Drugs are a critical part of health care delivery, and the inadequate supply or the inappropriate usage of drugs can have detrimental effects on any health care system.
Text for Health is a mobile phone project that will provide licensed chemical sellers with information that can help them better diagnose and treat diseases presenting in rural Ghana.
Ghana is a country in West Africa with approximately 23,000,000 people. 51% of these people live in rural areas, where only 45% of rural households have access to a health facility, compared to 92% of urban households.
Because of the lack of facilities in rural areas, chemical sellers are the primary point of contact for the healthcare needs of the population. This is a large issue; when people are sick, they go to chemical sellers for drugs to make them feel better instead of health care professionals. This demand has created a black market of chemical sellers, and when malaria and diarrheal diseases - both preventable diseases if treated appropriately and in a timely manner - account for a high proportion of a country's disease burden, the role of the chemical seller is pivotal to a country's socioeconomic development. The country now faces a huge problem of chemical sellers prescribing medication on a “trial and error” basis – only 15% of LCS are able to administer malaria medication correctly.
There is, therefore, a market need for a tool that can supply chemical sellers with the proper information on drug medication appropriateness and effectiveness, possible adverse effects and drug interactions, and the potential for reducing drug-related morbidity.
Text for Health fills this market need by offering a new, innovative diagnosis system for licensed chemical sellers in rural Ghana. Through a mobile phone network, licensed chemical sellers can submit a number code based on particular symptoms and receive proper diagnoses and therapy information. At 25% coverage of the rural population, the total benefit to the nation is $12.8million per year, with significant reductions in sick and productive work days.
The country wide market potential for Text for Health is all LCS (approximately 8000) in rural areas. In the first year of Text for Health, the rollout will target three villages within the West Akim municipality of the Eastern region: Okurase, Asuotwene and Asikasu. In year 2, the service will be expanded to 6 more villages, and the goal is to increase the number of villages by 6 each year between the third and fifth years after implementation. Because Text for Health increases access to drug-related information to rural areas with the utilization of mobile communication, chemical sellers who service rural communities are able to develop a reputable service without previous geographic barriers that hindered information access. Showing that drawing health services towards rural areas is possible, a recent intervention demonstrated a remarkable 250% increase between 1989 and 2002 in the number of pharmaceutical facilities throughout the non-urban areas of the Eastern region. This suggests a strong assumption that Text for Health can create performance incentives for chemical sellers, who dispense different classes of drugs than pharmacists, to continue serving the rural by making it more possible to develop a reputable service in underserved areas. This is particularly the case in Ghana, where 51% of its total population resides in rural areas.
The Text for Health service is a new, innovative diagnosis system for licensed chemical sellers (LCS) in the rural areas of Ghana, based on the steady increase in cell phone use in Ghana. Our product is a service via text messaging over a mobile phone network, that can provide rural LCS with better diagnosing information to sell appropriate drugs to the public. The steps for using our product are as follows:
1. Customer goes to chemical seller
2. Chemical seller completes a purpose built questionnaire with the customer to identify a constellation of symptoms and some demographic markers.
3. This constellation of symptoms is then translated into a proprietary text for health code using an on-premise manual.
4. Chemical seller texts the appropriate code to our system.
5. An automatic response from the server at the Text for Health center recommending what drugs should be sold to person, and also suggesting one or two alternatives if first drug is not available, is sent to the chemical seller. A response for transportation to the nearest medical center will also be sent if the constellation of symptoms suggests that the patient requires medical attention.
6. Chemical seller sells drug to customer.
7. Chemical seller then confirms to our system the following: which drugs he/she has in stock including quantity and which drug he/she sold including quantity.
