Archive for the ‘Mobile Phones’ Category
Please vote for Ben’s mobile payment for health systems project. Voting closes Friday.
VOTE – NETSQUARED: By introducing a smartphone and web-application system for submitting and reviewing claims, we hope to reduce the delays and errors, increase clinics’ profitability and improve communication. Below is a related post by Melissa Ho who is working with Ben on this project which fills a critical gap. Cross posted from ICTDCHICK:
As I have been pre-occupied with writing lectures for my class, and setting up my research, my collaborating partners at Marie Stopes International Uganda have been busy launching a new phase of the output-based aid voucher program, financing in-hospital delivery of babies, in addition to the in-clinic treatment of sexually-transmitted infections (STIs). The new program, called HealthyBaby is eligible to mothers who qualify under a specific poverty baseline and covers four antenatal visits, the delivery, and a postnatal visit. Last week they just started distributing vouchers, and this past weekend was the delivery of the first baby whose birth was covered by the program.
Like the HealthyLife program, the mother purchases a voucher for 3000 USh (approximately 1.50 USD, the HealthyLife program charges 3000USh for a pair of vouchers treating both sexual partners). The voucher then can be broken into several sticker stubs, one of which is submitted with a claim form on each visit.
The hospital then submits the claim form with the voucher to the funding agency (my collaborating organization), who then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. You can see in the picture to the right the nurse filling out the paper form and the mother putting her thumbprint on it. Filling out the forms can be tedious and error prone – this particular clinic had almost 18% of their STI claims rejected for errors last October. In the same month another clinics had 38.6% of their claims rejected. I am trying to work on digital systems that can help improve communications between the clinics and the funding agency, and also decrease the cost and burden of claims administration.
The Claim Mobile project actually focuses on the HealthyLife program – the STI treatment program, rather than the HealthyBaby program, but I hope to demonstrate the sustainability and replicability of the system that I’m developing by training the engineers here to retool my system for HealthyBaby – so by the time I leave, I am hoping it will be in place for both programs.
By coincidence, this first birth occurred in one of the two clinics where I’m running the pre-pilot of the Claim Mobile system.
I’ll be in New York attending the health portion of the following workshop. Please pass the word and if you are around and want to meet up send us an email (thdblog AT gmail).
“The CATER research group cordially invites you to attend the 2009 workshop on “Technologies for Development” which showcases our ongoing research efforts in the space of appropriate technologies that aid development in under-developed areas around the world.
Cost-Effective Appropriate Technologies for Emerging Regions (CATER) is a new multidisciplinary research initiative at NYU that focuses on developing appropriate, low-cost Information and Communication Technologies (ICT) for addressing pressing problems in developing regions. CATER is a joint initiative comprising faculty from Computer Science, the School of Medicine, the Wagner Graduate School of Public Service, NYU’s Economics Department, and NYU-Polytechnic.
This workshop will feature a combination of invited talks from accomplished researchers and short talks by student researchers within
CATER on their ongoing research efforts. The talks will cover four important areas:”
· Technologies for improving access to communications in rural areas
· Technologies for enhancing rural healthcare
· Technologies for enhancing financial and commerce services
· Technologies for enhancing rural education
Two recent awards were given out in the area of technology for humanity. The first was a generic “best of 2008″ in technology PopSci award. It was great to see PopSci pick a technology for developing countries as one of their top products, the CellScope, which we covered in a post on mobile phones for global health (hat tip BOPreneur). Additionally there was the annual Tech Museum awards which you can read more about over at CNET (the Star Syringe was their health awardee).
A few days back Aman wrote a post about Google Flu Trends. Thought I’d add a few thoughts here after reading the draft manuscript that the Google-CDC team posted in advance of its publication in Nature.
By the way, here’s what Nature says: Because of the immediate public-health implications of this paper, Nature supports the Google and the CDC decision to release this information to the public in advance of a formal publication date for the research. The paper has been subjected to the usual rigor of peer review and is accepted in principle. Nature feels the public-health consideration here makes it appropriate to relax our embargo rule
Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza epidemics using search engine query data. Draft manuscript for Nature. Retrieved 14 Nov 2008.
Assuming that few folks will read the manuscript or the article, here’s some highlights. I should say I appreciated that the article was clearly written. If you need more context, check out Google Flu Trends How does this work?…
- Targets health-seeking behavior of Internet users, particularly Google users [not sure those are different anymore], in the United States for ILI (influenza-like illness)
- Compared to previous work attempting to link online activity to disease prevalence, benefits from volume: hundreds of billions of searches over 5 years
- Key result – reduced reporting lag to one day compared to CDC’s surveillance system of 1-2 weeks
- Spatial resolution based on IP address goes to nearest big city [for example my current IP maps to Oakland, California right now], but the system is right now only looking to the level of states – this is more detailed CDC’s reporting, which is based on 9 U.S. regions
- CDC data was used for model-building (linear logistic regression) as well as comparison [for stats nerds - the comparison was made with held-out data]
- Not all states publish ILI data, but they were still able to achieve a correlation of 0.85 in Utah without training the model on that state’s data
- There have attempted to look at disease outbreaks of enterics and arboviruses, but without success.
