Commoditization of Mobile Based Data Collection

With the growth and maturation of XForm authoring tools and mobile clients like ODK (my choice for best/most important mobile tool in 2010), it’s getting increasingly easy to do robust mobile based data collection.   In 2011, expect the focus to shift towards building out web backends that provide support for unified data collection (Xforms, SMS, USSD, IVR) with greatly improved analytic and reporting capabilities.   As a result, expect to see a lot more turnkey tools/services similar to EpiSurveyor.org.  I wouldn’t be shocked even to see Google offer something in this space.

First Steps with IVR

Focus will start to shift from SMS to IVR as mHealth programs expand from service providers to beneficiaries where literacy is a lingering concern.  While ODK Voice shows a lot of initial promise and Freedom Fone continues to be worth a look,  there remains a lot of room for a new open-source tool in this space.   My guess is that it’ll be built using FreeSwitch (not Asterisk) to support a local webservice offering similar, albeit more limited, functionalities to Twilio or Voxeo.

REST APIs for OpenMRS

If you’ve ever developed an mHealth application, you quickly realize you really don’t want to build your own medical record system.  Things get complicated very quickly which is why the existence of platforms like OpenMRS is a very good thing.   OpenMRS, however,  has been strongly hindered by a lack of  web API’s which makes building applications upon it difficult.  This in turn has greatly limited the scope of how OpenMRS has currently been used.  REST APIs are on the road map for v1.9 coming later this spring.   With robust APIs, OpenMRS should be more accessible and flexible as a platform and in turn greatly expand it’s community of users.  Until then, I like many potential users, will continue to dip my toes in the water despite wanting to dive in.  If by 2012, I’m still waiting, I’ll probably start looking for a new swimming hole.

XForms and CouchDB

Expect to hear this combo increasingly.  They just make a lot of sense together.

Direct to Client Services First  to Reach Scale

Direct to client programs that incorporate SMS, USSD, IVR and “Please Call Me’s” could start to reach scale in 2011 that could reach into the millions.  Groups like  Text to Change and the Praekelt Foundation are starting to receive the funding necessary  to bring their approaches to the masses.  If positive impacts can be shown at scale, we’ll see rapid growth as donor’s jump into this space.

Building Block Webservices

There will continue to be a lot of talk around the need of an “enterprise architecture” in mHealth.  While good, I think the growth towards this will be organic in the form of common web services that will attempt to bring order to the increasingly fractured mHealth ecosystem emerging in many countries.   This would include services like a central mother and child registry providing each beneficiary a unique ID allowing them to be tracked across the health system.  I’m not sure such a service could be built or deployed by the end of 2011 but the realization for the need of such a service will likely grow.

Community Health Platforms

Expect to see a lot less discussion about the differences in particular platforms (CommCare, ChildCount+, FrontlineSMS:Medic, Mwana, MoTeCH) and a lot more on more discusion on content and methodologies.   In terms of functionality and to some extent underlying technology, many elements of the different platforms will converge.  As the tools improve, the challenge really shifts to figuring what works and what doesn’t and how can technology best be used to create value.  As a result, the realtime sharing of experiences, like on the incredible ICT4CHW mailing list, will only grow more important.   Groups like Tiyaten Health, with little current technical knowledge but a lot of domain expertise,  will become increasingly key to demonstrating mHealth success.

Functionally and technically, expect to see a lot of work done to strengthen the link between clinic and CHW programs to close the loop on things like referral tracking.  Tools like ODK Clinic and Bhoma linked to an OpenMRS backend (pending APIs) will really drive this.

This year’s Ushahidi?

It’s hard to imagine a breakout project capturing the public imagination like Ushahidi has this year (even though I think the iHub is the bigger innovation).  To me there are no clear or apparent frontrunners.  Perhaps 2011 is meant to be more incremental.

