FrontlineSMS let users send, receive and manage SMS over a mobile network.

Project in Argentina, University of Morón, School of Medicine (Buenos Aires, Argentina)

Implementing a mHealth initiative at a large University located in suburban province of Buenos Aires:


Dr. Domingo Liotta Jr.

Director of Medical Wellness, University of Morón




Mounting interest in the field of mHealth—the provision of health-related services via mobile communications—can be traced to the evolution of several interrelated trends. In many parts of the world, epidemics and a shortage of healthcare workers continue to present grave challenges for governments and health providers.1;2 Yet in these same places, the explosive growth of mobile communications over the past decade offers a new hope for the promotion of quality healthcare. Among those who had previously been left behind by the ‘digital divide,’ billions now have access to reliable technology.

There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services—even in some of the most remote and resource-poor environments. Throughout the developing world are demonstrating concrete benefits, including:

■ Increased access to healthcare and health-related information, particularly for hard-to-reach populations

■ Improved ability to diagnose and track diseases

■ Timelier, more actionable public health information

■ Expanded access to ongoing medical education and training for health workers


Due in large part to the successes of pioneering mHealth programs, activity in the field is rapidly gaining momentum. In 2008 alone, over a dozen new mHealth applications have been implemented or are in the trial stage. These include:

■ InSTEDD, a US-based non-governmental organization (NGO) that provides technology solutions for humanitarian and disease support, opened a development center in Cambodia where mHealth-based disease and surveillance solutions are being designed for the Southeast Asian region.

■ The Canadian development agency, IRDC, expanded support for a project providing nurses in the Caribbean with portable digital assistants (PDAs) to empower improved diagnosis and decision making.

■ The United Nations Foundation and Vodafone Foundation Technology Partnership, together with the World Health Organization (WHO), a specialized agency of the United Nations (UN), announced plans to expand their mobile data-gathering program to more than 20 countries in sub-Saharan Africa.


Potential of Mobile Phones to Improve Health in

the Developing World

As the first decade of the 21st century draws to a close, leaders in many developing countries can point with pride to tremendous strides in their efforts to improve the lives of their citizens. In many parts of the world, citizens in emerging economies have begun to taste the fruits of higher incomes and greater access to tools that promise to increase their quality of life and that of their children. Yet formidable obstacles remain. Health challenges present arguably the most significant barrier to sustainable global development. Disease and the lack of adequate preventative care take a significant toll on both developing populations, measurable in disability-

adjusted life years (DALYs), and economies. Despite the broad economic advances of this decade, the 2008 UN report on progress toward meeting the Millennium Development Goals (MDGs) indicates continuing dire conditions in crucial public health areas. For example:

■ A child born in a developing country is over 33 times more likely to die within the first five years of life than a child born in an industrialized country, even though the leading causes of deaths (pneumonia, diarrhea, malaria, and measles) are preventable through basic services and vaccinations.

■ Every minute, at least one woman dies from complications related to pregnancy or childbirth. And for every woman who dies in childbirth, approximately 20 more suffer injury, infection, or disease—nearly 10 million each year.

■ An estimated 2.5 million people were newly infected with HIV in 2007.

■ Communicable, and entirely avoidable, diseases such as tuberculosis (TB) and malaria continue to claim lives due to preventable factors such as lack of access to proper drugs and medical treatment. By current estimates, meeting the target MDG of halving the TB prevalence rate by 2015 is unlikely.


The ability of developing countries to overcome these serious health challenges is hindered by several core obstacles, among them a global shortage of healthcare workers. According to the WHO, among 57 countries, mostly in the developing world, there is a critical shortfall in healthcare workers; representing a total deficit of 2.4 million healthcare workers worldwide.

This human resources constraint intensifies the already increasing pressure on developing-world health systems. Not only must they cope with the burden of containing the spread of communicable diseases associated with extreme poverty, they must also contend with the growing incidence of chronic diseases, such as diabetes and heart disease, an effect of new-found (relative) affluence. Governments, businesses, NGOs, foundations, and multilateral organizations all recognize the importance of leveraging new tools and solutions to address these distinct but interrelated health challenges.

The Promise of Mobile Technologies for Health

Mobile communication offers an effective means of bringing healthcare services to developing-country citizens. With low-cost handsets and the penetration of mobile phone networks globally, tens of millions of citizens that never had regular access to a fixed-line telephone or computer now use mobile devices as daily tools for communication and data transfer. A full 64% of all mobile phone users can now be found in the developing world. Furthermore; estimates show that by 2012, half of all individuals in remote areas of the world will have mobile phones. This growing ubiquity of mobile phones is a central element in the promise of mobile technologies for health.


Defining mHealth Within the Context of eHealth

In recent years, mHealth has emerged as an important subsegment of the field of electronic health (eHealth). While there is no widely agreed-to definition for these fields, the public health community has coalesced around these working definitions:

■ eHealth: Using information and communication technology (ICT)—such as computers, mobile phones, and satellite communications—for health services and information.

