Kilifi Kids

Following up last week’s post, we thought we would give a few more use cases in which we hope to use cell phones in the field.

In particular, text messages will be sent to CHWs to notify or remind them about meetings and trainings.  This will improve the ability to coordinate such activities, provide more advanced notification by sending a notification as soon as information is known, but also make it possible to plan meetings without much lead time when the situation demands it.  Reminders can be sent to all CHWs with little effort making the communication with CHWs much less burdensome for the coordinators.

Missed appointments is something that providers struggle with all over the world. In places like Kilifi, where patients are remote and often don’t have access to phones, these issues are even greater.  Providers may not know if the missed appointment was because a patient’s condition has deteriorated to a point where they are no longer to travel or if they just forgot.  Now when a patient misses an appointment, the health center can simply send a text message to the CHW nearest the patient, and the CHW will go check on the individual and then report back.  If emergency medical assistance is needed, the CHW can then request transportation be dispatched.

CHWs visit patients in the community, and when a problem is identified, the CHW can set up an appointment for a patient via text message.  Without an appointment, a patient will have to wait in line at the clinic, so significantly more time must be budgeted for the medical visit.  The clinic will also notify the CHW when a patient arrives for their appointment, so the CHW knows that  no follow up is required to reschedule an appointment.

In the second phase of Kilifi Kids’ mHealth program, mobile phones are being provided to community health workers (CHWs) in parts of the Kilifi District.  There are several scenarios where we anticipate that these phones will have great impacts on the care the CHWs can provide Kilifi residents.

Outreach testing and vaccination days are events where medical treatment or testing can be done on a large scale.  The providers go into a community and provide either preventative care or test for illnesses that impact large segments of the population.  Kilifi Kids has used this method for providing de-worming medication. In order for these community events to be successful it’s necessary for the community members to know about the events and to attend.  Text messages will be sent to CHWs letting them know when and where testing and vaccinations will be taking place, enabling them to spread the word to community members.

Many of the residents of the Kilifi District live in rural areas and do not have access to motorized transportation on a regular basis.  When a person has been injured or is very sick and is unable to walk to the medical center, there had not been a reliable way to communicate the need for help.  Sometimes, a friend or family member would have seek help on foot. With the provision of mobile phones to CHWs, the community health worker can send a text message to the medical center indicating that medical transport is needed, and someone will be dispatched to come get the sick individual and take him to the hospital.  Using a phone to call for help instead of going in person dramatically decreases the amount of time that passes before the patient gets treated.

A close and candid look into our projects and work in Kenya would easily narrate to you the strength of our partners in Kilifi -The Rotary Club of Kilifi. With partnership dating back in the 2008/2009 the club leadership has been one without measure, dedicated and vibrant. A visit to any of their club meetings will tell you a lot and will for sure leave you with no questions on its vibrancy both in membership, project types and leadership.

This post profiles the club leadership/ presidents for the last five years and the projects initiated therein.

2008/2009 – Dr Lucy Ochola -Health Researcher

Past President Lucy Ochola

Taking over from John Abwao and Janet Midega the core team that oversaw the establishment of the Kilifi -Vinings relationship, Lucy steered the club to great heights and initiated a number of projects including the famous de-worming project. Her term saw her install a number of schools with water tanks for both rain water harvesting and extension of pipelines. By the end of Lucy’s term it was a great pace that the next president had to manage.

2009/2010 – Jonathan M Mativo, Information Technology Specialist

Past President Jonathan Mativo

Taking over from a Health researcher was an easy job looking at Lucy’s legacy. Jonathan’s term was thus categorised with an increase in membership and saw the initiation of the first ever technology based project -the mHealth or m-Health (using mobile phones to fight malnutrition). Within the same term the club developed it first draft strategic plan which was to steer the club for three years running. Important personalities helped the drafting and dissemination and within this our 2011/2012 President Dr Tsofa was to be nominated.

2010/2011 -Alex Maina, Library Specialist

Past President Alex Maina

Whenever you visit any of the clubs meeting, an eloquent English speaker full of humour would always be easily noticed. Alex with his outstanding checks and balances and a no-nonsense character saw the clubs vibrancy increase with lots of membership attendance. Injecting more ideas into the management of the club Alex saw the club board meet almost every week to streamline issues. Top on the wall of fame is a sanitation project initiated by Alex that saw the construction of a fabulous VIP latrine block for Ngamani Primary school. The president in waiting that time Dr Benjamin Tsofa sat in as the Sargent at arms ensuring that he fitted well within the presidents line up.

