Medic Mobile SIM apps for mHealth June 2011


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These slides are based on my announcement of Medic Mobile’s work with SIM apps at the GSMA mHealth Alliance Summit in Cape Town on June 7th, 2011.

I have added detailed notes to each slide, which you can access in the tab below these slides, next to comments.

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  • These slides are based on my announcement of Medic Mobile’s work with SIM apps at the GSMA mHealth Alliance Summit in Cape Town on June 7th, 2011. \n
  • Medic Mobile’s first SIM app was developed in partnership with the health services nonprofit PSI for child health programs in Malawi, Cameroon, and DRC. Community Case Management (CCM) of childhood illnesses is widely regarded as a key strategy in combatting illness and death for children under five years of age. Such programs are estimated to have reduced under-five mortality in some regions by 30 to 40%. CCM services are delivered by minimally trained Community Health Workers (CHWs) who live and operate far from traditional health facilities, making CCM services particularly amenable to mobile technologies that bridge geographic communication barriers. \n\nEffective CCM interventions require: \n1. Uninterrupted supply of essential medicines; \n2.Trained, motivated and locally accessible CHWs; \n3. Informed demand among caregivers; and \n4. Monthly Supervision of Community Health Workers. \n\nHistorically many programs fail to maintain all four elements consistently over time in many communities. Often this is because information about services in remote communities is so poor that managerial responses cannot prevent the deficient treatment of a child. \n\n\nPhoto by Alex Harsha\n
  • This picture features Deus, a CHW in Malawi, and the stacks of papers he uses to report his work. \n\nMedic Mobile has used SMS containing short logistical information to coordinate CHWs in a dozen countries, most in Africa. However, entering extensive structured quantitative data like in Deus’ reports is too slow and inaccurate on a plain text interface. \n\nOur clients demand services that support structured or forms-like data entry. In current health systems changing a form typically entails transporting all health workers to a central location, providing new materials by hand (either paper forms or a phone with a manually loaded app) and retraining. As a result forms change infrequently, and organizations are accustomed to paying various expenses whenever forms are changed.\n\nPhoto by Isaac Holeman\n
  • For many projects Medic Mobile uses a j2me (java) application to enter data in mobile phone forms, and then submit the data via SMS. J2me apps can also submit data via mobile Internet where available.\n\nA project in Malawi involving about 2,000 CHWs has used this application to increase reporting rates from just 30% to 80% in less than a year, saving enormous fuel and vehicle costs by collecting electronic reports rather than paper reports. The grant for the NGO that implemented this project will soon end, and they want to hand the project off to ministry of health. The ministry approves of the project and is able to pay for airtime, but cannot pay for the $60-100 cost of replacing phones, so the long term future of the program is uncertain.\n\n\n
  • To be truly sustainable and rapidly scalable, our clients are demanding services that can function on any of the low-end phones that health workers already own.\n\n\n
  • In this picture from the coastal province of Kenya, staff had created pouches with paper and staples to hang their phones up in the only part of their building that received even intermittent 2G signal. Apps that require constant connectivity are not viable here.\n\nMedic Mobile has discussed Interactive Voice Response and USSD with many of our clients because they are well known means of delivering structured information services across any phone. However, health systems have a mandate to serve hard to reach areas, and our clients often demand apps that can be accessed when the health worker does not have connectivity, waiting to transmit data until connectivity is available. On occasions where clients are more flexible about accessing services only when they have connectivity, IVR often remains unappealing because the expense of long voice conversations can be prohibitive and because it requires a much stronger and more sustained signal than SMS (which is a smaller packet of data that is sent in an instant rather than staying connected for an entire voice session). USSD is similarly subject to session failure if network drops in and out while a user is entering data, and has the added difficult of session timeout issues (network operators limit the maximum length of a USSD session, so a data collection service via USSD might have a maximum of as little as ten fields and less than one minute to enter all data and send).