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Posts Tagged ‘mhealth’

I spent the past few days at the mHealth Summit where James BonTempo and I (supported by Plan International USA and MCHIP via USAID) co-hosted the “mHealth Reality Booth,” which we hoped would bring some mHealth practitioner reality to the Summit and offer an opportunity to capture some learning from folks working on the ground and implementing mHealth programs in some of the less cushy environments.

As people came by the booth, we asked them if they’d be willing to do a short video that completed the idea:

“We thought that…. but in reality….” or “Most people think…. but in reality….”

We ended up with some great advice on mHealth design and implementation. Watch below or on YouTube! If you have an mHealth Reality you want to add in the comments or as a ‘video response’ please do!

Here’s our talk-show host intro (why does self-filming always make me look so weird?) and our list of mHealth Realities underneath. Enjoy!

1) Phones do get stolen, so you should involve health workers in determining what the consequences are when it happens.

2) When hospitals are gutted, cell towers are gone and there’s no electricity, for example during the Great Floods in Pakistan, you have to go back to the basics.

3) The technology should be the last thing to think about in the design process. You need to know the what first, and then think about the how.

4) Mobile operators are very interested in exclusivity. This is a challenge if you want your project to reach the entire population.

5) Even if your macro level research tells you that 80% of households have mobile phone access, it doesn’t mean that 80% of women have mobile phone access.

6) There’s literacy, and then there’s ‘mobile phone literacy’. Both are important.

7) If your paper form is crap, your mobile data collection form will also be crap.

8 ) You need policies on lost, damaged, stolen phones, and emergency mobile phone resuscitation training.

9) You will be beholden to traditional funding cycles regardless of how innovative you are, or how sustainable your own business plan is.

10) NGOs just want to come in and do one year pilots, pack up and leave, and come back to do another one year pilot. This is not sustainable. Governments need to be involved. (in French translation pending…)

11) You really need someone who’s available locally to provide technology support and someone who’s good at helping others use and be comfortable with tech.

12) Power is always a consideration. Having it figured out in one place doesn’t mean you have it solved for another place.

13) Things take a really long time. Much longer than you initially think.

14) You might love designing for iPhones and Androids, but if your users don’t have iPhones and Androids, well, that’s not very useful, is it?

15) There are very talented software development firms in places outside of the US and Europe.

16) Every assumption you have about an area or a population is probably wrong.

17) Every country has a different set of mHealth issues and there’s no way of anticipating until you have hands on the ground there.

18) User testing will help you understand what users really want. And NGOs need to ask themselves the hard question: why do we really want to use new technologies?

19) People in low resource settings and with no previous experience really can learn to use smart phones and like it.

Watch all 20 on YouTube.

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Some of the top organizations and corporations working in the mobile technology and health space will gather December 5–7 at the  mHealth Summit near Washington, D.C. The summit program offers several tracks and a wide range of sessions and  exhibits  for  just  about  anyone interested in mobile technology and health.

A few months back, James Bon Tempo and I came up with the idea to co-host a “Reality Booth” at the Summit.

Innovative business models are great. New behavior change communication technologies open huge opportunities. Mobile tools to help health professionals build capacity to improve healthcare systems sound like a dream come true. But what happens during implementation? What are the real life barriers and challenges that practitioners face when implementing programs with an mHealth component? Where can you get some honest answers?

The Reality Booth is a place for practitioners working in rural settings or implementing programs in ‘developing’ countries to connect with others working in similar situations and facing comparable challenges. It offers a space to share and learn from peers who implement mHealth programs on the ground and to get advice on resolving the kinds of difficulties that probably won’t be highlighted during the official presentations.

We’ve invited some of the most respected mHealth practitioners to attend the booth for an hour or 2, and are pleased to mention that we’ll have some fantastic folks joining us. (We’re filling our last few remaining slots, so stop by booth number 131 for the full schedule on Monday!)

Come and share your mHealth reality stories, ask your implementation questions and get some practical or strategic advice from:

Monday, Dec 5

11:15-12                Isaac Holeman

12-1                        Heather La Garde

1-2                          David Isaak

2-3.15                      David Cantor

4.30-5.30              Pamela Riley

Tuesday, Dec 6

2-3.30                   David Cantor

3.30-5                   Neal Lesh

Wednesday, Dec 7

10-11                     David Isaak

We’re also planning to make a short video on ‘mHealth Realities,’ so stop on by if you have a ‘reality story’ to share.

The Reality Booth is co-hosted by MCHIP, USAID’s flagship maternal, newborn and child health program, and Plan International USA, one of the oldest and largest children’s development organizations in the world, and co-coordinated by James BonTempo of Jhpiego and Linda Raftree of Plan International USA. Contact James (JBonTempo@jhpiego.net) or Linda (Linda.Raftree@planusa.org) for more information.

