In remote villages in Africa, it's not uncommon for the nearest health clinic to be a day's travel away. It's also not uncommon for villagers to make the long journey only to find out that a doctor isn't there that day or that needed medication isn't in stock.
United Methodist Communications is funding a project in Kamina, Democratic Republic of Congo, to improve better communications between clinics and villagers through mobile phone and texting technology.
The Rev. Betty Kazadi Musau, a United Methodist clergywoman from the Democratic Republic of Congo and a public health care worker, was an early adopter of ICT4D. Musau said that during a February 2014 cholera outbreak last February, messages sent through Frontline SMS — a free text-messaging system that does not depend on Internet connection — stopped unnecessary deaths. She simply sent texts reminding people to boil their water before drinking and to wash their hands frequently.
"A woman told me (that) messages to the villages to wash their hands before breast-feeding and before handling food worked to save lives," Musau said.
Musau received a grant from United Methodist Communications for the Kamina project, to show how text messaging and mobile health technology (mHealth) could be utilized in the developing world. Partnering with Medic Mobile, UMCom and the United Methodist Church of the Resurrection in Leawood, Kansas, Musau designed the project in Kamina connecting clinics and villagers via mobile messaging.
"Previously, they had no system to monitor the drug stock in clinics, and we couldn't know when or where we had an outbreak," says Julio Malikane, Medic Mobile's project manager in West Africa.
The project is divided into four categories:
- Disease surveillance: Monthly SMS reports help workers monitor outbreaks when there is disease in a region, so specific action can be taken.
- Drug stock monitoring: Clinics in remote areas frequently have a shortage of drugs. In this program, the clinics provide a monthly report via phone and note any shortage or outages they have. From there, the district clinics can either resupply or figure out another area clinic that may have plenty of the drug in stock to lend to the clinic in need.
- Personnel management: Sometimes there is an outbreak and there isn't enough staff at the closest clinic. The system can analyze the staff at other area facilities to see if anyone can be reassigned to the clinic closest to the outbreak.
- Antenatal care: This uses community health workers and SMS. The workers register pregnant women in their area, and continue to follow up throughout the pregnancy while updating the system. They are able to capture a wide range of statistics, from who went to the clinic, to the ratio of home births to clinic births.
"One of the key things in user-centered design is that you go to the people who are wanting a solution for their problem and work with them," says the Rev. Neelley Hicks, director of ICT4D at United Methodist Communications. "It was Betty who identified the problem, and we worked with her to help create the solution."
UMCom offers grants and has staff to work with the locals on the technology side, both with training and support.
"Our role is to see how it works so we can share this with other entities. We wanted a great case study in how this could work for the church," Hicks says.
The Kamina program currently covers eight area clinics. Each clinic has one nurse that sends four monthly reports, one for each of the four program categories.
In July, Malikane said they plan to add 56 more facilities submitting reports to the program. They will also deploy analytics — a dashboard system with graphs and statistics that a doctor at a clinic can upload reports to using a web browser.
The system is currently used by 10 community health workers. They have registered 40 pregnancies, and there have been six deliveries in this system.
"The challenge was that most deliveries were at home, which increased risk of difficulties or death for both mother and child," Malikane says. "With more education, with time we'll be able to increase the number of women delivering at the facility instead."
Malikane shared a success story of one pregnant woman who visited the clinic. Often, people don't go to clinics in remote areas because it's a long process, but the woman's community health worker urged her to go to there to deliver. She said no, and preferred to deliver at home, so the worker registered her and followed up throughout the pregnancy.
"The woman wound up delivering at the clinic instead, and she said this is the first good experience at a clinic where she felt she got special treatment. That all started with the phone system," Malikane says.