A doctor using the Family Folder Collector app on an Android pad, collecting information on a member patient. Photo Credit: bangkokpost.com

Thailand’s public health system has developed a mobile app for Android enabled tablet PC’s to monitor and collect household information on patients. The app, called Family Folder Collector (FFC), was developed by a research team at the National Electronics and Computer Technology Centre (Nectec).

Nectec researcher Watcharakon Noothong said the application comprises three major programs, including a walking map, genogram (a pictorial display of a patient’s health and family relationships) and Java Health Center Information System (JHCIS) synchronization.

FFC is designed to make life easier for public health workers who collect data on patients and for patients who are on time sensitive treatment schedules and cannot travel to health stations at any given moment for treatment.

The app is free. The only cost to utilize the service is paying for the tablet PC’s which is being covered by the province’s public health office.

Here are some of the features and capabilities of the FFC app:

  • Google maps shows the exact location and number of households in a given area
  • Genograms can be displayed
  • Chronic disease frequency can be color coded on a house-to-house basis
  • The program can collect and store other vital data, such as a patient’s weight, height, blood pressure and pulse rate, and even calculate a patient’s body mass index (BMI) automatically.
  • The program provides forms for treatment results, initial symptoms, health recommendations, and health behaviors
  • Doctors can schedule future appointments with patients
  • In the near future, the program will also be able to send an SMS to alert patients to get treatment at the health station.

All the collected data is updated and stored on the Android device then synchronized to the JHCIS database server. Public health workers were trained on how to properly input data into the tablet PC’s before pilot testing started. Of a total of 25 districts in the province of Ubon Ratchathani, eight are running the pilot trial of the FFC program, which, in its first phase, covers 123 health stations.

Ubon Ratchathani was chosen as the province since its existing IT infrastructure can accommodate sophisticated ICT’s for healthcare. There are over 1.8 million people in the province, all of whom will be accounted for by health workers using the FFC app.

This do-it-all app is a valuable tool for public health officials and physicians in Thailand. FFC can potentially replace the paper based system of collecting data and monitoring patients in Thailand.

The FFC application can display a genogram, monitor chronic diseases with Google Maps, and locate the house coordinates using a GPS system. Photo Credit: bangkokpost.com

The potential benefits of using this service are bountiful. Patient data will be gathered much easier and will be much harder to lose over time. Doctors can schedule appointments and prescribe treatments without physically seeing patients. Also, analysis of patient data will be faster, more efficient and more accurate.

Thailand may experience a revolution in healthcare if this service lives up to its potential. Currently, each health station has one tablet PC equipped with the program. The FFC application is expected to run throughout the province covering all 346 health stations by 2012.

Furthermore, according to Sinchai Tawwuttanakidgul, director of ICT Centre, Office of the Permanent Secretary, Ministry of Public Health, today there are some 45 provinces that are ready to switch from their paper-based system to the FFC mobile application. It sounds like Thailand is ready to experience that revolution soon.

Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah. Photo Credit: USAID

The Saving Lives at Birth program held its DevelopmentXChange event last week in Washington DC. The event was hosted by Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah and was sponsored by USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank.

The program called for scholars, researchers, doctors, and entrepreneurs to develop innovative prevention and treatment approaches for pregnant women and newborns in rural, low resources setting around the time of birth. There were over 600 applications from around the world, and 77 finalists were chosen to attend this 3-day event held in Washington. At the end of the 3-day event, $14 million in grants were awarded to 25 of the 77 finalists.

The 77 ideas and projects fell into two categories: seed grant finalists and transition to scale finalists. The former were completely innovative and fresh ideas while the latter were already existing ideas that were calibrated to fit for maternal health purposes.

The projects and ideas highlighted gadgets, treatment schemes, prevention methods, health centers, strategic plans and a plethora of mobile phone related solutions. Finalists came from all over the United States and from over the world including Bangladesh, Kenya, India, Uganda, Pakistan, Switzerland and Australia.

