Village health workers learning to use their new phones. © Josh Nesbit, FrontlineSMS:Medic

Charles Howes, PIH Development Assistant

A pilot project using cell phones and open-source software cuts the miles between patients, village health workers and health clinics.

Village health workers (VHWs) are the backbone of Partners In Health's comprehensive health care model in Malawi. They visit patients daily, walking with them to the clinic, supporting them in the community, and getting them to the health center if there is an emergency. Frequently, hours of travel separates patients, VHWs, clinics, and doctors. A new pilot project at Abwenzi Pa Za Umoyo (APZU), PIH’s sister project in Malawi, utilizes cell phones, an inexpensive laptop, and free software called FrontlineSMS to create a direct communications link between the clinic, VHWs and ultimately, the patients.

FrontlineSMS is free, open-source software that enables two-way communication between groups of people using text messages. A team of students and recent college graduates have adapted the software for medical use in a resource-limited setting and they have formed an organization called FrontlineSMS: Medic. This past August, Josh Nesbit, the Executive Director, traveled to Malawi with funding from Stanford University (his alma mater) to assist with the implementation of a pilot project. He arrived with 130 cell phones, an Acer laptop, and a GSM modem that enables a computer to send and receive text messages over a cellular network.

In Neno, 130 VHWs selected for the pilot were trained on how to use a cell phone to send and receive text messages. In addition, select clinicians, data clerks and VHW coordinators were trained on the FrontlineSMS software.

For evaluation purposes, the staff at the Neno District Hospital is using the system to follow up with patients listed as defaulters. Defaulters are patients who have either missed their doctor’s appointment, or who may have run out of medicine. Every Monday, Dyson Likoma, APZU data manager, generates a report with a list of patients. The report is checked for accuracy and then text messages are sent to the VHWs responsible for the patients needing follow-up. The VHWs then visit their patients and send a text message response with their patients’ status, typically within 24 hours.

Traditionally, when a patient misses an appointment, a staff member from the clinic is dispatched on a motorbike to try and find the patient's VHW. To maintain high patient follow-up, clinic staff must dedicate precious time and travel to reach the remote areas where VHWs and patients live. The introduction of FrontlineSMS has the potential to save staff time and enhance patient follow-up.

Evaluation of the pilot program will begin within the next week with teams tallying the number of messages sent and the types of responses received. In some cases, responses indicated that a patient did not need follow-up and they helped update the patient record stored in the EMR. While the pilot is limited in scope, room has been allowed for communication between VHWs and clinic staff to organically evolve, said Liz Bird, who helped coordinate the project for APZU.

FrontlineSMS: Medic partners with an organization that refurbishes used cell phones in the US and sends them out to the pilot programs. They collect cell phones through a donation campaign called, Hope Phones.

Learn more about FrontlineSMS: Medic.

Liz Bird and Evan Waters of PIH Malawi contributed to this piece.