Using mobile health for community mobilization

Dengue, Zika and Chikungunya are infectious diseases transmitted by mosquitoes which affect millions of people worldwide particularly in Latin-American and Asian countries. The prevention and control of these diseases depends on the reduction of mosquito abundance, however most health programs struggle to find feasible methods that involve to communities to achieve a massive impact. As a solution, our team has tested and validated a novel cost-effective method (painting of the main breeding sites, which are domestic water containers, with insecticidal paint) to disrupt mosquito-breeding in order to reduce the transmission risk of these diseases. This method will be combined with a mobile health using a cross-platform messaging application to foster health education and encourage to apply the painting by themselves. Our research will be conducted in one of the most vulnerable areas of Colombia and seeks to be a model for other areas that are affected by these diseases.

Over the last few years, these three diseases have caused the greatest epidemics in many tropical and subtropical regions, such as Colombia, where more than 700 municipalities are at risk of contracting dengue/chikungunya/zika and it is expected that this year the epidemic will reach more than 120 thousand cases in the country.

There are multiple factors associated with these diseases, but the social factors related to water storage in human communities have mainly contributed to the development of mosquito habitats. Although WHO has promoted community-based strategies to combat these mosquitoes, the community participation is still a challenge for the health authority in our region. Norte de Santander has implemented several vector control methods and programmes but its effectiveness is limited due to many operational problems, costs and poor motivation of community to adopt them. Therefore, cost-effective methods to fight mosquitoes which may be feasible for poor countries and supported by community actions are urgently needed. As a solution, painting water tanks supported by the community through mobile health can be a response for the prevention and control of these diseases.

Our solution is addressing one of Colombia’s most vulnerable regions: Norte de Santander, which is border with Venezuela. The capital Cucuta and its close municipalities are the most affected areas by these diseases. We are serving people living in urban settings with the highest incidence of dengue, zika and chikungunya and high infestation levels of mosquitoes. Our study will include disadvantaged people and refugees from Venezuela. We estimate that around 20.000 persons can initially benefit from the intervention (text messages with a coating). We involves people from community such as leaders and women groups (mothers) in the target areas who will be part of this mobile health to foster social mobilization againts these diseases. 

The use of mobile tools in health sector can enhance “healthy behavior” and improve health conditions of the most vulnerable groups. As a way to increase the participation of the community, we will use a reliable messaging app as a communication tool to allow the community to continue with the application of a new method by themselves. Community groups such as mothers will be included to be pionners and promoters of this strategy. The app will have the following functions: i) to motivate people that they themselves apply the coating at home, ii) to spread educational messages about target diseases and warning signs, iii) to inform about new cases in the vicinity of the user, iv) to alert about an outbreak of one of the three diseases and what needs to be done, v) to encourage the user to send photos when they detect mosquito breeding sites and call the local vector service, vi) to inform about relevant events of the health services (talks, meetings, health committees among others). This strategy seeks to establish a better communication between health authority and the community for ensuring the citizens have access to information that protect them of these diseases and raise their participation in control actions.

The novel vector control method is a transparent paint (coating) which has been developed with nanotechnology. This coating contains microencapsulated active ingredients with insecticidal effects for mosquitoes and a growth inhibitor for larval development. The application will be done every 6 to 12 months in internal walls of ground water tanks where mosquitoes are putting their eggs in order to kill the resting adult mosquitoes and inhibit the emergence of new mosquitoes. The safety of the water from painted tanks has been certified to be safe for human and animal use.This novel method with mobile health will contribute to the prevention and control of dengue, zika and chikungunya in Colombia.  Thousands of families will receive coating and preventive messages with support of health staff to ensure its sustainability.

we are introducing a new control method in order to strengthen health programs in the fight to reduce / eliminate mosquitoes that transmit dengue, zika and chikungunya. This control method will be applied for the first time in water tanks, which is the main mosquito breeding site in Colombia. However, this strategy is unlikely to be sustainable if the communities do not participate in its process. Therefore we will adapt mobile health through a messaging application which will address to the most affected families. The use a text messages will make local health authority provide instant information to reach to large number families. Our strategy will involve community mothers, a group of women who together with the health staff will conduct the promotional activities in their neighborhoods. They will be of vital importance in generating social mobilization in the fight against these diseases. The combination of this technological tool accompanied by a new method against mosquitoes is an innovative initiative for the prevention and control of tropical disease which seeks to inclusion of community for taking control actions against mosquitoes and raise awareness of these tropical diseases.

