed nets for pregnant women and children. This program also takes advantage of mobile technology as retailers can inform local clinics when their shops are getting low on life saving supplies by text messaging.

The program which is being overseen by MEDA, a Canadian organization, integrates health clinics, wholesalers, retailers and bed net manufacturers. Pregnant women and families with children in rural areas are eligible to receive a voucher from health clinics to get discounted insecticide treated bed nets from health supply retailers at 500 Tanzania shillings (about $0.35).

Once a woman takes a voucher to a retailer and pays a discounted price, she receives a bed net in return. The retailer then uses his or her cell to send a text message back to MEDA, which helps run the program. That SMS provides crucial monitoring data that includes the number of bed nets provided to the community and how many are needed in their next shipment.

The use of mobile technology to monitor bed net stocks and shipments is the feature that set this bed net initiative apart from others.

Each shipment contains a predetermined number of bed nets for a specific region based on their unique needs. Once the bed nets are delivered and the vouchers are collected, the retailers receive monetary compensation.

Long lasting insecticide treated bed nets. Photo Credit: medatanzania.org

In the “fight” against malaria, insecticide treated bed nets are a cost effective and proven weapon, especially for families in rural communities. According to the Global Fund, more than 300 million bed nets have been distributed in Sub-Saharan Africa since 2008. Moreover, Tanzania is a hard hit country as 2 million out of the 44 million people are affected by malaria.

Distributing vouchers for discounted bed nets is not a new method of tackling malaria. However, this approach produces a different sentiment amongst bed net owners than simply passing out bed nets to families for free.

Health workers have found that when a family makes a small investment in the net, it becomes a more valued commodity. Initiatives that pass out bed nets for free sometimes fail because families adopt the mentality that bed nets are valueless and easily replaceable.

This program distributes paper vouchers to the women that visit health clinics. Paper vouchers can easily be lost or ruined altogether. Therefore, keeping track of paper vouchers is often an obstacle. The next step is eliminating paper vouchers and developing text message based vouchers to make the process more efficient.

August 17, 2011/by actualize

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

Study shows importance of evaluating mHealth programs

One the biggest issues in mHealth and mobile campaigning in the developing world is the lack of evaluation. Well, the Lancet published an article last week that measured the effectiveness of mobile phone text message reminders on Kenyan health workers’ adherence to malaria treatment guidelines.

What the study found was that text messages can be a cost effective way to improve the care for malaria treatment in African children. Even though the study focused on malaria treatment, the results of the study suggest that using text messages can be an effective weapon to fight many different health burdens with.

According to the study, half of children received the correct treatment at the end of the study, more than double the starting figure. At the beginning of the study, 20.5% of children were correctly managed, this increased to 49.6% after the six month study.

The effect appeared to persist after the texts stopped. Six months after the trial ended, 51.4% of children were receiving the correct treatment due to the text messaging.

Professor Bob Snow, who headed the research group, said, “The role of the mobile phone in improving health providers’ performance, health service management and patient adherence to new medicines across much of Africa has a huge potential.”

Despite the positive numbers, the authors acknowledge that “we do not fully understand why the intervention was successful”. They speculate that the presence of the texts themselves serve as a reminder and reinforce the importance of the message itself.

One of the conclusions in the study is that “text-message reminders should be used to complement existing interventions—which themselves should be qualitatively improved—to target weak points” in health management practices.

The study however, sheds light on the importance of evaluating an mHealth campaign. Through evaluations, stakeholders can figure out whether a program is meeting its goals and how much of an impact it is making on the health issue it was designed for.

Currently in the developing world, numerous mHealth programs are being implemented on a small scale basis without monitoring and evaluation components. This not only leaves the project unfinished, but it is irresponsible as well. If a given program is appropriate to scale up to a wider population, we would never have the statistics to prove it. Then again, that hasn’t stopped NGO’s and governments before.

Evaluating mHealth programs is not a complicated task. Perhaps stakeholders are afraid to discover that their programs are not actually producing the impact they envisioned in the board room. This study has shown that positive results can indeed manifest from text messaging campaigns, and it is worthwhile to evaluate such campaigns.

