FrontlineSMS:Medic in Bangladesh- SSFP and Nokia
22 Sep
Filed under blog
Rickshaw Traffic in Dhaka, Bangladesh
This update was originally posted on DeshMedic.
Good afternoon, world! My name is Nadim Mahmud and I am serving as the Research Director here at FrontlineSMS:Medic. Our program has been expanding rapidly throughout Africa over the past several months, and this summer marked our official foray into South Asia. Back in February, we were contacted by an organization called the Smiling Sun Franchise Program (SSFP) inquiring about communication solutions for community service providers (CSPs). SSFP is a USAID-funded project based out of Dhaka, Bangladesh that seeks to improve the standard of care in over 300 clinics throughout the country. Working with nearly three dozen NGOs, the goal of the project is to help clinics become self-sustainable and successfully wean them off of foreign aid money. Utilizing CSPs to bridge care between patient and physician, the clinics under the SSFP umbrella chiefly provide family planning and maternal/child health services.
CSPs are SSFP’s equivalent of the community health workers (CHWs) that we write about so frequently. Their list of responsibilities is extensive, but fortunately their dedication to their work is equally matched. They provide counseling services to newly married couples and expecting mothers, sell condoms and other family planning methods, play crucial roles in health education, and refer patients for antenatal/postnatal care and serious illnesses. Each CSP manages between 200 and 300 households and many live at a considerable distance from their parent clinic. Within the SSFP network, a huge challenge for rural clinics has been managing CSPs and monitoring the types of services that are being provided in their catchment area. In the status quo, some 6,000 CSPs are reporting service statistics to clinics on a monthly basis. Aggregating this data takes at least another 15 days and is prone to errors at several stages (there are seven layers of forms that need to be filled out at successive administrative tiers). NGOs and SSFP headquarters receive data that is at the very least 45 days old. As a result, they cannot respond effectively to changing dynamics in healthcare trends, inventory stock-outs, high patient dropout rates, etc.
A quick example of why this is problematic: suppose SSFP conducts a nationwide clean-water educational campaign that is administered through their community educators and service promoters. They would hope to see greater a disbursement of water purification tablets from their CSPs immediately after this campaign, but without reliable or timely reporting data they have no idea what the outcomes are. This makes it difficult to decide whether or not the specific program was an effective use of resources, whether or not similar programs should be scrapped or modified, and sustainability margins consequently suffer.
CSP Focus Group – I’m the tall one in the back
To address problems like these, we planned to supply CSPs with java-enabled phones and utilize the FrontlineSMS Forms Client to allow them to fill out and send in daily reports on services provided. Using this platform, the 42-field paper form currently being filled out by hand can be compressed down to a single text-message. After a few days of brainstorming and getting up to speed on SSFP, I headed out to a few field sites to talk with clinic managers and CSPs and introduce the idea to them personally. Once accustomed to the idea of a real-time communication network, the CSPs began to buzz with ideas exploring how it might be used. One that was particularly popular involved a time-saving referral system:
Currently, CSPs that refer patients to clinics fill out a paper receipt that the patient is supposed to bring to the clinic. Too often the patients do not show up. Because of this high dropout rate, CSPs have been walking to the home of each referral patient a week after they refer them to check if they kept their appointment or not, a process that takes hours. This is time that could otherwise be spent conducting health education sessions, promoting zinc tablet usage, water purification methods, or family planning services. With FrontlineSMS, CSPs will provide patients with a paper receipt as before, but will also fill out a duplicate referral form on their cell phone and send this to the clinic. When patients show up with their receipt, the clinic will match this up with the form received in FrontlineSMS. If a record goes unmatched for a week, the clinic will send an SMS to the CSP with the name of the patient that needs to be checked on or nudged to visit the clinic. This will allow CSPs to conduct targeted follow-ups rather than lose time seeing patients who have already received care.
Moving forward, we have selected two rural clinics to test out this system- one in Gopalpur and another in Rajoir. In total, 90 CSPs at these clinics work to provide care to more than 180,000 people. Beginning in early October, each clinic will be running a Huawei laptop with the latest install of FrontlineSMS (including a Bengali translation that we managed to complete). Nokia has graciously agreed to provide 130 Nokia 2330s for these pilots, along with several free subscriptions for their Ovi web-based platform. Because neither pilot site has internet access, exported CSP data will be sent to NGOs and SSFP headquarters using Ovi (summarized below).