We will use the most widely used mobile application in Colombia in order to achieve greater coverage amongst the communities. This application is a messaging platform like whatsapp that allows to send short text messages to the most vulnerable community as well as health programme can receive rapid information from them and then take control actions. These messages come from a central web base managed by a health staff to guarantee its sustainability and security. The use of this technology will allow a direct and immediate communication about any information concerning dengue, zika and chikungunya, hot spots, pontential mosquito breeding sites and information on the control and preventative measures. This app will also provide guidelines on our method, a coating for water which contains two active ingredients commonly used in the control of Aedes mosquitoes. This method was developed with nanotechnology which allows a slow release of their ingredients, providing a high persistence and being a safe product.  This mobile strategy will allow families to easily adopt this product and can be applied by themselves.

Most methods of control against the Aedes mosquito struggle to involve communities to take control actions and adapt new strategies in their homes. Our solution will be the messaging app most used by Colombians to introduce a new control method and other preventive actions currently used by health authorities. Encouraging the communities through messages to apply this coating in the water tanks that produce the most larvae will be an effort that seeks that people participate in reducing the transmission risk and generate a social impact in the region.

Our team currently collected information around 6000 households to assess the level of infestation of mosquito and acceptance of the community in our target areas. This phase showed a great willingness of people for receiving this strategy (more than 85% of the population wishes to receive this strategy). In one year, 20000 water tank will be protected with this coating and thousands of families will receive text messages. In five years, we expect to extend this strategy to more affected areas in Colombia and other endemic countries.  

The next year, our goals is to reduce mosquitoes densities, reduce dengue, zika and chikungunya transmission and enhace the participation of community to fight against these tropical diseases.

In five year, our goal is to scale up our strategy to others areas of Colombia as well as other countries where are suffering by these diseases. We seeks the use of this technology can be a model of socia mobilization for vector-borne diseases.

The methods and activities applied by the regional health authority to combat mosquitoes have not generated sufficient engagement with the community, which is reflected in the high rates of mosquito infestation in the region.
There is no use of new digital technologies that establish a direct and timely communication between health staff and community.
Coverage in the most affected areas of the region is still limited due to the low availability of human and economic resources in the local health program. This situation can cause during outbreaks that health authority can not cover the emergency.
Currently we have basic resources to start with the implementation of mobile health program in some areas of Cúcuta, Villa del Rosario and Los Patios where our solution will cover some families. However, the increase in coverage will be necessary to reflect impact of this strategy on the reduction of cases in our region.

The use of mobile technology will be essential to reduce communication barriers currently present health programs.  Therefore, we use a technological tool that involves to people to be part of the strategy. 
The inclusion of Venezuelan and Colombian mothers and community leaders living in the neighborhoods most affected by these diseases will be our focal group to make decisions about our mobile health program because they will be the first to receive text messages in order to assess the content and funcionalty. Our focal group with support of health staff will be also involved in promotional campaings and mosquito control activities to encourage communities. The participation of the community is key to engage it to implement preventive measures and protect against these diseases, therefore we plan to lead with more focal groups within community. We will use the most preferred and used messaging application of the community to adapt it to the new coating for water tanks. Previously our team conducted a study to assess the acceptability and preference of this technological strategy, showing that more than 80% would like to be part of this program.
We are planning meetings with the governmental and non-governmental organizations to get more support for the development of this strategy. Our team participation in SOLVE will be key to achieve not only financial support but also potential partnerships which can help our work in different ways.

Our team consists of two researchers from Freiburg University working in communicable diseases, particularly dengue, zika and chikungunya, as well as an advisor in tropical diseases. 

Our team also has the support and the approval of the Colombian health authorities which provide us with health staff (40 people) to conduct the implementation of our solution.

We are team consisting of different functional expertises (engineering, social work, medicine and microbiology) working towards a common goal: public health. We are both working in our city (Cucuta) where our study will take place. We have experience working with vulnerable communities in Colombia and Venezuela. In 2017, we had the opportunity to be part of an international program in global health which has given us the necessary skills and knowledge to conduct this research.

Our research is supported by the ethical committee of the university and also the advice of an international expert who has vast experience in tropical diseases mainly in countries of Asia and Latin America. Our community is a rapid response for this constant health problem, we have a pontential idea to cope with these diseases.

We have the Colombian health authories partnering with us. 

• Regional Health institute Norte de santander (IDS)
• Local health Authority (SSM)
• Nacional health institute (INS)

 Our study from Freiburg University has partnerships with regional authority IDS for academic support which has helped for the implementation of our solution.

Technical health staff is working in our field study. They were trained by our team to conduct the first phase which consists in collecting baseline information through entomological and health surveys in the target areas. They will continue support our mobile health as well as the application of the coating in water tanks.

