Providing low-cost access to real-time health data

Providing low-cost access to real-time health data

In July 2003, Lee Jong-Wook, then director-general of the World Health Organisation said: "To make people count, we first need to be able to count people." Yet approximately 40 million people in developing countries are born or die every year without any official record.

Records of births and deaths may make two vital statistics but they are the bookends of a lifetime of missing health data that undermines development decision-making every day. Yet over the past decade, the global spread of mobile phone networks and cheap handsets stands out as an under-utilised means to transform the collection of vital statistics and development meterics.

A mobile phone in the hands of a semi-literate midwife in rural Sierra Leone becomes a means to regularly communicate the number of births and infant deaths in her community. For the WHO's global polio eradication initiative, mobile phones can replace paper forms to monitor coverage and manage stocks. In both cases a software programme, Magpi, makes this data collection possible even in the most remote and poorly resourced areas.

Previously named EpiSurveyor, DataDyne's Magpi uses what chief executive and co-founder Joel Selanikio describes as the Gmail model. "Our target audience for Magpi is regular people. We are following the model of the web applications that we all know and love – Google Maps, Yahoo, Facebook, Flickr – that provide great free functionality."

The US-based company has a 10-person team, with programmers in Kenya. The software is offered on a 'freemium' basis: free for those who want a basic service, and fee-based for those who want more customisation. Designed to be as easy to use as Facebook, it creates surveys administered on mobile phones across the technological spectrum, from smartphones to a basic Nokia with a Symbian operating system to a $10 (￡6) no-name handset that can only send data via text message.

Since 2005, 20,000 users (10,000 in the past year alone) in more than 170 countries have used Magpi for data collection, either for free, or for a fraction of what it would have cost for them to develop custom data collection software.

The International Rescue Committee (IRC) uses Magpi on between 40 and 60 projects at any given time. It started in 2011 in Kenema, Sierra Leone with a pilot of 60 of its 3,400 integrated community case management programme health workers. They used basic Nokia handsets to send weekly birth and infant mortality statistics from their practice. IRC paid DataDyne to make Magpi usable on the most basic of mobile phones, and in turn this function then became available to all Magpi users. The IRC project continues and has since been replicated in Congo, Liberia, and Somalia.

"Real time reporting allows us to observe mortality trends and to respond immediately," says Paul Amendola, IRC's technical adviser for health information systems. "We are able to get real time valid data in from rural far flung places with very little work to get it."

The pilot project gave valuable insights. Training times depends on the extent of existing technology: in Sierra Leone the community health workers, already familiar with mobile phones, were up and running in a few hours. In Congo, training had to start from the very basics.

The solar-powered chargers that IRC bought to keep the phones going turned out not to be robust enough, but the health workers then came up with their own solution: a few cents of extra phone time credit could be traded at the village store for charging time. Similarly, adding a small amount of extra credit for the health workers' own personal use ensured that the handsets stayed with them, and were looked after.

Literacy can be challenge, but it does not automatically equate to innumeracy. "Some of the health workers couldn't write down the numbers we wanted them to send but they were perfectly able to text numbers into a phone keypad. To understand that relationship between literacy and numeracy you have to observe that for yourself," says Amendola.

The same is true for mobile coverage. While an area may be marked on a coverage map as unreliable, on the ground there was generally a solution. "There was always someone who knew one place, such as a particular mango tree, where you could get just enough signal to send an SMS."

"Mobile data collection is not a catch-all solution but it gives an incredible advantage to collect vital health data that is normally inaccessible," says Amendola. "Mobile phone projects have a lot higher success when incorporated into existing health projects."

With the benefit of this software so seemingly apparent, why is it's use not more widespread in development or humanitarian work? Selanikio says the problem is not a technical one, but rather reflects a flaw in the NGO funding model: some organisations that work on a use-it-or-lose-it budget model are not at all interested in low-cost solutions. "In international development almost every organisation is designed to promote solutions where they spend hundreds of thousands of dollars to develop their own systems with almost no incentive to create something that lasts longer than a pilot project."

"The first one to sign up for the paid version of Magpi was JSI, one of the biggest recipients of USAid contracts, then Abt Associates, and Management Sciences for Health – all of them for-profit organisations. Why? Because it saves them money," says Selanikio.

Still for many of the organisations using the software enables them to collect data that was simply impossible to gather in any meaningful way before. For organisations that are comfortable with experimenting with technology, services like Magpi allows them to focus resources on programmes themselves, offering a low-cost, accessible means to monitor projects, better understand the target population and measure the impact of what they do.

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