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