The world needs to know what works and what doesn’t for the sake of the populations that are supposed to be the beneficiaries of the programs they are involuntarily thrown into. Otherwise, stakeholders are shooting in the dark with the well-being of innocent people.

August 11, 2011/by actualize

Agriculture, Health, Humanitarian Assistance, Infectious Diseases, Mobile, Nutrition, Originally posted on the GBI Portal

To UNICEF and WHO: Don’t forget to monitor your vaccines

Children and women waiting to get diagnosed in clinic. Photo Credit: WHO

In the wake of the drought and famine being experienced in the Horn of Africa, multiple vaccination campaigns have been launched in the region. UNICEF, WHO and Kenya’s Ministry of Health (MOH) are launching a campaign for the children situated in the Dadaab refugee camp in Northern Kenya, which is already triple the amount beyond its refugee capacity. UNICEF is also launching a solo campaign for children in the Horn of Africa, with a particular focus on Somalia.

The UNICEF and WHO-backed campaign in Dadaab will target 202,665 children under five years of age, with measles and polio vaccines, together with Vitamin A and de-worming tablets. The campaign is part of a regional push to ensure all children in drought affected areas are vaccinated against a killer disease like measles which can be deadly for malnourished children, and be protected from polio.

The solo UNICEF campaign for the rest of the Horn of Africa includes a strategy to vaccinate every child in Somalia under the age of 15 against measles which totals over 2.5 million children.

“This is a child survival crisis,” said Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa. “Children don’t die just because they don’t have enough food. In various stages of malnutrition, they are more prone to sickness and disease. As big a challenge as the rates of malnutrition pose, the danger for children extends even further.”

“Malnutrition can weaken a child’s immune system, increasing their susceptibility to infectious diseases like measles and polio,” says Ibrahim Conteh, UNICEF Dadaab Emergency Coordinator. “We are acting now because these diseases can spread very quickly in overcrowded conditions like we have now in the camps.”

Measles is a highly contagious disease which can flourish in unsanitary and overcrowded environments like refugee camps. Measles reduces a child’s resistance to illness and makes them more likely to die when they are malnourished and suffering from other diseases.

Launching a vaccination campaign in the Horn of Africa is no simple task, even without a drought crisis to worry about. The region experiences atrocious coverage rates as evidenced by Southern Somalia where vaccination coverage is just 26%, one of the lowest in the world.

This suggests that there may be issues with the cold chain transportation of vaccines in the region. In the developing world, transporting vaccinations is complicated as high temperatures, scarce resources, unreliable electricity, and long distances between health care facilities can all break the chain.

Mobile vaccine refrigerator. Photo Credit: True Energy

This means that as UNICEF, WHO and the Kenyan MOH roll out of their campaigns, they must take extra precautions to make sure vaccine spoilage is minimized as much as possible. So many children’s lives depend on the vaccines being functional and on time.

Most, if not all of the vaccines being distributed in the campaigns will be transported using mobile vaccine refrigerators. There are mobile refrigerators currently in use all over the developing world that utilize innovative vaccine monitoring systems.

SmartConnect box

True Energy, a company highlighted in the past supplies a grid powered or solar powered refrigerator that offers vial vaccine monitoring to monitor the temperature of the vaccines along the cold chain. They also include a SmartConnect SMS monitoring system that sends out an SMS to the recipient alerting them of temperature changes along the cold chain for instantaneous monitoring.

PATH is one organization that has purchased these vaccine refrigerators with the SmartConnect capability. UNICEF has also commissioned these refrigerators from True Energy and is shipping the refrigerators for use in over 30 countries. Furthermore, the True Energy refrigerators meet WHO cold chain requirements.

Therefore, there should be no excuse for inadequate monitoring of vaccines amidst the vaccination campaigns. The technologies exist to ensure cold chain efficiency. Moreover, UNICEF and WHO have both recently dabbled with these existing technologies.

