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For every child, end AIDS

UNICEF and partner awarded for Programme Mwana, programme using SMS messages to deliver HIV test results

© UNICEF Zambia/2011/Nesbitt
Zgambo Bede Majiwaka, a health worker at Nameebo Rural Health Centre in Zambia, uses SMS technology to receive the results of an infant's HIV test.

On 22 July, experts will gather in Washington, D.C., for the International AIDS Society’s biennial conference on rolling back the HIV and AIDS epidemic. UNICEF will host a leadership forum stressing the need for innovation in eliminating new HIV infections in children. This story is part of a series illustrating UNICEF's efforts on behalf of children and women affected by HIV.

NEW YORK, USA, 19 July 2012 – A leading US design organization has honored UNICEF and frog, a partner organization, with awards for an innovative programme that speeds the delivery of HIV information and reminds patients about clinic appointments.

The partners’ Programme Mwana initiative received a Gold Award in Design for Social Impact and a Silver Award in Design Strategy in the Industrial Designers Society of America’s International Design Excellence Awards. The programme is currently running in Zambia and Malawi.

The Industrial Designers Society of America is a member-driven society for product design, interaction design and ergonomics, as well as design research and management.

Designed to save lives

Programme Mwana uses mobile phone SMS messages to reinforce HIV and AIDS services in the developing world. In low- and middle-income countries, particularly in rural settings, it can take many weeks to receive the results of a child’s HIV test. The joint UNICEF/frog programme reduces this turn-around time by nearly 60 per cent.

The programme consists of two applications. ‘Results160’ delivers HIV lab results in real time to rural clinics. It also serves as a messaging platform between clinics and community health workers to ensure that results are communicated directly to mothers. ‘RemindMi’ prompts health workers and volunteers to remind mothers of clinic appointments.

HIV testing in particular is essential to achieving an AIDS-free generation – and to keeping children alive if they contract the virus during pregnancy, birth or breastfeeding. About half of all babies living with HIV will die by their second birthday unless they receive antiretroviral treatment.

© UNICEF Zambia/2011/Nesbitt
‘RemindMi’ agent Cecilia Chaamwe speaks to Universe Sindamu in Chiima Village, Zambia. Ms. Chaamwe is reminding Ms. Sindamu to return to the clinic for her 6-week-old son's vaccinations.

An innovative response

The health ministries of Zambia and Malawi asked UNICEF to help improve infant diagnosis and treatment in rural areas that are far outside the reach of traditional infrastructure. Programme Mwana was the result.

UNICEF normally takes a supply approach to addressing such challenges, but in this case, the goal was to reverse that model and start with the end user. The organization hoped to demonstrate the power of combining collaborative design methods and mobile technologies to reach the underserved – and to create a model that can be applied elsewhere.

The Programme Mwana team faced a number of challenges in rural Zambia: few families own mobile devices, network coverage is intermittent, villages and clinics are often far apart, and many clinics use antiquated record-keeping systems.

These constraints forced the team to work with the materials and people at hand, focusing on volunteer community health workers (CHWs) who are the only consistent link in the chain. The solution had to be designed for, and with, the health workers without adding new rules to complicate their lives.

Step by step

The first piece tested was a system for getting HIV results from a central lab back to the clinic via text messages. It replaced a postal system that takes up to four weeks to deliver the same information.

The success of this solution created trust within the community, which provided a foundation for solving the much more difficult problem of helping CHWs understand the information, communicate it effectively to mothers, and then get infants into treatment and report back to the health ministry.

The team members immersed themselves in the CHWs’ lives and routines, both in the clinic and in the community, and gave them phones to test early prototypes.

Because CHWs receive very little feedback, the design team wanted a feature that allowed all the CHWs within a given community see how many results each worker was delivering per week. The CHWs also requested an open channel to ask questions, allowing the system to learn from them.

Upon reporting results, each CHW receives a text ‘thank you’ message, a feature that would not have been created without a user-centered design process.

A good fit

Programme Mwana was the first project involving UNICEF and frog, and it led to an ongoing relationship. Today, the partners are working on projects covering a range of topics, from maternal and child health in rural communities to disaster response simulations. UNICEF sees this relationship as an ideal opportunity to demonstrate a model for collaboration between the world of design and the world of development.



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