As I see It (AISI) Texting Really Can Save Lives
I am the mother of a teenager, living in a text-obsessed world of communicating by “LOL, OMG, and 2GTBT.” I even have to admit that I’ve succumbed to the ease of texting “IM outside” when I arrive at school to pick him up---or more frequently “Where R U?” Hmmm. What’s up with that? So it brought joy to my heart when I visited the Knowledge for Health (K4H) Learning Center in Salima, Malawi and experienced texting in a whole new way---in a purposeful way---better yet, in a life saving way. The best part is that K4H is truly “owned” by the Ministry of Health’s District Health Office (DHO). And with ownership---comes action and results! Sure, this empowered Ministry receives technical support on the ground from Management Sciences for Health, funding from USAID, and is based on an open source platform from Frontline SMS Medic, but the Ministry owns K4H because they see it work every day.
Here’s what I heard from the mouths of volunteer and professional health workers using the K4H system: “Texting works. Texting saves lives. Texting improves health services.”
K4H trained and put cell phones in the hands of 85 volunteer community based distribution agents (CBDA), 170 health surveillance agents (HSA), health center based directors, and District Health coordinators (specialists in family planning, HIV, TB, etc). The team is linked through a server, “the hub,” which is housed in the K4H Learning Center at the District Hospital. (I mention team because the District Health Officer, Florence Bwanali, believes teamwork has been a critical factor in their success.) When a patient/client presents themselves to the community service providers with complex symptoms, the service providers text the symptoms to the hub. If the text starts with FP---then the server automatically forwards the text to the district family planning coordinator, in this case Elizabeth Chalera. Elizabeth can either text or call the service agent right back with instructions on how to treat or where to refer the patient. The original text is also forwarded to the local health center so they are aware that a patient with complications may be headed their way.
To truly appreciate the effectiveness and efficiency of the K4H system, we have to understand the context. Salima is a community of 350,000. It has one doctor who works in the only district hospital. That’s right- 1 doctor per 350,000 people. OMG! Nineteen health centers are linked to the hospital, and they each oversee up to 30-40 health service agents (trained in basic community health issues) and community based distribution agents (volunteers who are focused on family planning and HIV). HSAs live and work in what Malawians call hard to reach places. Think mountains. Think bush. Think 3 hour walk to the nearest health clinic.
The benefits of this mobile system are countless. Texting allows community service providers to treat people close to home, right in their village-- preventing the risky and costly trip to the health center. Texting reduces traffic at health centers allowing the nurses and clinical officer to focus on the neediest cases. Texting puts the district hospital in direct contact with the frontline community service providers. Texting feeds the emergency response system. Case in point: one service agent’s text alerted the District Health Coordinator to a measles outbreak. In response the DHO immediately sent a team to identify the breakdown in the immunization program. Texting improves the quality of care of Malawi’s poorest people---those living in rural communities. Texting ensures a quick response and builds the credibility of and trust in the system and the people who make the system happen. Service agents feel empowered, and get satisfaction from giving good care.
Blessings Makono, a HSA for 14 years, said K4H has helped him provide better service to his community because he has greater access to clinical advice. “One mother brought her 5-year-old daughter to me because the little girl had heavy breathing, swollen cheeks, was vomiting, and lethargic. Before I got my cell phone, I would have referred this family immediately to the health center.” The mother would have had three choices: carry the child on her back for the 6 hour round trip walk, find a bike, or pay an expensive fee for a ride. “But because I could quickly text my clinical question through the hub to the district health coordinator, I received instructions to give the child the antibiotic Cotrimoxazole, and send her home.” This simple text saved this family a risky and expensive trip to the health center; eliminated an unnecessary visit, freeing the nurse’s time for more serious cases; strengthened the relationship between family and community service provider---and kept this little girl AAS (Alive and Smiling)!
At the time of the original post, Julie Barrett O'Brien was the Vice President for Communications and Knowledge Exchange at MSH.