With reports that the drought in the Horn of Africa has not yet reached its peak, the vaccination efforts must be successful or millions of children may suffer the consequences.

August 8, 2011/by actualize

Agriculture, Democracy & Governance, Mobile, Originally posted on the GBI Portal

Texts and Balances: Nigeria’s 2011 Election

Photo: MobileActive

In Nigeria’s presidential election this April, election observers sent over 35,000 daily text messages to document validity or corruption of the election counting and results. The theory behind Project Swift Count 2011 was that having election observers at voting locations around the nation equipped with mobile phones could immediately report foul play. The theory worked—statistically significant samples by independent organizations verified the published election results from the Nigerian election bureau—indicating that corruption was minimal or nonexistent.

The National Democratic Institute worked with the government of Nigeria to hire 8000 election observers to monitor 4000 voting stations. A parallel vote count was collected and corruption monitored and reported. The observers documented peoples votes, whether they were pressured by anyone, and if all the candidates were listed. Then, the observers each sent a minimum of five text messages during the course of voting to verify the following events:

Photo: NDI

1. Voting accreditation booths opened on time

2. Closing of accreditation booths on time

3. Close of voting booths

4. Starting time of vote counting

5. Accurate reporting of final votes at verified time the next day

Subsequently, political corruption was stymied and the election results were accurate in terms of the sample NDI collected. President Jonathan Goodluck was elected in a fair and clean democratic election.

The project cost around nine million dollars in total, including an independent evaluation of the funds. A group of independent researchers, including Katrin Verclas of MobileActive, carried out the evaluation, and found that nearly all the money could be accounted as originally proposed. These clean results have motivated other countries to utilize this system as well. NDI is currently working with Zambia to monitor their next elections with a similar plan.

Given the high use of mobile phones and the live stream of communication possible via SMS, mobile phones present another solution to promoting democratic elections. And with the spread of mobile satellite service around Africa, this project is scalable in other nations.

August 3, 2011/by actualize

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

Grad students build novel tool in fight against malaria

Photo Credit: geardiary.com

A new faction has joined in the war against malaria: graduate students. A group of students developed a malaria diagnostic tool that will be rolled out in India and Ethiopia this summer. Called, the Lifelens project, the tool uses a micro lens on the camera of mobile phones that can ultimately test for and diagnose malaria.

Created by Harvard Business School student Cy Khormaee and UC Davis doctoral student Wilson To, the lifelens product attaches a $50 micro lens to the camera of a Windows 7 enabled smartphone.

With the camera in place, the phone can then capture high-resolution images of the cells in a drop of blood that is placed on the micro lens. Windows 7 software quickly analyzes the images, confirming the presence or absence of malaria. Once the images are analyzed, the results can be sent to public health workers and other health professionals via SMS for further assessment and data collection.

Current standard practices in malaria diagnosis involve administering a rapid diagnostic test (RDT). This method takes a blood sample, usually off of the finger of the patient, and then exposed to a cotton swab containing a solution that reacts with malaria antigens that may be in the blood. However, this method is inefficient and produces many false positives, with only a 40% accuracy rate.

Photo Credit: springwise.com

The lifelens tool acts as a powerful microscope and can easily be sterilized for further immediate usage. It is also more accurate than RDT since it detects malaria cells directly. To and Khormaee say that in the long run, the lifelens tool will be more cost effective than current RDT detection methods.

However, there are some obstacles. The lifelens tool only operates on a Windows 7 enabled smartphone. These phones cost hundreds of dollars and may be affordable in resource poor areas. Also, the lifelens tool is not the only novel technological tool in the malaria detection space. Disposable tests are already in wide use, and others are developing diagnosis technologies, including a DNA-based one that could, like Lifelens, test for malaria and other illnesses.

The lifelens project received an award in the Microsoft sponsored Imagine Cup competition that featured innovative technological tools that use Microsoft software. With this award in hand, To and Khormaee plan to roll out a testing phase for their tool in India and Ethiopia.