Some of the 25 award nominees. Photo Credit: USAID

Many of the ideas that had mobile solution components used mobile phones as an ICT. One innovative project was from Kenya called mAfya which aimed to set up health specific kiosks that would offer basic medical services for free for maternal health issues. There was another project from Kenya that aimed to provide pregnant mothers vouchers to use towards health services through mBanking called Changamka.

Among the awardees, one project from Save the Children provided a mobile phone monitoring system for recording maternal and neonatal deaths. This, along with an electricity-free fetal heart rate monitoring component aims to give communities in Uganda better intra-partum response services. Another project originated from Healthpoint services in India that has already set up rural health clinics and provides water, and is looking to expand its maternal health services using an integrated telemedicine and mHealth system.

Saving Lives at Birth, the first program in a series of Grand Challenges for Development led by USAID. The Grand Challenges is an attempt to bring science, technology and innovation to the field of development, lowering the cost of helping the world’s poor and, in the process, saving lives, said USAID administrator Shah.

“Especially in these very difficult economic times … coming up with more innovative, more local and sustainable ways to make it cheaper and easier to help mothers survive child birth and help children survive the first 48 hours of life is what this program is all about,” added Shah.

Maternal and child health issues still need a lot of attention. A woman dies every two minutes in childbirth, and 99% of the deaths are in the developing world, according to the World Health Organization. Also, about 1.6 million neonatal deaths occur each year around the world. Additionally noteworthy is that only a handful of countries are set to meet Millennium Development Goal 5 of reducing maternal mortality by 2/3 by 2015.

Pregnant woman on phone. Photo Credit: MOTECH

A new mobile phone service was recently launched in Ghana that provides free access to health information in ensuring safe pregnancies. The service, aptly named Mobile Midwife, offers text or voice messaging on maternal health to pregnant women.

Mobile Midwife was developed as part of the U.S. based Grameen Foundation’s MOTECH Ghana initiative, funded by the Bill & Melinda Gates Foundation. It is just one more result of rising donor attention to mHealth services. Its creation continues a trend of mHealth initiatives being churned out in Africa.

Educating women and making them aware of the maternal health risks associated with pregnancies are the cornerstone goals of the service. To make it convenient for the user, the service comes in several different languages, and is presented by text or voice via mobile phones. Additionally, the messages are time specific concurring with the woman’s stage of pregnancy.

When a pregnant woman registers for the service, they are asked to give the expected due date for delivery of the unborn child and their location. Then, periodically, the woman receives messages informing when appointments are due or overdue to remind them to visit the health clinic for check-ups.

The users also get reminders for specific treatments, information about milestones in fetal development, nutrition facts, tips on the benefits of breastfeeding and other pregnancy-related and prenatal health information. It also provides information that demystifies local pregnancy myths and helps users overcome the widespread fear of visiting doctors or health clinics.

MOTECH also rolled out a similar mobile health service earlier in the year that enables nurses in rural Ghanaian health facilities to automate much of their record keeping and reporting, which formerly took 4-6 days per month. The service is in the form of a java–based mobile phone application.

Both Mobile Midwife and the application mentioned above have made life easier for everyone involved in the process of delivering a baby.

One Ghanaian mother said to Grameen, “I would like to advise my pregnant friends to go to the hospital to enroll into MOTECH, to listen to the messages and also to practice what is said because it helps a lot…I used to be scared about pregnancy but now with the messages I am no longer scared and it has taken away my worries and that we feel ok and then the pregnancy is ok.”

This service is extremely pertinent since Africa exhibits some of the worst maternal health records in the world. Fourteen of the fifteen countries with the highest rates of maternal mortality in the world are in Africa. Furthermore, African countries are far behind in meeting Millennium Development Goals set for 2015; especially for those associated with maternal health. Perhaps services like this can lend a helping hand.