\n\nThe ability for a phone to function where connectivity is intermittent or absent is especially important in point of care applications that health workers use while they are seeing clients, as opposed to intermittent usage like weekly reports. Medic Mobile predicts point of care applications will play an increasingly large role in health services in the coming months and years, in part because every health worker has dozens of point of care tasks for every reporting or non-point of care task.\n\nPhoto by Jonathan Mativo\n
  • SIM apps are simple, menu-driven applications to run directly from a SIM card. They meet the core requirements of Medic Mobile’s clients more effectively than any other technology we are familiar with.\n\n- Take advantage of increasing mobile connectivity and phone ownership to improve data collection and communication that improves service delivery\n- A user interface amenable to entering forms and other structured data with 10-50 fields. \n- Function on diverse handsets, including ultra low cost handsets that health workers already own.\n- In places with occasional or absent connectivity, user can still access menus, enter data, have data submit to server later when they have connectivity.\n
  • Kuvela means “to listen” in Chichewa, the primary indigenous language of Malawi.\n\nThis app was created by Medic Mobile using the Gemalto developer tools for javacard 2.2. We expect this to be the first of many SIM apps, and are exploring SIM app development in C for native SIM cards. Our primary SIM app developer is based out of iHub in Nairobi.\n\nKuvela was built for the health sector client PSI. The are implementing large CCM programs in Malawi and three other countries in Africa, and plan to deploy the app and begin user training in Malawi in the beginning of July 2011. Medic Mobile has deployed the Kuvela SIM app to our own test SIMs using a SIM reader/writer connected to the developer’s computer via USB, but the pilot project is not yet operational.\n
  • Kuvela consists of two main forms, one with 21 fields and the other with 15 fields. Some apps for future clients will involve menus more complex than simple forms, but most will be similar to Kuvela, differing in the type and quantity of forms and fields.\n\nVC Monthly Report\ncharactersField Label\n6-8- VC ID\n4- Reporting Year\n3-8 text- Reporting month\n\n1-3- Fever cases < 1 day\n1-3- Fever cases < 2 days\n1-3- Fever cases > 3 days\n1-3- Diarrhea cases < 1 day\n1-3- Diarrhea cases < 2 days\n1-3- Diarrhea cases > 3 days\n1-3- Fast breath cases < 1 day\n1-3- Fast breath cases < 2 days\n1-3- Fast breath cases > 3 days\n\n1-3- Supervisor visits\n1-3- Mentorship sessions\n\n1-2- Days stocked out LA 6x1\n1-2- Days stocked out LA 6x2\n1-2- Days stocked out ORS\n1-2- Days stocked out Cotrimoxazole\n1-2- Days stocked out Zinc\n1-2- Days stocked out Eye Ointment\n\nyes/no- Is place of residence on list of villages serviced?\n\nHealth Facility Stocks\ncharactersField Label\n6-8- VC ID\n4- Reporting Year\n3-8 text- Reporting month\n\n1-4- Total dispensed LA6x1\n1-4- Total dispensed LA6x2\n1-4- Total dispensed Cotrimoxazole\n1-4- Total dispensed Zinc\n1-4- Total dispensed ORS\n1-4- Total dispensed Eye ointment\n\n1-2- Days out of stock LA6x1\n1-2- Days out of stock LA6x2\n1-2- Days out of stock Cotrimoxazole\n1-2- Days out of stock Zinc\n1-2- Days out of stock ORS\n1-2- Days out of stock Eye ointment\n\n\n\n
  • Currently the larger investments in health sector communication technologies are supported by foreign donors. Programs that receive donor funds typically have to demonstrate impact in a 2-3 year grant cycle and can’t afford to spend months negotiating with a mobile network operator. The time and the risk of failure are even more significant than the cost of services.\n\nApplications facing the general public could impact millions of people, increase health seeking behavior and demand for services, and might someday generate the kind of network operator revenue seen in mobile banking. But increasing demand for services won’t actually improve the quality of those services. Improving service delivery requires communication from health worker to health worker, and initiatives in this space typically involve hundreds, thousands, or tens of thousands of phone users, not hundreds of thousands or millions. \n\nNetwork operators can cover costs and profit with mHealth SIM apps, perhaps more importantly they can build their brand and increase customer loyalty. But currently the market is a relatively small percentage of the total market for network operators. The value proposition becomes most appealing for network operators when they leverage technically sophisticated third parties like Medic Mobile who can manage relationships with health sector organizations and make the provision of services extremely simple and not time consuming for the network operator.