When I first moved to West Africa back in 2009, you could travel to the most remote, rural villages — places without power, running water or any other modern conveniences — and you would invariably find Coca-Cola. Somehow the familiar red-and-white brand had solved the distribution and marketing challenges of reaching these ends-of-the-earth consumers.
In those same remote villages, you can also find some of Africa’s highest-tech companies are mobile providers like MTN, Tigo, Airtel, Vodacom and Safaricom. Africa has leapfrogged the power line and the PC and gone directly to mobile phones. By the end of 2015, there will be an estimated 1 billion mobile phone accounts in Africa — one for nearly every man, woman and child on the continent.
First disease beaten by mobile
In our first challenge, we talked about the importance of rapid diagnostics to locate the malaria parasite in people. What is a diagnostic test result but a plus or a minus, a one or a zero? It’s a bit of data. But in many malaria-endemic countries, that data used to just sit in stacks of paper to be collected every so often by health authorities. When you combine this data with rapid reporting via mobile phones, you have the makings of a revolution in global health.
Of all the tools in the malaria fight (including the obvious ones such as nets, testing, treatment and spraying) mobile phones may be the ones that tip the balance toward ending this disease. That’s why at Malaria No More we’ve been bold in proclaiming that malaria can be the first disease beaten by mobile.
A Swiss Army knife for malaria
Sounds ambitious, but when you look at the problems we have to solve — from case detection and response to stock management, and health education — mobile is at the center of the solutions time and again. It’s the Swiss Army knife of the malaria fight, helping to solve and accelerate a wide variety of other solutions. Here are a few examples of how mobile and data are already transforming the malaria fight.
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The Novartis-led SMS for Life program has demonstrated the potential of mobile to address stock outs and ensure that people have malaria drugs when and where they need them. The pilot program focused on three districts in Tanzania. When it started, 26 percent of public health facilities were completely out of malaria drugs at any given time. That means that parents had a one-in-four chance of showing up at a clinic with a sick child only to find that they didn’t have a dollar’s worth of lifesaving treatment on hand.
To address the problem and under the umbrella of the Roll Back Malaria partnership, Novartis and its public and private partners set up a simple SMS reporting system that enabled health workers and pharmacists at public health facilities to record and report their stock levels on a weekly basis. This made it possible to anticipate shortages and distribute malaria drug supply more efficiently. Six months later, less than 1 percent of the facilities were stocked out of malaria drugs: a 97 percent reduction in stockouts through better and faster information flows. SMS for Life has now been expanded to several other African countries including Ghana, Kenya and Cameroon.
In a similar fashion, mobile phones may be the key to solving the challenge of counterfeit and stolen malaria treatments. Nigeria is the epicenter of the malaria challenge, accounting for nearly a quarter of the world’s malaria burden. As the market for antimalarial treatments has grown, so too has the attraction for counterfeiters. Recent estimates suggest that nearly 40 percent of all antimalarials on the market are counterfeit.
The challenge is compounded by the fact that most Nigerians don’t get their treatments from public health facilities. Up to 80 percent of people go to the private sector for treatment. And this isn’t your corner Walgreens we’re talking about. In Nigeria, it’s not uncommon to see malaria drugs sold alongside open-air butcher stands and car parts in public markets.
The solution to this problem? You guessed it — mobile. Working with companies such as Sproxil, PharmaSecure and mPedigree, the Nigerian government now requires that every antimalarial drug (and antibiotic) carry a label that consumers can scratch off like a lottery ticket and text to for free to confirm their drug is authentic and safe. Read more about Sproxil’s efforts to combat counterfeiters here.
This scalable use of the technology is revolutionizing the fight against counterfeits, and even helping authorities to track down contraband drugs. Malaria No More is working with a group of partners to go a step further: to explore how this data — a real-time sample of antimalarial consumption — can be used to draw fresh insights that can inform public health decision making to save even more lives.
The big benefits of data
A study in Kenya presents another compelling example of leveraging nonhealth data to fight malaria.
Caroline Buckee of the Harvard School of Public Health worked with Kenya’s largest mobile operator to analyze anonymized mobile phone usage records from 15 million consumers to track human migration patterns. Researchers then combined this migration map with regional malaria incidence data to identify how malaria travels around the country via human carriers.
Unsurprisingly, most of the malaria emanated from the high-transmission areas along Lake Victoria on Kenya’s western border. But the data also spotlighted unusually high migration from the Lake Zone region about 50 miles inland to the western highlands region.
A few clicks on Google Maps reveal that the western highlands are host to massive and bustling tea plantations that serve as a kind of bus depot for malaria transmission. Infected workers came from the Lake Zone to the highlands, where mosquitoes picked up the parasite and infected fellow plantation workers, who in turn transported the parasite back to their home communities farther inland.
These data-driven insights can help direct resources and interventions to make the malaria fight more effective. For example, eliminating malaria in the Lake Zone might cut off the source of infections in the highlands — even if you didn’t run a large-scale elimination program in the highlands themselves.
Mobile aids elimination
If anything, harnessing the power of mobile and data becomes more important as countries move toward malaria elimination. As the scale of the problem shrinks, the need for timely and precise surveillance data only grows. Vital elements such as real-time reporting of cases and accurate intervention mapping are now possible thanks to Web, mapping, mobile and data analytics tools.
As you move toward the end game of elimination, countries must be able to track and respond to every case immediately to prevent it from spreading. They set up a sort of SWAT-team approach (painful pun intended): rapid-response systems in which health workers immediately report cases and teams show up to test and treat people in a perimeter around the infection to contain the spread of the parasite.
Even more so than Coca-Cola, that gives us something to smile about.
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