AudiencScapes

Josh Nesbit was doing HIV research at a clinic in Malawi in 2007 when he realized that new mobile infrastructure available there could be harnessed to bridge gaps and coordinate health care services. And so, Medic Mobile was launched in 2009- it develops technologies such as easy-to-use medical record systems and SIM card applications to help health workers communicate and coordinate patient care, and provide diagnostics using low-cost mobile technology. AudienceScapes Fellow Paromita Pain talks to Nesbit about how better information and communication access can help us live healthier and longer lives. 

By Paromita Pain

Josh Nesbit was a student at Stanford University preparing for medical school, when two conversations with a doctor and a community health worker in Malawi changed the course of his life. 

“I was doing HIV research at a clinic in Malawi, in 2007, when I met a doctor who was covering a catchment area of 100,000 people single-handedly, and a community health worker who walked 35 miles to the hospital each week to hand-deliver patient reports,” said Nesbit. But he also realized that he had a better mobile signal at that community health worker's home than he did in Palo Alto, California.  It became clear to him that this new mobile infrastructure could be harnessed to bridge gaps and coordinate health care services.

Inspired by volunteer village health workers in rural Malawi, Medic Mobile was launched in 2009 by Josh Nesbit and three co-founders while they were still students.  According to the organization's website, Medic Mobile develops technologies such as easy-to-use medical record systems and SIM card applications to help health workers communicate and coordinate patient care, and provide diagnostics using low-cost mobile technology. Medic Mobile believe that well-coordinated and connected health systems can save lives.

In June 2011, they announced the first SIM card application for health care, created with support from The Maternal Health Task Force and PSI. These applications run on any GSM device, from the simplest US$15 handsets to smart phones. Using SIM apps, they plan to bring structured information exchange to the “last mile,” supporting health workers and patients. Today, Mobile Medic have over 30 partnerships in 15 countries to improve health care delivery in extremely resource poor conditions.

An article on the website of Global Pulse, the international health journal of the American Medical Student Association, cites World Health Organization (WHO) estimates a shortfall of 4.3 million health care workers in the developing world. Medic Mobile believes that the intelligent deployment of mobile technology can help improve access and outcomes, even with this lack of health professionals.

“Sometimes the issues that need to be addressed are clear,” explained Nesbit. In the six weeks he spent in Malawi, Nesbit saw Dickson, one of the healthcare workers, always carrying around a notebook. It had beautifully handwritten drug adherence charts for HIV patients. Patients couldn’t reach doctors in time and often the care workers didn’t know when their patients needed them.

“There was obviously a vital disconnect between the co-workers and patients,” said Nesbit. He bought a laptop and 100 mobiles at US$10 a handset. Software called FrontlineSMS was being developed which could support bulk two-way text messaging.  A laptop was soon set up at the clinic, with community workers responding to nearly 130 such SMS messages in a week. Nearly 2,000 patient updates were received by SMS in six months.  This became Medic Mobile’s pilot project in Malawi that saved hospital staff 1200 hours of follow-up time and over US$3,000 in motorbike fuel.

Over 100 patients started TB treatment after their symptoms were noticed by community health workers and reported by text message. The SMS network brought the Home-Based Care unit to the homes of 130 patients who would not have otherwise received care, and texting saved 900 hours of travel time  for 21 antiretroviral therapy (ART) monitors, eliminating the need to hand-deliver paper reports. These results were published in the Technology and Health Care Journal.

Medic Mobile recycles discarded mobiles to empower healthcare workers in developing countries to connect better with their patients. Discarded mobiles are recycled in the US, and their value allows Medic Mobile to purchase appropriate handsets in local markets. These new phones run different software, such as FrontlineForms that allows low-end java-enabled cell phones to submit structured forms via text message. “On top of FrontlineSMS, we created a TextForms plug-in, which manages structured SMS interactions with end users like multiple choice, checklist, integer, and freeform responses,” explained Nesbit.

Medic Mobile now works with more than 30 international and local partners. The group has established programs in 70% of Malawi’s districts and implemented projects in twelve countries in Africa, Asia, and Latin America. The results continued - drug stock reporting improved from less than 35% to over 80% across 10 districts in Malawi, costs decreased four times and efficiency increased 112 times for community-level treatment support. An additional 2,000 pregnant women remained in a remote program for prevention of mother-to-child transmission of HIV.

While the results of the technologies launched are impressive, Nesbit says the challenges are many. “We do what we can to improve access to health care, by tracking vaccinations in India or strengthening maternal health referral networks in Ethiopia. But as our partners remind us, a lot more needs to be done. The demands of this space are endless,” he said. That’s why he encourages everyone to join in the efforts. “And everyone can, too,” he explained. “All of us at some point have a cell phone we no longer use. They could be recycled at Hope Phones to empower a health worker. Your old phone can be turned into a life-saving tool.”

Paromita Pain has been employed with The Hindu Newspaper, Chennai, India since January 2003. She writes for young people on a range of themes, with a special interest in media for young people, health issues, human rights and youth in situations of conflict. 

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