We will be serving to populations living in 12 clusters (each cluster with 2000 houses) which have been the most affected neighborhoods by dengue, zika and chikungunya in Cúcuta and its metropolitan area. Our solution will be a novel mosquito control method for water ground tanks which will be accompanied with text messages for families. This strategy will foster the community participation in control actions against mosquitoes Aedes and education about these tropical diseases. We will provide these tools with support of health staff and community groups within selected clusters.  We seek a solution which has the greatest social impact in our region and could be a model to other countries.

We will assess our solution through measures such as reduction of vector densities (assessment through larval and pupal indices),  increase knowledge and improve vector protection in intervention houses, coverage of mobile health users in households, analysis of dengue, zika and chikungunya incidence before and after the intervention  according with epidemiogical data in Cúcuta, Los patios and Villa del Rosario and assessment of the incremental costs for extending our solution in high endemic areas of Norte de Santander calculating mainly costs for transport, staff, time and consumables. 

The proposed control method will support other strategies commonly used by health authorities for the prevention and control of these tropical diseases. We want to demonstrate that our strategy can be included in the annual plans by health authority. This cost-effective strategy with a existing messaging app for the communities will enhance the community participation which always has been the biggest challenge in most existing methods againts mosquito Aedes. Therefore, we expect that our solution can be adopted by regional health program to ensure its sustainability.

We strongly believe to apply Solve would be a valuable opportunity to connect with other partnerships who can help us with innovative and practical advice in our research as well as financial support to protect more families against dengue, zika and chikungunya. The public health programs needs urgently COMMUNITY DRIVEN-INNOVATIONS to increase the social participation in mosquito control activities and thus reduce the transmission risk. Therefore we are working in this health mobile program to close gaps between comunnity and local authority in order to take better actions for tropical diseases control.  To be a Solver would make our solution to scale up to international scenarios and help to more affected contries by dengue, zika and chikungunya. To be part of Solve's community, a solid global player will strengthen our solution which is in line with the core values of Solve.

United Nations, World Health Organization, Global Fund, GIZ

Rockefeller Foundation, General Motors, Vodafone Americas Foundation,Morgridge Family Foundation and other potencial foundations.

Whatsapp, Facebook and other social networks

Vodafone, Movistar, Claro and other mobile telecommunication companies.

Partnering with prestigious organizations and foundations with high social commitment will guarantee us to increase the coverage of our solution to thousands of households and protect many families against these communicable diseases.  Being part of the community of these organizations will allow us to expand our strategy and contribute to other endemic countries around the world.  

Thousands of families will receive text messages to their mobile phones on how to prevent dengue, zika and chikungunya. We believe using a popular messaging application can conduct a healhty behaviour in the population and foster health education in poor areas. Our solution also help to local health authority to receive in real time information about potential mosquito breeding sites and cases come from citizens in order to health staff can give a rapid response.  We conduct a mobile health intervantion using a existing message app in areas where the coating will be applied allowing to strengthen the preventative actions against mosquitoes and enhance the communication with health authority. We expect that this prize can support our mobile strategy to reach to many families in our region.

This new strategy against dengue, zika and chikungunya is addressed mainly to community in the fight against these diseases. We believe our mobile health strategy will foster social mobilization in the most poor settings in Colombia. Citizens would use the messaging app most used as a informative tool for combating mosquitoes.  We believe this prize will be ideal to increase the coverage to many families in Cúcuta, Villa del Rosario and Los Patios as well as increase the inclusion of more community groups to be part in the activities of our mobile health program. Our team will apply our solution around 20000 houses within urban poor areas and thus reduce the risk transmission of dengue, zika and chikungunya.  We strongly believe this prize will not only support us to achieve this goal but also scale up to more affected areas around the world. 

Women are one of the most affected groups by dengue, zika and chikungunya tramission. Our solution will address also to this vulnerable group in poor neighborhoods of Colombia. In our solution we will have a focal group through mothers from communities in order to assess the content of text messages and funcionalty. Mothers with support of health staff will be promoters in our mobile health programme to encourage others citizens to receive our solution. This prize would be used to include more mothers to be part of the promocianal activities and extend our solution in more endemic areas.

High density of the population is a social risk factor for dengue, zika and chikungunya transmission.  Currently, Cucuta, Villa del Rosario and Los patios have a masive migration from Venuezuela. Our solution is addressed to areas in border with Venezuela. Cucuta has been the city most affected in Colombia due to this migratory crisis. Our research will include venezuelan families living in these target areas. We would use this price to protect more venezuelan and colombian families living in areas with high level infestation and transmission risk.

Our solution will be conducted in the most affected communities in Colombia. We will include the goverment entities, health programmes, foundations, communities so that many families can be benefitted with this mobile health program. This prize will be a valuable opportunity to solve one of the most important publich health problems of Colombia. We will use this prize to increase the areas in our region and protect a thousand of people with these novel technologies.