This is an interview with Mobile Medic, an organisation working on delivering care in the developing world through mobile phones.
Mobile Medic were approached through the OpenCare Twitter mapping process.
Can you tell us a bit about the background of Medic Mobile?
Medic Mobile builds mobile and web tools for health workers, helping them provide better care that reaches everyone. Operating as a nonprofit technology company, we develop free and open-source tools that can be adapted for specific uses, backed by evidence. Health workers currently use Medic Mobile to register every pregnancy, immunize infants against illnesses, track disease outbreaks faster, keep stock of essential medicines, and communicate about emergencies. Our platform is built for the last mile of healthcare, supporting over 12,000 community health workers in 23 countries.
We currently have 52 staff and three hubs: San Francisco, USA; Kathmandu, Nepal; Nairobi, Kenya. Not all of our staff works out of these hubs - about ⅓ of the team is remote. We spend a lot of time on Slack!
Our approach has its roots in service and human-centered design. A lot of people are using these ideas now. Seven years ago, when we started, they were not so well known. We have a whole team of designers, including regional designers who use a participatory, ethnographic, HCD approach. They do in-depth site visits and investigate the context in which the apps will be used, and use a variety of techniques to do so: system mapping, role playing, in-depth interviewing. Some questions they might ask: “What is the current workflow? Ideal workflow?”, “What is the day-to-day like for end users?” It’s an intensive and essential process.
We’re inspired by a whole host of organizations in this space, including IDEO, Acumen, etc. 100% of our staff do a HCD crash course. Specifically for our designers, we have our own design curriculum, and many of them come from an HCD or anthropology background.
What are the services that Medic Mobile provides?
Medic believes that health is a human right. We know that global health disparities around the world are vast, and it’s estimated that one billion people will never see a doctor in their lifetime. In many places around the world - especially low and middle income countries - community health workers (CHWs) are closing that gap. CHWs are community members - sometimes volunteers, but ideally paid - who provide basic AND complex health care for their neighbors. Our vision is to equip these CHWs with mobile technology and the right tools to increase their impact.
For example, a community health worker can support in the following ways:
- Identifying and supporting pregnant women;
- Helping ensure the pregnant woman gets four antenatal care checkups, and identify any danger signs. (Having frequent checkups increases the chance the mother will give birth in a facility and survive child birth.)
- Ensure that children are vaccinated fully;
- Screen children and adults for common diseases (diarrhea, malaria), malnutrition, mental health, etc.
In many of these scenarios, community health workers serve as first responders, so that patients can start getting treatment quickly.
Medic Mobile’s tools are oriented around specific evidence-based use cases that have a clear impact logic. For example, we know that if we support a pregnant woman receiving a full course of antenatal care, she is more likely to deliver in a facility and survive child birth. Our use cases currently are:
- Antenatal care
- Childhood immunizations
- Under 5 child health
- Stock monitoring
- Disease surveillance
What the means is that in above areas, we have a ton of evidence and experience that our tools work. For a new use case - say, an area of health services or protocol that we’re not as familiar with - we have to do a lot of design. The design and product development teams are very tightly integrated.
As far as tools, we have tools for basic phones and smartphones (Android exclusively). We work with implementing partners and/or governments to equip health workers with these tools.
I was interested that you mentioned delivering advanced/complex care this way?
Broadly, when you’re dealing with delivering care for complex health conditions in resource-poor settings, there’s two issues:
1) Practically, you need what Paul Farmer calls “staff, stuff, space, systems.” You need expert knowledge. For example, to treat cancer, you need a professionalized cadre, you need certain goods like chemotherapy drugs, etc. All of that won’t be delivered solely through community health workers.
2) Where community health workers can come in for complex health conditions is in coordinating access, screening, and adherence to treatment. For example, with HIV. Thirty years ago, the World Health Organization suggested that delivering HIV care to the ultra poor was “too difficult, that there wasn’t enough money, it was too difficult to get people to adhere to medications out in the community.” Partners In Health (whose work is very influential for us) showed that community health workers can support people in adhering to HIV medication.
Same for TB. They proved that if you make the drugs available, you can even support the treatment of Multi-Drug Resistant TB through CHWs– where you have to take drugs daily for almost two years (and they have terrible side effects). Again, this is through trained community health workers in a process they call “accompaniment,” where CHWs are following up every day, providing support and guidance and ensuring that people are taking meds. In India, there’s been a lot of success with the Home Based Newborn Care protocol which provides guidance to community health workers around the first 45 days of life and navigating the major risks to a child’s life during that period.
Community health workers are starting to be used in the US, too – in Harlem, First Nation communities, and the rural South. So CHWs can definitely support health issues that are complex and difficult, and in fact, can probably do so more effectively and with more touch points than a physician could.
Do health workers have to be literate to use Medic tools?
Ideally, yes, but we’ve worked with many CHWs that have mixed or low literacy. For example, the Female Community Health Volunteer (FCHV) network in Nepal has mixed literacy. We’ve equipped them with basic phones where the FCHV can text something very basic like “P 12 Jill” to mean “Jill is pregnant, her last menstrual period (LMP) was 12 weeks ago.” Then, Medic Mobile will send the health worker SMS messages, reminding her to remind Jill about her antenatal care checkups. Someone with a low level of literacy can still use these messages, and we provide booklets/guides to make sure they can remember how. We also have a thorough training process, where we start with teaching these health workers (if needed) how to turn on their phones, how to enter characters, everything from soup to nuts. In Nepal specifically, many FCHVs have reported feeling more empowered and motivated after being trained to use these mobile tools for their work.
How are your tools evolving?
That’s a very timely question. We are combining what we’ve learned over the last 6-7 years and developing apps that support key shifts that we’re seeing in global health care delivery.
We are moving beyond data collection to decision support. Previously, our tool was often a substitute for form filling (ie. registering a pregnancy), but more and more, we are helping community health workers make decisions – around complex protocols for under 5 child health, for example. We’re moving towards supporting integrated performance management of CHWs, managing CHW targets and providing support for supervisory meetings between community health workers and their managers. Also, integrated health systems require integrated technology tools that will support families over time and across a variety of health issues. If we simply organize health information by specific conditions or by form, we could miss opportunities to provide longitudinal support, leave out important social and historical context, and create unintuitive workflows.
In general, we know that reactive systems that rely on sick patients showing up at facilities don't achieve equitable health outcomes. Health systems should be proactive and timely by design: mobile tools have an important role to play in bringing health workers to families' doorsteps often and early.
How do you coordinate with local government and politicians?
We are usually working with long term community-based partners. Ideally, organizations who already work with the local government. At some point, we want the local government to take over our mobile tools; the goal is always for the ministry to take over. We also sit on advisory committees and advise national eHealth and mHealth strategy in many of the countries where we work. We are committed to sustainable use of our tools. For that, we have to work hand in hand with local and national governments.
Is it open source? Can I deploy my own?
All our software is open source. You can certainly deploy our tools yourself, especially our DIY toolkit. All of our code is available online at Github.