What has me most excited is Shreddr, a project created by Kuang Chen, a PhD student at Berkeley.  What Shreddr allows is to take a picture or scan of a filled out form and shred into individualized data components representing individual parameters of that form.  These form elements can be combined with OCR and presented in a way that changes the dynamics of digitization of paper forms from data entry to data validation.    Furthermore, since the forms are shredded, forms containing sensitive medical records could safely be farmed out in the form of microtasks for a local CHW or retiree sitting in Iowa to complete.

This year’s mHealth?

ICT4Ag.  Mobiles have tremendous unexplored potential to improve the livelihoods of small scale farmers.  Applications like Kilimo Salama show the use of mobiles is not just limited to providing market price information to farmers.  As for me, I’m going to be shifting some of my thinking in 2011 to farms.  They are a lot easier to count and don’t move around!

This recognition would not have been possible without the support of an incredible community of innovators, activists and friends whose passion and commitment to their work is not only an inspiration but important as their thoughts and actions are changing the way we think fundamentally about problems and how we can address them.   It’s amazing to work in a community where open-collaboration and sharing ideas take precedence to personal accolades and where each other’s work, successes and even failures are celebrated. Whatever we accomplish, we do so standing on the shoulders of friends.  I hope you see this recognition, as I do, as an incredible validation of our work.

I would like to take this opportunity to congratulate and thank my colleagues at MVP, many of who form the basis of the ChildCount+ team.  Are work has just begun but your demonstrated dedication and expertise hold the key to realizing this project’s potential.  In particular, I have the great fortune to work with Patricia Mechael and Andy Kanter, both pillars in m+eHealth respectively, and to whom I owe a great deal for their mentorship and guidance.  As our project continues to grow, I am incredibly excited to work with people such as Bennett Nemser and our talented Health and CHW team who bring the understanding and attention to this project that is needed.

As a former programmer, I need to thank our core development team of Renaud Gaudin, Dickson Ukang’a and David Gelvin who make all this possible and who I recognize will never get due credit for all they contribute. Through Renaud, the spirit of Geekcorps lives on in his organization Kunnafoni, and he is largely behind the success of the Rural Technology Lab which represents such incredible promise.  Lastly, I would like to thank the Sauri Health team led by James Wariero, who took a rough idea and forged it into a working model. I would also like to pay particular tribute to community health care workers who represent the best investment we can make, bar none, to ensure a community’s health.

Projects like ChildCount+ are possible because of RapidSMS and it’s incredible community, at the heart of which are Chris, Erica, Sean, Terra, Seth, Merrick, Malthe, Adam and Evan and the rest of the UNICEF Innovation Unit who are to me the definition of selfless collaboration. Jonathan Jackson and its incredibly talented crew at Dimagi (Cory, Dan, Rowena, Clayton) and others like Jeff Wishnie, Tim Akinbo,  Michael Benedict and Nic Pottier help make RapidSMS what it is and quietly work to demonstrate its potential.

We represent, however, only a small part of the picture.  One has to only look so far to the work of my colleagues with the Open Mobile Consortium (OMC) to understand this. My good friends Hajo and Bas’ work at Text To Change – was the first to convince me that a mobile phone could really be used to save lives, and Peter and his team with Cell-Life work to do this daily in fighting HIV in South Africa.  Neal Lesh of D-Tree and Dimagi have worked diligently to create CommCare another important tool to watch in community health.  Gaetano, Yaw and Carl out of the University of Washington have blessed us all with Open Data Kit, THE tool for complex mobile phone based data collection.  They have shown that you don’t have to be a project endowed with millions of dollars to release a world-class product.  Then there is Ushahidi (a project that no longer needs an introduction) that simply does things the right way; this is no surprise as it is a trademark of it’s co-founder, and personal inspiration, Erik Hersman.  Robert Kirkpatrick, who formerly helped lead the important work of InSTEDD, now as the director for GIVAS has the daunting responsibility of scaling our ideas to an important new level of scale. Last but certainly not least is Katrin Verclas of MobileActive of who sees where all this is going and is not afraid to drag us there if needed.

