While passing through the lobby of my dorm the other day, I happened to pick up a copy of the very first issue of the very first volume of Stanford’s Journal of Service in Global Health. One of the articles describes one student’s experiences volunteering in the community health services sector in Malawi. Specifically, this student’s work involved distributing cell phones to community health workers in local villages as a means of fostering efficient and accurate exchange of information between hospitals and health workers. So this week, I just wanted to share a bit more about this example of information and communication technology in the global public health realm. I found it to be particularly effective and hope to see it be done in other villages as well on an even larger scale.
Okay, so a bunch of cell phones were passed out to some people in Malawi. And? So what? Well, seeing as the majority of us probably could not go about our routine daily activities without our precious BlackBerries or RAZRs or iPhones or whatever else exists these days, perhaps access to mobile telephone technology can hugely impact people in small villages in Malawi as well. Granted, the primary aims of having access to this cell phone technology in Malawi would be targeted differently from our own. In the case of Malawi, we are looking specifically at the issue of healthcare and the challenges presented by geographical distances between central hospitals and remote villages. According to the article, many people had to walk nearly 100 miles to reach the closest hospitals (or if you were slightly better off, you could ride a bicycle or an oxcart). In Malawi, where people suffer from one of the highest HIV/AIDS rates worldwide, the role of community health workers is critical. These volunteers have often been impacted personally by the loss of a family member or friend who fell victim to the disease. They display a strong commitment to help afflicted patients, but are thwarted by the challenges of tracking patients across villages and delivering effective care when resources are often only available at distant hospitals.
This is where cell phones come into play. Frontline SMS is an instant messaging technology that has been developed to accommodate mass communication via the short message system (SMS). Though it does not require access to an Internet connection, it does depend on a connection between a laptop and cell phone. Thus, it is highly implementable in a rural healthcare setting, provided a laptop can be procured. The way this worked in Malawi was that community health workers each received a cell phone, attended a basic training session that taught them how to send text messages, and then they dispersed to their respective villages. Now, whenever they were attending to a patient in their village who required immediate care, they could send a text message to the centralized hospital. After receiving the text message, the hospital could disseminate a member of its staff to the village (on some sort of motorized transport as opposed to on foot) with the necessary drugs or medicine the patient required.
The Frontline SMS system is also a highly effective way of tracking patients. For instance, if a patient neglects to come in to the hospitals for his or her appointments or is forgetting to take his or her medication, hospital workers can send a quick message to the patient’s cell phone to remind them. And if patients have questions about certain drugs or dosage amounts, they too can send a message through the Frontline SMS system and immediately receive back instructions and information related to the drug in question. What used to take hours or even days is now just a matter of a few seconds.
So it seems like this system of cell phone technology and text messaging has made huge strides in alleviating the strains of health care provision in Malawian villages. And projects like these are definitely to be commended and continued. But it is difficult not to have at least some skepticism. Regarding the ease of implementation on a larger scale, I wonder just how far the scope of this can extend. And in this example as I understood it, only the community health workers had access to cell phones. But what if you do not have access to a community health worker? Or at least not at a time when you most need it? I guess everything has its challenges, but I applaud this text messaging approach as a very creatively simple response to a complicated public health issue.
This is an interesting idea, though I agree with you in some of your skeptisism. I would love to know more about how many programs like this exist, and how effective they have been so far. What about cost-effectiveness? Have any studies been done to look at the cost of distributing cell phones, and how much help they have been? However, it does seem clear that it is more cost-effective than building another hospital, for example, where you would need to build the facilities, buy all kinds of materials, and train and hire an entire crew of staff. Cell-phones might be a good temporary solution.
I think your point about access to community health workers points to the challenge of quick-fixes, though. Though the cell-phone is effective and life-saving in the short term, it should not necessarily replace other efforts to promote long-term development in those villages.
This is an interesting way that technology is spreading to areas that have never been introduced to technology. I am curious as to if all people in the villages received cell phones and if not how they decided which patients should get them over others. I like the idea of getting help for those in need faster and in a more efficient manner but I am also weary of the cell phones being a way to take care of consequences and symptoms that these people have instead of the social factors that get them into those situations. However, I do agree that this is a very unique and create way to solve problems, it might just simply be a quick fix for a huge problem.
I really agree with this texting idea. Although I agree that there are still some challenges, having this technology will be able to contribute more benefits than harm. I have a few other questions about it though. What would determine who is qualify to receive a cell phone? One person per family? What if they didn’t have HIV/AIDS, but another illness that required treatment? I feel equity is another important issue that needs to be discussed.