■ mHealth: Using mobile communications—such as PDAs and mobile phones—for health services and information.

mHealth and eHealth are inextricably linked—both are used to improve health outcomes and their technologies work in conjunction.

For example, many eHealth initiatives involve digitizing patient records and creating an electronic ‘backbone’ that ideally will standardize access to patient data within a national

system. mHealth programs can serve as the access point for entering patient data into national health information systems, and as remote information tools that provide information to

healthcare clinics, home providers, and health workers in the field. While there are many stand alone mHealth programs, it is important to note the opportunity mHealth presents for strengthening broader eHealth initiatives.3

 ■ Meeting Health Needs Through a Broad Array of Applications

A growing number of developing countries are using mobile technology to address health needs. The mHealth field is remarkably dynamic, and the range of applications being

designed is constantly expanding. The key applications for mHealth in developing countries are:


■ Education and awareness

■ Remote data collection

■ Remote monitoring

■ Communication and training for healthcare workers

■ Disease and epidemic outbreak tracking

■ Diagnostic and treatment support4





After reviewing different proposed mobile platforms the choice was made to implement generic open source (free) software that permits global communication with designated groups of users by Simple Text Messaging (SMS).5


The choice was based on several cross disciplinary programs already implemented at the School of Medicine, UM



An overview of the possibilities of the software is outlined below:


> Create and manage all of your SMS-related contact groups
> Send and receive messages via special on-screen consoles
> Provides incoming and outgoing message history for each contact
> Engage with your contact groups – run surveys, competitions etc. via the SurveyManager
> Run your own text-based information service via the automated ReplyManager
> Export data to Excel and other programs
> No need to be on-line – works on any GSM network via your own PC or laptop


Several constraints that need to be addressed at the time of this article being written are:

1)      Lack of a mobile education culture

2)      View of mobile technology as hype, overpromising results from the media

3)      Teachers aren’t frequent users of SMS technology which is very popular to the younger students

4)      Need of the creation of a centralized E Heath – M Health Department at our University.


Neverless the lessons learned from initiatives in other parts of the world and the possibilities to Network with different consortiums that promote Mobile technologies makes the wealth of information available to copy.

The low cost implementation proposed makes it easier to create a culture of change at the largest private University in Argentina


Reference List


      (1)    Naicker S, Eastwood JB, Plange-Rhule J, Tutt RC. Shortage of healthcare workers in sub-Saharan Africa: a nephrological perspective. Clin Nephrol 2010;74 Suppl 1:S129-S133.

      (2)    Riska O. [The health worker shortage in Africa worse than supposed]. Tidsskr Nor Laegeforen 2009;129:778.

      (3)    Gerber T, Olazabal V, Brown K, Pablos-Mendez A. An agenda for action on global e-health. Health Aff (Millwood ) 2010;29:233-236.

      (4)    Vital Wave Consulting. mHealth for Development.  2009.

Ref Type: Generic

      (5) Introduction to FrontlineSMS.  2003.

Ref Type: Generic



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Comment by Florence Scialom on May 5, 2011 at 9:30am

Hi Domingo, 


Great - thanks for the further details on your use of FrontlineSMS. Sounds like it is going very well so far! I will be interested to hear how things progress, and how the mobile computing R&D comes together too.


Thanks for keeping us updated - it's much appreciated!


All the Best,

Comment by Domingo Liotta on May 4, 2011 at 10:12am

Hello Florence: 

Thanks for your comments, Let me detail a bit more what I´m using FrontlineSMS for at this moment.


FrontlineSMS as a support for the University Tutorialships at the School of Medicine, UM, Buenos Aires, Argentina:


Let me outline where we are right now during this initial phase: 

Tutorialships at the University of Morón started in 2006 as an 
educational service directed to consolidate strategies for 
personalization of educational relations. 
It’s based on: Motivation, Contention, and Orientation of our students to consolidate personalized education. 
“A systematic conjunction of educational efforts centralized in the student, that complements the activity of the professor in front of the group, using models of interventions at different times and spaces to enhance academic performance."

As part of the existing layer of group sessions, personal interviews and email consulting m-education reaches out as a new way of intervention. (using text based messages - FLSMS Hub))

Students are massively responding to the new idea with more than 50% response to the new system after a few days of being alive.

Professors are enquiring about new ways to address there students with m-education and we will be moving quickly into clinical setting where m-education and m-health will be intertwined. 

Looks like the creation of a Mobile Computing R & D Department is also 
coming to reality 
I´ll keep posting 

Best regards 
Dr. Domingo Liotta Jr. 


Comment by Florence Scialom on May 3, 2011 at 1:48pm

Hi Domingo,


Thanks so much for posting this here - a very interesting read. I look forward to being in touch soon to learn even more about how you are using FrontlineSMS in an Argentinian University.


All the Best,



Florence Scialom

Community Support Coordinator


m: +44 (0) 780 9641177
twitter: floscialom

skype: flo.scialom

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