In addition to the Reality Booth, we’re hosting ICT4Drinks at Thai  Pavilion from 5.30-7.30 on Tuesday, December 6. Meet and mingle with your fellow mHealth practitioners! Free drinks for the first folks in the door and fantastic Thai munchies for everyone!

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A few weeks ago, Iulian Circo, who’s working at Population Services International (PSI) in Mozambique, asked if I’d look at some slides about an idea called ‘Movercado’. I checked it out and it seems pretty cool.

Movercado is described as “an  interpersonal communication experiment” with the goal of supporting behavior change communication (BCC) in large countries with poor infrastructure.

The problem that Movercado would address?

‘Taking behavioral messages above the line (TV, Radio, Mass media)  doesn’t really work beyond the all important effect of creating awareness. Organizations such as PSI know that very well and focus a lot on inter-personal communication. That means we need a critical mass of trained “agents” placed throughout the country that conduct standardized information, education and communication sessions in their communities.  Obviously, supervising, training and deploying such an army of “agents” is difficult, slow and very costly. Additionally, efforts to ensure quality and keeping the training materials up to date adds to the costs. Finally, reaching the critical mass required to have an impact with this traditional model in a large country is very difficult.’

Enter Movercado, which aims to facilitate this process through a series of face-to-face training, SMS, calls, incentives, data collection and personalized messaging with agents and the target population.

There is a step-by-step detailed description on the Movercado blog, but since I don’t know the context well, it was confusing at first. So Iulian created a quick user  scenario and had a friend draw up the visual below to help with understanding the process and flow of the application:

How would Movercado work?

‘Manuel lives in Beira, Sofala Province. He sells airtime and cigarettes nearby the port and is always looking for more business opportunities. He also goes to school at night. One day he sees an announcement in the papers about an inter-personal communication training offered by PSI, that will allow him to supplement his income. He registers for the training.

The training is about inter-personal communication in the area of Malaria Prevention. Upon successful completion of the training, he receives a training kit that contains training materials, training aids, information sheets as well as a stack of cards containing unique codes. He leaves his telephone number and some other personal details with the trainer and three days later he receives a SMS informing him that his registration with Movercado is completed and he can start delivering IPC sessions.
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Now, Movercado links his details to the range of codes in his kits, which means that every code in that range represents a session in Malaria prevention conducted by Manuel.
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Emelita works at the market nearby the port selling cashew nuts and tangerines. She often buys airtime from Manuel. One day Manuel asks her if she knows anything about malaria prevention and proceeds to go through the standardized session as learned in the training. Upon completion, he hands her a card and tells her that she should text the code on the card to such and such number – the message is free and she will receive an additional 5MTN in cash (6 cents US). 
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After arriving home, Emelita texts the code to the given number. A few minute later she receives a message congratulating her for having undergone a very important prevention session along with a voucher for 5 MTN in airtime. 
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Shortly after, Manuel receives an SMS  informing him that the session with Emelita has bene validated and he receives an incentive in Airtime or M-Kesh, whichever he prefers.
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A few months later, due to the rainy season, malaria becomes more prevalent in Beira. Manuel receives an SMS informing him that during this period his incentives for every session delivered will be higher. 
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A month later Emelita receives a call from a trained PSI quality control agent who goes through the session with her, reinforces the message and provides more specific information on Malaria, including health centers where nets are available for free.
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Less than six months later, Manuel finishes all his cards. He calls PSI on a toll-free number and is informed that in order to receive new cards he needs to attend a refresher training – he is given specific details about the regular refresher trainings implemented by Nova, a partner in Beira.  
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In another scenario, Manuel works for Viva, a local community NGO. In this case Manuel’s incentives may be slightly different, as per the agreement between PSI and Viva. Viva themselves receive a payment for every session that Manuel conducts (or they receive points that are then converted in financing), and they may be trained and certified to deliver either the initial training and/ or the refreshers themselves.

I think the idea has merit. My main concern is the still low mobile phone penetration rate and skill levels in Mozambique. The ITU reports only 31 mobile phone subscriptions per 100 inhabitants (likely lower in rural areas), an adult literacy rate of 55%, and the country has low network coverage. It is currently ranked 141st out of 152 in terms of ICT access, 135th in terms of use and 147th in terms of ICT skills by the ITU. So the idea would need to be supplemented by other approaches to reach the majority of the population (something Movercado aware of too, of course).

Iulian  has written up some other potential risks to the idea, such as quality assurance control and the possibility that people would try to game the system.

I think it’s a really interesting model. What do others think?

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