 

Iraq’s largest private telecommunications company, Asiacell, announced this week the launch of its mobile health content download and SMS service which is now available to its prepaid and postpaid subscribers. Asiacell is the only mobile telecom company providing coverage for all of Iraq.

An Iraqi man holds a cell phone. Photo Credit: Mario Tama, Getty Images

The new service offers information on various health practices which can be discriminately selected by the user. Asiacell offers a weekly and a daily health update service. The daily health updates include information on women’s health, men’s health, children’s health, dieting, mental health, and diabetes. Albeit a little more limited, the weekly updates is a downloadable service which only cover topics such as sports and fitness, mental health, and emergency medicine.

Customers can subscribe to the daily SMS service, by sending a blank SMS message to the toll-free short code “2330”, and then send their preferred health topic, which they can choose from a list that will be automatically sent via SMS, to short code “2331”.  This service costs IQD 2,500 ($2.14) per month.

Subscribers can also download content on a weekly basis by sending the number “1” to short code “2332” for sports and fitness information, or to “2333” for mental health information, or to “2334” for emergency medicine information. This service costs IQD 2,000 ($1.71) per month.

A similar service operates in India called mDhil which uses SMS to send health messages on various topics. The service overcame social stigmas regarding certain topics of health such as reproductive health, and became one of the most successful mHealth programs in India. Asiacell’s new service faces identical hurdles in Iraq and hopes to prevail like mDhil did.

Photo Credit: Asiacell

Asiacell is the only telecom provider to cover all of Iraq. They provide services to nearly 8 million of the estimated 31 million living in Iraq. This is remarkable given that just 5 years ago under the reign of Saddam Hussein, less than one million Iraqis had access to land lines and the average civilian did not have access to a mobile phone. Despite that and the war which ruined telecommunication infrastructure, Iraqis now have steady access to telecom services, especially mobile phones.

It is probably due to the increased access to information that has led Iraqis to become more health conscious claims Asiacell. Dr. Mustafa Adil, an Iraqi physician, said that maintaining a healthy lifestyle has become a major concern for communities, as people are more aware of the importance of following the latest health advancements and practices. He explained that Asiacell’s Mobile Health service supports the healthcare sector’s goal to promote sound health habits.

Text to Change (TTC), an mHealth non-profit organization based in the Netherlands, announced earlier this month that they will receive a €2.7 million grant to expand its services. TTC provides an SMS-based educational service to improve the health of citizens in eight countries in Africa and one in South America.

Already a big contributor in mHealth development, TTC hopes to become a leader in the field with the reception of its multi-million Euro grant from the Dutch Ministry of Foreign Affairs via Connect4Change (C4C), a consortium funded by the Dutch Ministry of Foreign Affairs that develops mobile based solutions on issues of poverty in Africa and Latin America. TTC will partner with C4C to expand its services to 11 more countries in Africa and South America by the end of this year.

Implementing ICT in the 11 countries is a top priority for both TTC and C4C. They are hoping the mutual partnership will make establishing ICT services an easier task as the expansion continues. According to TTC, the game plan calls for TTC to provide “low” technologies like SMS and mobile voice services while C4C provides “high” technologies such as mobile internet and video transfer. Therefore, TTC and C4C will play different roles.

C4C will also invest its time reaching out to local entities on the ground to strengthen ICT networks. TTC will focus on improving health outcomes through their established mobile phone initiatives.

TTC sets up their mobile platform through the recipient country’s mobile service infrastructure already in place. They then subscribe mobile phone users to their programs which use SMS communication to inform people of HIV testing, treatment clinics, and other health related services at no cost to the recipients.

TTC SMS system Photo Credit: TTC

TTC programs offer the information through a free educational quizzing service where participants are quizzed about a specific health topic. As participants answer the questions correctly, they are sent more rounds of questions, again at no cost. If the participant can answer enough questions correctly, he/she receives incentives such as phone credit, t-shirts and health products.