The main diseases that would be diagnosed by the Text for Health system include malaria and diarrhea, two of the most common diseases that affect both adults and children in the rural areas in Ghana. These diseases have been chosen for the initial start of the Text for Health service because the drugs for these conditions are classified as Class C drugs, and can therefore be sold over the counter by licensed chemical sellers, our target consumers. The benefits of the Text for Health service as compared to the current system of drug dispensing practiced by the LCS is as follows:
• Reduced trial and error in dispensing drugs, as recommendations provided are based on a constellation of symptom and information from database
• Higher potential for increased traffic for chemical sellers using service as they have better results
• Potential for point-of-sale information tracking for Pharmaceutical Companies, to provide real time information on how a particular drug is being sold and used
• Reduced adverse health effects, and preventable deaths
The Text for Health service will be marketed to licensed chemical sellers by first offering them an initial 3-month free trial subscription to the service, with the chemical seller being charged a fee per text message sent at the end of the trial period. Additionally, the licensed chemical sellers will be provided training on how to check for symptoms, and how to input the information on the symptoms into the text message format, so the server at the Text for Health center will be able to easily identify the information. A training manual will also be provided to the LCS for easy reference whenever they need it. Once the chemical seller receives the message with information on the diagnosis and the appropriate steps to take, the seller would be asked to send a text mentioning what drug was sold to the customer, and the quantity sold. Additionally, the LCS will be required to text to our system the names of any drugs they sell and the dosing information, even when patients do not present with symptoms but come in to request a particular drug, to enable us collect that point-of-sale drug information.
Before Text for Health can be rolled out to the first three villages, some things that need to be put in place include forming liaisons and alliances with various stakeholders, purchasing equipment for the project, and hiring staff to run the project on the ground. We will be negotiating for sponsorship and price reduction of the text messages from the cell phone companies, forming an alliance with the Ghana Pharmacy Council and the Ghana Licensed Chemical Sellers Association, and discussing possible networking with the Ghana Health Services, who are also interested in providing health information to health workers and hospital staff. On the product development side, we will be working closely with a software engineer to design and test the database program that will be interfacing with the text messages. As the database is being developed, an accompanying manual with codes for disease symptoms and drug symptoms for LCS use will also be in development. With these two things completed, a server and computer for the project will be purchased, and a program manager to run the project will be contracted. The project will be rolled out in two stages: the initial rollout will be to the three villages of Okurase, Asuotwene and Asikasu, and the second stage will expand services to districts across the region, and to several rural districts across the country. To monitor our success, we will be keeping track of the kind of drugs that the LCS will be selling to the customers, to verify that the proper drugs have been given out.
A computer program/database system that responds to text messages and employs an algorithm to match various symptoms in order to recommend a diagnosis will be the backbone of our service. Currently, the computer program is in the initial development stages, with a prototype being worked on by Geoffrey Asare, a software engineer who has volunteered his services for this section of development. The program is able to receive text messages and send a response via a GPS system using a SIM card. The timeline for completion of the computer program is as follows:
Project Stage (Estimated Completion Date)
Completion of prototype (April 2009)
Acquisition of symptoms and drugs list for database (April 2009)
Testing of and modification of prototype (May 2009)
Transition of prototype to working model/web-based model (June-July 2009)
Develop LCS reference manual (July 2009)
Purchase server and computer to host program (August 2009)
Develop website for project (September 2009)
The success of the program will be measured by its ability to receive text messages, accurately decipher the symptoms coded for in the text message, and respond with a correct diagnosis (90% of the time) and recommend the appropriate drugs (90% of the time). To check for accuracy, the same constellation of symptoms will be presented to a volunteer panel of Ghanaian pharmacists, to verify whether their diagnosis and recommendations correspond to those sent out by our system. The system will be tested with text messages sent from different carriers, using symptoms of different diseases already uploaded into the system, to ensure that the system is able to accept different combinations of symptoms in order to come up with a fairly accurate diagnosis.
With the completion of the software program, the next step would be to negotiate and finalize the sponsorship deal with the cell phone companies, finalize the alliance formation with the Ghana Pharmacy Council, the Ghana Licensed Chemical Sellers Association, and the Ghana Health Services. Additionally, more start-up funding will be solicited from various foreign donor organizations and NGOs. Once these collaborations are formed, a program manager for the Ghana office will be contracted, and the development of advertising messages, flyers and brochures will commence. While the development of advertising materials is occurring, the chiefs and people of the three villages (Okurase, Asikasu, and Asuotwene) will be approached, and given various educational sessions about the project, in order to obtain their buy-in. Once their consent is obtained, the LCS will also be approached and educated about this program. The time period for developing these relationships and producing the advertising materials would be 3 months, ending in December 2009. The LCS will be encouraged to enroll in the trial 3-month period, starting from January to March 2010, and will be encouraged to text in every visit they receive during this 3-month period, so we can obtain sizeable information on common diseases the LCS attend to and the drugs that they often dispense. The LCS will be incentivized to text more by featuring the “LCS of the month” on a billboard, or profiling him/her on a radio announcement, in order to drive traffic to their stores. Additionally, there will be various announcements urging members of the public to request the texting service from chemical sellers.
