Telephony-based health services:
from technology to cultural change
from technology to cultural change
According to the White Paper of the Institute of Audiovisual & Telecoms in Europe, entitled " Mobile 2008: Market & Trends" published for the Mobile World Congress 2008, Barcelona:
The Industry estimates that there were roughly 130 million mobile phone users in sub-Saharan Africa at the end of 2007, and over one million are being added every week according to Mobile Africa 2006.
The boom of mobile telephony in Africa can be explained by the lack of fixed line telephony, frequent power cuts, and poor internet services. Its impact on the economic and social structure is tremendous, especially in developing countries where it reduces information disparities between towns and rural areas, and improves interconnection among the populations. Young people being quicker to adopt new technologies are naturally targeted in priority by mobile phone operators.
At the same time, according to UNAIDS-WHO December 2007 AIDS epidemic update, 2.5 million people were newly infected worldwide in 2007, out of which 1.7 million adults and children live in sub-Saharan Africa.
Despite prevention campaigns, too many young people still die of AIDS every year, putting the economy and the social stability of certain Southern African countries at risk.
From left to right: Bas Hoefman, Marketing Manager, Marieke Hoefman, Medical Manager & Hajo van Beijma, IT Manager of TTC
"When we realized that knowledge about HIV/AIDS was poor among young Africans, while cell phones are increasingly becoming popular, we at Text to Change (TTC) decided to use text messages to improve awareness about HIV/AIDS, and motivate people to get tested and seek treatment. Even people with the most basic mobile phones will be able to participate in the program. Participation in the quiz is at a discounted SMS rate" says Bas Hoefman, Founder and Marketing Manager of TTC.
Text to Change (www.texttochange.com) is a non-profit organization located in Amsterdam, Netherlands, devoted to improve HIV/AIDS education, especially in sub-Saharan countries. The company is run by a Marketer, a Physician and an IT Engineer.
Fervently aiming at:
they designed a pilot project for implementation early this year in Uganda.
Their idea is simple, innovative, easy to apply, and cost-effective. The program consists in sending cell phone text messages in a rewarding quiz format to improve the knowledge that people have on HIV/AIDS, and encourage them to go for Voluntary Counseling and Testing (VCT), and seek treatment if necessary.
How does the program work?
The program is built as an interactive educational game.
Each week over a period of 6 weeks, mobile phone users receive 3 multiple choice questions from the local mobile operator focusing on:
The users answer these questions by SMS, in full anonymity.
Respondents with correct answers receive a message notifying them of their participation in a weekly contest that rewards selected winners with prizes such as free mobile airtime or Nokia handsets.
Those with incorrect answers get a rectifying SMS with an explanation of the specific subject, sent from TTC database. The dialogue established between the phone user and TTC will build trust in this educational system, while upgrading the knowledge of the respondent on HIV/AIDS to the extent that he/she might one day become the "counselor" of someone else in need of accurate information on the subject.
During the six week quiz, every participant can get a free HIV test to know his/her status and get the appropriate treatment on time, when necessary.
Cell phones have not been just about technology. They have brought about a cultural change in the countries. The seriousness and reliability of the quiz answers, relayed in a ludic manner will probably have a greater impact on youth, already addicted to video games and SMS contests. Most TV programs now come with an SMS contest, turning participants into active protagonists of the show. Their voice is part of the solution and they are aware of it. Their empowerment has been immediate and non reversible. Fun and incentive-based education… could it be the missing ingredient in previous sexual education and behavioral change campaigns?
Justine, Paul and Peter are sipping a soda at the Cafe Mateos, in Kampala city center, challenging each other on their answers to the latest quiz received via SMS. This vision of young people exchanging information on a long-lasting tabooed subject will become a reality when TTC pilot project is extended to the capital of Uganda. It is hoped that this targeted flow of information, education and discussion will progressively supersede stigmatization and discrimination.
For the time being, TTC is focusing on the primary results of its pilot program rolled out in Mbarara District, South Western Uganda. They launched it on February 14, 2008, with their partners:
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TTC's other sponsors were:
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The total number of people who received VCT on the launch day represented more than a 100% increase compared with an average outreach conducted by the AIC. The total HIV prevalence of 7% among the people tested that day corresponds to the prevalence of 7.1% shown in the latest population survey conducted in 2004-2005, slightly over the rate of 6.7% officially reported in 2006.
The choice of Uganda as pilot country
TTC team chose Uganda to set up their pilot program based on an early national response to HIV/AIDS, a decrease of prevalence in 1992 and a stabilization of the epidemic in the early 2000's, even if to date, 1.1 million Ugandan are still living with HIV/AIDS.
According to UNAIDS, globally 40% of the new STIs occurred among young people in 2006. Only 50% of young Africans have a sound knowledge of the disease.
One of the major challenges for scaling up prevention and VCT campaigns is reaching people located in rural areas, and young people.
Mobile telephony gives access to large populations, even in the most remote locations. There are about five million mobile phone users in Uganda, out of a population of over 30 million people (est. July 2006).
The choice of Mbarara District was justified by a homogenous local language compared to Kampala District, a large proportion of young people, an effective health infrastructure with AIC and good mobile phone coverage with Celtel.
A win-win deal for everyone
If, as expected, the pilot project proves to be successful in Mbarare District, TTC intends to scale up the program to other regions of Uganda, translate the messages in local languages, and reach other African countries.
Their wish of becoming a global platform of telephony-based health services in the near future has never been within easier reach!
Article by Sophie d'Aurelle de Paladines
Photos by TTC
Thanks to Mr. Apollo Ssemwogerere HIV Specialist and Mr. Saumil Shah, General Manager of Phillips Pharmaceuticals (Uganda) Ltd, for their local support to TTC's team.