2011/2012 – Dr. Benjamin Tsofa, Medical Doctor

Club President, Dr Benjamin Tsofa

Dr Tsofa’s history in community service dates back before him joining Rotary. He is a former DMOH Kilifi district and during his time in office saw RC Kilifi engage in a number of agreements with the Ministry of Health. Ever outgoing and a problem solver Dr Tsofa joined the presidency and all engagements with the government ministries became too easy for the club. Up to date he is re-known for his professional approach to partnerships and conflict resolution especially in the development world. While in office Dr Tsofa ensured that the strategic plan was done to completion and has prepared the president elect in readiness for take over in July, 2012. Dr Tsofa remains an icon establishing an array to key projects and unlocking deadlocks within the de-worming, mhealth and community health worker support, and other projects. In the coming year he will be in-charge of the Rotary Foundation  and is very keen in establishing new projects that are in line with the strategic plan that comes to an end during his term.

2012/2013 President Elect, Thomas Muli- Finance Specialist

President Elect, Thomas Muli

The new year starting July 2013, will see a new president get into office. Thomas, a re-known banker working with Barclays bank, Kilifi will be getting the mantle to steer the club into the next level. Top on his agenda is to increase the club membership to an ambitious figure of 50 members. Strict to detail, Thomas foresees the club growth being his core target in the coming year. “I will surprise members ” is always a statement he repetitively makes. Welcome President Elect, Thomas Muli.

The success of the various presidents possibly would not have been as vibrant were it not for the relenting support and commitment of one of the club founding members (Dr. Charles Mbogo, Medical Researcher) who is always present to ensure that the club is within limits.

Dr Chalres Mbogo, the “father of the club” (as commonly buffered) has been the cornerstone of the club and has seen the club through all the phases. Attending all the district conferences in the district and attaining a Paul Harris Fellow recognition has always made the club proud of Daktari (Doctor) Mbogo.

Though the leadership has been outstanding the diversity of membership in their professions, interests, Age and abilities has been the cornerstone to the success in executing the clubs projects and sustaining the partnership.

In 2007, Kilifi Kids began sponsoring, through Kesho Organisation, really bright secondary students from Kilifi and Ganze districts, who without financial support, would have had to drop out of school due to poverty.   The first cohort of 12 students graduated at the end of last year (2011) and they did really well, out-performing most of their peers.  (1 x B+ ; 3 x B; 2 x B-; 1 x C+; 3 x C; 1 x C-; 1 x D+).

What these results mean in practice is that 3 (25%) will qualify for Government assisted places at university early next year and 6 (50%) will meet the grade necessary to enroll on a Diploma course at a college locally.  These are excellent results when you consider the district average for University is 2% and for College 8%.  These students are now well on the way to having a successful future ahead and stand a very good chance of breaking the cycle of poverty in their families and help future Kenyan and African children.  Investing in bright young adults can really make a difference!

Leaving school marks another beginning with some difficult decisions ahead.  Ultimately, Kesho’s students make their own choices and take the lead in deciding their future paths.  Our role is more to facilitate the process so as to keep them firmly in the driving seat.   Kesho offers secondary school leavers assistance to access employment and courses of further study.  We advise on their options and help them seek employment by giving interview practice, career advice and promoting job vacancies and scholarships which we hear about.  We also provide further sponsorship for those offered places at university and those wishing to apply for college.  You can read more about our school leaver enrichment programme on our website: http://keshokenya.org/Initiatives/Initiatives/Initiatives/Graduateenrich.html

In February we hosted an IT and Entrepreneurship training programme run by DOTKenya for one month in our resource centre.  It was for all secondary school leavers and included, therefore the twelve Kilifi Kids students.  It was a really successful programme and 22 out of the 28 eligible students completed the course.   Several students gave power point presentations on their business ideas which was really very impressive.  It has been great to see some of the students returning to practice their skills on the computer and indeed one girl is coming in regularly to enter her cash flow for her new business venture selling cakes.  The first of many we hope!  You can read more about it on our blog: http://keshokenya.blogspot.com/2012/02/it-training-with-dotkenya.html

Of the 21 KilifiKids who are still at secondary school, we continue to be impressed with their progress and look forward to following their successes over the coming years.

Kilifi Kids was invited to take part in MobiHealth DC’s winter Meet Up in Arlington, VA.  MobiHealth DC meets quarterly and provides an opportunity for Washington area mobile health and communications professionals from government, industry, and non-profit organizations to come together and learn about new developments in mobile health or mHealth.  Attending organizations are focused on new technology and projects both in the US and abroad.