Reporting Schema from CSP to SSFP Headquarters
I will be posting updates on these pilots as well as other projects in Bangladesh in the near future, but two more things before I sign off: 1) I would like to thank the Clinton Global Initiative for supporting my work this summer in Bangladesh, and 2) thanks again to Nokia for providing the hardware needed to move these pilots forward. Needless to say, we are all very excited to have this level of sponsorship for such a noble cause, and hope that our relationship with Nokia will continue to benefit clinics, community health workers, and patients across the globe.
\+/ Nadim
11 Responses to “FrontlineSMS:Medic in Bangladesh- SSFP and Nokia”
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Nice to hear.
Greatz.
Thanks Nadim for let the rest of the world know about our program. I hope we’ll be working together to bring the whole thing in reality.
Good work Nadim. I’ll be interested in your progress. We call our CSPs barangay (village) health workers here in the Philippines (BHWs). I am sure we will learn from your implementation. Hope you succeed as the whole (developing) world will be watching…
Wonderful effort Nadim. Interested to get updated on future developments.
Best wishes
You have an interesting point of view
Awesome blog post, thanks for keeping me busy!
That was stimulating . I admire your style that you put into your writing . Please do continue with more similar to this.
I guess 4. 5. and 6. are spam comments.
Please remove them and this comment also.
Sorry,
I guess 5. 6. and 7. are spam comments.
Please remove them and this comment also.
Thanks for the post Nadim, really interesting idea and well written.
What is the infrastructure like in Bangladesh when it comes to SMS capabilities? Any interesting “hurdles” you had to overcome because of the country?
Regards
Mark
I am
Livia Bellina and I would like join in your project with project that Eduardo Missoni and me We built……
I am m
(age 56) medical doctor, specialized in General Pathology
Worked in Italy for the National Health Service, from 1987 until now.
In April 2008, working as a pathologist on the Italian Island of Lampedusa, I found myself in the urgent need to confirm a diagnosis of malaria from a blood sample of an African immigrant. With no other means at hand, I took a picture of the microscopic field using the camera incorporated in mobile-phone, without additional devices, and sent it via MMS for tele-diagnostic purposes to a reference center. …. The described method has been filed for patent in April 2008, with the sole purpose to protect the idea from commercialization and consent its free use and dissemination (EPO application number 09005054.3 2002 – 2008 April).
Through that experience I was motivated to deepen my knowledge about tropical diseases, poverty diseases, global health and international development cooperation.
Meeting Eduardo Missoni at a meeting of the Italian Society for Migration Medicine(SIMM) (Trapani, February 2009) and listening to his words about Global Health and Human Rights deeply changed my life… (I have been always fighting alone in Sicily for the right to health care and medical dignity).
I asked him to collaborate and soon after we met at the Bocconi University, in Milano, where he teaches. In June 2009 our work about low cost diagnostic image transmission (Bellina and Missoni) was published in Diagnostic Pathology (an Open Access Journal) Bellina, L., Missoni, E., Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories, Diagnostic Pathology, 2009, 4: 19
Since then, we intensified our collaboration. With Prof. Missoni, we advocate the use of this image transmission method and, where needed, I make myself available to teach the method in practice.
We believe that access to health and access to care is a fundamental human right and medical technology must serve and be fit for purpose. Unfortunately health is a right which is still neglected to the majority of humanity.
Sharing my experience in Lampedusa with Eduardo Missoni gave also rise to collaboration in the area of migrants’ health care and rights. On the subject, we made an oral presentation in September 2010 at the 6th European Congress of Tropical Medicine and International Health and 1th Mediterranean Conference on Migration and Travel Health – in Verona (Italy). (Bellina, L., Maugeri, M., Missoni, E., Ethical and public health concerns based on the retrospective analysis of referrals for diagnostic parasitology of immigrants and autochtonous population in Lampedusa island (Italy), European Journal TM&IH, 2009, 14 (Supp. 2) 66) and we are currently elaborating further on the subject, examining other aspects concerning migrants’ right to health, health care delivery and related economic aspects.
My interest for Migrants’ rights and Health care dates back to 1991 when I started to work in Lampedusa (1991). However, the direct relationship with migrant people landing in Lampedusa and, later, the work with Eduardo Missoni have been decisive for my commitment.
In 2009 I became a member of the Italian Society of Migration Medicine (SIMM) and of the Italian Society of Tropical Medicine (SIMET).
