Book Review: ‘The Rise of the Reluctant Innovator’, pt 4



reluctant innovator cover

Each Friday this month we featured a series of articles focused on innovators and how they came to do what they do. Some are inventors, others humanitarian workers, but all have a passion for taking problems and turning them on their heads.

Ken Banks, author and innovator, is the editor of a book every international development student should read, The Rise of the Reluctant Innovator. This is the fourth and final installment looking at the opening chapters of the book. Find the review of chapter 1, about the use of subtitles to spread education in India, here, and chapter 2, about the concept of the outlier in innovation, here. Chaper 3, about innovative data collection techniques, is here.

If you are interested in the book, download a sample by clicking on the cover image, or better yet, support their work and buy a copy (available in hard copy and ebook).



Chapter Four: “Dial M for Medicine”, by Josh Nesbit

medic-mobileHe wanted to become a doctor, but instead he invented a tool that has become indispensable for medical practitioners in 20 developing nations in Africa, Asia and Latin America. Josh Nesbit was doing a Stanford University undergraduate internship at a hospital in Malawi when he noticed that many patients lived 40-100 miles away. Health workers doing follow-up with patients with HIV/AIDS and tuberculosis had to visit these patients regularly, take notes, and deliver them to supervisors at the hospital. It was a time-consuming process.

Nesbit’s eureka moment came when he pulled out his cell phone and realized the newly wired region had great coverage. Nesbit had recently met the editor of The Rise of the Reluctant Innovator, Ken Banks, who was developing a text message tool, Frontline SMS, that provided two-way texting for non-profits. Matching the need to provide medical updates regularly over long distances with Banks’ new texting tool, Nesbit came up with a system in which health workers could cut down travel time but provide the same amount of detailed patient information to supervisors at the hospital.

Named One of the World’s Top 30 Social Entrepreneurs by Forbes magazine in 2011, Nesbit launched Medic Mobile after securing a small grant from Haas Center for Public Service in 2008. He chronicled the process from start to finish in journal entries that comprise the chapter. The first entry on June 20, 2008, describes going to a hospital management meeting with 100 cell phones and 100,000 units of airtime. The ideas were flowing as the first group of community health workers from local AIDS committees agreed to pilot the project. Later that month he introduced texting to the group and the first messages dealt with the notification of cancer patients, left over anti-retroviral (ARV) drugs and the death of a patient.


Saving Time, Saving Lives


josh_malawiBy the end of the month he had heard from all the participants and the response was positive but some tweaking needed to be done. In particular they needed to create guidelines for reporting and a protocol for follow-up. Logistical details also had to be worked out, such as the dispensing of surge protectors at the hospital for phone charging (solar panels came later). Mapping with colour coded pins marked the location of various home-based care workers including ART monitors, reproductive health volunteers and youth volunteers. The maps helped clinicians track down the nearest health worker to text about a patient.

Nesbit found managing the 100 phones manually was almost impossible. Text messages cost 10 cents each and he needed to monitor the unit levels in each phone. He set up a system where the phones topped up automatically. An automatic reply system was also created for queries about medications.

As the project proceeded, health workers learned to keep their texts short. They also became adept at letting the hospital’s mobile team know if a patient would not be available for a follow-up visit.

By Christmas he had a good grasp on how the program was working. He found that in the TB program in six months 700 hours of follow-up time had been saved. SMS follow-ups had saved $2000 in motorbike fuel and 100 new patients were enrolled in the TB treatment program. The other programs had similar savings. SMS messages also directed the nurse to remote areas where patients otherwise would not have received care.

By January 2009, the hospital staff and community health workers had taken ownership of the initiative and a public service grant of $500 per year would keep it going for 10-15 years.

By 2013, Medic Mobile was in 20 countries and 10,000 underserved communities, improving healthcare delivery for 6 million people. Monitoring in Malawi sped up 134 times and childhood vaccinations in India jumped from 60 per cent to 90 per cent.

Rather than becoming a physician himself, Nesbit provided a tool that allowed doctors to do their job better. “My five year plans continue to be disrupted. Life’s steering wheel yanked me to a new path,” he explained at the end of the chapter. It will be interesting to see where that path takes him next.



Maureen Littlejohn

Maureen, a seasoned travel writer and communications consultant, currently lives in Hanoi and works with the Uniterra program as a communications/marketing advisor for a local partner college.

Leave a Reply

Your email address will not be published. Required fields are marked *

15 − fourteen =