Kilifi Kids was one of five organizations asked to take part in the Innovation Showcase, where we had the opportunity to talk with other professionals in the mobile health arena about the mobile health projects that KK has undertaken. We described the improved reporting that is already taking place since clinics started submitting their weekly reports via text message to help African childen, notably in Kenya.  We were also able to talk about Kilifi Kids’ latest program that provides Community Health Workers (CHW) with mobile phones that can be used in a variety of ways to improve health.  We shared the use case diagrams, developed with Medic Mobile, to illustrate the benefits and received very positive feedback from all attendees.

The enthusiasm attendees had for Kilifi Kids and the projects we have undertaken was very apparent, and it was great to have the opportunity to share our story with so many new people!

“A journey that started a few years ago starts yielding results”

In 2008, as the idea of mHealth came into mind, it looked more blurred than clear. Project teams at all levels hardly could visualise the actual deliverables and whether the efforts would contribute to our goal of rural healthcare in Kenya. As we connected with our colleagues in Kenya, we saw the motivation and assurance from them that they will work towards success of our project.

Initially seeing the amount of manual paperwork involved, paper shelves, full tables, busy data staff, we really saw no space left for our pilot project. “We intend to make use of text/SMS to ease the numerous paper-to-computer data transfers and eliminate errors and late reporting,” a comment that never got much attention at the project onset. We hardly knew that!

Phase I of our project included a number of trainings and sensitization of the health officers in Kilifi district on the use of SMS for reporting on a weekly report used for disease surveillance in the district–a report whose aggregates are submitted to the national level. With 40-plus health facilities reporting, we provided them with a phone and installed FrontlineSMS forms that could capture all the fields required by the national government. Health facilities could easily fill in the form and hit a “SUBMIT” button and have the data submitted to a central computer upon which a simple export to a spreadsheet would do the magic that resulted into the district aggregates for the week. “Surely it works” were common comments from the health records officers directly involved with the data.

As we set in for our new phase, where we intend to work directly with community health workers to to help both Kenyan and later African children across the continent, our efforts seem to be contributing towards improved and meaningful performance. For the last year, all of the 248 districts in the country have been reporting and their average reporting been observed and woh!

Kilifi district is reported as the leading nationally with an average reporting rate of 99.23% 

Kilifi County emerges tops in the average reporting of Health information in Kenya

We are very excited by this and give a big thumbs up to our partners (Rotary International, Medic Mobile, Ministry of Health Kilifi) and well wishers for the success of the project!  We hope to continue such meaningful work to not only improve health reporting but also improve patient outcomes, improve prenatal care, and fight malnutrition and help starving African children for years to come.

While it comes to no surprise to the volunteers and partners of Kilifi Kids, technology is sweeping Kenya, as recently documented by McKinsey in their most recently Quarterly publication. As noted in the article, greater efforts are being made by the government to increase transparency and push for an open-data plan to improve the country’s long-term economic prospects for not only Kenyan but African children. The full article can be read at:

https://www.mckinseyquarterly.com/Innovation_in_government_Kenya_and_Georgia_2865

In the article, there is mention of a low-tech incubator called iHub in Nairobi. Our team, with Michael and Erik, visited iHub in their trip last summer (see pictures below) to meet some of the leaders of that organization and learn firsthand of the work their doing.

We’re excited to see more news becoming available of the strides being made in Kenya.

Mobile health (mHealth) is the name used to describe medical services or health care that is provided through the use of mobile phones, mobile telecommunication devices, or using multimedia technologies. This model of providing health care has become very popular and effective in developing countries because of the large-scale penetration of mobile phones in these regions, whether to help starving children in Africa or expand prenatal care in South America. Estimates show that by the year 2012, mobile phones will be possessed by about half the population living in the remote regions around the globe. Mobile phones enable immediate and inexpensive communication with individuals living in these areas.

Now that mHealth programs have demonstrated what might be done, the next step is to make them self-sustaining. The most successful mHealth projects have moved away from depending on external consultants and have obtained technical self-sufficiency. A number of organizations depend on open source software to accomplish their missions. By utilizing open source software, programs can minimizes costs and increase the number of programmers working to achieve their goals. It also eradicates the requirement for consultants from outside and promotes innovation.

Saving Money through mHealth in Cape Town

One successful mHealth project that also reduced the cost of providing care used cell phones to improve treatment of Cape Town tuberculosis (TB) patients.  The project began April 1, 2004 in South Africa and continued for 6 months. The main objective of the project was to improve the success rate of TB treatment and to remind patients to adhere to treatment for TB and other diseases. The project utilized SMS, sent to the patients’ mobile phones, to remind patients to take their TB medication. In this project, the community health workers made use of timely, two-way electronic transmission of information text messages enable to send communicate with the district offices. They depended on mobile caching servers to send out data over the cellular network. A significant number of patients were interviewed to collect health data and to understand how this intervention improved patient adherence. A cost-benefit analysis done after completion of the project showed that the network brought about 24% savings per unit of spending over the traditional manual data collection and transmission approaches. The text messages had removed the tedious paperwork and the travelling of the health workers from one place to another. Thus it saved a lot of money on paperwork and fuel for vehicles.

