How texting saves lives in rural Africa

by Andrea Marshall

©Steve Evans - Initiation ritual of boys in Malawi

The K4Health SMS project saved a dying mother’s life in central Malawi. But it also provides an effective response to emergency medical situations in remote parts of Africa and beyond. A mobile phone-based system for delivering key medical information to service providers, it can improve preparedness and give basic information and advice to people affected by crises.


From the Bua health centre in central Malawi, Piers Bocock, the former Director of Knowledge Exchange at Management Sciences for Health (MSH) who is now the Deputy Director at    Johns Hopkins Center for Communication Programs’ K4Health Project, reported on the K4Health blog:


“It is late in the evening in a hard-to-reach village in the Malawian District of Nkhotakota. There is no electricity in this village and none in the Bua community health centre that serves 11,280 people, including a pregnant mother who goes into pre-term labor. The local Health Surveillance Assistant (HSA) is called to provide assistance because the local maternity nurse is not at home.


The battery-powered radio at the health centre has long-since died, and the only form of communication they have is a K4Health mobile phone that was provided to the HSA to improve knowledge exchange and communications between frontline health workers, their health centres, and the District Hospital. The HSA, who had recharged her phone that day using a solar panel charger provided by the project, sends a text message to the maternity matron at the District Hospital who immediately dispatches an ambulance to pick up the expectant mother. She is taken to the hospital and treated. Her baby was still-born, but had it not been for that text message, the mother would have died too.”


Supporting health knowledge management

Knowledge for Health (K4Health) is a U.S. Agency for International Development-funded project implemented by the John Hopkins  Center for Communication Programs  (JHU/CCP) in partnership with FHI and Management Sciences for Health (MSH). The K4Health project is designed “to increase the use and dissemination of evidence-based, accurate, and up-to-date information to improve reproductive health service delivery and reproductive health outcomes worldwide”.

Equipping health workers with mobile phones and solar chargers is only one of the numerous ways in which the K4Health project supports knowledge management activities in international public health in countries such as Malawi, Indonesia, Senegal, South Africa, Swaziland, and Lesotho, to name a few examples.


The heart of K4Health’s strategy is in providing policy makers, programme managers and service providers with medical information that is easy to find and easy to use.


“We start by identifying their needs through assessments in the countries we work to identify information gaps,” says Lisa Basalla, eLearning coordinator at the John Hopkins Center for Communication Programs  (JHU/CCP), Baltimore, USA, where the project is based. She will present the project’s approach at eLearning Africa 2011.


©K4Health - The K4Health mobile phone improves knowledge exchange between frontline health workers, their health centres hospitals.“We then forge relationships with local family planning / reproductive health organisations, strengthen their knowledge management capacity, and provide the technical assistance required to capture, organise, adapt, and disseminate FP/RH information in the most useful formats and through the most appropriate communication channels.”


eLearning and eToolkits in Southern Africa

Amongst other tools, K4Health has developed an eLearning solution at low to no cost to users. It offers instructional design, technical assistance and an eLearning platform to house original, interactive courses that deliver technical content and organisational guidance.


In Africa, K4Health has fostered a partnership with SAfAIDS, a regional non-profit organisation based in South Africa that implements programmes in ten countries in the region, to develop and implement an evidence-based knowledge management strategy. One component of this partnership which has been running since September 2009 is training SAfAIDS staff members to build the organisation’s eLearning capacity.


The Malawi project, implemented by MSH, is a pilot project of K4Health’s knowledge management model applied to a local setting. It started in 2009. “Respondents to the needs assessment reported that they lack up-to-date and relevant information necessary to do their work. Even when information exists, it is scattered and difficult to find. Community health workers also rarely receive updates after their initial training, even when new guidelines or protocols are introduced at the district or national level,” Basalla explains.


As a result, K4Health worked with local partners to establish a national knowledge management taskforce, created country-specific electronic toolkits, set up district-level learning centres with online access to eLearning courses and launched a community health worker mobile network (FrontlineSMS system). “This summer we will transition our direct involvement in Malawi over to local institutions and the government,” Lisa Basalla said.


Walk 30 km to report a difficult condition

SMS till you drop - Mobile phones are enabling African countries to leapfrog generations of communications technology as they spread rapidly.

Coming back to the SMS system – of course not all information exchange is as dramatic as in the Bua health centre case mentioned above. But the system does make a real difference.


Take Rose Douglas, a volunteer Community Based Distribution Agent (CBDA) for family planning based in Mkwatire village which is 30 kilometers from the nearest health centre. Rose has 123 clients which she visits, provides contraceptives and monitors monthly. She gets supplies from her supervisor, a Health Surveillance Assistant at the health centre. She reports difficult conditions she encounters such as medicine side effects, and reports monthly.


However, before the project started, it took Rose more than a month to consult her supervisor on difficult cases she met in her daily job – because she had to walk 30 kilometers to the health centre. It took more than a month to report a drug stock out and get the needed supplies. It took two months for Rose’s monthly report to get to its final destination, and it took more than a week for Rose’s supervisor to send a message to Rose.


Now, with the implementation of the SMS hub which enables people to send data and monitor reports instantly, all this can be done within a few minutes.




K4Health general website:

K4Health Malawi portal:

Lisa Basalla, eLearning coordinator at the K4Health project, will present Promoting Knowledge Sharing, Adaptation and Use: An Evidence-Based Approach at eLearning Africa 2011 in Dar es Salaam, Tanzania. Her presentation will be part of the session eLearning and the Future of Africa’s Health Sector on Thursday, May 26, 2011, from 14:30 – 16:00.


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