Ken Banks, Josh Nesbit, Ben Lyon and the rest of FrontlineSMS team deserve incredible recognition not only for their pioneering work but for building a community of EMPOWERED users that sets the example for us all to follow.   Joel Selanikio and the DataDyne team have not only made mobile phone based data collection easy but understand that for applications to achieve their potential they need to be Coded in Country.

For years, our friends at Inveneo (like TIER) have set the example of how to appropriately bring low cost and appropriate computing and connectivity to rural communities and is now playing a central role in restoring connectivity in Haiti.  Then there is the inimitable Wayan Vota (now with Inveneo) who works tirelessly to raise awareness to what matters and who also gave me my first shot with the Geekcorps.

So many more deserve recognition including the OpenMRS community, the pioneers of point of care — Gerry, Mike & Jeff of Baobob Health, Jørn and the OpenXData project,  eMocha, The Gather Project, the Grameen Tech and their MoTech project, the people behind the innovation labs and centers like AppAfrica (Jon Gozier), LimbeLabs (Bill Zimmerman) and iHub (Ushahidi). Ian Shuler of NDI who has helped pioneer the use of SMS in election monitoring and groups like Development Seed who are teaching us all how to make data look GOOD.   This is just a partial list and omitted are the people we don’t yet know — the teams of programmers and social activists in Africa, India, Asia and Latin and South America working to better the world around them.

In short, I feel blessed to part of this wonderful community.  If you want to learn more about this field, I would encourage you to contact anyone from this list, as they are all incredible ambassadors to our work.

Personal thanks go out to my friends and family for their support of the life I’ve chosen and Leigh for her continued belief in me throughout all of this. My schools Knox College and Thunderbird for an education that I will never take for granted, my colleagues and close friends Jess and Yanis for helping create an opportunity to test out my ideas early, and my supportive boss Vijay and brilliant team mates of the Modi Research Group and The Earth Institute – my home for the past three years.

Finally, I would like to remember Dennis Bilodeau, whose commitment to promote democracy and governance through better access to information in Mali is represented by the country-wide network of thriving community radios he’s left behind.  It’s the memory of people like him that help us get through the tough days.

In an earlier post, I covered the work of a Ghana inventor named Nana Owusu Acheampong who was using D-Cells and a custom made wooden battery holder to charge cell phones. On a recent visit to Bonsaaso, a small village about 100KM south of Kumasi, the great pleasure of meeting Mr. Acheampong and seeing first hand some of the projects he has been working on.

Cheap Chinese LEDs, which are pervasive in Mali, have not yet reached this part of Ghana so Mr. Acheampong and others have started to make their own LED light arrays powered by wooden box battery holders. Asked how he came about the idea for the battery boxes, Mr. Acheampong explained that observed his radio worked that way so he “took the power out of his radio”.

I’ll let the photos speak for themselves. It was a thrill to meet someone so truly passionate and excited by his own creations. He is exactly the kind of person who with a bit of support, access to better materials and little extra electrical training could help light up a community.

LED light made from MTN advertising and LEDs purchased from Kumasi.

Used CD helps reflect the light from the LEDs.

How Mr. Acheampong lights his room. He no longer purchases kerosene he claims.

Note: Rural Africa still relies heavily on disposable D-Cells for much of its energy. They are popular for their low purchase price, however, they are expensive on a $/AH basis and environmental standpoint. Thus, the idea of creating small businesses around rechargeable D-Cells intrigues me. It seems like an obvious idea but I’ve yet to see it done. If you know of examples of where this is being attempted please let me know.

One of the real highlights thus far at Maker Faire Africa 2009 has been the presence of William Kamkwamba. William is a remarkable young inventor from rural Malawi, who at the age of 14, built his first windmill out of scrap parts (including his father’s bike) after learning about one in a book.  William’s simple message of not letting your goals be defined by constraints is inspirational and resonated particularly powerful with the other African maker’s in attendance at Maker Faire.