Once the three-month free trial period comes to an end, our aim is to have at least 2 LCS in each village signed up for our service. Quarterly visits will be made by the project manager to solicit an ongoing evaluation of the project from the LCS using it. At the end of the first year, the project will be evaluated to see how accurate the service was compared to regular diagnosis and dispensing by LCS. Based on the evaluation, the service will be reworked and the software program updated to incorporate any recommendations from the evaluation. The project will then be rolled out to other villages, expanding district by district in the Eastern Region, and then to other districts in other regions.
Our management team has research and medical knowledge of the state of healthcare and access to healthcare in Ghana, as well as knowledge of health systems in international health.
• Ada Kwan is a Master’s student at the Johns Hopkins School of Public Health studying Health Systems in the Department of International Health. Ms. Kwan graduated from the University of Michigan with a Bachelor of Science in Neuroscience. She is most interested in ICT for development and public health - in particular, the ways that mobile phones can be used for disease surveillance, data collection, and as a device for health monitoring and real-time health information analysis in developing countries.
• Yehoda Martei is a medical student at Yale University School of Medicine. Ms. Martei graduated Harvard University with a Bachelor of Arts in Neurobiology. She is interested in practicing medicine and building affordable healthcare programs in sub-Saharan Africa. She spent last summer doing research at the Korle-bu Teaching Hospital in Ghana. Ms. Martei is the currently the coordinator for the African Health Professionals Interest Group at Yale.
• Denise Twum is a Master’s student at the Johns Hopkins School of Public Health studying Social and Behavioral Interventions in the Department of International Health. Ms. Twum graduated from Amherst College with a Bachelor of Arts in Biology, and Women & Gender Studies. Ms. Twum is interested in improving the health outcomes of people in rural Ghana, and is especially interested in the sexual and reproductive health outcomes of young women and children. This past summer, Ms. Twum conducted a qualitative study in Okurase, one of the villages earmarked for the piloting of the Text for Health service.
• Emmanuel Asiedu, CFA. Head of Stanbic Investment Management Services. Mr.
Asiedu has a decade of experience in an emerging economy’s financial markets. Emmanuel Asiedu works to boost Ghana’s economic development through strategic assess management and investment initiatives.
• Chilongo D. Mulanda MS. Senior software engineer, Oracle. Mr. Mulanda worked with MIT media lab to develop a texting system by which farmers in developing countries could obtain the going prices for their produce. The system was set to be piloted in Brazil and India.
• Daniel Mensah MBA. Social Franchise Manager, Freedom from Hunger. Mr. Mensah has over 15 years in healthcare management and 8 years of experience in microfinance. He is currently playing a leading role in the design and implementation of FFH’s new social franchise initiative in West Africa called MicroBusiness for Heath which involves community distribution of life-saving health protection products. Most recently, he managed the development process and the launch of the CareShop franchise in Ghana, West Africa. CareShop is an essential medicine franchise with over 300 franchised medicine sales outlets in rural and underserved areas of Ghana.
A mobile device that sends an SMS to a person letting them know their power is on or off.
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It works by logging when a phone’s charge is interrupted. So you purchase a cheap phone, give it a sim with a few shillings credit and then plug it into an outlet at your home or office. When the power goes out, or when it comes back (if you're away) it sends a message telling you exactly when the power has come on or gone off. OhmSMS offers trending as well, so the user can see relations between outages. Ex. if Wedensdays are particulary bad, you know not to buy a whole lot of perishables on Tuesday.
We have found 2 major problems that the Internet presents for both the western world and the 3 billion people living on less than $2/day (see http://www.globalissues.org/TradeRelated/Facts.asp):
1) Those without Internet have comparatively no information
2) Those with the Internet have information overload
What if we were to solve 2 problems at one time? What if we delivered information to people without Internet access via the quickly expanding 2 billion cellular phone users worldwide? And what if we did it all through keyword-filtering of RSS feeds of their favorite sites and information?
What if we created a partnership of CellAlert.net with non-profits that can apply to use a CellAlert Open API which allows them a completely customized mashup of their own design (within the CellAlert Open API rules)?
In short, we have so many mashup possibilities, we hope you'll want to mash CellAlert.net and FreeAlert.org with non-profit organizations anywhere they need to distribute urgent content to the 2 billion cell phones in the world. So why not go with the approach of an "API mashup"?