- For those familiar with GPHIN and Healthmap, two other online , the major difference is in the data being examined – Flu Trends looks at search terms while the other systems rely on news sources, website, official alerts, and the such
- There is a possibility that this will not model a flu pandemic well since the search behavior used for modeling is based on non-pandemic variety of flu
- The modeling effort was immense – “450 million different models to test each of the candidate queries”
So what does this mean for developing world applications?
Here’s what the authors say: “Though it may be possible for this approach to be applied to any country with a large population of web search users, we cannot currently provide accurate estimates for large parts of the developing world. Even within the developed world, small countries and less common languages may be challenging to accurately survey.”
The key is whether there are detectable changes in search in response to disease outbreaks. This is dependent on Internet volume, health-seeking search behavior, and language. And if there is no baseline data, like with CDC surveillance data, then what is the best strategy for model-building? How valid will models be from one country to another? That probably depends on the countries. Is it perhaps possible to have a less refined output, something like a multi-level warning system for decision makers to followup with on-the-ground resources? Or should we be focusing on news+ like GPHIN and Healthmap?
Another thought is that we could mine SMS traffic for detecting disease outbreaks. The problem becomes more complicated, since we’re now looking at data that is much more complex than search queries. And there is often segmentation due to the presence of multiple phone providers in one area. Even if the data were anonymized, this raises huge privacy concerns. Still it could be a way to tap in to areas with low Internet penetration and to provide detection based on very real-time data.
1. Microsoft is funding research in Argentina and India into low-cost electrocardiogram (ECG) machines. The devices, which can cost less than $100, use cell phones to transmit data to a computer, where it can be analyzed and then conveyed to a doctor.
2. Using Rubinsky’s gear, a doctor could use a cell-phone screen to view a cross section of tissue. In this image, a doctor uses a cell phone to magnify a patient’s breast tissue and examine it for a tumor.
SOURCE: Business Week
This is our third post on mobile phones and international/global health (post 1, post 2). This post is largely imcomplete, but I wanted to get it up. The above pics and quotes below are based on a feature in Business Week:
“It’s not easy to lug an ultrasound machine into a remote village’s health clinic—much less keep it running. But a cell phone? No problem…”
“According to the World Health Organization, about half of the imaging equipment sent to developing countries goes unused because local technicians aren’t trained to operate it or lack the necessary spare parts. So researchers are stepping up efforts to employ wireless technologies to deliver crucial medical services, particularly in underserved areas…Scientists from the University of California, Berkeley, have just developed a prototype technology that uses cell phones to deliver imaging information to doctors.”
“The University of California professor says that by reducing a complex electromagnetic imaging machine to a portable electromagnetic scanner that can work in tandem with a regular cell phone and a computer, he has essentially replicated a $10,000 piece of equipment for just hundreds of dollars.”
Another source – Imaging technology could be useful in poor countries:
Some types of medical imaging could become cheaper and more accessible to millions of people in the developing world if an innovative concept developed by an engineer at the Hebrew University of Jerusalem fulfils its promise. The device uses cellular phone technology to transmit magnetic resonance images, computed tomograms, and ultrasound scans (PLoS One 2008;3:e2075; doi: 10.1371/journal.pone.0002075)
One other recent article in this area, from PC World -
Mobile Phones and the Digital Divide: Whether you’re building an application for the 3G iPhone in the United States or trying to figure out how to deliver health information via SMS (Short Message Service) to a rural community in Botswana, the mobile space is diverse and exciting in equal measure.
Also be sure to check out:
- Why people seek out health information, link
I missed a few links from our previous post on global health and mobile phones, so this is part deux, which will be followed by Part III later this week. As you can see from the frenzy of recent activity – the mobile phone for health revolution is moving ahead rapidly, where it will take us and how useful it will ultimately be will be known in due time. And as mentioned, this is a case where the “Third World is First”, innovation is happening far ahead of what we are seeing in the US. There are a several good links below. For those seeking more documentation beyond news items, see the report from the Bellagio e-health conference which I believe is being organized by the UN Foundation, Vodafone Group Foundation and the Telemedicine society of India.
CellScope: Mobile-phone microscopes, Link
Dan Fletcher, a professor of bioengineering at the University of California, Berkeley (Go Bears!!), has developed a cheap attachment to turn the digital camera on many of today’s mobile phones into a microscope. Called a CellScope, it can show individual white and red blood cells, which means that with the correct stain it can be used to identify the parasite that causes malaria.
Cellphones for HIV, Link
mHealth and Mobile Telemedicine – an Overview
Great links below and full news link here
- Sizing the Business Potential (Link)
- Relationship among Economic Development (Link)
- mHealth: A Developing Country Perspective (Link)
Wireless Technology for Social Change: Trends in NGO Mobile Use, Link
Related to above: “Technology plays crucial role in vaccination distribution”, Link
The Pill Phone for US Markets. This kind of application was used long before in developing countries – now it is slowly entering the US market: “In a first-of-its-kind application, Verizon customers in the US can get information and set reminders regarding medication and dosage with “the Pill Phone”. Link
Managing Symptoms By Mobile Phone May Revolutionize Cancer Care For Young People, Link
New wi-fi devices warn doctors of heart attacks, Link
“The Bluetooth wireless technology that allows people to use a hands-free earpiece could soon alert the emergency services when someone has a heart attack…” How they will manage the data flow and response is a big question in my opinion.
