1. Response: Results :  St. Gabriel’s Hospital serves 250,000 Malawians spread throughout a catchment area 100 miles in radius  St. Gabriel’s Hospital is located 60 km from Lilongwe, the capitol city  The vast majority of the people the hospital serves are subsistence farmers, living on under $1 a day  The hospital has enrolled over 600 volunteers to act as community health workers (CHWs) in their respective villages  Many of the volunteers are active members of the HIV-positive community, and were recruited through the hospital’s antiretroviral therapy (ART) program.  Many patients walk up to 100 miles to the hospital – to see one of the three doctors on staff.  In order to report patient adherence, ask for medical advice, or request the mobile clinic’s attention, CHWs had to travel similar distances to the hospital.  The most motivated of the CHWs kept their own patient records, and journeyed to the hospital when they could – by bicycle, foot, or oxcart. The hospital now follows up on distant patients. HIV/AIDS and TB drug adherence is tracked Remote medical emergen- cies are reported and responded to by a mobile team CHWs check medication dosages before adminis- tering drugs in the villages Commun- ities’ medical questions are fielded HIV/AIDS support groups effectively organized The CHWs, and the villages surrounding them, now enjoy previously unimagined connectivity The smart but simple nature of Frontline- SMS allowed the tool to be readily integrated into hospital programs A Rural Health Initiative Elizabeth Nesbit—Rice University Josh Nesbit—Stanford University The hospital staff has been trained to maintain the communication system DateInitial SMS Response SMS CHW Community Health Worker Action TakenAlternative 6/25/2008 A patient with CHF has run out of drugs. This patient should not miss medications. Advise him to come to the hospital. VK VK counsels patient, who claims to be too ill to travel. Verona comes the hospital and picks up drugs. Patient discontinues treatment. 6/24/2008 I visited two patients who are not getting better. They have cancer problems. Received your message. I will come tomorrow. ZK Mobile clinic visits patients. Patients remain unseen in their respective villages. 7/7/2008 Request to inform BL that MP will visit their Village AIDS Committee on Saturday, June 12th. A message has been sent to BL. Thank you. BM VAC mobilizes for a meeting when the Community AIDS Committee chair visits. CHW spends a full day traveling, in order to alert VAC that MP will visit. 7/17/2008 AC is on ARVs. He is developing sores that are itching. Is that a problem with the ARVs? Patients who have developed scratches should come to the hospital immediately. MM Possible ARV side effects reported, patient asked to come to the hospital. Patient remains in village, side effects persist. If effects worsen, patient visits the hospital. During the summer of 2008, FrontlineSMS was introduced, along with 100 cell phones, in order to implement a text-based communications network for the hospital and the CHWs. Stationed at the hospital, a laptop running FrontlineSMS acts as a text- message hub – coordinating the health network’s activities. 70 CHWs were trained to use their cell phones to contact St. Gabriel’s Hospital. Impact: The system was programmed to automatically top up the phones. CHWs learning to use their cell phones Alex—the hospital’s HBC officer—travels to a rural village upon the SMS request of a CHW Background Information: Problem: 1 5 4 3 2