Innovation in public health is often bottom up: new processes and technologies are often identified by grassroots and non-governmental organizations and deployed locally before achieving broader use. Mobile technologies have a vast potential to strengthen health systems for under-served populations, but innovation is hindered by the difficulty and expertise required to create robust and deployable solutions. This work seeks to change this state of affairs by providing a set of tools based on commonly available mobile devices that will permit these organizations to easily deploy new health services, supervise their delivery, improve logistics, evaluate their programs' effectiveness, and disseminate their learning and tools to others around the world. The approach is based on cost-realism, namely, the appropriate mix of technology elements to tackle a problem based on a realistic assessment of the solution's sustainability in the community where it will be deployed. Thus, the focus is on using a mix of communication devices that are already likely to be in the possession of a large percentage of the target population such as mobile phones. There will also be experimentation with adding new sensor devices to mobile phones for physiological measurements. This collaborative work includes PATH, an organization uniquely suited to realizing scalable technology solutions in the public health space.

The goal of the research is to understand how mobile and cloud software can be constructed to make it easier to deploy modular applications that take advantage of components designed by a large community rather than a monolithic solution that is difficult to extend. In this way, a flourishing ecosystem will be created, much like application markets today, with the added capability of composing modules into larger systems. Evaluation will include both the use of the tools in a public health context as well as the ease with which new information services and systems are built and deployed. Given the wide range of potential applications students will be recruited from a wide variety of disciplines including the University of Washington Medical School, School of Public Health, and Information School and inter-disciplinary projects will be introduced into undergraduate capstone courses.

As the work is multi-disciplinary, research results will be as well. The focus is on human-computer interaction, mobile systems, communication, and software engineering. The primary technical challenges are in management of mobile data collection, expanding the sensing/perception capabilities of mobile phones for health, and architecting distributed information services. Improved methods for organizing data collection campaigns and their sustainable management in terms of both the deployment of instruments on mobile devices and tools to supervise the data collectors themselves will be foremost. Connecting mobile phones and their sensors in a structured arrangement that will allow use of everything from paper and cheap voice/SMS phones on one end of the spectrum to smartphones and tablets on the other will be a significant contribution to data collection methods. Exploiting standard interfaces and internet protocols between cloud-based modules will formalize the development of data architectures (above basic databases) that embody work processes and sustain management feedback loops.

Project Report

This collaborative research grant between PATH and the University of Washington’s Department of Computer Science and Engineering was predicated on the understanding that innovation in public health is often catalyzed from the bottom up, and that new processes and technologies are often identified and defined by end users to meet specific contextually localized needs. Mobile technologies have significant untapped potential to strengthen health systems around the world, but the ability to actualize the innovation is hindered by the expertise required to create robust solutions. This grant proposed to change this state of affairs by providing a set of tools based on commonly available mobile devices that enable end users to easily and rapidly deploy mobile phone based services in a contextually relevant, cost effective and robust manner - regardless of technical capacity. Under the grant a large number of individual projects were conducted, some were small single student studies at UW, while others were larger initiatives including Projecting Health, Human Milk Banking, and ODK. PATH contributed public health expertise, and in two projects (Projecting Health and Human Milk Banking) PATH played a major role in implementation of these projects in low resource settings. The core theme to our approach has been to develop innovative technologies that could be demonstrated and evaluated for impact with partners and then generalize the tools so that they can be adapted to support a range of needs. The various projects fall into the following four broad categories: Design: Use research-based approaches to design and create technology-based solutions that meet the needs of diverse user populations. Tools for data collection and use: Focus on collecting data in the field and then providing different mechanisms for using and analyzing the data. Mobile devices: Mobile computing technologies are at the heart of the toolkit that is being developed. A central theme of the research is to investigate how the powerful, low-cost, consumer technologies can be the basis of tools to support public health. Deployment studies: All of our technologies are evaluated through deployments in the field. This generally requires working with organizations that have a strong presence in the target country, a field staff to help with implementation, and a deep understanding of local conditions. Significant Results: Personas of key community health workers were developed based on six weeks of field work in Karnataka, India. These are important tools that will help the design of appropriate tools to support health workers in low-resource settings. The key outcome of Mobile Women and Child Health project has been showing that women living in a study area in Kenya will engage with the health system via SMS. This has laid the foundation for a new three-year study funded by the National Institutes of Health (NIH) comparing the cost and effectiveness of two-way messaging vs. one-way messaging for the prevention of HIV transmission from mother to child in Kenyan health clinics. We deployed an SMS data-reporting system in Laos for immunization information to be reported from health facilities. The pilot system is operational in three districts and discussions are in progress to extend the system to a national deployment. This is a collaboration with United Nations Children’s Fund (UNICEF) and the Lao Ministry of Health (MOH). We developed an online tool that allows people to design and print their own scannable forms. We also developed ODK Scan forms and ODK Tables reports for two major use-cases: a child vaccination card and an HIV patient register. All of the necessary files for scanning and digitization are created automatically, thereby substantially increasing the usability of the system. We conducted a field test in Ghana of ODK Sensors to connect a pulse oximeter to a mobile phone implementation of a clinical protocol. This provided important usability information and confirmed that the basic smartphone technology would be suitable for rural deployments. The Kwa-Zulu Natal Department of Health has approved the continued testing and installation of five additional FoneAstra-equipped pasteurizer systems to be deployed at district-level hospitals in KZN province. Projecting Health an innovative approach to health education based on community-led video was deployed in Northern India. An evaluation study showed that mothers in the implementation site had substantially greater knowledge of health practices than women in comparison sites. Through grant #1114622 titled, Collaborative Research: From the Ground Up -- Mobile Tools for Grassroots Programs in Public Health, we achieved our goal of creating a toolkit that consists of highly modularized components that have been demonstrated to be easily composed to field a variety of applications. Thus enabling efficient and efficacious implementation within underserved populations to address public health challenges.

National Science Foundation (NSF)
Division of Information and Intelligent Systems (IIS)
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Sylvia J. Spengler
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Program for Appropriate Technology in Health
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