- Microtelecom for the Next Billion Mobile Users, Link
- MobileActive08 is the only global gathering that is connecting leaders who are working at the convergence of civil society, mobile technology and social change. Link
Over the last year there I have noticed a tremendous up-tick in mobile phones for health/global health stories. The innovation in this area has been worldwide and the sense I get is that use outside the US and in developing countries is far more creative and wide ranging (I haven’t done the research, but this is probably a case where a country like the US will be taking lessons from less developed regions or the “South” as people love to say). We did a previous link drop on SMS/Text Messaging for Global Health that you should check out. Below I begin with two links about the power of mobile phones in general followed by recent links in a plethora of areas from countries around the world. Enjoy:
“Within the next three years, another billion people will begin to make regular use of cell phones, continuing the fastest adoption of a new technology in history” Taken from a very good post on “Mobile Phones for Development” over at CrissCrossed.
New NextBillion MIT Network: “Eventually there will be more cell phone users than people who read and write.” —Eric Schmidt, CEO, Google. The goal of the Next Billion Network is to deploy innovative mobile technologies that help people reduce friction in their local markets from the bottom up. (Link)
- Telemedicine and Monitoring AIDS Treatment in Africa (Link)
“With software developed by Ericsson and phones donated… health workers can call up the medical records of pregnant women from an online database and then, by cell phone, tell care-givers what to do during an emergency…”
- Another story on the above: A toll-free mobile service being launched in selected remote areas in Africa promises to save lives by connecting people with emergency medical cases to health personnel. (Link)
- STOMP (STop smoking Over Mobile Phone): “Clinical trials have shown that using STOMP doubled reported quit rates from 13% to 28% after six weeks“. This would be of tremendous use in LDC’s as smoking is a serious global health issue. (Link)
- Glucose (Diabetes) and exercise monitoring (Link)
- Tracking chronic conditions remotely and sending info to clinicians (Link)
- Managing symptoms for cancer care (Link)
- Cardiomobile exercise and monitoring system: “The Cardiomobile system works by the patient attaching to their chests a mini ECG (electrocardiogram or heart signal) monitor and wearing a cap with a lightweight GPS receiver, both connected to a mobile phone via Bluetooth.” (Link) ; mini ecg picture (Link)
- Mental Health Monitoring: Mobile phones and the internet will soon be used to help up to two million Australians manage their mental health problems. (Link)
- India to develop their unique mobile phone health monitoring system (Link)
- Review Article: Innovation in practice: mobile phone technology in patient care. (Link)
- Solar Charger For Mobile Phones (Link)
- Nokia Phones go Green: “Today Nokia chargers save 90% more energy, 65-80% of the phone components are recyclable and have reduced packaging by more than 50%…” (Link)
- Solar-powered GSM towers (Ethan Zuckerman)
- Kenya’s mobile revolution (Link)
- iPhone health and fitness applications (Link)
The UN Foundation and the Vodafone Foundation released a new report this week – Mobile Technology for Social Change: Trends in NGO Mobile Use. Thanks to Mark over at the UN Dispatch blog for telling me about this in the first place. Credit for the below description goes to an email I recieved (thanks very much Adele!) from folks at the UN Foundation, which is reproduced below:
Case studies exploring use of ‘mobile activism’ for public health projects include:
Mobile health data collection systems ( Kenya and Zambia ): Collecting and tracking essential health data on handheld devices, in countries where statistical information was previously gathered via paper and pencil, if recorded at all.
Monitoring HIV/AIDS care ( South Africa ): Using mobile devices to collect health data and support HIV/AIDS patient monitoring in a country with the world’s highest HIV/AIDS infection rates, and where rural populations often otherwise go unassisted.
Sexual health information for teenagers (US and UK ): Connecting youth to important information on sexual and reproductive health via anonymous text messaging, to empower young people to make informed sexual health decisions.
Continuing medical education for remote health workers ( Uganda ): Providing medical updates and access to vital information via mobile phones for doctors and nurses working in some of the most destitute regions, where continuing medical education services are lacking.
A total of 11 case studies identify emerging trends in ‘mobile activism,’ and investigate both the promise and challenges of innovative use of mobile technology to meet international development goals.
CDC researchers have developed new tools using GPS technology and PDAs to help prevent the spread of malaria in Africa, according to a study published in the August issue of the American Journal of Tropical Medicine and Hygiene, InformationWeek reports. Researchers used the devices to collect data on the use of insecticide-treated nets in homes in Niger and Togo.
The researchers used sampling software for Windows Mobile devices to compile complete lists of households in the area and employed GPS systems to locate homes and interview a random sample of people. Study co-author Jodi Vanden Eng in a statement said, “Before we developed this method using these devices, it usually took days, or even weeks to complete the same task” that the researchers now can accomplish in one day.
Full story summarized on KaiserNetwork.
A bit of diversion here, but an important one from the latest issue of Fast Company. I do not yet have an opinion on the 10 year retrospective review below, however, the numbers from Fast Company (if accurate) are dramatic. Dave Richards at “Defeating Global Poverty” has a more detailed post that you should check out and the author of “You Can Here Me Now“, Nicholas Sullivan, has published a letter countering this article (excerpts at the end of this post).