Virtually all deaths from malaria occur in the developing world with 90% occurring in Africa. Any advancement in malaria diagnosis is highly valued. The lifelens project is aiming to change the way infectious disease diagnosis is handled. “Malaria is just the beginning,” says To. “We’re building a platform.”

August 3, 2011/by actualize

Agriculture, Health, Health Systems, Infectious Diseases, Mobile, Originally posted on the GBI Portal

Army of mothers set to fight malaria in Mali

It was recently announced that an initiative called Mobiles Against Malaria will be launched in Bamako, Mali. The initiative will be executed using mothers who are community health workers in an effort to use mobile phones to prevent, diagnose and treat malaria in a more effective way than it has been.

The project is being funded by Akvo, a foundation created in 2008 that uses open source web and mobile software to attract funders to a spread of projects being done in the developing world.

CHW's at work. Photo Credit: Akvo

Mobile phones will be used by the mothers who were recruited as community health workers(CHW) to record data from neighborhoods on malaria. The CHW’s will visit each household in a particular neighborhood ready to ask pre-formulated questions.

The answers to the questions will be gathered on the mobile phones. For example, some of the questions asked may be ‘how many people live in the house’ and ‘how many people are ill’ and ‘what is the number of newborns’.

After gathering all of the necessary answers, the data will be sent via SMS to a central database located at a local hospital. It is hoped that NGO’s and local organizations will take advantage of the databases to analyze the trends and assist households in need of help. Officials hope the SMS data collection system will shed light on estimating how many insecticide-treated nets are needed in the poor areas in Bamako.

These community health workers will travel to malaria impacted areas around the capital city of Bamako to administer a revamped program. An older version was implemented using CHW’s who tested 2,796 children for malaria with a finger prick test after visiting nearly 100,000 households. That framework will be enriched by the introduction of the SMS-based frontline data collection.

The use of mothers as the CHW’s is a hallmark feature of this program. That along with using the SMS based frontline data collection sets this malaria detection program apart from other ones going on in Africa. Using mothers presents several advantages:

mothers are trusted in the community
they easily gain trust from other women from whom data is being collected
they can persuade women to visit hospitals using that established trust
they often have insider knowledge to the neighborhoods they work in
they ensure use of treated mosquito nets
they support treatment adherence

Along with attaining malaria specific data such as households using insecticide treated bednets, officials hope the program will create easier access to information on the burden. They also hope the cell phone-based application will improve patient management via a cell phone risk assessment and triaging tree, strengthen patient history documentation in the field, enable clinical communication (text, image, audio) between community health workers and clinics, and provide access to previously unrecorded health information.

The program aims to use mothers and cell phones to decrease costs of malaria detection and treatment while improving the access to treatment and treatment adherence. The program will train and utilize 50 CHW’s and 2 hospitals over the span of a year. It hopes that using mobile phones will build off of prior success.

August 2, 2011/by actualize

Agriculture, Health, HIV/AIDS, Mobile, Originally posted on the GBI Portal

Fight against HIV/AIDS in India gets helping hand

Argusoft, a Fremont, CA start-up that’s combines video, instant messaging and Internet telephony in a platform for “e-health” programs in the developing world, is ready to implement a mobile phone application that will enable field workers to register HIV-positive mothers and provide regular updates on their care.

The application, called mAID, runs on any java-enabled phone and utilizes the SMS interface. It is designed primarily for health workers that go out into rural communities to inform citizens on different health issues.

Using the application in the field is simple. Cell phones are given to health workers who communicate through the phone to a central database. The health workers are sent daily instructions in the morning via SMS on where to go and which houses to visit. The health workers collect relevant data on HIV/AIDS prevalence and awareness and report the data back to the central database via SMS.

The new program is overseen by the Indian government with financing from the Global Fund, a nonprofit in Geneva that targets AIDS in developing countries. IL&FS, an infrastructure development conglomerate based in Mumbai, is handling logistics.

mAID underwent a pilot test where 35 health workers reached over 2500 patients using the application. The pilot phase ended last month, and based off its results, the Indian government wants to inject 3600 more health workers into the field with the mobile app for a nationwide scale up. There are even talks about using the application in Africa.