I am the co-founder and CEO of FreeAlert.org and of CellAlert.net. My applications are RSS search technologies that instantly notify subscribers 24 hours per day by cell phone and/or email of the items that the subscribers are seeking when the item appears in any RSS feed they search worldwide. The flagship application we started with is called FreeAlert.org. Since that time, we've expanded to include http://www.cellalert.net and expanding soon to http://www.Africalert.org, http://www.Asialert.org and http://www.Americasalert.org
FreeAlert.org is an RSS search technology that instantly notifies subscribers 24 hours per day by cell phone and/or email of the *free* items that they are seeking on Craigslist whenever the item appears in any Craigslist RSS feed they search worldwide.
We hope that one of our mashup ideas will be something that you will facilitate.
Currently we are focused on El Salvador, but we see tremendous potential for good purposes being served and facilitated by text alerts in developing nations worldwide!
Today Grameen Phone has more than 10 million subscribers, connects 100 million people through 250,000 phone ladies, who buy phones on microloans from the Grameen Bank and lease air time to villagers to make a living after paying off their loans.
The project will in particular employ an extremely economical open source technology for cellphones, " OpenMoko ", which support all Web2.0 services and an unique, cost-efficient and effective way to deliver, commercialize and financing these services.
While mobile phones have been heralded as a powerful new tool for poticial activists, human rights advocates and public health initiaves around the globe, they are a step backwards when it comes to personal liberty, anonymity and safety. Google Android's open-source mobile telephony platform provides a foundation on which a new type of phone that cloaks its user and their data, both on the device itself and as it communicates around the world.
You can review a detailed presentation on this concept here: http://nathanialfreitas.s3.amazonaws.com/Guardian022709.pdf
Last year, I ran the global communications network for Students for a Free Tibet's campaign at the Beijing 2008 Olympics. Over seventy people had decided to travel to Beijing to take visible action, sacrificing their own personal liberty and safety for a cause they believed in. This included organizers, media spokespeople, documenting bloggers/videobloggers/photographers and the actual protesters themselves. In addition to the teams in Beijing, SFT also worked to get all of the information possible out from the ongoing uprising inside of Tibet.
Beyond the Tibet cause, there are many compelling stories about the power of mobile phones in human rights causes. However, there are almost as many stories of how the authorities use these same phones against the people.
The common question in both of these scenarios ("free" people traveling into an authoritarian state and citizens of the state trying to find some freedom within) was how everyone could have their voices heard, and communicate safely, security and effectively with the outside world. How SMS messages be sent with vital information without that same message being used to reveal or incriminate someone? How can the amazing power of these tiny mobile computing devices be fully realized, while at the same time not being used against them by the power of the who usually runs or at least monitors all mobile phone communication. While great strides have been made in Internet-based security, privacy and anonymity, the same can't be said for our telephones. This project gives power to regular people to own and control their mobile phones without being afraid they are their own worsed enemy.
Existing mobile security products show promise, but are out of date, not good enough or too expensive. A movement is already underway to create custom versions of Android for a wide variety of phones and purposes.... we just need to tap into that!
What should a secure, private, anonymous phone offer?
All security functions must be hidden with the standard operating system.
How we'll make it happen:
- Launch an official, public project in order to recruit open-source developers, supporters and potential users and funders
- Recruit the top open-source Android kernel hackers, app developers
- Find pilot project partners to test and validate technology in the field
- Create a strong brand around the project, like TorProject.org has
MocaMobile is a remote medical imaging and diagnosis solution using mobile phones. The handset program trains and instructs rural health worker while the bank end managers workflow for diagnosis by medical experts located anywhere in the world.
Between 80 and 90 percent of the world's population live within range of a cellphone tower. A centralized health record, accessible and updatable via mobile phones and web-browsers therefore permits a secure and continuous record of health care for the poorest section of society worldwide. The use of a mobile phone to add images, audio recordings and video, to a patient's medical record leverages an existing infrastructure to deliver medical technology and decision support to regions of the earth that lack a supply chain and infrastructure for training, hardware support and treatment compliance.
Our system provides an instant end-to-end infrastructure for media-centric remote diagnosis by experts that can be located anywhere in the world. Packetization, a synchronization model, and multi-modal data transport allow MoCa to operate even in poor cellular coverage areas. While the system is mobile-centric, it is designed to provide alternatives such as WiFi and tethered uploads for bandwidth constrained situations.