Has Grameen’s Village Phone Program Gone Obsolete? Fast Company Magazine September 2007
“At first, they all came…And then, one by one, each talked on Laily Begum’s wondrous new possession, a cellular telephone. A caller might come to check on money that her husband was supposed to send from his job as a day laborer in Dubai…But that was in the beginning, a decade ago; these days, cell phones are so commonplace that most visitors come only for a haircut, a shave, groceries, or a place to sleep, all of which Begum offers now. The few wireless calls are no longer made from her home but from one of her nearby shops–usually the one with the barrels, drums, and cans of motor oil out front and lining its walls. In March, when I visited her home in Patira, a stretch of dusty intersections 90 minutes northeast of Dhaka, she told me, “Hardly anyone uses my phone anymore.”
“Begum’s success has become legendary, embraced by the media and the world of economic development as an example of how microcredit and technology can help those born in poverty escape it, largely through their own entrepreneurship. The Grameen organization continues to boast that its Village Phone Program “has been incredibly successful … establishing a clear path out of the poverty cycle”…But as it turns out, the legend is far out of date…In Bangladesh today, the only one making real money on GrameenPhone’s wireless service is … GrameenPhone.”
The Village Phone Program no longer sustains its entrepreneurs — yet Grameen continues to recruit operators…” Full story
Counterpoint by Nicholas Sullivan:
Re: “Unplanned Obsolescence” (September), I wonder if you don’t miss the forest for the trees. The big story is that Bangladesh has increased its phone penetration from 1 per 500 people in the mid-‘90s to 1 per 7 people today. The phone ladies, whose income and profits are surely declining as noted, and who represent at most 3% of GrameenPhone subscribers, are not the raison d’etre of GrameenPhone; distributing tens of millions of phones throughout the country is the company’s mission and has been from the start. Utilizing Grameen Bank’s network in 60,000+ villages was merely a way to deliver phones into remote rural areas where there was and still is no reliable electricity or roads. The fact that the foreign investors behind GrameenPhone (Telenor of Norway, Marubeni of Japan, and Gonofone of New York) endorsed this strategy while also perceiving its developmental impact in lifting people out of poverty is one of the most positive business stories in recent memory.
Read the full letter here…
“MY NAME is Mohammed Sokor, writing to you from Dagahaley refugee camp in Dadaab. Dear Sir, there is an alarming issue here. People are given too few kilograms of food. You must help.
“A crumpled note, delivered to a passing rock star-turned-philanthropist? No, Mr Sokor is a much sharper communicator than that. He texted this appeal from his own mobile phone to the mobiles of two United Nations officials, in London and Nairobi. He got the numbers by surfing at an internet café at the north Kenyan camp.”
The article touches on the benefits that modern technology can bring to humanitarian relief, citing examples as diverse as the UN’s ReliefWeb portal, Mukuru.com (an SMS-based voucher system for connecting the Zimbabwean diaspora community with relatives back home), and Sri Lanka’s tsunami “early-warning system which would send SMS messages to every mobile phone in an area at risk of flooding”.
The most interesting portion of the article for me was about the potential drawbacks of the technology:
“Oisin Walton of Télécoms sans Frontières has a different worry: e-mail may supplant aid workers’ conflict-avoidance skills; they may come to rely too much on e-mailed security warnings, and not enough on their instincts. And the Red Cross’s Florian Westphal fears satellite or mobile phones will make warlords even more suspicious of aid workers;
it is now harder to eavesdrop than it was when aid workers used open radio frequencies.”
There is not much left to say about the iPhone, it is clearly one of the most hyped electronic gadgets in history and it is an understatement to say that it has lit up the internet (a google search for iPhone yields 103 million hits, compare that to only 70 million hits for a google search on “paris hilton”). It looks like an enterprising non profit decided to see if they can use the iPhone hype to market their cause (getting anti-retroviral treatment to children infected with AIDS in Africa, KCA website). They were first in line at a New York store in order to get an iPhone that they will auction off. The “first iPhone sold” will be presented by Alicia Keys at the Black Ball.
As the highly anticipated iPhone launch approaches, so does the promise of improved communications and connectivity with people around the world. Connectivity is not limited to technology; rather, it’s a fundamental fact that we are “one.” source… Supporters of Keep A Child Alive took advantage of the wildly hyped iPhone launch by standing in line for 4 days and communicating the charity’s grass- roots mission to New Yorkers and media from around the world. At 6 pm on Friday, June 29th, Spike Lee, renowned director, producer, writer and actor, joined Keep A Child Alive volunteers at Apple’s Soho location to purchase the first iPhone.” Full story, Earth Times
I would guess that getting in line on Tuesday will have garnered more knowledge and advertising about their cause than the auction will. I am not sure what the impact has been on the organization, but it is certainly a unique and innovative idea. They have been smart about getting the word out. Of course there is the publicity they received from actually being first in line, but in addition to that, I have seen their cause mentioned on widely popular techie websites such as InfoWorld, Gizmodo and Endgaget and on other sites they have partnerned with (iphonelaunch.tv). The Taproot Foundation also had someone in line for charity (see stories here and here). Some pics below from the folks at Keep a Child Alive (via flickr):
“This morning we started lining up for the iPhone – we are first in line at the Soho Store! We’re doing it with our friends at Keep A Child Alive an amazing organization that provides drugs for kids in Africa.”
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This idea has been mentioned a lot, but I just ran across Computainer on a Uganda listserv. CompuTainer recently announced SIMmed at the 3rd South African AIDS Conference. The technology uses SMS and USSD messaging to track and monitor patient compliance in taking chronic medication such as TB medication, ARV medication, Diabetic medication, Cardio medication and other chronic medication.
