Big World, Small World

by Cory Zue on April 12, 2009

The Ministry of Health and the National Malaria Control Program (NMCP), the Support to National Malaria Program (SuNMaP) , UNICEF, and a whole host of other acronymed organizations are rolling out the largest ever distribution of bednets in Africa over the next two years, and have chosen to integrate RapidSMS into their program for real-time monitoring and tracking of nets as they travel across the country for the pilot in Kano state.  Just the pilot program, encompassing a half of one of Nigeria’s 36 states, looks to distribute over two-million insecticide treated nets, which, in layman’s terms, is “a whole lot”.

We’re thrilled to be working on this project, and the enthusiasm we received from the local team on our system was extremely satisfying.  UNICEF Innovations Group and Dimagi just completed facilitating a 4-day  workshop in Abuja that provided an overview of RapidSMS at its use.

The workshop consisted of an extremely diverse group of people, including higher-ups working for various government agencies, UNICEF staff assisting in the operation, university students from Lagos, and Abuja, and people we met on the Internet.

That’s right people we met on the Internet.

Ok, technically we didn’t meet them.  Evan Wheeler, one of our colleagues working for UNICEF did.  Evan was “researching the local programming scene” and through a series of popular and local social networks somehow got in touch with two developers based out of Lagos and convinced his supervisors to invite them to the workshop.  Think “Tweet tweet.  Cory is off to Abuja to learn about RapidSMS!”

So what was the result?  Well they learned Python over the weekend, took a crash course in Django, and within two days they were churning out a brand-new AJAX interface to RapidSMS that enabled real-time testing of any RapidSMS application in the confines of a web browser.  In non-programming terms, that means making it a whole lot easier for developers and non-developers alike to learn and work with RapidSMS.  Tim Akimbo’s new code was demonstrated in one of the modules before the workshop was even over!  Needless to say, everyone is trying their hardest to get these guys to continue working on the project now that the workshop’s over…

So, as we continue to think about how the heck we’re going to assist in managing and tracking the distribution of trucks, people, coupons, and millions of malaria nets across Nigeria, someone can pick up a computer in New York and somehow find an amazing programmer in a city with 8 million or so people and convince them to work with us one week later.

Now that’s how you get local ownership of an open source project.

Below are some photos from the workshop.

Evan walking the programmers through some code

Tim (one of the guys we met on the internet) showing the other developers his new tricks.

ARemind orally presented at IAPAC 2009

by Vikram S. Kumar on April 10, 2009

Dr. Helene Hardy presented one of the select oral abstracts at the 4th International Conference on HIV Treatment Adherence in Miami:

Title: Assess and Remind (ARemind): a Personalized Cell Phone Reminder System is Superior to a Beeper to Enhance Adherence to Antiretroviral Therapy

Background: Adherence to antiretroviral therapy (ART) represents one of the strongest predictor of progression to AIDS, yet innovative technologies are needed to sustain adherence over time. The purpose of this study was to compare the efficacy of a personalized cell phone reminder system called Aremind in enhancing adherence to ART versus a beeper.

Methods: Twenty-three HIV-infected subjects on ART with self-reported adherence <85% were randomized to a cellular phone (CP) or beeper (BP). CP subjects received personalized text messages and had to respond with a text message when taking ART. BP subjects received a reminder beep at the time of dosing. Interviews were schedule every 3 weeks over 6 weeks. Adherence to ART was measured by self-report (SR, 7-day recall), pill count (PC, past 30 days at baseline, then past 3 weeks), and MEMS (cumulatively at 3 and 6 weeks). ANCOVA model adjusted for baseline adherence was used to compare SR and PC adherence changes. T-test was used to evaluate difference between groups for MEMS.

Results: Twelve males and 11 females were enrolled; 19 completed all visits. Mean baseline viral load and CD4 count were 21,309 copies/mL and 295 cells/mm3. Most subjects were on a boosted PI (52.2%) or an NNRTI (17.4%). Past adherence barriers included active substance abuse (73.9%), fear of side effects (69.6%), and lack of daily routine (65.2%). Both SR and PC adherence increased significantly from baseline to week 6 in the CP arm (83.4% to 92.8%, p=0.03; 65.2% to 82.8%, p=0.005). Furthermore, cumulative MEMS adherence (88% vs 60%, p=0.008), average SR adherence (92% vs 75%, p=0.07), and average PC adherence (80% vs 65%, = 0.06) were higher in the CP arm.

