SMS for Life

SMS for Life is an innovative public-private partnership led by Novartis and supported by the Tanzanian Ministry of Health and Social Welfare, IBM, Medicines for Malaria Venture (MMV), the Swiss Agency for Development and Cooperation (SDC), Vodacom and Vodafone. The project comes under the umbrella of the global Roll Back Malaria Partnership.

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 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, huge 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
• Very poor IT and communications infrastructure, particularly in rural areas, although mobile coverage is growing

Having defined the problem and deciding that the solution had to be mobile phone-based, we used the IBM “Extreme Blue” problem-solving method – enlisting the help of students with fresh thinking to map the supply chain, investigate possible improvements and research mobile phone coverage in sub-saharan Africa.

Impressive results

The core of the solution is the use of SMS messaging between the health facilities that dispense antimalarials (artemisinin-based combination therapies, ACTs, and quinine injectables), and district managers who are responsible for medicine availability in their 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 Monday the system would send information about stock levels and non-reports to the district management officer, who can then monitor stock levels and order or redistribute medicine between sites accordingly.

Next steps

SMS for Life has been rolled out across Tanzania, with over 5000 facilities trained and reporting on a weekly basis. Tracking of tuberculosis and leprosy medicines has also been added.

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. In Kenya, where we have also completed an extensive pilot, we are working with the NMCP on a plan for a full country scale-up. In Cameroon, with support from NORAD, we are in the planning phase for a full country scale-up of malaria medicine tracking in addition to collecting patient surveillance data on the use of RDTs.