Improving health access where it’s needed most

2wT is appropriate, evidence-based, and effective for low-resource settings and can be swiftly deployed to improve health care for those who are most vulnerable. 2wT is designed to maximize resources and individual health outcomes while minimizing HCW load. For clients, 2wT requires only commonly available, simple, feature phones (not smartphones) and uses text to establish a direct and efficient channel of communication between healthcare providers and patients. For HCWs, 2wT operates with a web-interface that is usable for even low digital literacy users. 2wT offers several advantages: 

  • Accessibility: It allows individuals, even in remote or underserved areas, to connect with healthcare providers via their mobile network, overcoming many geographical barriers.
  • Timely Communication: Patients can receive important health-related information, reminders for appointments, motivation, and even consult with healthcare professionals through text messages. Clients do not have to answer calls from providers but can send and receive SMS when it is convenient for them.
  • Reduced Workload for HCWs: 2wT can automate routine communications like daily check-ins, educational messages, or visit reminders, triaging clients with concerns to interactive communication while allowing most clients to benefit from more passive support.
  • Decision supports for stretched HCWs: Embedded 2wT alerts swiftly identify clients who do not communicate as expected, prompting HCWs to follow-up or trace clients. When referrals to care remain open, alerts remind care teams to connect with clients to ensure they are okay, ensuring quality care provision.
  • Health Education: 2wT serves as a platform for health education, empowering individuals with responsive information about preventive measures and self-care tailored to their recovery period.
  • Improved Data for decision making: All information in the 2wT system is stored in easy-to-use reports for documentation and complete healthcare records. Secure text conversations are stored, aiding in better diagnosis, treatment planning, supervision, and continuum of care.  

Why use the CHT?  

Quality health care should be accessible to everyone. We are committed to using digital tools that offer the most benefit at the lowest cost. Our interventions, like 2wT and CARES, use the Community Health Toolkit (CHT), a Global Good that is available open source, without user fees. The CHT is a versatile, user-friendly tool set that is adaptable and can be accessed on desktop computers, tablets, and mobile devices with or without an internet connection. CHT apps provide client records over time; give clinicians decision-support tools to help adhere to complex guidelines; streamline workloads with task management; support two-way texting (2wT) between clients and caregivers; and provide routine data for decision making. The CHT is designed in low-resource settings for healthcare delivery in low-resource settings, meaning that the tools are developed, optimized, and scaled for users in the contexts where we work. By leveraging and expanding on an existing open-source platform, we speed the app design process to close gaps in healthcare delivery, optimize existing services, and ultimately improve health outcomes for underserved populations.  

 

Building trust, Improving healthcare, conveniently 

2wT gives access to patients at the time and place that is convenient for them.  No one has to answer a call at a specific time. Text messages are available when the patient or provider can attend to them. Patients know where to access cell service – be it in an urban area or in a rural site closer to a cell tower. SMS can also be sent and received for free to the client while Smartphone apps or WhatsApp communication requires a continuous data plan.  

In many low- and middle-income countries (LMICs), access to quality health care can be a significant challenge. 2wT bridges this gap by providing patients with access to healthcare services at the time and place that suits them best, and in more remote locations. This level of convenience is particularly essential in LMICs, where barriers to health care, such as long distances, limited resources, and overloaded healthcare facilities, can impede access to timely medical care. By enabling patients to communicate with their healthcare providers through text messages, 2wT promotes trust-building. Patients can ask questions, share concerns, and receive guidance from their healthcare professionals, thus fostering a sense of confidence in the healthcare system. Moreover, the convenience offered by 2wT allows patients to actively engage in their own health care, contributing to improved health outcomes. This technology not only empowers patients to take control of their health but also strengthens the bond between patients and healthcare providers, ultimately leading to better health outcomes and a more patient-centered healthcare experience. 

 

Improving health outcomes through human-centered design (HCD) 

We recognize that the most effective healthcare interventions are those that are deeply rooted in real-world insights and practical feedback from diverse intervention users. We do not apply a one-size-fits-all approach. We work closely with patients, providers, data managers, and program teams in an iterative process where we observe, listen, learn, and gain clear understanding of the gaps and barriers to quality healthcare service delivery. Our approach adheres to core characteristics of digital health excellence, including prioritizing client accessibility and acceptance, low technology costs, locally led adaptation, strong stakeholder collaboration, and government partnership for sustained impact. In partnership with local teams, we use HCD to design, test, iterate, and optimize collaborative mHealth tools within the clinics and communities in which we work. This deliberate, intentional process may slow the pace of innovation. But HCD also ensures that our solutions are tailored to the specific needs and preferences of the end-users and reflect iterative improvements to get the right intervention for the most pressing problems, ultimately speeding the likelihood of identifying a successful innovation.  

 

Building evidence of direct impact

While national adoption of mHealth innovations offer considerable promise, few have been tested, proven effective, or successfully scaled in real-world settings with severe human and financial resource constraints. We collect, use, and analyze rigorous evidence to identify gaps and iterate improvements to close them. We share evidence from both failures and successes to capitalize on gains and reduce waste. We conduct qualitative, quantitative, and costing analysis to better understand where, why, how, and for whom our interventions work – disseminating our findings to spur innovation replication across communities and contexts. Our interventions are built on this evidence, providing confidence that these interventions are well designed, tested, and evaluated before adaptation and scale-up.  

 

Converting scientific findings into daily practice

We translate our scientific findings into adaptable, open-source tools that other health programs or settings can apply to reduce provider workload while enhancing the quality of patient care. This implementation science process helps ensure that our research findings are actionable and applicable in other routine program settings. Our commitment to implementation science does not end at publication. Our role extends to collaboration with healthcare professionals, administrators, and policymakers to design and deliver similar interventions that are practical, feasible, and tailored to the unique challenges and needs of recipients of care, providers, program managers, and data users in their unique settings.  

 

Ongoing, adaptive, responsive for continual improvement

The combination of iterative human-centered design and implementation science helps ensure that our methods and tools are not only effective but also user-friendly and tailored to the evolving demands of the healthcare landscape. Through collaboration, data-driven insights, and a dedication to learning, we pave the way for continual improvement, ensuring that our interventions not only reflect the needs of the current use cases, but are primed to swiftly evolve to meet the changing demands and opportunities in the future. 

 

Focused interventions, broad impact

Digital health innovations are dynamic and rapidly evolving. There is no one-size-fits-all innovation. Not every solution works in all places for all people. We are not trying to fix entire digital health ecosystems. Rather, we work to create timely, focused improvements that can have big impacts for the lives of individuals – both patients and healthcare workers – in specific places. Focused interventions can have broad impact when the innovations are well-targeted, tested, and optimized for their setting. Our interventions may also start small, but ripple effects are large. For example, although 2wT for post-operative care started with one clinic, our evidence-based intervention now reaches over 35,000 males in two countries.  

 

Improving health outcomes through collaborative partnerships

The best solutions are generated locally. To that end, our team works closely with local partners and Ministries of Health to ensure that our efforts are closely aligned with the needs and priorities of the communities we serve. These collaborative partnerships allow us to leverage the unique insights, knowledge, and resources of our local counterparts, fostering a sense of ownership and sustainability. By working hand in hand with local organizations and government bodies, we not only gain a deeper understanding of the challenges they face but also co-create solutions that are contextually relevant, pragmatic, and appropriate. This approach prioritizes local perspectives and enhances the potential for sustained positive impact of our interventions.