With 47% of patients simply forgetting to take medication and a further 33% not taking medication because they feel well we find an issue in medication compliance. With the ongoing struggle against drug resistant strains the introduction of SIMmed has resolved compliance issues.
I don’t have a copy of the report, but according to the listserv posting, in a recently completed trial in TB clinics in South Africa the compliance ratios were raised from between 20% and 60% to a staggering 85% to 93%. Cure rates were raised from a dismal 65% to above 91%.
The info on the SIMpill is copied here:
A pill bottle which, when opened, delivers an SMS text message to a central server. The SMS contains a unique pill box ID number as well as some information about the battery status of the pill box. Each SMS is time stamped. The central server receives the incoming SMS and, if it is within the time tolerances set for the pill box sending the message is simply stored for statistical purposes.
This is the second of two posts from UC Berkeley doctoral student Melissa Ho. Melissa is working on the Blum Center’s initiatives in six African countries. She’s got a few posts about the OBA work and I’m cross posting them.
It’s been a busy couple of weeks, with not nearly enough access to internet cafes!
This week I am back in Mbarara, currently using the computer science lab (which is empty because the students are all doing exams now), but also meeting with various professors here (again!) and working with Ben and Richard on the Smartphones for OBA project.
The major update is that we are now collaborating with the Faculty of Science at Mbarara (Physics Dept) to figure out solar power options for the health clinics participating in the OBA program. They are currently engaged in research evaluating the degradation of imported solar panels and are the perfect collaborators for this project. They also have experience with circuit-soldering, so they’ll try to use Manuel’s solar charge controllers both for their own experiments and our project.
We also visited the Marie Stopes International Uganda office and one of the Marie Stopes Uganda clinics. They are currently using the VMUS database developed by Microcare, and have two people entering the data from the (triplicate-carbon-copy) forms that are collected from the various clinics participating in the OBA program. Right now the system is down, so the forms are piling up, and they are entering the data into Excel, so they can process the reimbursements. I’ll head back there today or tomorrow to hammer on the SmartForm and figure out exactly what it should look like. At the clinic we spoke to Steven about his experience participating in the program. The major issues he identified are timeliness of reimbursement processing, limitations on the range of treatment options (if someone is diagnosed with a non-STI bacterial infection then they have to pay for treatment in addition to what they paid for the voucher, although I think the consult is covered), and patients coming in with vouchers that clearly don’t have an STI, and therefore are not eligible for subsidized treatment. So there is a need for better and clearer marketing. Richard suggested giving distributors placards that (literate) patients can read so they know what services the voucher will cover. They also have problems with people going to multiple centers, and not having documentation for previous visits, or buying multiple vouchers and having tests done unnecessarily. We hope that with the SmartForms project we’ll be able to address some of these issues, by making voucher records more accessible, and improving the communications process around the form submissions. There’s lots of ideas flying around and a lot of work to do!
For the rest of the week (before I take off for Ghana) Richard and Ben and I will be visiting the various health clinics and talking to them about the project, getting a feel for their willingness/interest, as well as the environment in which the phones would be deployed. We’ll start testing/piloting in August when I get back.
I am back in Uganda until January working on the output-based aid project for STI treatment. There are several Berkeley projects in the country with some collaboration across project sites. TIER doctoral student and good friend Melissa Ho is working on the Blum Center’s initiatives across Africa this summer. She’s got a few posts about the OBA work and I’m cross posting them here.
I’ve been in Uganda for almost a week now, doing a needs assessment with the East Africa Blum Fellows smartphone team – on whether and how smartphones can be used in the context of healthcare in Uganda. We’ve had meetings all over Kampala, with Satellife/Healthnet Uganda, the Ministry of Health, and various people at Makarere University. See my flickr account for a photo diary.
My most productive meeting so far has been with Francis and Gerry at Microcare, Uganda’s largest insurance company. Ben Bellows has been working with Microcare and Marie Stopes International on Output Based Aid (OBA), a voucher-based scheme for the delivery of STI treatment in the Mbarara district 6 hours drive west of Kampala (by the way, I just arrived in Mbarara yesterday). Ben and I (along with Mahad and Sonesh) have been talking about how to integrate smartphones into the voucher claims process and recently won a CITRIS award to fund the implementation of a pilot deployment. So when I arrived in Kampala, I made plans to meet Microcare and MSI to talk about our plans.
What strikes me most about Gerry and Francis is how fast they think. Having learned all about their insurance system, I asked why they didn’t use smart cards for the OBA program as well. In a flurry of conversation we realized that the smart cards are durable enough to be reused – and would be a useful platform for a new rural program promoting antenatal care. Rather than using vouchers, which could be resold or appropriated, they will issue smart cards for the 9-month duration of the pregnancy, recording visits. The “admission” into the program would be the cost of the smart card (about $1), and upon completion the patients would return the card in exchange for a small gift (we were thinking of baby socks). Within five minutes of my question, we not only had a whole scheme worked out, we also had a name: Smart Delivery. Using smartphones enabled with smart card readers we can set up a rural terminal such that transactions can be delivered efficently via SMS at extremely low cost. Within one hour, we had defined a protocol, and Francis had assigned the project to one of his software engineers (Microcare insources their work to a wholly owned software company in Chennai) and made plans to complete the work by June 15th. I’ll keep you posted on what happens! In the meantime, I’ve loaned them my two GPRS modems, so they will be testing the system using two PCs. I’ll see what I can do to implement the smartphone version…although it’s been entertaining trying to figure out the APIs without access to the web for documentation!
