FrontlineSMS for Community Health Education in Malawi

[Phil Marston]

Hi Everyone,

I'm looking for opinions and advice.

I'm a learning technologist at the University of Aberdeen in Scotland and I've been asked for some advice by some colleagues in medicine, but while I know a bit about education and technology, I know next to nothing about the infrastructure or culture of places like Malawi (and it's not just Malawi) where they wish to use the technology. :-/

Basically, as I understand it, they wish to improve local understanding of various preventable/curable diseases and the treatment for various others (such as, I assume HIV). I think there's also a desire to help with crop disease identification and the appropriate treatment for that too.

My advice to them so far has been to not be too ambitious with technology (i.e. not even basic smart phones or internet) and stick to tried and tested tech like SMS, and focus more on using innovative and imaginative (and robust) ways of using it (well designed learning). I'm keen that it should be something that is in the hands of the community that uses it and is flexible enough to be adaptable to their own needs by each community.

It sounds to me like FLSMS is the perfect tool for that. We also have a simple tool that we developed to author and deliver 'branching tree' simulations via SMS to our students that I think would integrate nicely with FLSMS. While I'm not sure that simulations are necessarily useful in this instance, it could just as easily be used for diagnostic keys (disease diagnosis) or the delivery of formative quizzes.

The big unknown for me is whether there is the mobile phone infrastructure in rural communities (reception), the access to the phones (phone features, cost and distribution) and even the access to the message credits (affordability).

Could anyone enlighten me as to whether I'm thinking along the right lines?

Cheers,

Phil

[Scott Daniel]

Hi Phil
I've just been working in the Caprivi Strip in northeast Namibia for 18 months, where I introduced FLSMS to communicate between teachers, principals, and the regional education office. I can't speak to the particular community health applications, but I can say that for my purpose, maintaining quick lines of communication between school staff in remote areas and the central office, it was very effective.
In Namibia and much of southern Africa (altho I haven't been to Malawi) mobile phones are very widespread and the coverage is surprisingly wide. The Namibian mobile carrier MTC has a 500-free-texts-a-day plan, where you only pay for the first one (about 15 US cents) and so I used Frontline with that package very successfully. It was only used for basic texting (I didn't develop the use of keywords and so forth, tho that might be more relevant for your intended use). Smart phones and internet coverage were largely unknown outside of the regional capital, but for texting it was perfect.
I hope that helps - any questions, just ask.
Scott

[Phil Marston]

Thanks Scott, the MTC txt plan sounds great - I hope there's something similar in Malawi - I've been particularly concerned as to whether the end users would find the high volume txting that might be part of an interactive educational tool unaffordable. I gather in some countries in the world users get charged to receive SMS too, which would really put a spanner in the works!

[Ruth Goode]

Hi Phil

I don't know if you've seen this report, but I thought it might be useful to see what other health care providers are doing with cell phones in Africa.

Best,

Ruth Goode

[Phil Marston]

Hi Ruth,

Sorry which report are you referring to?

Cheers,

Phil

[Ruth Goode]

Hi Phil

Sorry , I tried to attach it, but I don't have much bandwidth here. I'll try again. If you don't get it this time, let me know and we'll get it to you another way.

[Phil Marston]

Thanks Ruth,

Got it now - yes it does look very useful. :-)

Thanks,

Phil

[Isaac Holeman]

Hi Phill,

I've worked extensively with FrontlineSMS:Medic (http://medic.frontlinesms.com) throughout Malawi and can offer feedback on the local context. You are on the right track with SMS and/or voice services - they are available broadly throughout very much of the country. Smart phones are not, and internet over the mobile phone network is very sketchy outside the two bigger cities. Adults who are employed in the formal economy (perhaps 20% of working adults) virtually always have phones, while 1/10 (very rural areas) to 6/10 (more urban areas) of other working adults have phones. Children are less likely to own their own phones, though sharing is common. In Malawi it does not cost to receive SMS or voice calls and socially/culturally people are usually happy to sign up for programs to receive messages (though this could vary if HIV is involved - stigma varies greatly throughout the country). Airtime is a big barrier though; your response/participation will tend to be very much lower if you don't have a way of reimbursing people for airtime, and this is particularly frustrating as the people less likely to afford airtime are often the ones most in need of practical information about health and self care.

Feel free to reach out to me off the forum if you want to continue the conversation.
cheers
Isaac

[Phil Marston]

Thanks for your response Isaac,

Sounds like you're just the guy I need to speak to!

I'm curious about the reimbursement issue - if we were able to setup a community based education initiative (health and agriculture) that helped people get answers to their questions and learn things they wanted to know, would they also expect to get paid/reimbursed too?

Cheers,

Phil

[Isaac Holeman]

Hi Phil,

To some extent it depends on who you want to reach, and how, in addition to SMS, you are reaching them. The poorest of the poor rarely have any airtime, they may keep a phone so that they can be called and so that they can 'flash' people (call them, let it ring, hang up before they pick up - so that there is no charge), to ask those people to call them back.

Many subsistence farmers do have airtime, but they are very sparing with it, so you will have to convince them that that your feedback is worth the non-trivial cost of an SMS. Will this be done via community outreach workers? Are you connecting with village councils/elders who will in turn encourage community members to SMS their questions to you? I know of a few projects that are partnering with trusted community radio stations - they may host an expert on a topic such as HIV or maize farming, and then enable listeners to SMS their questions in.

I've been in Kenya but I head back to Malawi later today, excited to be back!

cheers
Isaac

[Phil Marston]

Thanks Isaac, that's useful :-) Phil

[James BonTempo]

Hello, Phil :) Sounds like you're working on some stuff that's similar to what I've been doing lately.

 

From an instructional design perspective and performance support perspective, you might be interested in reading something I wrote for the Educational Technology Debate series on mEducation, "SMS4Learning: Supporting healthcare providers through FrontlineSMS:...."

 

And I'd be curious to learn more about the tool you developed to deliver simulations via SMS - I would love to start thinking now about possibly adding this kind of functionality into a future version of FrontlineSMS:Learn!

 

James

[Phil Marston]

Hi James,

 

Here's a poster describing the project

Disaster Sim Poster

and here's a presentation at a Blackboard Users conference this time last year:

Txting Disasters

Hope that gives a better idea?

 

Cheers,

 

Phil