Thus far, TTC has reached thousands of individuals with their programs on HIV/AIDS, malaria, and reproductive health. Furthermore, to assess the impact of ICT in the countries they are currently working in, TTC will even conduct large scale ICT evaluations over the next few years in those countries.

TTC is poised to make an impact in ICT through their mobile services. Their work is just another example of how mobile phones are being used as a medium to educate, inform and save lives. The tag-team partnership with C4C will be expanded to all 11 target countries by the end of this year. However, we will have to wait some time before confirming the outcome of this joint strategic approach.


Mobile maternal health clinic on the road. Photo Credit: UNFPA

Nearly a year after the devastating floods in Pakistan, calls are being made by UNICEF health officials to expand capacities of mobile health clinics in the country. The clinics were first developed in response to the 2005 earthquakes in the northern region of Pakistan. Although the mobile clinics have touched hundreds of thousands of lives, more will be needed with expanded capabilities to ensure their long term impact.

In October 2005, the UNFPA joined hands with the Pakistani government and created mobile health clinics, whose main focus was on maternal health needs. By 2008, these clinics had treated over 850,000 patients, mostly for maternal and child health related issues. The clinics, still running, are staffed by women and are stocked with equipment and supplies for quality maternal health care. Since 2005, UNICEF has also become a key funder for mobile health clinics in Pakistan.

The UNICEF funded mobile health clinics tackle a variety of health issues, with an emphasis on maternal and child health. These clinics are staffed by three health workers, and treat up to 300 patients on a daily basis. After the emergence of the floods that affected 20 million people in Pakistan in July 2010, these health clinics became pivotal in reaching isolated populations.

Healthcare for women and children is better now than it was before the floods and the earthquake. However, despite the welcomed success of these mobile health clinics, there has been a call to expand the capacities for the mobile health clinics in order to make them more sustainable. This is where the world of ICT can step in and lend a helping hand.

The potential for impact is highest is rural and isolated areas where resources are poor and hardest to reach. According to a UNDP report, “ICT is yet to be widely mainstreamed to assist developing countries in addressing traditional development problems with innovative solutions and approaches that are both effective and more easily scalable and replicable.”

ICT services can complement existing initiatives such as the mobile health clinics in Pakistan to attenuate health burdens such as maternal mortality, which is what the UNFPA funded clinics focused on. This would be crucial in rural areas where ICT services would be invaluable. ICT services can potentially offer live video or audio feeds to health professionals when examining patients as well as educational classes to women from urban based instructors using the mobile clinics already in use.

Once ICT services are in place, NGO’s and government agencies can directly improve citizen access to information and at the same time, immediately strengthen their own capacities to help the citizens. Pakistan and other developing nations will only continue to reap the benefits for years to come.

A community health worker shows a visual aid

Photo credit: Dimagi

With funding from USAID, World Vision and Dimagi will conduct operations research to test if the use of CommCare will increase the uptake of healthy actions, improve knowledge of important information points, and improve communications and coordination between community health workers (CHWs) and higher trained workers.

CommCare is a phone-based application to strengthen community health programs. CHWs use software running on a phone during each client visit to improve quality of care and data reporting. When the CHW is within range of a cellular network, data is automatically submitted to a central server for use in program management, monitoring and health surveillance.

World Vision’s study will focus on improving the uptake of a list of identified “Healthy Actions” and knowledge of key “Important Information” points. It will also study the improvement that the phone make between the CHWs for coordination with midwives and other health experts. World Vision expects the following:

  1. Utilization – increased percentage of healthy actions taken by pregnant women
  2. Knowledge Access – increased knowledge by pregnant women of the important information points
  3. Access- increased use of midwives and expert services via phone calls

The primary CommCare module the study will focus on promotes essential care during and immediately after pregnancy. The module reinforces the training the CHWs will have received based on the American College of Nurse-Midwives Home Based Life Saving Skills. The module is designed to quickly bring a CHW through key points of identifying and responding to emergency signs including difficulty breathing, low birth weight, and hypothermia. The module then helps the CHW promote simple but effective hygiene and preventive care to reduce infections such as infected cord stumps, pneumonia, and tetanus.