I am also a member of the National Migrants’ health Care Work Group (at the Istituto Superiore di Sanità – National health Institute in Rome); of the Working Group “European AIDS & Mobility Project” and, since June 2010 of COST Action (European Cooperation In Science and Technology ).
For my personal up-date in related fields I attended a number of courses, including:
Advanced Course in “Basic laboratory for tropical disease and health cooperation”, at Verona Negrar Hospital (director Dr. Zeno Bisoffi)( October 2008 )
Advanced Course in “Tropical Medicine and Health Cooperation” (4 months), at Florence Careggi University (director Pro f. Alessandro Bartoloni) (March-June 2009 )
Course in “Management of transmissible disease in sub saharianan Africa”, at Pemba (Zanzibar) Public Health laboratory, supported by De Carneri Foundation. (July 2010).
I soon realized that my mission was to dedicate myself to the Poor and to facilitate their access to care, including through the adoption of low-cost telemedicine, mainly in rural communities. Thus, immediately after the course in Verona, I contacted the Corti Foundation and, after a meeting with Dominique Corti, in Milan in January , 2009, I made myself available to work in Uganda, where I spent two months (October to November 2009) volunteering at Lacor Hospital, in Gulu. I was sent there as a supervisor of the Corti Foundation, and to support “on the job” training in diagnostic laboratory for students of the Laboratory Course for Technicians.
I had previously entered in touch with Nobel Laureate Professor Mohammad Yunus, and had offered also to him to help in introducing the “mobilediagnosis” method (i.e. the use of cellular phone for tele-diagnosis and support) in rural communities in Bangladesh. I met Prof. Yunus in Milano (Februray 2010) and he invited me to go to Bangladesh and contribute to the improvement of Grameen Kalyan rural health centers and train local healthworkers.
Having accepted the invitation I volunteered three months in Bangladesh (April-July 2010) teaching and applying mobilediagnosis, linking centers in rural areas of Bangladesh and the headquarters in Dhaka. In Bangladesh I lived in rural centers (first in Tangail, in the extreme North of Bangladesh, and later in Comilla district, in the East of the country ). For several weeks, I taught and worked with my students all day long, from early morning to sunset . In Grameen Foundation’s health centers, I practically organized a “school “ of lowcost telepathology and basic telemedicine, based only on the local minimal equipment and available personal cellphones. 16 lab technicians of 16 different rural health center where involved. I taught the use of the microscope; theory and practice of laboratory techniques and basic parasitology, urine analysis, hematology and stool sample examination, as well as capturing and sending images from microscopical fields, and differential diagnosis and logic clinic.
I also taught to 6 medical doctors (about logic clinic, differential diagnosis, primary health care and to transmission of ultrasound images with the mobile-phone) from 6 different health centers.
In the second phase of my permanence in Bangladesh, I was based in Dhaka at the central Grameen office and supported the distance diagnosis for images sent by the lab-technicians I had trained. Confirming the validity of the method. My work is summarized in two reports and a tutorial booklet.
The experience developed using the mobilediagnosis method is summarized in a paper entitled “Increasing connectivity of isolated health workers in poor countries using locally available technology” co-authored with prof. Missoni, that will be presented at the coming 41st Union World Conference on Lung Health -Berlin, Germany, from 11 to 15 November 2010.
To promote mobilediagnosis, with Eduardo Missoni, we have been developping since 2009 http://www.mobilediagnosis.net .
Our aim is to develop it into an interactive consultation site, to provide free support to low skill – low resources and isolated healthworkers (lab technicians, pathologists, clinicians) working in low resources countries or isolated and rural areas, offering the possibility to receive diagnostic confirmation from more skilled colleagues.
Thanks to my attitude and my open and communicative behavior I easily establish a good human relation with patients, as well as students and colleagues, as documented by several letters from Bangladeshi students, labtechnicians and medical doctors.
I would like to dedicate the rest of my life working for poor people, as medical pathologist and as teacher, and to promote mobilediagnosis to low resources settings and to the poorest communities; to give my little contribution to bridge the health and technological divide, and to put the global health care network at the service of the poorest and neglected community. I am ready to leave immediately my current work, and to travel. I have no difficulty to reside in any country and in any socio-economical setting.
Thanks for your attention
Livia Bellina
mobile: +39 3389112818 / +39 3926180630 skype id: liviamarcellaclaudia
e-mail address: liviabellina@hotmail.it and liviabellina@gmail.com
Palermo Italy, November 8 , 2010