I just read that Google is logging into rural India: “The latest company to seek a fortune in India’s rural markets is Google.” (3/21 news release).
You might ask what does this have to do with health? Well, on the surface, nothing. However, there are three significant reasons to pay attention to this. First, “bottom of the pyramid” (BOP) markets are all the rage right now, and Google’s most recent entry is significant, in part just because of who Google is and more interestingly because of who they are becoming. This coincides with the “Next 4 Billion” book release and if you haven’t heard about the BOP book launch, you would be remiss in not checking it out. BOP has strong implications/promise for healthcare delivery, as Kevin Jones from Xigi states: “half of BOP health care spending is on pharmaceuticals, much higher than in more affluent countries. This is especially the case in rural areas, where access to clinics is often limited.” It is too early to assess the impact, but for those of you unfamiliar, there is a growing drumbeat and unmistakable energy surrounding this concept. NextBillion, CTP and AIDG have all covered this watershed moment.
Second, Google is already in the health and development space. Most obviously they created Google.org, which is headed by Larry Brilliant (formerly of Seva). This is significant because Larry is not your run of the mill public health or public sector type guy. He is a physician and internet/technology entrepreneur who has a strong understanding of BOP markets as he was an integral partner with the non-profit Aravind Eye Care System (often mentioned as a success story by CK Prahalad in BOP discussions). For more information on Larry Brilliant’s colorful past, see Google’s Brilliant Philanthropist and for a more in-depth bio check out the “Epic Story of Larry Brilliant”.
Third, besides Google.org, Google Inc is now getting involved in the information and development game. This week they announced their purchase of Trendalyzer, the software used to power Gapminder which was made “famous” by international health professor – Hans Rosling. If you haven’t seen the application of this software, you are really missing out.
Not only have they purchased Trendalyzer, there also have been rumors for a while that Google is going to launch some sort of health portal or products targeted at domestic healthcare. See Google’s own blog post from Nov 2006 on this issue. On a related background note, for those who are not aware, all the major technology giants, Microsoft, Intel, IBM, etc. have already made formal forays into the health space.
The business and philanthropic products of Google suggest a strong convergence:
- Google’s growing presence in India (the CEO has said it will be the internet’s #1 market) , as well as parts of Africa – this week they just inked a deal with Rwanda and Kenya
- Focus on rural markets (news release above)
- Acquisition of Gapminder/trendalyzer project
- Rumored development of a mobile phone
- Google.org’s mission to gather data on the ground (e.g. via SMS mobile) to inform outbreaks and create an early warning detection system
These together could offer a synergistic platform and suite of products for global health solutions. The Google founders have said that they hope that the Google Foundation (Google.org) one day eclipses Google Inc. They haven’t said if the above acquisitions and partnerships are strategically aligned with this vision, but these actions might indicate they really mean this.
I am not an expert on the pure philanthropic or internet technology side, but for more information on business and non-profit convergence and philanthropy in general I highly recommend the Philanthropy 2173 blog. Now all I have to do is get a job at Google to get the inside scoop.
Following on the announcement of the Voxiva $10 million Phones for Health program, I’ve pulled together other programs using text or SMS messaging to improve access to health care and health information in developing countries.
There has been a lot of hope for cell phone technologies for a number of years now. Warren Kaplan’s paper helps bring to light some of the challenges and points to the need for more rigorous evaluation of these programs.
Below are a few services used in developing and developed countries. If you’ve used any of these or others, what’s your experience?
- DocVia.com – a pilot project with the Perinatal HIV Research Unit (PHRU) in Soweto, South Africa to provide drug and appointment reminders.
- SIMpill – On-Cue Compliance Service – drug and appointment reminders among others. Their TB work in Cape Town, South Africa is described.
- Mobile for Good – a program in Kenya delivering health, employment and community content. Users can access health info and ask HIV and breast cancer related questions.
- Frontline SMS – a downloadable SMS platform for NGOs. Looks great for testing the utility of SMSing before scaling up.
- The South African Depression and Anxiety Group has launched a program that enables teens to communicate with counselors
- Kenyan National AIDS Control Council – HIV information program.
- Health-SMS – aims to bring health information services to the UK National Health Service.
At the 3GSM World Congress just this morning in Barcelona, a new public-private partnership was announced between Motorola, MTN (a leading African mobile operator), Voxiva, and PEPFAR.
Excerpts from Earth Times, Feb 13, 2007:
“Leading players in the mobile phone industry and the U.S. Government have joined forces to fight HIV/AIDS and other health challenges in 10 African countries. Phones for Health is a cutting-edge US$10 million public-private partnership, which brings together mobile phone operators, handset manufacturers and technology companies – working in close collaboration with Ministries of Health, global health organizations, and other partners – to use the widespread and increasing mobile phone coverage in the developing world to strengthen health systems.”
“Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information,” said Paul Meyer, Chairman of Voxiva, the company that has designed the software. “Managers at the regional and national level can access information in real-time via a web based database.”
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It’s time to do some housekeeping, there are several interesting stories this week that you will find below. Also do not forget to vote for the 59smartestorgs online.
