Development using SMS, not SMS4Dev
Cross-posted at TechnologySalon.org
Where the last SMS4D Technology Salon reminded us of the unique gift of mobile technologies to be based where there impact will be, The Cloudy SMS4D Salon really drove home mobile as a multifunctional tool whose true impact is tied more to the usage than the technology itself. While we gathered to discuss SMS4D, we really talked about heath reporting and outreach, education, and community-building through knowledge management and sharing. It just so happened that these health projects were using SMS codes to report longitudinal child health statistics.
Data gathering in health, and even knowing when to gather data, is a huge burden, often relying on community health workers doing the healthcare version of the T&V system of the agricultural extension world. Waiting around for a planned infrastructure is hopeless, but working with the more incremental nature of mobile can improve reporting rates and reduce errors -- "utter chaos works everywhere" being the best quote of this tech salon. Childcount builds on existing SMS reporting to enable community health workers to rapidly register children, note any symptoms or diseases they might have, improve patient tracking (and thereby reducing duplication), and schedule immunizations and outreach. The SMS "encoding" builds off of a simple and familiar paper form, which is handy for training (but less useful than a mango tree, as we'll see). The runner-up quote from this Salon dealt with discussion around the potential risk of intentionally fabricated data -- "humans are awful at falsifying data" -- digitizing and quick, auditable reporting exposes both errors and lies.
Winning the award for innovative ideas in mHealth was the HappyPill project -- instead of boing old SMS, HappyPills uses "flashing" - where you call a number and hang up immediately to "ping" someone. Usually, flashing is just a free way to ask someone to call you back, or you can sometimes work out extensive codes -- one missed call is just saying hi, two is call me back, three means an emergency, etc.. HappyPills takes this basic, essentially binary interaction and applies it to help improve adherence rates for prescription regimens. A medical center can send out flashes to their patients, and the patients are reminded to take their pills and would then flash back to signal that they took their medicine. It's naturally not foolproof, but hugely more cost effective (almost cost-free) in comparison with sending a community health worker out to the patient on a motorcycle to witness their pill-taking.
It turns out that people are not just willing, but economically motivated and excited to use (and pay for) basic SMS-based services to improve their numeracy and literacy skills, improving their ability to communicate cheaply over their phones as well as better navigate market prices. In these low-technology communities, Tostan's Jokko Initiative is creating a curriculum to enable this via SMS, and they have also come up with an amazingly simple methodology to introduce people to menu systems using a mango tree metaphor which gracefully transitions from the concrete (planning a climbing route on a real tree to get to a specific mango) to the semi-concrete (the same, on a diagram of a tree), to the abstract (the tree diagram becomes the menu diagram, the mango a specific function). Anyone who thinks that is basic has never shown their grandparents a new shiny piece of technology, or had their entire worldview of user interface challenged by someone physically pointing a mouse at a screen).
Patatat is an early-stage solution which puts SMS into the role of a community town hall/newsletter/email list. It removes not only the normal geographic barriers that a listserv gets around, but also infrastructure barriers, so (for example) farmers across a region or the world can share knowledge around their crops without relying on the grid and hardwired phones/Internet to do so. This also centralizes costs to one "host" and minimizes it to the community, so a farmer could send one SMS (free to receive, costs to send), and the host would re-broadcast it to the entire "community." With Twitter already showing that it can (technically) report earthquakes faster than the earthquake itself spreads, this rebroadcasting tool also has clear applications in emergency announcements, citizen journalism and a myriad of other fields.
So, was this technology salon about technology, or was it about development projects? Sure, all of the projects discussed at the salon happened to use server and cloud-based SMS technologies. They also probably use paper, transportation, and people. That the technology is now moving from the focus of a project to being a (cool, exciting, powerful, still new-and-shiny) tool in the toolbox is truly heartwarming. It means it is maturing into a cross-sector role and not into another silo (sorry, a "cylinder of excellence" in the parlance of our times).