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Preventative Child Health in Mali

Pesinet, a French NGO, is assessing the added value of technology in reducing child mortality.

November 16, Bamako, Mali - In an article titled “African Valley,” the September issue of the French magazine Geo declares, “The United States has its Silicon Valley. Today many African countries are witnessing the birth of their own valleys where technology—mobile telephones, Internet, and applications—leads economic development.” This is one of many examples of the excitement created by mobile technology in the development sector over the last five years. The trend has been fuelled not only by the media but also by donors increasingly looking to fund “innovative” mobile technology projects.

Yet while technology has undoubtedly facilitated development in the last decade, the side effect of all the hype is that we risk seeing technology as a solution in and of itself, rather than as a facilitator of clear development objectives. I recently joined a small French NGO, Pesinet, which runs a mobile health service for children in West Africa. In this post, I reflect on the added value of technology in our service—for doctors, patients, and the overall healthcare system.

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A Pesinet agent weighs a subscribed child and enters the data into the mobile application. (Photo courtesy of Pesinet)

Pesinet’s mission is to sustainably reduce the rate of child mortality by facilitating the access of families to existing local healthcare systems. The project combines home visits by health monitoring agents with an affordable insurance scheme. The objective is to detect simple childhood diseases starting with the first symptoms and to encourage families to seek immediate care. Pesinet trains and deploys agents—equipped with a mobile phone, a scale, and other basic equipment—to visit the families of subscribed children several times a month. On each visit, the agent records information concerning the child’s health into an application on the mobile phone. The data is sent to doctors at the closest partnering health center so that they can monitor children’s health and summon children at risk.

Dr. Siaka Sako is the general practitioner at one of Pesinet’s partnering health centers in Commune III of Bamako, Mali. Like all of Pesinet’s partnering doctors, his role is to review the health data collected by the agents during their home visits via a web platform that displays the children’s weight as a fluctuating curve over time alongside other indicators. “Every morning, the first thing I do as soon as I arrive is connect [to the web platform] and consult the curves there,” he explains. “If there are [children] to summon, I summon them.” The agents return to the families of those children identified as at risk by the doctor, and tell them to take their child to the center. Dr. Hamadoun Cissé, another doctor at the center, feels that the web platform is particularly useful in the early detection of diseases. “With Pesinet, I have gotten a taste for preventative medicine” he says. “What has really pleased me about Pesinet is the ability to anticipate complications.”

There are other benefits from introducing of new information technology into the healthcare centers. For example, the medical teams use the computer provided by Pesinet for Internet research to keep themselves up to date on medical knowledge. “The practice of medicine is not static,” Cissé says. It is essential to have “access to information at any moment.” Internet access and the growing use of mobile phones in the community has also sparked new ideas for health service improvements. Cissé is enthusiastic about the possibility of sharing best practices with doctors in the United States and France. “We hope Pesinet can help develop relations between us and doctors elsewhere and facilitate long-distance training.”

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Dr. Cissé examines the risk curves for subscribed children via the Pesinet web platform. (Photo courtesy of Pesinet)

But there remain barriers to the widespread adaptation of technology in Mali, even in its most basic uses. Underdeveloped technological infrastructure makes for very unreliable mobile and Internet connection, which slows the work of doctors. “The problem with the network is a real problem, but we work with it,” says Cissé. Cell phone reception is equally challenging. Pesinet’s agents have taken to noting the children’s data on paper before entering it into the phones, because data is too frequently lost. “Certain agents resist the use of mobile phones, because it is slow and unreliable,” says Dr. Karim Samaké of the same health center.

Still, the biggest challenge for Pesinet is convincing families to bring their children to the doctor following the summons—and it is a challenge where technology is of little service. “Really it’s a problem in Mali,” says Cissé. “The process of summoning the children … The mother says to herself, a little fever, a cough, it will pass, and she leaves it. … Only when [the illness] is complicated do the mothers bring in their children.”

In this regard, mobile technology facilitates contact, but it cannot replace interpersonal communication. “We need both,” says Cissé. “It’s not easy to change the prevailing mentality in a day. … But we are moving overall toward preventative medicine. …  It is a practice that is very interesting, because it allows us to avoid complications and to reduce the cost of care.”

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COMMENTS

  • Steve Somers's avatar

    BY Steve Somers

    ON November 21, 2012 10:02 AM

    Elena - a pleasure to read about a young American spreading the potential benefits of emerging technology in places with limited health care infrastructure. Question: can the summoning Doctor ‘talk to’ the resistant parents in selected more serious cases?  Parallel web-based technology - first tried in places like India etc - is being used to train rural primary care doctors in the US to deal preventatively with more complex chronic diseases like Hep C and diabetes, so that patients don’t have to travel long distances to see specialists at great expense to themselves andntomthe overall health system. You are in a growth area in the health care field. Rock on (Bill and Deb will appreciate that). Steve (of Kate and Steve)

  • Elena Bridgers's avatar

    BY Elena Bridgers

    ON November 21, 2012 01:28 PM

    Thanks for your comment Steve. You raise an interesting point. The way the service currently functions, once the doctor summons a child, parents are alerted via the health agent who returns to the family and tells them to bring the sick child to the center. Families do not always respond. Dr. Cissé, who is featured in the article, has suggested that we equip mothers subscribed to the service with mobile phones so that the doctor can communicate with them directly if the child is at risk, the idea being that a family will be more responsive to a summons directly from the doctor than from an intermediary, and that the doctor would be able to give more specifics on the reason for the summons. This is obviously an expensive solution and one that would require external support. Another catch is that most of the mothers are illiterate, so we would need to develop a system of visual texts that communicate using standard recognized images.

  • Steven Crane's avatar

    BY Steven Crane

    ON November 21, 2012 09:37 PM

    This is great stuff, Elena! So glad to hear about this project and your progress.  I’m wondering about the backing and the funding of your program, and how it can sustainably supply these services?

  • Elena Bridgers's avatar

    BY Elena Bridgers

    ON November 22, 2012 12:05 AM

    Steven - our economic model functions as a hybrid in which part of operations are covered by external funding (mostly large grants from foundations, as well as in kind donations of equipment and technology) and another part is covered by the monthly fee which families pay to subscribe to our service. The service costs 500 FCFA per child per month, which is the equivalent of less than a dollar. Although our objective is for all program operations in the field to be self-financing (covered by the fee families pay), we have not yet achieved this and depend in part on the grants to fund a portion of operations. It is more important for us that we continue to offer a quality service at a price affordable those with unstable incomes than that we cover costs. That said, we are always looking at ways to improve our self-financing rate through strategic partnerships, cross-subsidization strategies, and scaling.

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