- Fast Company has another issue devoted to the Social Capitalist Awards with several articles. Link
- More on the Gates Foundation story, it looks like they have decided to stick to their guns. WorldChanging haswritten extensively on this, check it out (Transforming Philanthropy) and Philanthropy 2173 is asking you to vote on this issue. For the LA Times article see the link below:
- Gates Foundation to keep its investment approach. Link
- Are mobile phones a human right? Link
- RH Reality Check has a posting about the US lack of support for UNFPA, an issue taken up by an impressive grass roots campaign, known as 34 Million Friends. You can view a video here.
Pharmaceutical & Device Developments/Breakthroughs
- A Real-World AIDS Vaccine? Link
- Researchers Discover Drug That Blocks Malaria Parasites. Link
- Nigeria to enact law to back malaria, HIV drugs. Link
- Roche Diagnostics Submits West Nile Virus Blood Screening Test to FDA. Link
- This is a very cool story about the discovery of forgotten “cures”.
Ancient Book of Herbs Used in the War on Bacteria. NY Times link, via MedGadget.
- For another take on the “Ethical Pharmaceuticals” Model, check out this lengthy piece.
Piya Sorcar, of the Learning, Design and Technology Program at Stanford University is leading Interactive Teaching AIDS (ITA), an initiative to develop “an animation-based curriculum to teach HIV/AIDS awareness and prevention strategies.” There are currently two versions of the application in development, one for India and one “general Asian version”.
I had the opportunity to speak with Piya about her work:
Why cartoon animations?
When I started this project last year, as part of my research I interviewed dozens of people on this subject. I couldn’t understand why so much misinformation was out there about a virus which many organizations have tried to combat through strong dedication and millions of dollars. After many interviews and running an IRB-approved study in India, I realized that people averse to discussing HIV/AIDS because of the stigma associated with its connection to discussing sexual practices. The educational materials are actually quite simple, it is getting the education to the people that is hard. Fighting stigma is not easy and we know this because people are so embarrassed and frightened of asking simple questions that in the long run might save their lives. I wanted to use cartoons to make the subject less embarrassing, to enhance learner comfort. When I originally ran the IRB-approved study in India, I gauged the comfort of students in learning HIV/AIDS material with various illustrations. People were most comfortable with simple graphics and actually, the simple graphics seem to get the points across just fine. It was important to me that individuals learn about this subject while feeling comfortable. I felt that cartoons accomplished this mission.
Why emphasize the biology of HIV/AIDS?
HIV/AIDS is a difficult subject to talk about. There are schools that won’t teach the prevention strategies because of its close ties to sexual practices. What we often forget is that HIV is just a virus, and we study viruses in biology classes all the time. By bringing the subject back to the basics, we can discuss it more openly and clearly. In order to prevent the spread of the virus, it’s important to build a coherent conception of where it lives, how it works and how it is transferred. In order to fully understand this, it’s important not to merely memorize a list of safe actions but to understand why a virus spreads.
What is the underlying pedagogy of this initiative?
There are many pedagogical principles utilized, but I would say the most important is based on the cognitive theory that it is important to create a coherent conception in the mind of the individual learning the material. Since in many countries there are few, if any, requirements for students to learn about HIV/AIDS in educational institutions, they tend to learn about it from mass media campaigns through television, billboards and radio. Although there are strong efforts to disseminate HIV/AIDS information in India (among other countries), because of the nature of the aforementioned education strategies, individuals must make sense of short, out-of-context pieces of information on their own. This often leads to misunderstanding as well as the memorization of random fragmented data, which doesn’t build a clear conceptual map. Interactive Teaching AIDS provides calculated learning steps to provide scaffolding for learners, allowing them to develop a coherent conception of basic biology, bodily fluids, transfer of bodily fluids into the human body, and their application to various actions or scenarios. In addition to building on a cognitive approach, we relied on other learning techniques including the use of mnemonic devices as well as Vygotsky’s scaffolding techniques. [See also: ITA Learning Theory & Rationale]
What is the current status of the projects in India and Korea? What makes those initiatives different from one another?
The Asian version of Interactive Teaching AIDS was fully funded by the Medical Research Information Center in Korea, which is funded by the South Korean government. The storyboard, which was developed at Stanford University, was animated by a professional development team and now needs to be translated into several different languages. We plan to test the production version of the project early next year. The prototype for the Indian version is complete and we have just received funding from a couple donors to create a more industry-ready version. Once that is complete we plan to test it throughout India. We hope the testing will provide us with useful data so we can iterate and make the project more effective. Finally we hope to give it away for free to various AIDS control societies, schools and eventually port to mobile devices so the information can truly be viewed in the privacy of one’s home. We are hoping also to partner with various organizations who are interested in the same goal as us – to promote awareness and prevention methods to people all over the world.
What is the overall assessment plan?
As I mentioned earlier, we hope to test this project with many students in Asia in order to inform our design and create a more effective learning tool. We hope to compare and contrast our work to other AIDS and general health education materials.