A key challenge World Vision encountered was that the CHWs in the Herat region are low-literate. CommCare was, therefore, adapted for low-literate users by including audio prompts and images. These multimedia prompts have been found to also help engage the client more, as the CHWs play the audio clips and show images to their clients.

The following video demonstrates how the CommCare application works:

CommCare-Sense House Visit 1 from Derek Treatman on Vimeo.

Click here to learn more about this project.

Working with diverse partners, the mHealth Alliance (mHA) advances mHealth through research, advocacy, and support for the development of interoperable solutions and sustainable deployment models. The mHA, hosted by the United Nations Foundation, sponsors events and conferences, leads cross-sector mHealth initiatives, and hosts HUB (HealthUnBound), a global online community for resource sharing and collaborative solution generation.

Some FAQs about mHealth

Q. What is mHealth?

A. mHealth stands for mobile-based or mobile-enhanced solutions that deliver health. The ubiquity of mobile devices in the developed or developing world presents the opportunity to improve health outcomes through the delivery of innovative medical and health services with information and communication technologies to the farthest reaches of the globe.

Q. What is the mHealth Alliance vision?

A.  The mHealth Alliance seeks to mobilize innovation to deliver quality health services to the furthest reaches of the wireless networks. At the leading edge of the mHealth ecosystem, they seek to unite existing mHealth projects and guide governments, NGOs, and mobile firms to deliver innovative, interoperable solutions in the exploding mHealth field.

Q.  How did the mHealth Alliance begin?

A. The idea for the mHealth Alliance emanated from a July 2008 conference in Bellagio, Italy, on the future of mHealth, during which participants committed to forming a non-profit mHealth Alliance to maximize the impact of mobile health, especially in emerging economies, by ensuring interoperability and open-standards based solutions.

Launched at the GSM Mobile World Congress in February 2009 by the Rockefeller Foundation, United Nations Foundation, and Vodafone Foundation, the mHA now includes the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the GSM Association among its founding partners.

Q. What are the key areas of focus for the mHealth Alliance in terms of public health problems?

A. The mHA is committed to ensuring the positive impact of mobile/ICT-based services across all health sectors, geographies and communities. The mHA has chosen to focus initially on maternal and child health with the inception and launching of the Maternal mHealth Initiative (MMI), as a way to model the potential of mHealth and developing the necessary reference models and prototype solutions. By focusing on mHealth solutions for the full continuum of maternal care, from pre to post-natal health, the mHA is able to identify a set of common needs that can also be applied to a wide variety of health areas.


A Peace Corps Volunteer harnesses the power of text messaging for good health

Written by by Shannon Cummings

In a few short years, messaging (also called “SMS” for Short Message Service), has seemingly replaced phone conversations, letter writing and the traditional two cans attached by a long string as the primary form of communication for young people worldwide. Imagine if young texters in the developing world could get quick and accurate answers to their most personal sexual health questions anonymously, by simply sending an SMS. In Namibia, Peace Corps Volunteer Rashid Khan has developed a program that does just that. Khan is harnessing the global texting trend to fight rampant sexual health misinformation that contributes to a towering HIV infection rate and many unwanted pregnancies.

When Khan arrived in country, he immediately became aware of the lack of knowledge and resources Namibian youth had regarding sexual health. “After talking to local youth, both formally and informally, it became very clear that there exist serious misconceptions about pregnancy, sex, circumcision and other important topics,” explained Khan. And he was right—in his region “lack of knowledge” was listed among the top factors driving the HIV infection rate by the 2008 National HIV Sentinel survey. As a whole, the country of Namibia has an 18% HIV infection rate.

