SMS for Life
SMS for Life is an innovative public-private partnership led by Novartis and supported by several partners, each bringing specific skills. The initiative runs under the umbrella of the global Roll Back Malaria Partnership.
Jim Barrington on the first SMS for Life pilot in Tanzania
“The team had a small number of people with very specific skills. No one company or organization had all these people skills, so our group brought together the relevant people from a number of different places – IT and process knowledge from Novartis, a communications expert from Vodafone, a mapping person from Google, and a project manager from IBM.”
Jim Barrington, SMS for Life
SMS for Life harnesses everyday technology to improve access to essential malaria medicines in rural areas of developing countries. It uses a combination of mobile phones, SMS messages, the Internet and electronic mapping technology to track weekly stock levels at public health facilities in order to:
- Eliminate stock-outs
- Increase access to essential medicines
- Reduce the number of deaths from malaria
Exploring the problem
In many African countries, supply chain problems make it difficult to get malaria medicines to patients. Barriers include:
- High stock-outs at rural health facilities, i.e. the point of care, where patients can get free drugs rather than having to pay for them at pharmacies or private clinics
- Zero visibility to district management on the medicine stock levels in their facilities
- Extreme difficulty in forecasting demand for the drug, resulting in emergency orders that require to ramp up production and transport the drug by air
- Inconsistent reporting of consumption and sporadic, paper-based ordering
SMS for Life in the media
The core of the solution is the use of SMS messaging between the health facilities that dispense antimalarial medicines (artemisinin-based combination therapies, ACTs, and quinine injectables) and their district medical officers who are responsible for treatment availability in the districts.
Every Thursday, the system sends a stock request message to the mobile phones of all registered health facility workers. They then count how much stock they have and send the information back to the system via a free text message. If they have not done this by Friday, the system sends them a reminder. On the following Monday, the system sends information about stock levels and non-reports to the district medical officer, who can then monitor stock levels and order or redistribute medicine between sites accordingly.
Stock-outs can thus be resolved within just one or two days whereas in the past this would have taken one or two months.
What makes this solution unique is that it has demonstrated it works in the targeted environment by reducing and eliminating stock-outs. It is flexible, expandable and scalable to support any number of additional health facilities, countries and products. It can be deployed quickly (5000 health facilities in 7 months) and at a total operational cost of less than USD 80 per health facility per year.
SMS for Life has been rolled out across Tanzania, with 5,100 facilities trained and reporting on a weekly basis. Tracking of tuberculosis and leprosy medicines, funded by the Novartis Foundation for Sustainable Development, has also been added.
Results from the Tanzania pilotThe six-month pilot program, which was conducted in three districts in Tanzania, covering 229 villages and a population of 1.2 million people, had impressive results:
- Stock-outs were reduced from 79% to less than 26% in the three districts
- At the beginning of the pilot, 26% of the facilities had no dose form of the Novartis ACT and by the end, this figure had been cut to less than 1%1
In Ghana, following a successful pilot in six districts, sponsored by the Swiss TPH Institute, we are working with the Ghana Health Service on planning a full country scale-up. Further, the system is tracking 28 blood products from the National Blood Transfusion Service and from 10 regional hospitals in the greater Accra region. The online information on availability of blood products has helped reduce child birth mortality.
In Kenya, where Novartis supported the completion of an extensive pilot, we are working with the National Malaria Control Program (NMCP) on a plan for a full country scale-up. In Cameroon, in the context of the UN mHealth Alliance, we are collaborating with the Norwegian Development Agency (NORAD) on a full country rollout to track malaria medicines and collect patient surveillance data (3,800 health facilities in 91 districts).
In an initiative led by the President’s Malaria Initiative and rolled out by Greenmash, SMS for Life is currently being implemented in five provinces of the Democratic Republic of the Congo (1,245 health facilities). Further, the solution is also being used to track bed nets, rapid diagnostic tests (RDTs) and disease surveillance data, as well as antibiotics, medicines against leprosy and tuberculosis, and blood supplies.
We are in the process of expanding SMS for Life in several ways. In Ghana, together with the Novartis Foundation for Sustainable Development and Microsoft, we are piloting a Windows-based smart phone app (i.e. ‘eBloodBank’) to track blood supplies for 20 hospitals in the greater Accra region. If the pilot is successful, we will deploy to all 220 hospitals across the country. Also in Ghana and in Cameroon, tracking of neglected tropical diseases such as trachoma and onchocerciasis has been added to the system.
René Ziegler on the potential of SMS for Life
“SMS for Life has proven to be flexible, scalable and expandable to new disease areas. The increasing availability and affordability of mobile technologies throughout Africa is leading to new mHealth opportunities based on SMS for Life. In particular, smart phones and tablets are opening up new prospects to achieve our most rewarding goal: the improvement of healthcare in remote facilities.”
René Ziegler, SMS for Life
In the Lagos state of Nigeria, we are piloting the use of tablets to track stock and surveillance data and do online training of healthcare workers.
A widely acclaimed initiative
Since its inception, SMS for Life has received numerous awards and recognitions, including the 2012 Ethical Corporation Award for Best Corporate/NGO Partnership and Computerworld’s 21st Century Achievement Award in the Innovation IT category. Earlier recognitions include the Wall Street Journal’s Technology Innovation Award in the Health-Care IT category and a catalytic grant from The Innovation Working Group, part of the UN Secretary-General’s Every Woman Every Child effort, and the mHealth Alliance.
- Barrington J, Wereko-Brobby O, Ward P, Mwafongo W, Kungulwe S. SMS for Life: a pilot project to improve anti-malarial drug supply management in rural Tanzania using standard technology.