What are the key challenges ahead? (development, deployment, adoption, behavior change)
I would love to see the educational content available on all mobile devices across Asia. Perhaps governments and mobile service providers would be interested in partnering with us in order to either make this content freely available to download online or better yet, be preinstalled on the buyers cell phone or PDA. In terms of development the challenge is, of course, to develop something that is fairly short yet still gets the message across using limited screen real-estate. Once we have tested this project widely, hopefully we will have a better idea of what works and what doesn’t work and this will inform us in designing a mobile version of the project. Secondly, since there is no universal platform for cell phones, it will be challenging (not to mention expensive) to develop the animation using various scripts. When I ran the study in India, I was appalled that so many college-educated students were misinformed. The number one question was whether there was a cure for AIDS. My goal right now is to inform masses about the virus and prevention strategies. I think we have a huge problem if the population of the country with the greatest number of HIV/AIDS cases in the world doesn’t have a general understanding of how the virus spreads. Once the goal of educating people has been met, this will hopefully lead to behavior change.
Internet Extends Reach Of Bangladeshi Villagers
Cellphone-Linked Computers Help Break Rural Isolation
By Kevin Sullivan / Wednesday, November 22, 2006; Page A12
CHARKHAI, Bangladesh — The village doctor’s diagnosis was dire: Marium needed immediate surgery to replace two heart valves. The 28-year-old mother of three said she was confused and terrified. She could barely imagine open-heart surgery. She had no idea how her family of farm laborers could pay for an operation that would cost $4,000.
Mahbubul Ambia, who started an Internet center in the town of Charkhai, has helped customers find doctors, make Internet phone calls and communicate by video conference. Mahbubul Ambia, who started an Internet center in the town of Charkhai, has helped customers find doctors, make Internet phone calls and communicate by video conference. The next day, Sept. 16, her father went to see Mahbubul Ambia, who had recently installed the only Internet connection for 20 miles in far northeastern Bangladesh. Ambia sat down at a computer, connected to the Internet by a cable plugged into his cellphone, and searched for cardiac specialists in Dhaka, the capital, 140 miles away. He found one and made an appointment for Marium, who like many people here goes by just one name. The specialist examined her and said she needed only a routine surgical procedure that cost $500.
Villages in one of the world’s poorest countries, long isolated by distance and deprivation, are getting their first Internet access, all connected over cellphones. And in the process, millions of people who have no land-line telephones, and often lack electricity and running water, in recent months have gained access to services considered basic in richer countries: weather reports, e-mail, even a doctor’s second opinion.
Cellphones have become a new bridge across the digital divide between the world’s rich and poor, as innovators use the explosive growth of cellphone networks to connect people to the Internet. Bangladesh now has about 16 million cellphone subscribers — and 2 million new users each month — compared with just 1 million land-line phones to serve a population of nearly 150 million people.
Red Herring highlighted a study published in the British Medical Journal yesterday. “How Google is changing medicine” showed that, when the two medically trained authors entered symptoms of an illness into Google, the search engine was able to correctly provide a diagnosis 58 percent of the time.
Drs. Hangwi Tang and Jennifer Hwee Kwoon Ng from the Princess Alexandra Hospital in Brisbane, Australia, wanted to see whether Google could be helpful for doctors in the diagnosis of tough cases. They were astonished to read a piece in the New England Journal of Medicine about a doctor who was able to diagnose a complicated immunodeficiency disorder by typing the information into Google.
“We think Google is likely to be a useful aid in diagnosis … It has the advantage of being easier to use and is freely available,” the doctors wrote in the study. And according to their research, Google is now used more widely than PubMed, a popular medical search engine, to find articles about medical research.
The pair selected 26 cases at random from the case records of the New England Journal of Medicine and chose between three and five symptoms that described each illness. Without looking at the conclusions of the studies, the doctors entered the symptoms as search terms into Google. The doctors then chose the diagnoses that came up most often within the first three pages of the Google search, and compared them to the actual results of each case.
In 15 out of 26 cases, the Google search provided the correct diagnosis for some pretty tough illnesses. For example, Google was able to correctly identify Creutzfeldt-Jacob disease, cat scratch disease, and lymphoma. The search engine failed, however, to diagnose pylephlebitis: It settled firmly on cirrhosis.
With search capacity moving to mobile platforms, the potential for this type of clinical second-opinion in areas with limited numbers of healthcare professionals is intriguing. A related model using menu-driven options on phones has been piloted in Kenya according to AllAfrica news (“Kenya: Health tips on your cellphone”) and blogged on NextBillion.
This story was found on a fantastic website: WorldChanging -“Cell phone ring tones are now music to the ears of the 35 million Bangladeshis at risk for numerous cancers and debilitating impairments from groundwater tainted with arsenic… colleagues at the Lamont-Doherty Earth Observatory of Columbia University are working to reduce the exposure to arsenic through their development of an SMS… A pilot project incorporated data from 300,000 wells into the Welltracker database, which reports for each village the number of wells tested, the proportion of unsafe wells and, when available, the start depth together with an estimate of the probability that the estimate is correct. “ The information is well laid out along with video at WorldChanging, check it out.
From the Columbia University website:
“Welltracker helps people in rural Bangladesh avoid arsenic poisoning occurring naturally in about 50% of private tube wells. Despite warnings from the government, many villagers cannot afford to dig tube wells deeper than 40ft. They continue to install shallow tube wells at a fast pace…Welltracker makes safe tube wells more affordable. Instead of the typical 800ft depth of a deep tube well, we use mathematics and statistics to find shallower safe depths. We encourage communities to invest in deep tube wells together. Our intention is to help set up an independent organization that provides loans and secures well investment with a money-back arsenic-free guarantee.”