Community Health Worker Leaders at Bayalpata Hospital Achham, Nepal. Photo by Lewis Feuer
When you see communication gaps through the eyes of a community-based health worker, it makes sense to use lowest-common-denominator mobile infrastructure like text messages, ordinary $15 phones, SIM apps and off-grid electricity. We’ve used these tools to support maternal and child health, immunization programs, HIV and TB, infectious disease surveillance, malnutrition programs, family planning, and reporting general health service statistics – and we’re interested in exploring new areas.
Rather than focusing on specific health verticals, we’re focused on finding the right kinds of partner and use cases. Our best partners may not have any experience with technology, but they are providing high-impact health services in a challenging setting, and they have a clear sense of communication gaps that affect their work. They tend to be opportunistic, and interested in using existing software applications rather than reinventing the wheel. With each potential partner we discuss established opportunities for impact using mobile technology, the impact per unit for our proposed intervention, potential for scale, the role of human centered design, local ownership, and our partner’s ties to their community. If your goals aren’t a good fit for our niche, we’ll let you know – we’re happy to refer you to other technical organizations in the mHealth community.
Most of our partners hire us out of an existing budget or co-apply with us to a new contract or grant, but we also maintain a few innovation sites with outstanding, low-budget partners whose extreme flexibility and deep community insights enable us to innovate long-term. We’ve guided more than 30 mHealth projects from concept to impact, typically emphasizing the following core services:
Human Centered Design
Our approach to mHealth prioritizes program participants and interactions; we sketch complex service workflows to shine light on the perspectives of individuals with distinct roles. We design familiar technologies and services, taking care to document the existing workflow and maintain aspects of it that already satisfy participants. And we value iteration – ensuring each initiative builds on past work and undergoes multiple revisions before being delivered at scale. By emphasizing familiar technologies, work contexts, and the perspective of participants, we help our clients think holistically about health system strengthening. Our approach draws on a methodology called Human Centered Design.
We help our partners make sense of the pros and cons of various communication channels, including ordinary text messages, structured SMS or TextForms, USSD, email, SIM Apps, J2ME apps, Android, hosted and distributed web applications. We also keep tabs on free and open source software and help our partners understand which tools could work for a particular program. We’ve worked with a growing toolkit of software applications and tested dozens of others. We generally like using software developed by other organizations, but we’re opinionated about when and how. There really is no substitute for practical, on the ground experience with more than 30 organizations in 18 countries.
When we talk about partnering with NGOs, Ministries of Health, and grassroots clinics, training is the core of what we actually do. Broadly, this means sharing our perspective and written resources that structure our approach to planning, deploying and monitoring mHealth interventions. Specifically, we introduce partners to procuring electronics hardware and software, train program managers or IT staff to install and maintain software locally, train community health workers to use phones and exchange messages, train program managers to become trainers of future groups of health workers, and help managers see how monitoring technology projects is similar to and different from monitoring health services in general.
Often this means directly managing a new mHealth project as it gets off the ground, but the goal is always to quickly share responsibility with local staff. We’d rather stay in touch than stay in charge.
We aim to be able to support most mHealth projects using generic, flexible software applications that do not need extensive project-specific customizations by software developers. That said, our software team is working on a carefully curated log of feature requests, and our partners often budget time for software development so that their priority features can jump closer to the front of the queue.