Liberian churches turn to texting to fight Ebola

by Adele Waugaman | United Methodist Committee on Relief (UMCOR) - USA
Monday, 1 December 2014 11:00 GMT

A health worker checks the temperature of a man at a roadside health checkpoint outside Ganta in Liberia, October 7, 2014. REUTERS/Daniel Flynn

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* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

With drugs and doctors in short supply, mobile text messaging can play a key role in stemming the spread of new Ebola infections

Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

When the Ebola epidemic ravaging Liberia leaves Kokoya’s district pastor Reverend Benedict Greene feeling down, he immediately reaches for his mobile phone to look at his text messages.

The United Methodist Church is sending messages of encouragement and public health alerts to hundreds of its pastors across the West African nation, who in turn are passing them on to their congregations.

With no known vaccine and a tremendous shortage of the medical equipment and personnel required to treat Ebola patients, awareness messages offer some of the greatest hope in stemming the tide of new infections.

According to Internews, a non-profit media group, over 100 organizations are operating behavior change communications campaigns in Guinea, Liberia, and Sierra Leone - the three West African nations hardest hit by Ebola.

While the vast majority of these programs are using posters, radio, or face-to-face communications, a growing number of groups are looking to mobile phones to increase their reach.

Before queuing up the first text message, however, humanitarian organizations should first consider the limitations of mobile use.

First, the reach of mobile networks is limited.

According to estimates from the mobile trade association GSMA Intelligence, in the three countries most heavily affected by the Ebola outbreak active mobile subscriptions reach less than three-quarters of the population. Network access is concentrated in urban areas, leaving large swaths of the country with no mobile signal or Internet access. 

Second, the capacity of mobile networks is being stretched.

Even where a mobile signal does exist, the sharp rise in communications since the Ebola outbreak is taxing the already weak mobile infrastructure. According to one account, outside of Liberia’s capital city of Monrovia it can take an hour or more to get a call to go through, and days for a text message to be sent.

Third, mobile ownership and use varies widely.

In many low and middle-income countries mobile phone ownership is concentrated among men and in urban areas. Whether mobiles are used for voice, SMS or data depends on who is using them, creating variability that can be difficult to account for in a widespread messaging program.

Despite these challenges, a number of examples exist of organizations creatively using mobiles for Ebola awareness messaging.

The United Methodist Church’s work in Liberia shows one way of overcoming the limited mobile network reach. 

In partnership with United Methodist Communications, the global communications agency of the church, in Liberia and Sierra Leone the bishops’ offices have input the mobile numbers of its pastors and district superintendents across the country into FrontlineSMS to send them regular text messages. These pastors in turn share the messages with their communities, extending the program beyond the reach of mobile networks alone.

A typical health-focused text message warns communities of the risk of spreading Ebola through the traditional practice of washing the dead.

Applications also exist that attempt to ease strain on mobile networks. 

The International Federation of the Red Cross’ Trilogy Emergency Relief Application (TERA) works with network operators to push SMS messages only to mobile phone users whose handsets are switched on. TERA also enables geo-targeting by sending messages just to users within a set distance of cell phone towers in areas affected by Ebola.

To understand the information needs of their target audience, organizations are working directly with affected communities to develop relevant messaging content.

In Liberia, for example, the UN children’s agency recently partnered with teens in Monrovia to script messages about Ebola. As a result questions such as “What has changed the most in your community because of Ebola?” were adapted to a more colloquial format used by texting teens: “wat bother U d most abt Ebola?”

Limitations to mobile network coverage, and mobile ownership and use, pose one set of technical considerations that humanitarian organizations should bear in mind when weighing whether to use mobile technology for Ebola awareness messaging.

For guidance on ethical and practical considerations in creating a mobile messaging campaign, the principles for digital development point to good practices beyond those addressed here. Will user communications be private and secure, particularly where communications relate to the location of suspected Ebola cases? Will the project enable monitoring and evaluation to measure its efficacy?

Lessons learned from the use of SMS in Haiti also point to the importance of establishing systems capable of handling inbound queries, and enabling users to ‘opt out.’

Mobile messaging will be most effective when bearing these considerations in mind.

Adele Waugaman is an affiliated expert at the Harvard Humanitarian Initiative and managing director of Catalyst Advisory, a consultancy providing strategic, technical and operational support to clients using communications technologies to strengthen global development projects. Follow her on Twitter @Tech4Dev