In 2015, FrontlineSMS celebrates its tenth birthday. Damian Radcliffe spoke to Sean Martin McDonald, the CEO of FrontlineSMS, about their first decade.
The first prototype of FrontlineSMS was launched in 2005, designed to help harness the power of mobile technology for social change.
Using an open-source SMS-messaging software that allows you to send, receive and manage text messages, their platform has been harnessed for a wide variety of purposes from improving service delivery after floods in Pakistan, to creating an SMS helpline to help tackle violence against children in Benin.
Since 2012 their platform has had over 225,000 downloads, and in the past decade Frontline SMS has been used in over 135 countries, averaging over 300 downloads per day—reaching over 30m people in the process.
"In the last ten years we’ve seen the advent of mobile come up as a recognized platform for digital engagement” McDonald says, "and [mobile] being the bridge between online and offline ecosystems in a lot of places."
"There’s just never been a new technology, including water and electricity, and no utilities infrastructure has had the reach that mobile has,” McDonald argues, although he acknowledges that radio still reaches a wider audience. “But mobile, of course, is two way,” he adds, “and that makes a big difference in terms of what it makes possible and the way that it can rebalance power.”
The resilience of SMS
He agrees with the United Nations’ view (previously reported on nuviun) that “there appears to be substantial underutilized potential of text-based Short Message Service (SMS)”, noting that “people think Frontline got started in SMS and that is why we advocate for it, but the truth is we advocate it because it is still the best of its ilk.”
As he explains, “SMS is different from what a lot of people think of as their technological peers because it is an open standard, it is hard wired into the GSM standard.” The benefit of this for government agencies, NGOs and health providers is that “SMS is not is single product, if one company goes out of business, SMS lives on.”
“You would have to have 900 mobile operators go out of business at the same time for SMS to disappear and that’s not true with any of the other messaging platforms out there, all of which are individual products,” McDonald observes.
Following an initial focus “proving the user case in mobile”, Frontline has increasingly turned its attention to building “better tools in terms of connecting clinics to hospitals, hospitals to ministries of health, and community health workers to hospitals and clinics.”
FrontlineSMS:Medic, now known as Medic Mobile, launched in 2009 with a mission to “help health workers communicate, coordinate patient care, and provide diagnostics using low-cost, appropriate technology.” Within six months, a pilot in Malawi using FrontlineSMS had saved 1,200 hours of hospital staff follow-up time and over $3,000 in motorbike fuel. Meanwhile, over 100 patients began tuberculosis treatment after their symptoms were noticed by Community Health Workers and reported by text message. (Read more about these efforts in the Journal of Technology and Health Care).
Following the 2010 earthquake in Haiti, FrontlineSMS:Medic helped coordinate The 4636 Project, which acted as an emergency communications channel. As their website notes, “over 80,000 messages were received in the first five weeks of operation, focusing relief efforts for thousands of Haitians.”
During this time, FrontlineSMS:Medic expanded from 75 to 1,500 end users and implemented projects in Malawi, Honduras, Haiti, Uganda, Mali, Kenya, South Africa, Cameroon, India and Bangladesh.
McDonald highlights partnerships with Stop Stockouts in their campaign to increase access to medicines in public health institutions in Uganda and Kenya, and efforts with Trek Medics, as examples of work in the digital health space that he is particularly proud of.
Using FrontlineSMS, Stop Stockouts was able to perform audits to ascertain why medication was not reaching patients as promised. Through this, they were able to “figure out where the blockages were” by reporting – via SMS – the availability of medication and uploading these findings onto an online map of the country, using the mapping tool Ushahidi.
Efforts with Trek Medics, meanwhile, focused on addressing the fact that “in many parts of the world, when you call an ambulance they take you to a clinic which is unable to service your needs.” As McDonald reflects, “people get taken around often quite difficult roads whilst experiencing severe trauma and in some instances die, going from facility to facility.”
To address this, “they’re using Frontline to find out in advance if hospitals have the right supplies to treat people who are suffering from an injury.” This way, he notes, medics “can go from point of injury to the right facility.”
More recently, the team began working with Brad Pitt and Angelina Jolie’s NGO, the Maddox Jolie-Pitt Foundation (MJP), to trial an SMS alert system for villagers in Cambodia. The project will communicate essential information related to disease outbreaks—like tuberculosis—as well as other important health and agricultural information.
“We started off with this ‘with the right tools people can solve their own problems' mentality,” McDonald says, “and that’s been wildly and overwhelmingly true.”
He adds, “a lot of our work in the last year and a half has been figuring out what it looks like when people communicate in context, and to build data flows and relationships between different parts of supply chains, many of which have never been connected before.”
Interoperability, McDonald argues, is not just about getting technological solutions to talk to one another. “This is a proxy for building real connections between analogue systems,” he says.
“What you’re really doing is managing information relationships between different organisations and different tiers of the same organisations. This is fantastically difficult, but it is also in my opinion the core of what we’re trying to do.”
SMS will continue to be a key tool at the heart of their efforts. After all, McDonald tells us, this is a technology which “has grown by 10% a year for 22 years.”
On any given day, Frontline states, 22 billion SMS are sent by 3.2 billion mobile phone users worldwide.
And despite an explosion in different messaging applications over the last few years, the simplicity of SMS continues to also be its biggest strength.
“Would you download a messaging app for every context you have?” McDonald asks.
“Health, education, legal services, government… ultimately you run out of hardware space,” he notes, “and you’re not going to download 100 different apps.”
The killer app, he suggests, is the “one app that meets you where you are. And more often than not, that’s SMS.”