Andre Tanoe from partner NGO Amaryllis showing local Health Department staff how to send health data to Frontline SMS
There are 6.3 billion mobile connections globally, with 90% of the world’s population having some access to a mobile phone (compared to a 34% global penetration of the internet). Furthermore, SMS is the most used two-way communication tool globally. More than 7.8 trillion SMS were sent worldwide in 2011, a number continuing to grow. As opposed to the internet, which privileges a wealthy minority of the world’s population, SMS allows for much more equitable community engagement, particularly when working in remote, rural and poor contexts.
Currently SMS is used for a wide variety of community development activities around the world including: supporting micro credit financial services, community radio, providing legal advice, election monitoring, education, and improving public health service delivery.
Map showing some islands of Eastern Indonesia
When I started working in Eastern Indonesia for CDU 11 years ago, mobile phone coverage was just being developed. The first thing our local colleagues would do whenever we took a break during field work was to check if they had a mobile signal. The novelty of this remote area communication tool was very high and it was clear that we were witnessing the beginning of a communication revolution in this traditionally isolated part of the world. Today signal coverage is well developed across the many rugged islands of Eastern Indonesia and has become a standard form of communication for most people and a tool integrated into every workplace.
The rugged landscape of Nusa Tenggara Timor, Eastern Indonesia
The landscape of Nusa Tenggara Timor (NTT), the closest Indonesian province to Australia, is largely rugged and infertile with a short and intense wet season. In this environment subsistence farming, the predominant livelihood, is marginal with many communities experiencing periods of hunger through the dry season. The provision of services to the rural population is difficult because the few roads are generally of poor quality and frequently impassable in the wet season due to flooding or landslides. For many, accessing health services requires walking long distances and the use of public transport where available. It is not uncommon for people in need of emergency care to be carried by a group of villagers to a point where road transport is available. For the last few years we have been working with local health departments building capacity in collecting and mapping health information, and modelling access to services. Through this work we found that, whilst SMS was already an important tool for health data reporting at some clinics and district offices, its use was fairly ad-hoc and unstructured.
Through researching tools that could assist in SMS based community engagement and service delivery, I came across FrontlineSMS software. Originally developed to engage local communities in Africa around national park management, it is now used in over 90 countries around the word for a wide variety of activities. It was clear that FrontlineSMS could play a useful role for improving the effectiveness of SMS for the delivery of health services in NTT. It does not require an internet connection, and it is free, efficient and simple to use, enabling easy implementation at districts and clinic levels.
The bottom-up implementation philosophy of FrontlineSMS is described by its founder Ken Banks:
The default position for many people working in ICT4D [information and communications technologies for development] is to build centralized solutions to local problems – things that ‘integrate’ and ’scale’. With little local ownership and engagement, many of these top-down approaches fail to appreciate the culture of technology and its users. … My belief is that users want to have their own system, something which works with them to solve their problem.
Ken Banks, January 2009
In Indonesia over the last decade there has been rapid decentralisation of governance to the district level. This increased regional autonomy allows for most planning and budgeting decisions to be made at the local level. FrontlineSMS fits well into this paradigm, allowing an implementation that supports local programs and priorities. Health workers in this region are generally already over-worked and under-resourced so FrontlineSMS is promoted to them as a simple tool that makes their work easier. Through building capacity in the use of this tool, without stipulating what it should be used for, we are developing local ownership and engagement.
We have recently delivered training in West Timor, Sumba and Flores to 11 districts. A total of 40 mobile phones and modems were provided for use at the clinic and district level, with an additional 60 mobile phones given to midwives for further field trials in West Timor. All the participants in the training could see immediate benefits from FrontlineSMS particularly to support programs monitoring pregnant women. Currently rates of maternal mortality in this region are very high. In an effort to tackle this, SMS is being used to assure women are provided with trained assistance during their pregnancy and birth. This has been done through health officers monitoring SMS requests to a mobile phone 24 hours a day, seven days a week. FrontlineSMS is now providing a way to conduct this around-the-clock service in a more efficient way. It was also clear from the training that participants could see a wide range of potential applications. FrontlineSMS is now, for example, also being trailed for monitoring rabies cases in Eastern Flores.
Key to the delivery of this project is our partnership with a local Indonesian NGO (Amaryllis). Amaryllis has assisted with the development of training materials, the on ground training and will conduct follow-up research assessing the sustainability, successes and difficulties in the implementation of FrontlineSMS. The results of this assessment will form the basis for a workshop later in the year to discuss its ongoing use.
The SMS for public health in Eastern Indonesia project is funded by AUSAID through their public sector linkages program. You can find out more about this project and download the Indonesian Language FrontlineSMS training material.
Any project involving community engagement, particularly where there is not a strong culture of internet use, can benefit from tools such as FrontlineSMS. Furthermore, it is an excellent tool for not only for delivering information but also collecting data and thus has huge potential for supporting research. The latest version of FrontlineSMS has a well-developed polling feature allowing quick responses from a large audience to research questions. I would be interested in exploring opportunities for FrontlineSMS to support CDU’s local and international community engagement and research activities. I hope to deliver a couple of FrontlineSMS workshops (Menzies, RIEL) sometime in the next few months to explore its functionality and utility for local researchers.