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Article Insects, us & the future

How a basic mobile phone reinvents the house call

Photo: Medic Mobile equips community health workers in Africa, and around the world, to increase life-saving health care to the most under-served communities. Programs on basic mobile phones and devices help remote workers monitor symptoms, check on patients and send data to key decision makers. Credit: Medic Mobile. __

Toronto – From August 4 to 6, President Obama is set to host the inaugural U.S.-Africa Leaders summit in Washington, D.C. where officials will discuss trade, investment and democracy. One of the first sessions is titled ‘Investing in Health: Investing in Africa’s Future’ where the White House Press office says attendees are scheduled to “envision” ways to improve health in the region. They’d be wise to take note of Medic Mobile, a small non-profit organization, which is getting international support, for its markedly positive impact on health outcomes in Africa, and around the world.

Despite work toward achieving the Millennium Health Goals, sub-Saharan Africa still has the greatest burden of child and maternal deaths worldwide: 10 to 20 percent of children die before reaching the age of five, and as many as one in 38 women will die of complications related to childbirth (by contrast, a woman’s lifetime risk in the U.S., Canada or the U.K. is around one in 4000). In many areas, Africa has halted the spread of HIV/AIDS, tuberculosis and malaria. Still, every day, there are multiple deaths from these treatable and preventable conditions. The health session attendees are sure to discuss strategies to counterbalance the area’s enduring health inequity.

While many African communities have limited medical resources and shortages of skilled workers, they have access to a mobile signal like 95 per cent of the world’s population. Medic Mobile jumped on this reality to improve health in the world’s most under-served communities. A team of developers and outreach workers help create web and mobile tools to increase life-saving health coverage using basic mobile phones and devices. Medic Mobile’s users are an army of mainly local volunteers—community health workers, caregivers, patients and families – who can monitor symptoms and medications; stay in touch with clinicians; send emergency alerts; and convey critical data to decision makers. Medic Mobile also partners with clinics, doctors, nurses, ministries of health and non-governmental organizations to determine if and how mobile and web technologies could be used to improve health care.

“We only design new tools when they’re needed, and we design for our users. We believe that the only way to unlock sustained impact is to put users at the centre of the whole process,” said Josh Nesbit, CEO, Medic Mobile.

In the seven years since its inception in Nesbit’s Stanford dorm room, Medic Mobile’s reach has crossed 20 countries. Its tools support 8,000 front-line health workers and serve approximately six million people.

The product development process involves projected users participating from the very start. They are part of the idea generation, research and planning process.

“Our human-centred design approach alleviates some issues that you would face later down the road,” said Jacqueline Edwards, the Atlanta-based director of partnerships, who recently joined Medic Mobile after three years with the Centre for Disease Control and Prevention and its foundation. “We don’t engage unless someone is committed to iteration and to really testing the system.”

This approach has created products that focus on malaria treatment adherence; improving immunization rates; antenatal and postnatal care; infectious disease surveillance; reducing the stigma against mental health; and preventing malnutrition.

In Liberia, Medic Mobile works with Last Mile Health to deliver community-based newborn and child health services. In Kenya, Medic Mobile partnered with Kilifi Kids and the Ministry of Health to train 450 community health workers to register women as soon as they become pregnant to ensure regular antenatal care visits. Last year in Malawi, 75 community health workers used mobile phones to relay symptoms of rural patients, doubling the number of people found to have symptoms of tuberculosis and who were referred for treatment. The 1,300 text messages saved time-strapped hospital staff over 2,000 hours in follow-up time and $3,000 (USD) in fuel.

Medic Mobile’s measurable success has attracted the attention of foundations and corporate grants, which support its $1.5 to 2 million (USD) in annual costs for research and product development. In the spring, Medic Mobile won the coveted the $1.25 million Skoll Award for Social Entrepreneurship, distributed by the foundation started by Jeff Skoll, the former first president of eBay turned philanthropist.

“These are not lifetime achievement awards,” said Sally Osberg, President and CEO of the Skoll Foundation. “These are bets on the people who will create better futures for millions.”

