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Interview: Mobile health guru Matt Berg on the value of the SMS in Africa

Named by Time Magazine as one of 2010’s 100 Most Influential People in the World, Matt Berg is the technology director of ChildCount+, a ground-breaking mobile health (mHealth) platform that uses mobile phones to monitor the health of tens of thousands of African children.

In between a hectic schedule that sees him flying regularly between Africa and the U.S, Matt spoke to about mHealth, open-source software and what the world can learn from Africa.

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MB: Childcount+ uses simple, standardised text messages to co-ordinate the activities of health care workers, register new patients and monitor their health statistics. How did the idea for Child Count+ develop?
Matt Berg: I was working with a colleague who is a nutritionist, Jessica Fanzo, and we identified a real need to try and strengthen community based management of acute malnutrition (CMAM).  At the same time, I had been doing a lot of work with RapidSMS, a platform UNICEF was beginning to develop, and we figured this would present a great use case.
But it wasn’t until we got to the site in Kenya and spoke to the local health team that we realized its potential to monitor all children and not just those that had acute malnutrition. So ChildCount+ really developed in an iterative agile manner.

MB: How long has the project been going?
Matt Berg:
ChildCount+ has been in existence for a year now.

MB: How many children have you monitored so far?
Matt Berg: We have been monitoring about 10,000 children at our site in Sauri, Kenya for the last year.  We are in the process of rolling out ChildCount+ in sites in Uganda, Ghana and Malawi and have another 10,000 children and pregnant woman preregistered.  We hope to have ChildCount+ operational in a total of 14 sites in 10 African countries sometime in the fall.

MB: Why does SMS technology work so effectively in an African context?
Matt Berg: SMS is great because it allows us to leverage the phone already sitting in most people’s pockets.  Since there is no client on the phone required, any phone that can send or receive a text message can leverage these tools.  SMS is also good in areas of poor connectivity.  If you lose connectivity or power you can still pull down your messages letter when you find the right tree to stand under.  Finally, for health interventions, while SMS is more expensive then data, the use of toll-free SMS numbers allows us to control costs centrally which is critical as it means we don’t have to try and manage credit with our end users.  They can participate without any incurring any costs.  It’s usually the small things like this that actually pose the biggest challenges when implementing projects I’ve found.

MB: Are there any drawbacks to it?
SMS does have some limitations.  For one it does require some basic literacy of the end user.  It’s also more expensive on a transaction basis than data, especially given that SMS rates in Africa are still very expensive when you compare them to places like India where messages cost less then $0.01 USD.  IVR will play an important role in the future as will data as data-enabled phones (especially android based smart phones) become cheaper.

MB: The remarkable penetration of mobile phones into developing countries has seen mHealth make a significant impact in communities with little or no healthcare infrastructure. What sort of training is given to field workers?
Matt Berg: ChildCount+ is based on building upon existing community health worker (CHW) programs. So much of the CC+ training is integrated into the trainings on how to do the health interventions themselves. We usually spend about an initial day or two of training to introduce the CHW’s to the technical components of the system and explain to them how the forms work.  We then do follow-up trainings when new features are introduced and when we identify an area that needs reinforcement.

MB: RapidSMS is a free and open-source framework for dynamic data collection, logistics coordination and communication, which leverages basic short message service (SMS) mobile phone technology. How does Childcount+ use it?
RapidSMS is a great framework for developing SMS-based applications.   ChildCount+ is a set of packaged health interventions related to child and maternal health that sits on top of RapidSMS.  Since RapidSMS is so useful in a number of domains, we felt it was important to brand the set of functionalities we were working with, to create and implement into the ChildCount+ project.

MB: What is the value of using open-source software on a project like this?
It’s critical. We don’t want to introduce any technology that makes a host organization or government dependent on us for licensing issues in the future. With ChildCount+ we are trying to promote the idea of being an “open project” where not only our source code but our training materials, progress and findings are meant to be as open as possible.  We are also dedicated to building local capacity in the sites where we implement ChildCount+. I’m really proud to say that a lot of the core work on the ChildCount+ project has been done by African developers.

MB: Where is all the generated data stored? Who works with the data?
Matt Berg: It’s stored on a local server that our health team maintains.  The health teams in the community have access to the data via a website and by paper reports generated.  This includes providing, on a bi-weekly basis to each CHW, a printout of their patients.  This feedback has been critical to promoting use of the system.

MB: What kind of impact did your listing in Time’s 100 Most Influential People of 2010 have on this project?
Matt Berg: It’s helped bring attention to our work in a positive light.  Overall, I think it’s been very good for  mHealth in general.  There are other very good projects like ChildCount+ out there. What I think this has done is help open people’s eyes to the potential of these exciting new platforms we are building.  The space is becoming very real, very quickly.

MB: To what extent can technology intervene to improve the daily life of ordinary Africans?
Matt Berg:
Mobile phone services will have an enormous positive impact around the world for all people, not just Africans. In resource poor settings, my hope is that mobile based services will help make things like health systems more efficient to make best use of their limited resources. I think better access to information in general will be extremely important when it comes to agriculture, business and just also socially.  No matter where you are people want better ways to connect with their friends and family.  Facebook’s tremendous growth is clear proof of this.

MB: What does the future hold for this kind of technology?
Matt Berg: In the short run, I think the major focus will be on health since this is where there is the most money and urgent need.  If technology can help reduce maternal deaths, then we should probably focus on that now.  The good news is this is a very wide space and I think the private sector will probably play a great role filling the needs in social media and business that market conditions will create.

Mobile services will soon become ubiquitous and seen more as just an extension of the web (we are already starting to see this with iPhone apps), with the mobile networks and phones really just providing the infrastructure for an expansion in users and services.  The real game in the future will be providing valuable data and logic to drive these services.

MB: What can the world learn from Africa?
Matt Berg: For one, Africa is forcing us to figure out how to do more with less — keep things simple and be more efficient.  I think US health systems could definitely trim a lot of the bloat.

More importantly, I just think Africa has a lot to contribute back.  Technology is also a great enabler / leveler.  I don’t think it will be too long until we start seeing an increase in ideas from African entrepreneurs and health specialists that will change the world.  This is already happening now but I look forward to seeing how Africa grows as a source of innovation.

Contact Matt Berg on Twitter for more information: @mberg

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