How text messaging could keep tabs on thousands of children

A TIME 100 innovator talks about how SMS technology could change the way governments around the world register their citizens.

The children of Kenya are being counted -- by the thousands. ChildCount+, a pilot program keeping tabs on thousands of young Africans, could change the way governments around the world register their citizens.

Matt Berg, technology director for ChildCount+ and information and communication technology director for Millennium Villages at Columbia University's Earth Institute, was named as one of 2010 TIME 100. Berg spoke with me recently about how simple SMS technology could make a world of difference.

The TIME article describes you as having 100,000 children to look after. How is that possible?

We don't have that many yet. The hope is by the end of the summer we'll have about 100,000 kids registered. ChildCount+ supports existing community health programs and allows us to do it in a way that's a bit more systematic. We wanted to create a system to support community-based management of acute malnutrition. You can do at-home testing for malnutrition using a MUAC measurement, a measurement of the mid-upper arm circumference of a child. It's probably the best way to determine whether a child is severely malnourished and that is the leading factor in 50 percent of all deaths in children. There's a ready-to-use therapeutic food called Plumpy'nut. It's a peanut butter paste [that's] really high in protein and micro-nutrients. You feed this to a malnourished child and it allows them to recover quite quickly. You try to catch it early through careful monitoring and prevent them from getting really serious. It costs $20 to $30 to get a moderately malnourished kid healthy, but once a kid is severely malnourished to keep them alive you're spending hundreds of dollars.

We set up ChildCount+ to register the sick children that were malnourished and then support [them]. That was the basic idea when we went to Kenya for the initial pilot. But the health coordinator there said, "We're going to try to register all children." There were 10,000 kids in our cluster under five. There are 100 health care workers and in three months they registered about 96 percent of all the kids. That formed the basis of what ChildCount+ is now. We're empowering communities to have the information of their children. It's about monitoring and maintenance, keeping them up to date on their immunizations and on their MUAC measurements. The basis of ChildCount+ is this registry. Every health care worker gets a print out once a month of all their children. It has all their names, their date of birth, but also their age in months. It also gives you their last MUAC measurement. We can show the kids who are more at risk. It's just systematizing everything that would be really hard for a person to keep in their head.

How do you use technology?

We use a text message to send data and interact with the computer. The health care workers learn some basic, formatted messages. [To register a child] they would send that message to a server. The server is using our basic software, which we built using this platform called RapidSMS, an open-source project that we've been working on with groups like Unicef. RapidSMS takes the message, basically like a web server, reads it in and takes that information, puts it in a database, updates the website and then sends back a message with an ID for that child. It's like a web client. We can now create complex workflows using very simple messaging. You keep it very systematic, like the fever form is just F. You can build a simple language that captures a lot of information. Then you can build in alert systems. When a case of malaria is found, we can calculate the proper dosing for the child and send it back to the health care worker. We can alert the doctor at the clinic that we found a kid with malaria. It's not just about data collection. It's about service delivery. You collect information, but you also improve communication flows, reduce knowledge gaps. You can do transactions, use it for monitoring inventory. Any $20 phone, any phone that the health care worker probably already has, can be used for this.

How could your system be a model for others?

On the technology front, it's similar in some ways to what Unicef is doing. We're all innovating and sharing ideas. If we come up with a cool idea, they can copy the code. There's a lot of open collaboration, which has been really key to the success of this. With ChildCount+, I think we've shown some very basic ideas that are valuable. We can register a lot of people with this technique. The [community health workers] are capable of registering kids with some pretty complicated commands without making too many mistakes and without it being too difficult. It's not about the technology. We spend a lot of time with our team looking at what [community health workers] should do, like manage fever, manage malaria [and] pneumonia, check for malnutrition, check for diarrhea. The plus in ChildCount+ is for maternal health. We do prenatal care, making sure the mother gets her visits before she gives birth and making sure the child gets his initial couple visits after. We designed forms that could work with most governments' [community health worker] reporting practices.

What are your goals?

I'm trying to advocate how these tools can be used with different groups and establishing some of the initial piloting. Once people [understand how] they can do workflow with SMS and the tools get more mature, there's going to be a lot less need for people like me. With ChildCount+, our goal is that we really want it to become the premiere package for child health that uses technology to support it. We work closely with Unicef and I'm hoping that they take on elements of it or take it over and make it their own platform. We can focus on making one or two systems better instead of everybody making their own system.

What makes you so passionate about the use of technology in Africa?

I was born in Cameroon and I grew up in Senegal. I just kind of always knew what I wanted to do. Africa got in my blood. It was always somewhere where I wanted to work and I felt at home. I've always loved technology, so this was kind of a natural marriage.

Image: Matt Berg

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