Trevor Perrier

Projecting health: community-led video education for maternal health

We present a qualitative study of Projecting Health, a public health project we deployed in rural Uttar Pradesh (India) to address persistently high maternal and infant mortality rates. This project is based on our model of Community-led Video Education (CVE), which leverages community resources for the generation, dissemination, and assimilation of visual media. We use the lens of information flows to examine how our instantiation of CVE enables the translation of globally approved health care norms to local household practices. We also demonstrate how CVE allows for integration with current community practices, existing state-supported health care infrastructure, social and patriarchal structures, and power dynamics within our target populations to drive community participation.

Paper-Digital Workflows in Global Development Organizations

Global development organizations rely on the essential affordances provided by both paper and digital materials to navigate hurdles posed by poor infrastructure, low connectivity, linguistic differences, and other socioeconomic constraints that render communication and collaboration challenging. This paper examines the collaborative practices around paper-digital workflows within global development organizations operating in low-resource environments. We use a mixed methods approach to gather data from 23 organizations in 16 countries. Our findings show the tensions that arise between the ubiquitousness of paper and the desirability of digitized data, and highlight the challenges associated with transitioning information several times between paper and digital materials. We also reveal design opportunities for new tools to bridge the gap between paper-based and digital information in low-resource settings. Finally, we contribute a nuanced understanding of the cross-cultural and infrastructural challenges that influence the paper-digital lifecycle. Our findings will be useful for researchers and practitioners interested in understanding or participating in the workflows that drive global development.

USSD: The Third Universal App

In this paper we argue for the use of Unstructured Supplementary Service Data (USSD) as a platform for universal cell phone applications. We examine over a decade of ICT4D research, analyzing how USSD can extend and complement current uses of IVR and SMS for data collection, messaging, information access, social networking and complex user initiated transactions. Based on these findings we identify situations when a mobile based project should consider using USSD with increasingly common third party gateways over other mediums. This analysis also motivates the design and implementation of an open source library for rapid development of USSD applications. Finally, we explore three USSD use cases, demonstrating how USSD opens up a design space not available with IVR or SMS.

Supporting immunization programs with improved vaccine cold chain information systems

Immunization is recognized as one of the most successful public health interventions ever devised. A critical component of immunization programs is the vaccine cold chain - the cold storage to keep vaccines safe from manufacture to eventual delivery to the child. Countries need to manage their vaccine cold chains and logistics systems to ensure sufficient storage capacity, distribution of adequate supplies of vaccines, and functional cold storage equipment. There are particular challenges for remote facilities where transportation costs are high, power infrastructure is lacking, and communication is limited. Accurate information about the cold chain is essential to address these challenges and to evaluate the impact of different interventions. A Cold Chain Information System (CCIS), which tracks health facility information and the countrys cold chain equipment can help address these challenges at both the strategic (planning) and tactical (management) levels. This paper describes our efforts to develop a CCIS for Laos, in collaboration with UNICEF and the Lao Ministry of Health. The work builds on experience with deploying CCISs in multiple countries along with developing analysis tools and data standards. The CCIS in Laos uses DHIS2, a widely used web based health indicator system as the back end, which is integrated with SMS reporting from the district and health center level where internet is not guaranteed to be available. A central goal of the system is to allow regular reporting of vaccine stock levels and vaccine refrigerator status (measured by logging devices recording high and low temperature alarms). The system is designed with notifications to promote action by technicians or managers. The technical contributions of this work include the development of a new data model for DHIS2 and a text message system using an Android gateway to RapidSMS with a custom notification engine interfacing to DHIS2.

