Lucky Gunasekara, a student at Stanford's School of Medicine, and Tom Wiltzius, a student in Stanford's Computer Science program, took us through the rationale behind working with mobile phones and the content of their project working with health workers in Malawi.

According to the International Telecommunication Union, there are now more mobiles in the developing world than developed world. Mobile phone connectivity is much more common in Africa than internet connectivity. And mobile phones are much cheaper, around $35 for a standard phone compared to $200 for even the designed-to-be-affordable One Laptop per Child. Mobile phones are therefore the obvious tool of choice for groups interested in exploring the use of technology for development in Africa.

FrontlineSMS is a free software platform enabling large-scale, two-way text messaging using a laptop, mobile phones, and a GSM signal. FrontlineSMS:Medic uses this platform to support Community Health Workers (CHW), initially piloting this work in Malawi. The role of CHWs is to provide continuity of care in places where there are limited health professionals. However, they can be extremely disconnected from the patients they are serving, often responsible for huge geographical areas. Having access to mobile phones through the FrontlineSMS:Medic project has enabled CHWs to respond to actual need and what is happening in the villages they serve. It has also resulted in significant efficiencies, both in saved healthcare hours spent on the road, visiting areas where there is no immediate need, and in fuel costs.

The team is now working with a number of clinics to implement a system to replace paper collection of clinical data with simple forms on mobile phones with the aim of improving accuracy and efficiency of collection and analysis. All FrontlineSMS:Medic's work is characterized by a commitment to provide solutions that are locally owned, genuine replicable and shaped by user feedback.

Tom outlined a number of current challenges, including:

• Reliability of cell phone networks: This is not always high in remote areas, creating difficulties in emergencies. Overload on the network can result in messages being held in a queue, delaying sending
• The ability of older or less literate individuals to use the system: improving the interface to ensure it is as intuitive as possible will be important in addressing this
• Cost of data transmission: individual texts are not expensive but if many CHWs throughout different clinics are each sending multiple messages a day, this becomes a significant cost. One solution may be not to send the data via text but to transfer it onto another phone via GPRS when in range

Jonathan Zittrain is a Visiting Professor at the Stanford School of Law. In his presentation he raised a number of concerns about current trends in online behavior. He suggested that these developments may undermine the practice of ‘civic technologies’, where unconnected individuals voluntarily come together to achieve something they could not do individually. 

The web is now full of opportunities to engage in tasks that somehow benefit a company or organization. At the most skilled end of the spectrum, there are sites such as Innocentive, a market place that organizations use to post specific problems they need solved; anyone can respond with their solution to win a cash prize. Then there are companies like LiveOps which draw their entire workforce from internet users who engage in call-centre tasks from home. There are also unskilled tasks available in exchange for extremely small amounts of pay; for example, Mechanical Turk gets workers to complete Human Intelligence Tasks (HITs) such as labeling photos. ESP Game offers no pay at all but gets users to participate in its goal to label web images by turning this into a competitive game. Then there are activities we might not even realize could be beneficial to someone else – for example, creating hyperlinks in material you put online helps search engines to rank pages effectively.

Jonathan posited two kinds of concerns about these activities. Relating to participants themselves he is concerned about:

• Alienation: participants do not get to see the outcome of their work, but view a tiny part of the whole
• Moral valence: participants often have no idea who is hiring them and for what purpose
• Misappropriation: participants have no say in how their work is used
• Lack of rights: there is no protection for online workers – an individual can get laid off from LiveOps at any time, regardless of their time investment

He also set out some systemic concerns:

• Given the conditions of moral valence and misappropriation, the door is open for online users to be complicit in totalitarian government efforts to use the net to monitor and suppress (imagine Mechanical Turk being used to match protestor photos with citizen databases)
• There is likely to be a ‘race to the bottom’ – companies wanting to get tasks done in this way will operate wherever regulation protecting ‘workers’ is most lax
• Monetization of online tasks could mean the crowding out of voluntary contributions to the internet. Would so many people have freely devoted time to Wikipedia had there been a rival site offering pay for each entry?

Jonathan acknowledged that these are tough issues to address, but suggested a number of responses including: finding ways to apply labor standards so that those who invest a lot of time working on something like LiveOps have some protection; allowing workers to take their experience with them, so that it counts elsewhere if they get laid off; forcing companies to disclose the intended outcome of the overall task to enable users to make more informed decisions about how they use their time.