Andrew Wyborn (CEO), Susan High (Operations Director) & Tim High (Technical Director)

Andrew Wyborn (CEO)

Susan High (Operations Director)

Tim High (Technical Director)

Interview by Kamran Rafiq (ISNTD)

Ahead of Greenmash CEO Andrew Wyborn's presentation at this year's ISNTD Bites conference, follow this in-depth interview with the company Greenmash about the Mango platform for surveillance, mHealth and measurement & evaluation, and its potential impact on vector-borne diseases and neglected tropical disease control! Greenmash's Mango platform offers a complete mhealth data surveillance, monitoring, and reporting solution that can operate in the toughest environments.

The biggest on trend message coming out of the NTD ecosystem right now is 'data data data' - with so many potential data streams from supply chain to diagnostics and so how does Greenmash play out against this backdrop?

Andrew Wyborn (AW): Yes, that’s a great question. By way of background, Greenmash is a UK based software and services organisation supporting international development agencies, private companies, ministries and research institutes. We help get data from the toughest environments using mobile devices and generate meaningful reports, charts and maps in real time to enable sensible decisions to be taken to improve monitoring, management, surveillance and performance management. We develop, deploy and support systems on a robust and scalable cloud-based mobile application platform known as Mango and are operational in many low resource countries including 12 in sub-Saharan Africa. We have deployed solutions for a wide variety of health areas including NTDs, HIV/AIDS, Malaria, Family Planning, Sexual and Reproductive Health and many of these solutions are 'cross-cutting' including commodity tracking, referrals and e-vouchers and disease surveillance.

Getting the data is, in many cases, the easy bit. The value that we add is turning that data into meaningful information that can be used to support informed action. We work closely with our clients and partners to understand their requirements. This includes identifying the data sources, which can include health workers at the community and primary health care levels. We also agree upon the frequency that the data needs to be collected and identify the most appropriate available channels to enable us to collect that data - this often includes SMS and Voice messaging, USSD, Android applications and direct data input in to web forms. We configure Mango to manage the data to support the requirements of our client. This can include presenting the data as information automatically in a rich series of reports, charts and maps that are available at any time to any authorised user. We can automate workflows and processes and push the information to the people that need it, in real-time.We can also capture data from third-party systems and applications and integrate Mango with other management information systems to help create an information 'eco-system'.

Susan High (SH): Greenmash enables all levels of an organization to benefit from the data streaming in. While the robust features of the Mango platform capture, manage and analyse data, the Greenmash team provides a layer of expertise and experience. We partner with you to redefine processes so data is captured in the most cost effective and efficient way, and then we help you parse the data into information that is valuable to your different departments and teams. The power of data is pulling it together in a meaningful way so it can shine a light on the critical indicators within your business and allow you to see if you are performing as you should be. Greenmash has the tools, and knowledge to do this.

Tim High (TH): Data allows teams to make informed decisions about where best to apply their efforts and funding, without it, programs may or may not work and money may be spent in areas that aren't achieving the full potential. With mango data collection teams can choose the best way to obtain the data depending on the infrastructure available at the point of collection. Mango provides its own set of data collection tools from basic SMS and USSD tools through to feature rich mobile applications, as well as providing a strong API built on open standards that allows third party apps to push data into mango. Once the data is in mango we provide workflow and reporting tools that allow you to slice the data anyway you want, or we can push that data into other reporting tools such as DHIS2. The aim of all of this is really turning what was a piece of raw data into information that then leads to decisions. Data on its own is really just facts, decisions come from what you can do with it.

Developments such as the African Center for Disease Control (CDC) going live at the start of this year have further highlighted the data gaps that exist in both the region and at a wider level - how can your Mango system facilitate the filing of these gaps?

AW: The biggest gap is often from 'the last mile’ i.e. the community and primary health care levels where the majority of healthcare services are delivered. This is where we are particularly strong. We have the ability, experience and the technology to connect the last mile to the rest of the health system. Some examples include the work we are involved in with Sightsavers and FIND.

For Sightsavers we have configured Mango to improve the monitoring and management of Mass Drug Administrations for a range of NTDs including schistosomiasis, onchocerciasis, lymphatic filariasis and trachoma. This provides Sightsavers visibility into and control of the pre-distribution census and drug distribution itself. Treatment coverage requirements are automatically calculated and Mango informs the program participants as to appropriate actions e.g. continue treatment, stop treatment and so on, based upon the coverage achieved at each reporting stage. The stock usage is also monitored which has resulted in significant cost savings and reductions in loss and wastage. Following a successful pilot program in Cameroon, Sightsavers are now implementing Mango in 18 countries.

With FIND we have configured Mango to capture and manage data for a HAT elimination program. Mango tracks the test results from RDTs. microscopy and LED facilities, creates and updates patient records and alerts the appropriate health centres and patients with information related to the test results and appointments. Health workers at these primary health centres report using SMS messages with those at the larger LED centres using Android devices. FIND have been using Mango successfully since 2015 in Uganda and are about to introduce the same system in to Chad followed by Guinea and Angola.

The data that these systems capture and manage can be analysed within Mango and can also be shared with other tools and systems either by using the simple data extraction tools that Mango provides or by integrating Mango with other systems to support seamless and automated data sharing. Mango helps to fill the gaps and support a comprehensive information environment.

SH: Mango’s strength is in its flexibility, it can be used at all levels within the community, integrate with any system and use a wide variety of technologies all under the same platform. We can collect information from the last mile using basic phones and SMS, moving on to smart phones at Health facilities with internet connection and direct web access at hospitals and the ministry of health. All of this means mango can plug the gap at which ever level is required.

TH: We see mango as a data collection and analysis tool as well as a data hub. This means mango can play a central role in gathering data from hard to reach places, provide operational support for teams on the ground who have their own data requirements, as well as pass data through to others such as the African Center for Disease Control. For us the whole point of applications like mango is that they play a strong role in gathering and storing data and integrate that data into other systems. Everyone has their strengths and ours is getting data.

We recently ran a global hackathon as part of our ISNTD Festival (vreative arts, science communication and tropical diseases) and from the response we received it is very apparent that apps will have a huge role to play in the fight against these diseases - given how varied the scope and type of apps being developed are, how will Greenmash's Mango platform work with apps?

AW: An app can be a very useful way of delivering a set of tools on to an affordable device to enable tasks to be undertaken online or offline. However an app on its own can quickly become 'orphaned' and unless it can be easily updated, and if the data it is managing cannot be shared then it can have limited value. We have a two-pronged approach with apps. Firstly we have the Mango app, available on the Google Play Store now and shortly to be available on all platforms. This enables anyone with a smart device to download the Mango app, browse from their device to their online Mango application, log on and have the surveys and reports that are relevant to them automatically downloaded to their Mango app. Users can then work from their device online or offline collecting, managing and analyzing data. Whenever users have an internet connection they can easily synchronize their Mango app with the Mango website. This uploads any new data they have collected to automatically update the reports, charts and maps in Mango. At the same time the synchronization downloads any changes or additions that have taken place since the previous synchronization. This is fast, simple and ensures that all program participants are working with the same set of tools and same data.

The second option we provide is the Mango application programming interface (API). This allows other apps to be integrated with Mango to take advantage of the data management and visualization tools that Mango provides.