Evaluation of mHealth strategies to optimize adherence and efficacy of Option B+ prevention of mother-to-child HIV transmission: Rationale, design and methods of a 3-armed randomized controlled trial

BACKGROUND Lifelong antiretroviral therapy (ART) (Option B+) is recommended for all HIV-infected pregnant/postpartum women, but high adherence is required to maximize HIV prevention potential and maintain maternal health. Mobile health (mHealth) interventions may provide treatment adherence support for women during, and beyond, the pregnancy and postpartum periods. METHODS AND DESIGN We are conducting an unblinded, triple-arm randomized clinical trial (Mobile WACh X) of one-way short message service (SMS) vs. two-way SMS vs. control (no SMS) to improve maternal ART adherence and retention in care by 2years postpartum. We will enroll 825 women from Nairobi and Western Kenya. Women in the intervention arms receive weekly, semi-automated motivational and educational SMS and visit reminders via an interactive, human-computer hybrid communication system. Participants in the two-way SMS arm are also asked to respond to a question related to the message. SMS are based in behavioral theory, are tailored to participant characteristics through SMS tracks, and are timed along the pregnancy/postpartum continuum. After enrollment, follow-up visits are scheduled at 6weeks; 6, 12, 18, and 24months postpartum. The primary outcomes, virological failure (HIV viral load ≥1000copies/mL), maternal retention in care, and infant HIV infection or death, will be compared in an intent to treat analysis. We will also measure ART adherence and drug resistance. DISCUSSION Personalized and tailored SMS to support HIV-infected women during and after pregnancy may be an effective strategy to motivate women to adhere to ART and remain in care and improve maternal and infant outcomes.

Questioning feedback: improving public health messaging

This note explores methods of analyzing questions asked during public health video showings. The goal is to provide feedback to content creators and session facilitators based a limited subset of the audiences questions. We analyze five videos produced in the first year of Digital Public Health focused on maternal health issues in rural India. We demonstrate a prototype web based tool to collaborate on the qualitative analysis of questions and propose mechanisms for systematically improving future videos based on this analysis. Initial results show that it is possible to extract useful information on how the target audience perceives the messaging in a video exclusively from questions asked. Based on these results we explain how Digital Public Health can integrate this feedback into an iterative review process for quality assurance of messaging.

User errors in SMS based reporting systems

This note presents data from two large-scale data reporting projects in Pakistan and Laos using SMS as a channel of data collection. These projects share several major features: (1) the use of health workers personal mobile phones for data reporting (2) support from the Ministry of Health (3) planned expansion to every health facility in the country or province and (4) low ICT penetration at the periphery of the health system. Both projects are currently at the stage of rolling out to additional health facilities. The purpose of this note is to help understand the challenges faced in the early stages of the deployment by reviewing the content and errors in submitted SMS messages.

eKichabi: Information Access through Basic Mobile Phones in Rural Tanzania

This paper presents eKichabi, a tool for retrieving contact information for agriculture-related enterprises in Tanzania. eKichabi is an Unstructured Supplementary Service Data (USSD) application which users can access through basic mobile phones. We describe our focus groups, a design iteration, deployment in four villages, and follow up interviews by phone. This work demonstrates the feasibility of USSD for information access applications that have the potential for deployment on a large scale in the developing world. From user interviews, we identified strong evidence of eKichabi fulfilling an unmet need for business related information, both in identifying business contacts in other villages, as well locating specific service providers. One of our key findings demonstrates that users access information through multiple modes, including text search, in addition to menu navigation organized by both business sector category and geographic area.

Short message service communication improves exclusive breastfeeding and early postpartum contraception in a low‐ to middle‐income country setting: a randomised trial

To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use.

UW-Pesa: A Mobile Money User Experience Experimentation Platform

This paper presents UW-Pesa, a simple web based mobile money sandbox for fast prototyping and demonstration of financial service products. The purpose of UW-Pesa is to enable academic groups to explore issues of privacy, security, and usability within the rapidly growing space of Digital Financial Services for Development and especially mobile money services. Although financial services are an important sector within the broader field of mobile for development, innovating and understanding core concepts within these services is difficult because the ecosystem is complex and dominated by a few mobile operators. Most large scale mobile financial services rely on either SIM Toolkit or USSD based user interfaces with an assortment of smaller scale services introducing Android based mobile money applications. UW-Pesa aims to create a simplified testbed so that smaller projects can quickly prototype ideas without involving large mobile operators. Currently the major components of UW-Pesa are a web interface, transaction API, and a USSD implementation.