Reaching the unreachable through SMS health messages in Somalia

Health, Methodology

Polio is a crippling and potentially fatal childhood disease which is close to being eradicated globally. When a fresh outbreak of the disease occurred in Somalia in 2013 urgent action was needed. Here Amy O’Donnell, ICT in programme lead, explains how Oxfam used mobile phones to raise awareness of the disease and help communities to protect themselves.

Prior to May 2013 Somalia had achieved polio free status. Then a case was identified in the Dadaab refugee camp (in Kenya near the border with Somalia), which triggered an ‘explosive’ polio outbreak. The situation was exacerbated by large-scale population movements, persistent immunity gaps and lack of immunisation activities in insecure areas; 193 cases of Polio were recorded in Somalia in 2013. The need for community education and hygiene items was more urgent than ever. Yet the fragile context in Somalia, and the associated access barriers, meant there were barriers to traditional field visits and face-to-face training or distributions. Oxfam in partnership with UNICEF had to consider alternative mechanisms to ensure life saving advice got through to hard-to-reach communities.

So Oxfam, UNICEF and local partner Hijra decided to develop a mobile phone based health promotion project to improve awareness of polio prevention and control, as well as provide items to support safe hygiene practice. The polio prevention project
followed on from an existing project which used mobile messaging to help tackle cholera. Two complementary components were designed and delivered through an Oxfam run mobile phone platform called mLink. The first component was pre-emptive community education delivered through interactive SMS on Polio prevention, and the second, distribution of water and sanitation items through SMS voucher redemption.

The benefit of using mobile phones is that conventional approaches for delivering education involve face-to-face gatherings which can imply security risks, whereas delivery of education messages through SMS allows people to access the information in their own time. SMS is also durable; people can refer back to messages and communities appreciated the flexibility this offers and the benefits of time saving. They told us that ‘the mobile is portable and we take it everywhere we go,’ which means ‘you can reply whenever.’

A recent evaluation of the project recommended that the widespread penetration and use of phones in Somalia meant that it was appropriate for reaching hard-to-reach communities and represented a relevant mechanism to deliver health and water, sanitation and hygiene (WASH) information. The polio education component reached 104,358 people and had a completion rate of 86%. There were some content design
issues with the education component, which demonstrates the need for information to be tailored to information needs based on the current status of the emergency or issue.

The polio education component reached 104,358 people and had a completion rate of 86%.Previous distributions in Somalia commonly involved community members meeting at a certain point at a certain time to receive their entitlements. Besides the logistical challenges posed by insecurity, this conventional distribution mechanism takes significantly more time and human resource to manage. By contrast, mVouchers mean that community members do not have to go to distribution points at predetermined times, rather they visit local traders when it is
convenient or suits them. Most of the time vouchers are conditional so exchanged for predefined goods.

The report acknowledges that a very high number of people received the voucher but did not pick up the items, claiming they were ‘too busy’ or the distance to the distribution centre was too long. Nevertheless, the report recommends that mVouchers show huge potential for making distributions more convenient for beneficiaries. Eventually, if the model works in the way it is envisaged it could be a game changer
for the way conditional distributions take place. Vendors could be responsible for doing work typically done by NGOs with knock on benefits to livelihoods as they profit from distributions.

While the project was designed to mitigate some of the access barriers, these access barriers themselves have posed challenges in the implementation of the programme. In trying to engage women, men, youths and traders remotely, some steps in the process were missed, which meant that not everyone understood the purpose of the messaging or the
technical mechanisms of voucher exchange. It was hard to build up this understanding when we were forced to operate remotely, training traders over the phone and inviting the community to sign up following a radio alert. These limitations need to be kept in mind for future projects, along with clear justification of introducing SMS messaging based on the context and appropriateness for the challenge that is being tackled.

Now Polio is close to being wiped out across Africa and it has been almost 9 months since the last Polio case in Somalia. Technology alone can neither be blamed for failure of Polio prevention, nor be fully credited for impact on knowledge and attitudes, but the report shows it may facilitate activities to complement the way in which people
receive, use and access information – especially when there are few alternatives.

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Author: Amy O Donnell
Archive blog. Originally posted on Oxfam Policy & Practice.