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