Expect to hear more from William this year as he is about to release a book, The Boy Who Harnessed the Wind, which comes out September 29th. I expect it to be very popular as his is a story that particularly deserves telling.

To learn more about William and find out about his important work please visit: www.williamkamkwamba.com

I am writing this from Kisumu, Kenya.  I’m here to follow up on the progress being made with the RapidResponse Pilot and to work with Dickson Ukanga, a talented young Kenyan programmer, I just hired.

It’s been about a week now since the Seacom cable has come online and according to Dickson Safaricom users are already seeing the benefit.   Today, I also noticed for the first time that Mountain Dew, the drink synonomous to late night coding and considered by some code-junkies “an essential ingredient for successful computer programming“, is now available in shops at Kenya too.  Coincidence? I think not. =)

What encourages me is that African programmers increasingly have access to the tools critical to compete: cheap computers, good internet, solid computer science university programs, time to code and increased inclusion to global geek culture both actual through bar camps and symbolic with Mountain Dew.  Cheaper and faster Internet should also help translate into a larger market for local Internet based services critical for growing the African software industry.

I think it is time to be excited.   As the barriers to entry continue to tumble, the number of really good programmers coming out of places like Nairobi, Kampala, Accra and Dakar will only increase.   It will still take some time but at least but at least Africa is starting to overcome the infrastructure challenges that have choked ICT growth in Africa. It’s hard to train to compete when you are sipping through a straw.  The only thing ultimately inhibiting African programmers from making their mark on a global (and local) stage is hard work and brainpower.

That’s a bet I’m willing to take.

Note:

If you are interested in finding programmers in Africa please checkout this job board at:

http://jobs.whiteafrican.com/

I’m very proud to announce RapidResponse, a mHealth platform built with RapidSMS.  This is a project that I have been working to develop at the Earth Institute with Professor Vijay Modi in collaboration with UNICEF Innovation team and a number of other partners for the Millennium Villages Project.

The idea for RapidResponse originated from a conversation with Jessica Fanzo, an amazing nutritionist that I am lucky enough to work with. We spoke at length about a program called Community-Based Management of Acute Malnutrition (CMAM) that she was interested in implementing in the Millennium Villages.  At that time, I was increasingly involved with the UNICEF team on the development of RapidSMS. CMAM struck me as a great example of medical system that we could support with technology.  I wanted to avoid the trap of creating a use case around a technology that we were keen to deploy. As a result, RapidResponse was originally designed to provide support for the management of a CMAM program deployed primarily by Community Health Workers (CHWs).   It has since morphed to include support for malaria and diarrhea screening two other major killers of children under five in Africa.

What excites me most about RapidResponse, besides the impact I hope it will have in health, is that it begins to show us the full potential and range of application that an SMS based approach with server-side logic can provide.  RapidResponse is more than just data collection providing decision-tree based diagnosis support, workflow management, and core messaging services. It helps automate and facilitate and coordinate the activities of field based health care staff and supports a powerful alert system that has the potential to help reduce gaps in treatment.

RapidResponse is very much a collaborative effort between a number of groups and individuals who have all contributed tremendously to the progress made thus far. The UNICEF Innovations Team have been fully engaged with this project from the offset and have provided along with many other things generous programming support. Their continued engagement will be key to RapidResponse’s growth.  Also highly influential was the incredible work of a group of SIPA students from Columbia University, who showed that RapidSMS could effectively be used to monitor malnutrition in children in Malawi.   Working closely in particular with Ray Short and Sean Blaschke,  we incorporated the needs of their system and what we were developing for MVP into a single, unified malnutrition monitoring platform.   Special thanks are due to the MVP Health team and in particular to Dr. James Wariero and Saleena Subaiya who provided the on-the-ground insight of the how the system should work.  Jessica Fanzo and Roger Sodjinou, the nutrition and malnutrition treatment experts, provided guidance in developing the system around the CMAM protocol.  Lastly, thanks are due Schuyler Erle and Andy McKay who transformed concepts into code, and the growing RapidSMS open source programmer community who have built the pieces to make all of this possible.