Medic Mobile plans to reach its first million by 2020. By the end of this year, Nesbit says Medic Mobile should equip 20,000 community health workers with mobile tools. He says for every community health worker supported, at least 100 families are connected with, talked to, or checked up on. These workers are trusted members of the community who, according to like-minded organizations like Partners In Health and 1 Million Health Workers, are key players to ameliorating Africa’s health woes.

“These remote workers are the touch point for a billion people who will never see a doctor,” said Edwards.

According to Nesbit’s calculations, if Mobile Medic can reach 200,000 workers by 2020 that will be the tipping point in helping one million people. The growth would be exponential from there. But without support, these workers would very likely remain well intentioned but struggling community members. That’s exactly what Nesbit witnessed seven years ago.

In 2007, Nesbit, then a pre-medical undergraduate student at Stanford, spent the summer working in a hospital in rural Malawi. He observed patients walking up to 160 kilometers to see the hospital’s single doctor and community health workers walking over 50 kilometers to deliver reports by hand. He also observed stronger cell phone reception in the Malawian rural village than back home in California. Josh returned to school mulling over inefficiencies in the system and its delivery. He shifted his focus from medicine to mobile health. Medic Mobile soon took shape.

“I can’t imagine a just world where everyone is covered by cell phone coverage and not vaccines,” said Nesbit.

“What we’ve developed in the last 100 years – preventative medicine and treatments – can double life expectancy in these areas.” He says designing a system with the community health worker at its core is a new and sustainable model of how health care can be delivered. And using mobile and web technologies is one way to do it.

Medical professionals in the participating African districts agree.

“You have a picture of what happened in all of the facilities that you’re monitoring. Something that could take you one month to analyze can actually be done in a single day,” said Augustus Lugo, acting district disease surveillance coordinator, Kilifi County, Kenya.

Medic Mobile helps health care workers monitor the stored medication. Thousands of dosages of temperature-sensitive vaccines can be ruined if the power goes out one night after a clinic closes. In reaction to this, Medic Mobile partnered with Nexleaf Analytics to monitor the temperature of stored vaccines in Kenya. Whenever a refrigerator dips or rises outside the required temperature range, the phone sends an SMS alert to local clinic staff so they can take immediate action.

“Before this system, I would sleep very bad. Nights I would not know if the vaccines were okay. Now, I receive an alert, and I fly out of bed to fix the fridge. I sleep like I know everything is okay,” said Sharlet Anzazi, a nurse at Kenya’s Mnaroni Health Center.

Medic Mobile’s impact attracted the attention of Sal Khan from the Khan Academy and Premal Shah of Kiva Microfunds.

These social entrepreneur powerhouses are only two of dozens of minds behind Fast Forward, the accelerator for non-profits using software to improve the world. In May, Medic won a place in the three-month summer program, which includes mentorship, training, networking and a $25,000 (USD) grant.

Grants like these are essential to Medic Mobile, which prides itself on being free and open-source, which means that any programs created by the organization are shared openly on the web for other groups to study and benefit.

Like Open Medicine and the Mozilla Foundation, Medic Mobile believes in the open knowledge economy.

“Any learnings should be shared not held tight as differentiating business intelligence,” said Nesbit.

While Medic Mobile certainly balances its humanitarian outreach with digital innovation, its staff emphasize that technology is not a panacea.

“We know from working with many partners that the technology piece is just a tool, not the solution,” said Toronto-based Marc Abbyad, product manager, who says the best thing about his current role is working with talented and driven people worldwide who are motivated by social impact, not financial reward.

“Instead of seeing ourselves as a tech company, we sit with the community health worker,” said Edwards. “Every project we go into is designed from the ground up and the community is part of the process. That’s very unique for development or design programming.”

In July, Medic Mobile announced its new tagline ‘We are all health workers’. The phrase was adapted from a meeting Medic Mobile’s Africa regional director had with Liberia’s Minister of Health earlier this year. They discussed how anyone, from fundraisers to nurses to surgeons, who contributes to health equity is determined to be a health worker.

“Our goal is health equity and human rights and includes anyone who is helping to further that goal. A lot of people identify with social justice through medicine,” said Edwards.

Medic Mobile puts health workers front, center and at the core of their mission. If only the ministers and President Obama would consider this approach when envisioning Africans’ health and the region’s future at the August summit. Medic Mobile, a 30-member team, has shown what happens when you put such a vision in action.

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