After discussing possible ways to address this problem, Khan learned of an automated, menu-based health information system started by two volunteers in the Philippines. This program allows consumers to access an abundance of pre-written health information through text messages. Khan recognized the potential to implement a similar system in Namibia, where cellular phone service is widespread and text messaging in the cheapest and most frequently used way to communicate. Together with Jennifer Moore, a fellow Namibian PC Volunteer, he developed the Health Education Response System (HER) in February of 2009.

Rashid Khan

Optimistic, but not content, Khan realized that “a fully automated system could only address the most basic of questions.” Searching for a more complete solution, he stumbled upon a North Carolina-based text line designed to answer sexual health questions from teenagers called the “Birds and the Bees Text Line.” Realizing that the demand in Namibia was present for such a service, Khan designed software so that by sending a question via SMS, consumers receive a tailored answer from a trained health Volunteer that is both accurate and timely. Additionally, the program was expanded to deliver SMS in a round robin fashion to a pool of 10 Volunteers across the country. Consumers can still view the pre-written content by texting MENU, and then following the directional guide through a menu of choices. A directory of anti-retroviral (ARV) clinics with complete contact information can be accessed by texting “ARV TownName”.

In Namibia, HER has proved transformative. The system’s popularity was evidenced in June of 2009 when nearly 2400 SMSs were processed to and from 325 unique clients. One key feature of the system is the anonymity of the questioner.

“Our goal was to answer the questions people couldn’t ask anyone else—to be a reputable, anonymous source of information,” said Khan.

By filtering all SMSs through a central server so that both Volunteers and consumers are shielded from each other’s phone numbers, anonymity is preserved. This lends itself to frank and open questions that the asker may deem too private, embarrassing or demeaning to ask without the veil of anonymity.

Another powerful attribute of HER is its connection “to a complex monitoring and evaluation system that automatically tracks, compares and reports themes of conversations.” Without identifying the data source, the records can be used as a database to inform other health-related projects of frequently asked questions and common misconceptions. The hope is that this wealth of information will contribute to a more informed and effective fight against the spread of disease bred by ignorance.

On top of all of this, the program has been meticulously designed with sustainability in mind. “Sustainability and replication were goals from the beginning. I designed the software to be installable and maintainable by anyone with minimal training,” Khan said. Not only have Khan and his group been able to secure free service from MTC, Namibia’s largest mobile network, they have also partnered with Lifeline/Childline which provides counseling to clients in need. Lifeline/Childline is in talks to take over the program when Khan completes his service and leaves Namibia.

In June 2009 alone, the HER program system exchanged 2,382 SMSs with 325 unique clients.

Khan’s success implementing HER serves as a model to others motivated to make a difference in their corner of the world. When asked for the advice he would offer someone with an idea to improve his or her community, Khan remarked:

“Dive right in today. Take inspiration and help wherever you find it.”

For more information see the PeaceCorps Press Release on the project here

About this talk:

Hans Rosling reframes 10 years of UN data with his spectacular visuals, lighting up an astonishing — mostly unreported — piece of front-page-worthy good news: We’re winning the war against child mortality. Along the way, he debunks one flawed approach to stats that blots out such vital stories.

Hans Rosling

About Hans Rosling:

As a doctor and researcher, Hans Rosling identified a new paralytic disease induced by hunger in rural Africa. Now he looks at the bigger picture of social and economic development with his remarkable trend-revealing software. Rosling developed the breakthrough software behind his visualizations through his nonprofit Gapminder, founded with his son and daughter-in-law. The free software — which can be loaded with any data — was purchased by Google in March 2007. (Rosling met the Google founders at TED.)

Rosling began his wide-ranging career as a physician, spending many years in rural Africa tracking a rare paralytic disease (which he named konzo) and discovering its cause: hunger and badly processed cassava. He co-founded Médecins sans Frontièrs (Doctors without Borders) Sweden, wrote a textbook on global health, and as a professor at the Karolinska Institut in Stockholm initiated key international research collaborations. He’s also personally argued with many heads of state, including Fidel Castro.

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