\n\nMedic Mobile as the talent to quickly create custom SIM apps for our clients, but the core process holding back enormous growth in use of SIM apps to support health services is SIM app deployment. Deploying SIM apps requires authenticating with the secret keys for the network operator’s SIM cards, these secret keys cannot be shared widely for a variety of reasons essential to mobile network integrity. \n\nPhoto by Isaac Holeman\n
  • SIM apps are typically deployed in one of three ways.\n\n1. Loaded onto the SIM by the manufacturer. This currently is the way most SIM apps are deployed by most network operators. SIM card manufacturers typically produce shipments of hundreds of thousands of SIM cards. The expense and amount of time required for smaller orders from the manufacturers is unappealing to health sector clients.\n\n2. Via a SIM reader/writer connected to the developer’s computer via USB. This process could support Medic Mobile’s smaller projects, but would require the network operator to either share secret keys with Medic Mobile or dedicate their own staff time to deploying apps.\n\n3. Over The Air deployment has the potential for network operators to retain control of SIM secret keys, minimize staff time required for SIM app deployment, and charge an airtime fee each time a SIM app is deployed to a new phone. mHealth SIM apps will typically be deployed to a select group rather than all of the network’s clients, so on demand OTA is most appropriate, in which the end user initiates deployment of a SIM app by entering a USSD command or sending an SMS with a keyword to a short code. On demand OTA would require:\n- Network operator installing OTA software on their infrastructure\n- Accepting a new SIM app from Medic Mobile, loading it onto the OTA server\n- Setting up an SMS keyword that phone user can use to initiate deployment of SIM app to their SIM. \n- Would need to check that user’s SIM has enough space, and either delete the existing SIM app that network operator deems least important or allow user to select which SIM app they would like to delete to free up space on the SIM.\n- Bill phone user a fixed amount of airtime each time they request a new app be deployed.\n- Automatically adding any SIM that has requested a custom SIM app to the list of SIMs not to be updated during network operators routine SIM app update blasts (similar to how vendor SIMs are excluded from generic OTA blasts).\n
  • SIM apps will proliferate dramatically and profitably when network operators develop systems that lower the amount of time required by their staff to deploy SIM apps created by third party value added service providers like Medic Mobile. This will require a process for verifying and trusting the technical competence and professional integrity of organization’s like Medic Mobile, establishing them as Trusted Service Providers. For a network operator to pursue the process of on demand OTA described in the last slide, Medic Mobile would need to be trusted to create well-built SIM apps that would function well on the operator’s SIM cards. We manage client relationships, market the service, and provide the network operator with routine updates on health systems impact that could be used for further marketing and brand building.\n\nMedic Mobile is among the most respected organizations working in the mHealth space in Africa. We have technical competence in SIM app development, intend to innovate around SIM app deployment, and we have a wealth of experience in working with health sector clients to create connected, coordinated health systems that save more lives. I look forward to hearing from you.\n
  • Medic Mobile SIM apps for mHealth June 2011

    1. 1. Isaac Holemanchief &
    2. 2. community case management
    3. 3. structured text
    4. 4. java app for structured text
    5. 5. diverse low end phones
    6. 6. occasional connectivity
    7. 7. SIM apps
    8. 8. kuvela SIM app
    9. 9. kuvela SIM app
    10. 10. health sector demand
    11. 11. paradigm for operatorstoday: provide a few value addedservices on the SIM cardtomorrow: make SIM card a platformfor value added service providers
    12. 12. Isaac Holemanchief &