As any parent knows, the birth of a healthy child is truly a miracle. Unfortunately, pregnancy and childbirth can pose significant health risks to mothers, and around 350,00 women around the world die because of childbirth every year. That’s about 1,000 women every day. The real tragedy is that most of these deaths could have been prevented, with access to proper medical care and increased health information.

That’s where mHealth comes in. Mobile phones can be used to share information about what to expect during pregnancy and childbirth, empowering mothers to make healthy decisions for themselves and their babies. By using their mobile phones to register their baby’s due date, women can automatically receive text or voice messages with information pertaining to their stages of pregnancy.  For example, messages could contain nutrition information about what foods will benefit mother and baby and what foods to avoid during pregnancy.  Once the baby is born, the new mom could receive information about recommended vaccinations for the baby. Knowledge of maternal health can dispel myths, connect women with local health services, promote breast feeding, and help new mothers care for their babies.

The United Nations (UN) Millennium Development Goals include a goal of reducing maternal mortality by 75 percent between 1990 and 2015. Maternal mortality rates range from under 10 per 100,000 live births in most developed countries to over 1,000 per 100,000 in Afghanistan and some African countries.  To help meet the UN’s goal, several global health organizations and other African children charities have chosen to focus on maternal applications of mHealth. One such organization is the Mobile Alliance for Maternal Action (MAMA), a new public-private partnership between the U.S. Agency for International Development (USAID) and Johnson & Johnson, along with the UN Foundation, the mHealth Alliance, and BabyCenter LLC. Founded in May 2011, MAMA is dedicated to delivering mobile health information to pregnant women and new mothers in India, Bangladesh, and South Africa. MAMA was developed in collaboration with the White House’s Office of Science and Technology Policy and the U.S. Department of State, and is expected to mobilize $10 million to these countries in the next three years.

The mHealth Alliance is also focused on this cause, with its “Maternal-newborn mHealth Initiative.” MMI, as it is known, brings together stakeholders from all sectors of the mobile health delivery system to share best practices, data, and technological developments. Maternal health-focused mHealth initiatives have the potential to save or improve the lives of thousands of women and newborns every year, ultimately leading to decreased maternal and infant mortality rates.

I heard a story once – an American man visiting an African village was approached by a young boy who said, “Bob* was here and he told us he was going to help us.  Why hasn’t he been back to help? Can you tell him we need help now?”  Bob* is an international celebrity, known for his contribution to global issues, who made a terrible mistake.  He went to this village, surrounded by fanfare and declared to the people of the village that he was going to help them.  Seems innocent enough, right?  But what happened a year later when the village was still rife with poverty and disease?  Bob wasn’t there.  Bob hadn’t helped.  Bob has done a lot of things for Africa and Global Health, but his impact hasn’t yet reached that boy.

Years ago I was working with a malaria program and one day I decided to voice how silly it was that the mosquito nets we delivered were bright pink or neon blue.  Turns out the bright colors were intentional.  While white is the most neutral color you can think of here in the U.S., in some countries it is the color of mourning and bodies are wrapped in white fabric for funerals.  Imagine then, what would it mean to someone to lie down every night in a bed wrapped in white?  One simple unspoken message and a protective, life-saving object turns into a reminder of death and dying.

Now, do me a favor: Think about the words “help,” “save,” and “cure.”  Aren’t they are good words and messages?  Well, yes, they are.  They are filled with great intention, right? Of course!  But what happened when Bob used one of those words?  He made a promise he couldn’t keep.  I’d also love for you to think about what they mean to you.  I, for one, am a pretty stubborn person…just ask my family…I don’t need “help,” and don’t even THINK about trying to “save” me.  I’d argue that most people are like me in that way, even those with the greatest need.  Doesn’t it feel better to help yourself than to have to rely on others?  Now take a look around the Kilifi Kids site…notice some of the words, “change,” “innovate,” “empower,” and “sustain.”  It is great to “help” African children, but how much better is it to “empower” them?

It is impossible to think of all of our messages and to make sure that each one is perfectly crafted to prevent us from sticking our foot in our mouth, but thinking about change and need and community in a different way can make a tremendous impact.  One of the reasons I decided to get involved with Kilifi Kids is that I noticed this difference in messaging – but also in actions.  Think about the Community Health Care worker approach that Erik Michielsen described on this blog – how much more effective are messages of health when they come from a fellow community member?