Argusoft's Ram Gopalan. Photo Credit: mercurynews.com

The CEO of Argusoft, Ram Gopalan has cited the difficulties of preventing HIV/AIDS as the impetus of his application. “It’s fully preventable, but one of the highest killers of children in the Third World,” Gopalan said.

Gopalan echoes the same sentiments of the Indian Government who have been working to prevent prenatal HIV transmission since 2002, using counseling and testing centers around the country. The Indian Government also cited issues with health worker capacity. Regarding that Gopalan said, “There was a lot of inefficiency, workers misinterpreting instructions, and paperwork getting lost.”

Argusoft is no stranger to implementing eHealth initiatives. In the eastern Indian state of Tripura, Gopalan linked isolated villages with a hospital in the state capital where doctors can remotely diagnose simple but life-altering problems such as cataracts. This telemedicine project has provided eye care for more than 100,000 patients over the past five years.

In the future, Gopalan wishes to introduce a network of accredited family-care doctors from India who could be available 24/7 for live video chats with patients. This is similar to the meradoctor project which already exists in India. In the meantime, the HIV/AIDS burden in India needs some attention as it is the third highest burden in the world in terms of sheer numbers living with HIV.

July 28, 2011/by actualize

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

SMS campaign in India to reach 5.5 million people

Blood bags. Photo Credit: anemia.org

HLL Lifecare Ltd, one of the largest blood bag manufacturers in India, launched a massive SMS blood donation campaign last month, targeting to reach over 5.5 million customers belonging to the top telecommunications company, BSNL.

The campaign, launched by state Health Minister Adoor Prakash on Blood Donation Day last month in Kerala, a southern state in India, wanted to highlight the virtue of blood donation as a civil responsibility for those who are able in order to help those in need.

Prakash also created a help desk called ‘Heart Beats’ designed to assist prospective blood donors. This was funded by the Hindustan Latex Family Planning Promotion Trust (HLFPPT), an organization affiliated with HLL Lifecare, in association with the Kerala State AIDS Control Society.

The purpose of the help desk is to funnel the donors to the patients. Individuals who want to donate blood voluntarily can register their details, including name, place, blood group and phone number either at the help desk or to the help desk via SMS. They are intended to be set up at local health care centers and can also assist patients during emergencies.

India has harbored SMS blood donation programs in the past. Indianblooddonors.com is a website that serves as a database listing for thousands of blood donors from over hundreds of Indian cities. It was launched in 2000 with the SMS component implemented a few years later.

It works in the opposite way of HLL Lifecare’s system. A person in need of blood sends out a text message to a special number, mentioning, in a particular format, his name, city and the blood group required. Within a few seconds, he gets a return SMS with the name and number of a donor in that city.

Photo Credit: HLL Lifecare

Despite having the capability of saving lives, this was a little known service in India. However HLL Lifecare’s current campaign seems to be aiming for much more publicity and awareness on blood donating.

India frequently engages with shortages of blood supply. India usually faces deficits of up to millions of units of blood per year.

Furthermore, isolated populations usually have difficulties reaching out to blood donors and suppliers and often don’t get the blood they desperately need. India’s telecommunications industry is the fastest growing in the world. Nearly 75% of the population, about 900 million people, has mobile phones. Hopefully, this SMS campaign will bring light to the issue of blood donations and help curb the burden by taking advantage of mobile phone prevalence and growth in the country.

July 12, 2011/by actualize

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

Drug traders paying pharmaceuticals for counterfeit drug detection?

U.S. based social enterprise Sproxil announced the start of its counterfeit drug detection program in India two weeks ago. This comes after the company announced it would receive a $1.8 million financial backing from Acumen Fund to expand its operations to India back in March 2011.

Sproxil is well known for its Mobile Product Authentication (MPA) architecture which fights the distribution of counterfeit drugs in developing nations. The MPA system takes advantage of the mobile phone market which is widely accessible in Africa. MPA uses scratch off cards that come with purchased drugs. These scratch off cards display a unique identifier which is texted to the pharmaceutical supplier to verify the authenticity of the drugs.

