“SMS for Life” is one example of how technology can be used  to check  the problem of malaria. This has been made evident in a 'public-private' project  that  harnesses  everyday   technology  to eliminate  stock-outs  and  improve  access  to essential medicines  in sub-Saharan Africa.

Susan Musyoki, who  has worked  as  a  nurse  at  Kola Health  Centre  in  the Machakos  district  of Kenya, admits that for the last three months the facility has been able to monitor drug stocks more effectively  than any other  time.

She says the 'SMS for Life' initiative that is being piloted in Kenya and Ghana has “truly prevented drug stock-outs” since its inception in September this year.

With  the help of  IBM,  Novartis  , Vodafone and Roll Back Malaria and a partnership with the Ministry of Health,  the  'SMS  for Life'  initiative  is already bearing  fruits  in Tanzania where  it  is helping  to save  the lives of people residing  in remote malaria prone areas of the East African nation.

In  Kenya,  it  is  being  piloted  in  five  districts  namely, Machakos  in  Eastern  Kenya, Manga  in Nyanza,  Vihiga  in Western Kenya, Msambweni in the Coast of Kenya and Ijara
in  the semi- arid North-Eastern part of  the country.

Although  there  are  no  reported  alarming  incidences  of malaria  in Machakos  as  compared  to Nyanza,  Coast  and parts of the Rift Valley, the 'SMS for Life' initiative has  been instrumental  in  the  reduction  of  drug  stock-outs  in  the district especially  in Kola dispensary where Musyoki works. She attributes its success to the user-friendly nature of the facility.

She  however  says  that  despite  the  ease  of  using  the initiative,  it  needs  to  be  complemented  by  ensuring  that health centres have microscopy services.

“Well,  this has been  a  very  friendly method with  limited difficulties, though there is a challenge with   the efficiency and accuracy of the rapid diagnostic test (RDT'S) whereby a
microscopy  examination  is  required  to  clear  doubts,” Musyoki told 'Eyes on Malaria' during a survey to find out  ow the initiative is working at its pilot stage in Machakos district.

The  initiative was  introduced  in Machakos district  in August through an organised seminar involving medical staff from various health facilities. And  in September as  it got a nod from the government through the Ministry of Public Health and Sanitation's Division of Malaria Control (DOMC), 'SMS for Life'  then was  launched  in  the  five districts.

According  to  the  “SMS  for  Life"  Program  Director,  Jim Barrington,  the pilot stage will run  for six months; and  if found to be effective, the Kenyan government would then formally roll  it out  in March 2012 across  the country.
 
“Maintaining adequate supplies of anti-malarial medicines at the health  facility  level  in rural sub-Saharan Africa  is a major barrier to effective management of the disease. Lack of visibility of anti-malarial stock levels at the health facility level  is  an  important  contributor  to  this  problem,”  said Barrington.

Barrington told 'Eyes on Malaria' during the launch of the system's pilot project in Kenya that the innovative system works well.
 
“An  SMS  is  sent  to  one health worker  at  a  health  facility every Thursday by 2pm. Then the health workers are asked to reply with  information on  the drugs available  in stock. The SMS is programmed with a message 'Please send your stock data of artemether-lumefantrine (AL) and RDTS'. The worker also gets a reminder to send data within 24 hours,” says Barrington.

The information is sent to the District Medical Officer who then takes action during  meetings  every  Monday morning.

The  new  SMS  service  also  gives incentives for each reply with airtime valued at Ksh50.

Barrington  says  there  would  be  no incentives however  if the message has not been delivered by Friday evening. Surveillance Data  is  sent  to  'SMS  for Life' number 8428 every Monday and on Thursday    information  regarding the balances of all AL'S and RDT'S  is sent  to  the same centre.

Essentially  according  to  Barrington, the  new  initiative  helps  to  track medical  supplies  to make  sure  they get  to patients.

“The problem was that remote clinics often  ran  out  of  malaria  medicine because  central  health  facilities  had no way of keeping track of how much supply  the  cl inics  had,”   says Vodafone's  Global  Head  of  Health Solutions,  Joaquim Croca.
   
In  Tanzania  where  the  system  is officially  in  use,  once  a  week,  rural clinics send a text message listing the amount of medicine they have  in stock to  heal th  of f icials  at   central   distribution sites. The  information  is displayed  on  a  Google map  and  has enabled officials  in  the health sector to see which clinics are  running  low on supply versus those that still have plenty  of  medicine,  and  schedule deliveries accordingly.

The  21-week  pilot  study,  'SMS  for Life',  was  undertaken  during  2009- 2010  in  three  districts  of  rural Tanzania,   involving  129  health facilities, covering a population of 1.2 million.  

Undertaken  through  a collaborative  partnership  between Novartis,  the  Roll  Back  Malaria Partnership,  IBM, Vodafone  and  the Ministry  for Health of  Tanzania,  SMS f o r   L i f e   u s e d   m o b i l e  telephones,  SMS me s s a g e s   a n d   e l e c t r o n i c   m a p p i n g t e c h n o l o g y   t o   facilitate provision of  comprehensive and  accurate  stock  counts  from  all health  facilities  to  each  district management  team on a weekly basis.

The system covered stocks of the four different  dosage  packs  of  (AL)  and quinine injectable. The data captured through  the  SMS  stock  count   messages  was  available  through  a secure  reporting  website.   The website  was  then  accessed  via  the internet   on  a  computer  or  a Blackberry  or  other  smart  mobile phone.

Stock count data was provided  in 95 per cent of cases, on average. A high response  rate  was  maintained throughout  the  pilot.  The  error  rate for  composition  of  SMS  responses averaged 7.5 per cent throughout the study;   almost  al l   errors  were corrected and messages re-sent.

Data accuracy, based on surveillance visits  to health  facilities, was 94 per cent.  District  stock  reports  were accessed on average once a day. The proportion of health facilities with no stock  of  one  or  more  antimalarial medicines  fell  from  78  per  cent  at week 1  to 26 per cent at week 21.

During the study, AL stocks increased by  64  per  cent  and  quinine  stock ncreased 36 per cent across the three districts.

At  the end of  the study,  the partners concluded that the SMS for Life pilot provided  visibility  of  anti-malarial stock levels to support more efficient stock management using simple and widely available SMS technology, via a public-private partnership model  that worked highly effectively.

It further said that the system has the potential  to  alleviate  restricted availability  of  anti-malarial drugs  or other  medicines  in  rural  or  under- resourced areas.

Prof.   David  Mwakyusa,   former Tanzanian  Minister  for  Health  & Social Welfare, could not hide his joy when  presented  with  the  "SMS  for Life" Pilot results.

"I'm grateful  for what you are doing for my country –  I  lose a child every five minutes which  is a waste from a d i s e a s e   t h a t   i s   c omp l e t e l y   preventable.  This  is  a  great  project and an innovation that I support very much,  it's exciting  to me" he said.

Overall,  the SMS  for Life system was built  to  be  a  generic  and  highly scalable  solut ion  that   can  be leveraged to support any medicine or product, and can be  implemented  in any country with minimal  tailoring.
 
The system could also be utilized for disease surveillance.