How Mobile SMS Saves Lives in Africa | Josh Nesbit, Co-Founder of FrontlineSMS Medic

By | March 18 2010 | Comments (0) | Trackbacks (0)

In this week’s interview, Josh Nesbit, Co-Founder of FrontlineSMS Medic, shares the behind-the-scenes story that inspired him to start FrontlineSMS Medic, an international organization that uses mobile technology to connect health workers in rural communities in developing countries.

The service, now deployed in ten countries, saves community health workers’ time which allows them to treat more patients, saving countless lives. In Malawi alone, FrontlineSMS Medic has saved clinics $US 3,000 in fuel, 2,100 hours of travel time, allowing clinicians to identify and treat two times the number of patients infected with TB. Check out the video to learn more about FrontlineSMS Medic, its business model, and impact around the globe.

Thank you Josh for taking the time to meet for this video interview.

The Full Transcript

Katrina: So here I am with Josh of FrontlineSMS Medic. First of all, thank you so much for joining, and can you share, what is Frontline?

Josh: Sure. So FrontlineSMS is a free and open-source platform that enables large-scale two-way communication using only a laptop, a GSM modem, and a phone and a GSM signal. So you don’t need the internet. It was created by Ken Banks to allow any organization anywhere to get an SMS hub up and running.

I met Ken a while back. I was a student at Stanford and it made a lot of sense to apply that software to rural health care. We had a very successful pilot in Malawi and it became clear that there was demand for these tools and that it needed to be rolled out.

So we co-founded this non-profit, FrontlineSMS Medic. Our core competency is really in connecting remote community health workers and remote staff to central clinics. But we also do disease surveillance and most recently we were involved with emergency response efforts in Haiti.

Katrina: Fantastic. How did you get FrontlineSMS Medic off-the-ground? You mentioned you were in Malawi. Can you share a little bit more about that story?

Josh: Sure. So I was sure I wanted to get my medical degree. I was gung-ho on the pre-med track, and shipped off to Malawi to this rural hospital and worked in an HIV clinic, and more than anything, had conversations with clinicians and community health workers (CHWs) and these CHWs were walking thirty, sixty miles to deliver messages on patient statuses. And I had better cell reception in rural Malawi than I did in Washington, DC or San Francisco. It was clear that we could harness this expansion of the GSM networks to help coordinate care.

We basically applied for a very small public service grant, enough to get a hundred phones, a laptop, and a plane ticket back to the clinic, and basically turned the tools over.

Katrina: Had you used the FrontlineSMS platform previously before this trip?

Josh: No, FrontlineSMS was brand new to me and was brand new to the home care-based nurse at that clinic. Alex had never used a computer in his life. And after three hours of hashing around on Frontline he was off and running himself. So that’s a huge testament to Ken’s software.

Katrina: That is amazing. So, it sounds like it’s pretty easy to implement – if you only need three hours of experience without and computer background.

Josh: With these initiatives, local ownership really is key. So the level of tech support needed has a direct impact on the success of a project long-term, and also locally on the ability of people to innovate.

Katrina: Did you find that there were any glitches or challenges along the way when it came to implementing this in the field?

Josh: There were a lot of challenges. And the challenges really, it’s not the technology that’s the challenge, but making sure that the process is right. I think that once the word is out about these tools, lots of people rush to choose a product or a tool, or even choose a technology, and then try to implement it.

We found the most success when you start with the need and the requirements from people who actually know them. And then toss it over to us at that point to ask questions about cost and feasibility.

Katrina: When you’re having these conversations and talking about what the community needs, do you then customize the platform to fit those needs?

Josh: There’s an intense customization about the programs and the actual implementation design. At the same time, I think you mentioned implementation strategies. And really, what we’re seeing is that there are two paths to scale. I mean, there are multiple paths, but the two we think we have the best shot at are sort of a horizontal path and a vertical path: horizontal being what we’re calling community projects where we have a downloadable field guide for a particular use case that communities and clinics and one-off implementations that can take those materials and get going themselves. But then there are also team projects where our core staff are involved and we’re working with massive NGOs that have massive networks and want to implement at scale with resources from the U.S. government and others. So that’s sort of a two-part strategy.

Katrina: It’s incredible to hear that you made the transition from pre-med student to engineer and entrepreneur, how did that happen?

Josh: Well, I’m not an engineer and I’ll be the first one to say that. I’m very much a softie with techie friends. The tech isn’t that complicated, right? And I don’t know or not if we’re technically digital natives, but we grew up texting and we grew up using wi-fi.

Katrina: I was recently in South Africa and Swaziland, and a lot of people were using Facebook on their phones. How do you see people using social networks, social media, and mobile phones together in places like Africa and other developing countries?

Josh: Facebook has told us one thing: it’s that when the web is available it will be used for social networking. Period. And I think that once the mobile web hits, wherever it hits people will be using it for social networking.

There’s sort of a strange tension for us because there are different groups of people who meet, right? You have NGOs and implementers, clinicians, and people who want tools that work today and tomorrow and they want to get it out there and they want to help serve people better.

And then you have technologists who meet and want to talk about what will be available in how we can plan for the tools that will be available in five years. And I shuttle between those two groups. And there’s a disconnect of sorts. And so we’re trying to straddle that and we’re trying to make sure we’re implementing what works right now with existing infrastructure and that means SMS. And that is the lowest common denominator right now.

Katrina: What has been the impact of the implementation to-date with FrontlineSMS Medic? How many people have you served? How much does it cost?

Josh: We’re working in ten countries mostly in sub-Saharan Africa, but also in India, Bangladesh, Honduras, and most recently, Haiti. We started off in Malawi, and the best impact analysis has been done in that first clinic in Malawi. It’s costing the clinic about $US 300 for six months. And, we’re not talking about the start-up costs or my flight to Malawi. We’re talking about the operational cost that the hospital is absorbing. And that’s the number of cents per text message. We saw some really exciting outcomes. For the first time ever they were collecting ARV/HIV and TB drug adherence records. And they were collecting symptoms, and there was a really exciting case finding mechanism that was put in place where CHWs (community health workers) could text in that a community member was having a chronic cough. The TB officer would go out and take a sample, get back to the clinic, and run it, and if they needed to be started on meds, the officer would send a follow-up text message. And they actually doubled the number of patients in their TB program in six months with that very simple feedback loop. So really it was about connecting people.

They were able to do simple things like shift their HIV and TB and home-based care follow-ups to SMS. And that saved them roughly $US 3,000 in fuel, around 2,100 hours in travel and work time in about six months. So, it’s a realization that we’re building tools rather than solutions has been something that I think has resonated well with our clinical partners. The idea that once you parit these tools with end users, then it becomes a solution – when people are actually using these tools out in the field in the way that they want.

Katrina: Wonderful, thank you so much Josh. And best wishes with HopePhones and FrontlineSMS Medic, and everyone can find you on the web at?

Josh: HopePhones.org, medic.frontlinesms.com. And we’re all over Twitter, you can find me @joshnesbit. You can find us @smsmedic or @hopephones.

Katrina: Wonderful, thank you so much Josh.

Stay tuned for Part II next week in which Josh explains the difference between FrontlineSMS, the platform developed by Ken Banks, and FrontlineSMS Medic, a spin-off of the umbrella Frontline platform. Also, learn about other niches being served by Frontline, including Frontline: Credit for microfinance.