Response:

Results:

St. Gabriel’s Hospital serves 250,000 Malawians spread throughout a catchment area 100 miles in radius

St. Gabriel’s Hospital is located 60 km from Lilongwe, the capitol city

The vast majority of the people the hospital serves are subsistence farmers, living on under $1 a day

The hospital has enrolled over 600 volunteers to act as community health workers (CHWs) in their respective villages Many of the volunteers are active members of the HIV-positive community, and were recruited through the hospital’s antiretroviral therapy (ART) program.

Mobiles in Malawi

Many patients walk up to 100 miles to the hospital – to see one of the three doctors on staff. In order to report patient adherence, ask for medical advice, or request the mobile clinic’s attention, CHWs had to travel similar distances to the hospital.

The most motivated of the CHWs kept their own patient records, and journeyed to the hospital when they could – by bicycle, foot, or oxcart.

The hospital

now follows up on

distant patients

.

HIV/AIDS and TB drug

adherence is

tracked Remote medical

emergen-cies are reported

and responded to by a mobile team

CHWs check

medication dosages

before adminis-tering

drugs in the

villages

Commun-ities’

medical question

s are fielded

HIV/AIDS

support groups

effectively

organized

The CHWs, and the villages

surrounding them,

now enjoy previously unimagine

d connectivi

tyThe smart but simple nature of Frontline-

SMS allowed

the tool to be readily integrated

into hospital

programs

A Rural Health InitiativeElizabeth Nesbit—Rice University

Josh Nesbit—Stanford University

The hospital staff has been trained to maintain the communication system

Date Initial SMSResponse SMS

CHWCommunity Health Worker

Action Taken Alternative

6/25/2008A patient with

CHF has run out of drugs.

This patient should not

miss medications. Advise him to come to the

hospital.

VK

VK counsels patient, who

claims to be too ill to travel.

Verona comes the hospital and picks

up drugs.

Patient discontinues treatment.

6/24/2008

I visited two patients who are

not getting better. They have cancer

problems.

Received your

message. I will come tomorrow.

ZKMobile clinic

visits patients.

Patients remain unseen

in their respective villages.

7/7/2008

Request to inform BL that MP will

visit their Village AIDS Committee on Saturday, June

12th.

A message has been sent to BL. Thank

you.

BM

VAC mobilizes for a meeting when the Community

AIDS Committee chair visits.

CHW spends a full day

traveling, in order to alert VAC that MP

will visit.

7/17/2008

AC is on ARVs. He is developing sores that are

itching. Is that a problem with the

ARVs?

Patients who have

developed scratches

should come to the

hospital immediately.

MM

Possible ARV side effects reported, patient asked to

come to the hospital.

Patient remains in

village, side effects persist.

If effects worsen,

patient visits the hospital.

During the summer of 2008, FrontlineSMS was introduced, along with 100 cell phones,

in order to implement a text-based communications network for the hospital and

the CHWs.

Stationed at the hospital, a laptop running FrontlineSMS acts as a text-message hub –

coordinating the health network’s activities.

70 CHWs were trained to use their cell phones to

contact St. Gabriel’s Hospital.

Impact:

The system was programmed to automatically top up the phones.

CHWs learning to use their cell phonesAlex—the hospital’s HBC officer—travels to a rural village upon the SMS request of a CHW

Background Information:

Problem:

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