Conclusions: Aremind was more successful than a beeper in enhancing adherence to ART in this population. A larger prospective study is necessary to confirm these findings.

Citation: Hardy H, Farmer EK, Kumar V, Jackson J, Myung D, Doros G, Rybin D, Drainoni M, Backman E, Stanic A, Skolnik P. Assess and Remind (ARemind):  a Personalized Cell Phone Reminder System is Superior to a Beeper to Enhance Adherence to Antiretroviral Therapy. Fourth International Conference on HIV Treatment Adherence. April 5-7, 2009, Miami, Florida. Abst 0289. Approved for Oral Presentation

Panel at HBS Africa Business Conference

by Jonathan Jackson on February 23, 2009

I recently spoke on a panel at Harvard Business School at the Africa Business Conference.  The conference had a very good mix of attendees, with many students and many folks from industry.  Interestingly, during the panel, there were many questions comparing the US Healthcare IT issues to developing settings scenarios that we responded to.  After the panel, Mina Hsiang, the panel organizer and a student at HBS, raised a very interesting point: Experts can talk with credibility about capital markets and access to capital as the developed world has set up a functional, efficient system (although that appears to be up for debate more recently).  However, particularly in the US, we can’t claim to have done a good job with the US healthcare system and healthcare delivery.  Therefore trying to determine the similarities or models from the US that could be translated to developing settings could be an ill-advised approach.

The NYHE

by Vikram S. Kumar on December 23, 2008

“Welcome to the New York Health Exchange! At the closing bell on Dec 31, 2008, you saved 40% of your allocated money for the year, received dividends amounting to 10% of your starting balance, benefited from a 15% appreciation in your health indices, and a corresponding drop in your mortality markers. The NYHE reminds you to ease on the holiday gorging and wishes you a healthy Q109.”

I had an interesting conversation yesterday with Jessica Shambora from Fortune. Whether patients will own and control their health information through personal mobile technologies was one of the topics we discussed. It became clear to me that while we will have the ability to browse our medication histories on our phones, we need to look beyond technology if we want to get our health system back in shape.

Thanks to Mikhail Elias who recently joined our team at Dimagi, I have been learning lots about Health Information Exchanges. They form a cloud of health information between institutions and stakeholders that make it easier (at least conceptually) to share data. So in theory we can have a central way to access all of our data. But we can do more than that.

We need some innovations in health financing (eg HSA 2.0) that’ll make spending or saving on healthcare fashionable. Put control of the purse with the patient and their family/network since the patient is where all pieces of the puzzle converge. Run the dollars and data through a centralized exchange; so a patient is able check the status of a lab (with simple interpretation) and also the balance in a health dollar account. The data is all there, but focusing only on fixing the data exchange misses the bigger picture. That is, of making all the hard data work relevant to a patient.

Back in the day we made a video game for children with diabetes. People criticized us, saying that patients would compromise their health for the sake of the game. The good news (or bad news for those who work on behavioral change) is that patients are more sensible than that. If given the means, they will do what they think helps their health. An exchange where they also can make some cash by saving the health system some dollars (eg. prevent hospitalizations by taking those asthma meds) can change the game. Or as John Hammergren of McKesson says in his aptly titled book, we will change the game when we give patients some Skin in the game.

Google Epidemics

by Cory Zue on November 12, 2008

I’ve always been a huge fan of Google Trends and Zeitgeist, and felt that there was TONS more that could be done with the data besides it’s current uses, which as far as I can tell are (1) entertaining bored people like me, and (2) making Google a bunch of money.

Well today Google announced one great (and, admittedly, obvious) thing to do with the data: track diseases. 

Google Flu Trends is a new service that uses organic Google searches to track and predict flu outbreaks in the US.  According to the article Google is able to predict flu spread much more quickly – and just as accurately – as the CDC’s existing system (in some cases beating the CDC by as much as two weeks).

Unfortunately, this type of organic information gathering via Google searches is not going to help the developing world anytime soon (where most don’t have the internet access necessary for this to worK), but this is an exciting first step towards using the population’s collective wisdom and information sharing towards mitigating the world’s health problems.

Looking forward to seeing where Google takes this!