Contaminated drinking water is a major public health threat in Haiti, a problem worsened by chronic poverty and malnutrition. It contributes to Haiti’s staggering childhood mortality rate ― one in eight die before they reach the age of five.1 Not only did last year’s earthquake in Haiti kill an estimated 230,000 people, but it led to a cholera outbreak resulting in over 300,000 cases and 5,986 deaths, according to the World Health Organization.2
David Holstius, a PhD candidate in the School of Public Health at UC Berkeley, travelled to Haiti in October 2011. In the town of Léogâne, near the epicenter of the quake, Holstius is piloting the deployment of mobile phone software he developed to help the non-profit Deep Springs International (DSI) monitor their safe water program, which encourages Haitians to disinfect drinking water with chlorine.
Half the population in Haiti lives in rural areas where only 3% of households are connected to public water systems. This means villagers, mostly women and children, travel back and forth to contaminated wells and streams to manually fill household water containers. DSI distributes a low-cost 0.7% sodium hypochlorite solution called Gadyen Dlo that disinfects drinking water.3 The cornerstone of the DSI initiative is their household follow-up program, which helps reinforce the health benefits of water sanitation.4
“Monitoring at the household level takes a lot of resources, from transportation to personnel,” says Holstius. “Before the cholera epidemic, DSI workers visited households once a month. Unfortunately, when relief organizations distribute chlorine for free on a short-term basis, it can undercut programs that focus on long-term sustainability and job creation, like DSI. Since the earthquake, they’ve had to reduce base salaries for staff, and now they visit once every two months.”
Holstius loaded forty phones with a survey questionnaire for community health workers to track whether a household’s water tested positive for residual chlorine, the identification tag of the water bucket and the amount of chlorine on hand with a rating of 1 to 5. “The prompts on the phone are in Creole,” says Holstius, which is one of the country’s two official languages. A DSI technician who became vested in the project has written a training manual in Creole for other staff.
The phone survey makes the safe water program more sustainable by automating household data collection. “It’s doable to manage up to 1,000 households using an ad hoc Excel spreadsheet,” says Holstius, “but as you scale up to 40,000 households it becomes more difficult to manage.”
Digicel, a cell phone service provider in Haiti, underwrote the costs of text messaging. Nokia supplied the phones, a laptop for DSI and an initial gift of $12,000 U.S. to fund the pilot. A second gift from Nokia of $28,000 will enable the team to deploy another 100 mobile phones to fieldworkers.
Holstius wants to further explore the potential of using open software platforms for the monitoring, measuring and modeling of community exposures. “What happens when you open up platforms for two-way communications?” questions Holstius. “Not only are you tracking data, but you can begin to push information to health workers and individual households, changing the relationship between epidemiologists, health practitioners and the communities with which they collaborate.”
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