Our partners include General Electric, CIDRZ, OpenMRS, The NextBillion Project, the ASEAN Center for Telehealth, Harvard Medical School and six leading medical universities in Asia.
ClickDiagnostics enables existing health-worker networks and micro-entrepreneurs to provide advanced medical consultation and to gather health data by connecting them to our global health servers via mobile phones.
ClickDiagnostics addresses two main healthcare issues in developing countries: 1. Access to medical specialists in under-served regions; 2. Collection of real-time data for interventions in areas such as maternal mortality, cancer or AIDS.
ClickDiagnostics connects health workers on the ground, via mobile phone software, to a central server. This model enables the following essential services:
1. Allow doctors on their own time to provide consultations which can later be relayed to the patient.
2. Gather data and upload the data whenever connectivity is available.
3. Convey automatic warnings or actions to field workers.
The back-end network is an open system which enables rapid deployment of any new health-related solution (created by ClickDiagnostics or by a third party) that involves mobile phone-based data gathering/dissemination, efficient communication among health-related stakeholders and distributed, centralized human or machine processing.
ClickDiagnostics provides governments and NGOs an entire “health eco-system”, an end-to-end service chain, containing the following: 1) mobile phone software and inexpensive medical tools for local health-care agents, 2) web-based interface for remote specialists, 3) backend system for data routing, intelligent analysis, quality control and auto-flagging of health hazards, 4) network of “remote” medical specialists, and 5) service quality control through regular monitoring and supervision.
By providing the technological eco-system, we enable local clinics and even micro-entrepreneurs to disseminate the model where it is needed most, allowing market forces to determine demand and speed growth throughout the developing world.
People are becoming more socially responsible, and want to be up-to-date with news about social change and impact. Plus, they are self organizing in online and real world communities to work together and bring change.
CBC (Change Broadcasting Channels) allows users to select channels of social change, and receive instant news about these channels on a mobile phone through SMS or twitter. Every channel has a community of subsribers that use the community tools to promote and share big stories and events. create momentum to find solutions to problems and trigger change.
Today there are a few barriers to getting instant access to socially relevant news:
· Relevant news needs to be obtained from sites dedicated to socially responsibility.
· Most of these sites have information from blogs and RSS feeds. Very few if any, have information from global news wires.
· These sites by nature offer a pull-based model, rather than an alert-based one where the user is notified of any news of interest as it happens.
· The user does not have much flexibility in choosing the news they want to track.
The idea of Change Broadcasting Channel is to create channels of news about issues of social change, and the endpoint for these channels is your mobile phone. Twitter serves basic phones with only SMS functionality. Flurry serves phones with a data plan.
A user can subscribe to an existing channel or create their own, based on a set of keywords.
Each channel has a community which is the group of subscribers to the channel. And this community gets triggers (the SMSes/twitters from a river of news) that create momentum, driving them to address their cause.
CBC will also integrate with http://www.groundreport.com to bring real user-reporting on channels mixed with mainstream media news from Daylife.
Change Broadcasting Channels will change the world by instantly informing socially active individuals of news of their interest, eliminating any delay in action. These users are part of communities where they actively use the modern tools to bring out the most relevant stories and issues and cultivate a discussion to find solutions.
Question Box gives rural populations access to the internet and information, even if they don't have computers or bandwdith.
The concept behind Question Box is simple. It's an all questions answered service where people call or SMS a given number with a question about anything, speaking in their local language. Using a pre-populated database and the Internet, Operators look up the answers to the users' questions and answer them, translating if necessary. The service works for any type of information, no matter how broad or focused.
Question Box brings the power of the Internet to people who prefer speaking and listening. It takes advantage of the explosive growth in mobile phone use, while recognizing that sucessful bottom of the pyramid technology needs to be simple, intuitive, and fun.
Question Box brings information to people who are likely to never get on the Internet. It requires no literacy, and can be accessed anywhere. The advent of the Internet brought about enormous, unexpected changes. We aim to bring some of that same power to people who currently have tremendous difficulty in accessing information.
The Question Box integrated software platform (SMS, Voice, Web) will be licensed to organizations. It will be open source with an optional service contract for deployment and implentation.
This work is licensed under a Creative Commons Attribution 3.0 License.
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