In the summer of 2008, an SMS-based communications network was implemented for a
rural hospital and its volunteer community health workers (CHWs) in Namitete, Malawi.
Located 60 km from Lilongwe, St. Gabriel’s Hospital serves 250,000 Malawians spread over a
catchment area 100 miles in radius. Distance presents an often-insurmountable obstacle for
patients seeking care at St. Gabriel’s. Many patients walk up to 100 miles to the hospital; those
with more resources ride bicycles or oxcarts. In order to report patient adherence, ask for medical
advice, or request medical care for remote clients, CHWs had to travel similar distances to the
hospital’s doors.
Josh Nesbit, a Senior in the Human Biology Program at Stanford University, traveled to
St. Gabriel’s with 100 recycled cell phones, a donated laptop and a copy of FrontlineSMS – a
free computer program developed to act as a central text message hub. Over 8 weeks, a total of
75 CHWs were called to the hospital, given cell phones, and trained in text messaging. The
volunteers’ locations were mapped, and the phones were disseminated throughout the catchment
area. Stationed at the hospital, a laptop running FrontlineSMS coordinates the health network’s
activities. The day-to-day program operations were handed over to hospital staff within two
weeks. Josh returned to St. Gabriel’s in December 2008, to distribute solar panels donated by
G24 Innovations, taking the SMS network off the grid.
As a result of the SMS network, the hospital now responds to requests for remote patient
care, tracks distant patients, informs CHWs of proper drug dosages and uses, receives patient
updates, facilitates CHW-to-CHW communication and group mobilization, connects HIVpositive
patients to support groups, and relays outreach HIV testing schedules. In six months, the
SMS program has saved the hospital staff 1200 hours of follow-up time and over $3,000 in
motorbike fuel. Nearly 1,400 patient updates have been processed via SMS. Over 100 patients
have started TB treatment after their symptoms were noticed by CHWs and reported by textmessage.
The SMS network has brought the Home-Based Care unit to the homes of 130 patients
who would not have otherwise received care. Texting has saved 21 antiretroviral therapy (ART)
monitors 900 hours of travel time, eliminating the need to hand-deliver paper reports.