I realize developing a system is meaningless if we can’t show impact.  We are in the initial faces of piloting RapidResponse to support the delivery of CMAM by CHWs in one of our sites in Kenya.  While the pilot is in its early stages, I am encouraged by the initial results that we hope to be able to share through updates in the upcoming months.

In the mean time, our hope is to continue to build RapidResponse as an open mHealth platform that will ultimately enable partners in the field to deliver health services more effectively and efficiently.   Our hope is to build a flexible platform around which a coalition of partners can coalesce and to which they can contribute.  Through the actual implementation of projects in the field, we are hoping to drive resources into the further development and refinement of a system that will benefit all partners.  We envision a system that is flexible enough for any group to customize to their individual use case (there will always be the need) and that will eventually be easy enough to configure (via web interface) that grass route groups or government agencies with limited resources could deploy on their own.   We realize this is a grand vision (and we’re not the first with this aim) but we feel that by taking an open approach we’ve started to put together a solid foundation, both from a technical and partner standpoint, to make this possible.

RapidResponse Malnutrition Report

For a complete technical overview please visit the RapidResponse project page on www.rapidsms.org

Nana Owusu Acheampong's C-Cell Phone Charger

Kevin Rehak, an MBA Student at Columbia University that I am working with, recently sent me this photo of an innovative approach to cell phone charging in Ghana.  Using a charging system he made himself, Mr. Acheampong, one of the Abusuapanin Community Leader’s in Bonsaaso village, use’s 4 C dry cell batteries to charge mobile phones.  The four 1.5V batteries in series adds up to 6V which is similar to the 5.5V that most cell phones require (amperage varies). The set of batteries cost 1 Ghana Cedi and he is able to charge four phones before needing to replace the batteries.  This compares to the 1 Cedi cost of charging a phone at the local cell tower.

Obviously, for a number of reasons this solution is not ideal.  The phones charge very quickly (~10 minutes) but are probably receiving too high of a current which damages batteries.  From an environmental standpoint, this method is particularly wasteful.  All this is to highlight both the huge demand for cell phone charging in rural areas in Africa and a general lack of cheap and efficient technologies available for entrepreneurs like Mr. Acheampong.

Tough Stuff Solar Panel

Luckily, a lot of new products are beginning to enter the market that should help change this.  The Tough Stuff Solar Panel a 1W (5.6V, 174mA) highly robust, amorphous panel that is ideal for charging individual cell phones is a particularly exciting example of this.  More important then spec, the Tough Stuff Panel (with cell connectors) comes in at about €10 or less per panel retail.  The retail price will obviously have to be a bit more but if you consider existing charging practices (see above) even a $20 price-point seems very viable.

Also see related post on 12V Cell Phone Charging Practices in Mali

I had a really interesting discussion at work with my boss Vijay Modi and some colleagues about the real costs of an off-grid “solar” systems.  The perception is often that solar panels make up the bulk of the cost of an off-grid system.  The reality, however, with any time horizon over three years is that the cost of batteries will be the biggest determining factor of cost over time.  It is for this reason, that Mark Hankin’s argues that off-grid system should not be called “solar systems” but rather battery-based systems.

If you consider that most off-grid systems in Africa fail after three years, this term is unfortunately even more appropriate.

Matt Berg – Millennium Villages Student Research Showcase from Earth Institute on Vimeo.

Here is a brief talk I gave at a recent research showcase at Columbia.  In it I discuss how we brought Internet connectivity to Ruhiira our rural community in Uganda using a large wifi network that we put in place with the help of Inveneo. The network is currently being used to connect about 5 clinics, 3 schools and several other community institutions to the nearest Internet connection 35KM away. As a local intranet, the network is adding tremendous value by enabling free VOIP calls between sites and is also being used by the clinics to facilitate a central medical records system.

In the future, I will try and provide a much more detailed overview of this project but for now it provides a glance at how wifi can be used to bring connectivity when commercial options are not currently available.