Photo Credit: Sproxil

When drugs depart the factory they are manufactured at, the scratch off card with the unique identifier accompanies every package manufactured ensuring authenticity from the source. When the drug is purchased, customers can scratch the card and text the identifier to a number provided by Sproxil from any cell phone and receive verification within seconds on the authenticity of the drugs. Sproxil says the texts are free of charge to the consumer.

Sproxil has affected the lives of many uninformed consumers before going into India. They established the first national mobile-based anti-counterfeit program in Africa and has already sold millions of anti-counterfeit labels which provide services to several global pharmaceutical companies, the company says. Drug suppliers in Africa that have lost potential revenue claimed to have covered for their losses and even experienced growth after using MPA.

Sproxil moves to a market in India that is suffering from counterfeit drug trade. “India has one of the largest pharmaceutical markets in the world, but is plagued by counterfeit (spurious) medicines made elsewhere that tarnish brand India,” said Ashifi Gogo, CEO of Sproxil. Gogo cites the recent success of a pilot program in Nigeria as the basis to expand to India. Sproxil’s Mobile Product Authentication technology has touched the lives of over 80,000 people, helping patients avoid getting ripped off by counterfeiters,” said Gogo.

Photo Crdit: SRxA

The world of counterfeit drug trade is a devastating one. According to the World Health Organization (WHO), up to 30% of drugs sold in developing nations are counterfeit with the counterfeit drug market estimated at $200 billion by the World Customs Organization (WCO). The number of deaths and drug resistance levels continue to rise due to consumption of fake drugs, which is creating a healthcare nightmare.

The MPA system is a cost effective and relatively simple way to track fake drugs for both consumers and (authentic)drug suppliers. To allay the costs of his service, Gogo thinks his system gets drug counterfeiters to pay for MPA services. “Consumers are not paying, government is not paying as well. Pharmaceuticals are paying Sproxil to recoup shares lost to counterfeiters. So in some sense, the counterfeiters are paying for this service.”

In any case, Sproxil seems poised to make a dent in India’s counterfeit drug trade, and it is much needed.

July 7, 2011/by actualize

Agriculture, Agriculture Markets, Farmer to Farmer, Livestock, Mobile, Originally posted on the GBI Portal, Sustainable Agriculture

Kenya, the Land of the Apps churns out the iCow

Kenya is arguable the epicenter of the worldwide mobile application frenzy. The east-African nation churns out a new top-rated, demand driven application nearly every six months. The latest innovation is iCow,

iPhone screen shot of the iCow app

a voice based mobile information application for diary farmers. Green Dreams Ltd, the developer, says iCow will help farmers optimally manage livestock breeding.

The earthy app is rapidly winning over agriculturalists and tech enthusiasts. It won first place in the recently held Apps4Africa competition, a U.S funded project. The iCow has also been lauded by the Social Development Network (SODNET) and Biovision Africa Trust.

The iCow will help farmers efficaciously track a cow’s estrus cycle, manage nutrition and breeding, which will enable them to yield more milk and calves—the two indicators of a cow’s economic value. This demand-drive and culturally appropriate technology complements the ubiquitous cellphone to address key agricultural challenges. Chief among these challenges are: Poor record keeping; outmoded and hard to acquire and comprehend calendars, including the cardboard wheel system; and the gaping information vacuum.

The iCow app address these problems. It will deliver prompt farmers about their cow’s nutrition, illness and diseases, vaccinations, milk hygiene, milking technologies and techniques. This will be done via a series of voice prompts and SMS messages that will be sent to the farmer throughout the cow cycle. Critically, the voice-based nature of this application combats the problem of literacy, a major impediment to ICT4D.

The iCow is Green Dreams’ most recent plugin for the flagship app, Mkulima Farmer Information Service and Helpline (Mkulima FISH), which is being developed.

June 7, 2011/by actualize

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