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January 4, 2010

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January 4, 2010

Using mobile phones to combat medicine shortages in Africa

January 4, 2010
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Most of the coverage (and hype) around mobile phones and development is based on their potential to improve access to markets for small farmers, especially those in remote areas and to provide easy ways to transfer small amounts of money in the absence of functioning bank networks. But mobiles, which are rapidly becoming ubiquitous in most poor countries (like a kind of technological Coca Cola), have some real possibilities for those campaigning on access to essential services such as healthcare, according to an article by Ken Banks.

The “Stop Stock-Outs” campaign is based around a little-known, but devastating, problem. Medicine stock-outs — where local clinics and pharmacies run out of high-demand, crucial medicines — are a potentially lethal problem in a number of African countries, yet governments insist they don’t occur. The team behind the project set out to find a solution and asked themselves, “What could be more powerful than a map which contradicts these government claims?”

Last year, activists in Kenya, Uganda, Malawi and Zambia started surveying clinics in their respective countries, checking stock levels of essential medicines. These included first-line antimalarials, zinc tablets, penicillin, first-line anti-retrovirals (ARVs) for the treatment of HIV/AIDS, and diarrhoea medication. Each of these medicines is widely used in the four countries.

After visiting clinics and pharmacies, activists reported their results using their mobile phones through structured, coded text messages (SMS) – “x,y,z” – where the first number represented their country code (Kenya, Malawi, Uganda or Zambia), the second their district or city, and the third the medicine which they found to be out of stock. The messages were then visually displayed on an online map, showing specific reports by location and building up “hot spots” of activity. In the case of the “Stop Stock-Outs” campaign, the bigger the hotspot the greater the number of stock-outs, and the greater the problem in that area.

Within the first week alone, the team collected reports of 250 stock-outs of essential medicines in their four target countries. Because incoming data automatically populates the map, it represents an almost real-time picture of stock-outs. After a successful launch and a week piloting the service, the “stock-out SMS number” has been distributed to medicine users throughout each country so that anyone with a mobile phone can send in a stock-out report. However, unlike reports from official, known data collectors, these messages will firstly be checked by staff at Health Action International before being posted up on the map. Then the government can’t deny it’s happening and the public pressure can really start.

stockouts map

Very smart indeed. Anyone know of other examples of using mobiles to campaign on essential services? Oh, and Happy New Year everyone…..

[h/t Nancy Holden]

11 comments

  1. Thanks for sharing – great story to start off the new year. A Happy new year indeed if the government responses are useful. Part of me wonders how Mbeki would have responded had a similar thing happened in South Africa – I’m thinking a TAC map of real time ARV deficits. Might have been entertaining. Not sure how Zuma would respond now though. Good luck to the campaigners.

  2. Duncan, HNY too. I’m sure you know about MobileActive but it’s always worth checking their site. They did a revamp last year and their database of projects and articles continues to grow and is a lot fuller and easier to search.
    http://mobileactive.org/directory (though “essential services” doesn’t bring up anything specific, unsurprisingly, there are masses of campaigning examples)
    Pete

  3. Very intersting. Do we know whether this “stops” stock-outs or simply reveals them? Obviously the latter is critical for the former, but it would be nice to be able to distinguish.

  4. This is a great idea .. really I find it very inspiring.

    However, I don’t believe you when you say, ‘Then the government can’t deny it’s happening.’

    You know that in many developing countries that’s exactly what the gov will do, or just ignore the question, or blame someone else. What happens then is more frustration builds up and people no longer see the point in contributing to such schemes.

    So is this a way of getting up the governments nose (advocacy), or is this a way of making sure the medicines arrive where they are needed? It has to be the former because you don’t need this system to do the latter (Health workers are in the best position to ask for more drugs, unless the will has been completely beaten out of them)

    BUT, if you use communications to publicise some expamples where this has worked, this will encourage more people to contribute.

    Anway, despite those thoughts, it is is a superb idea, if not for only building up a picture how bad things really are.

    Still preventative health, not drugs, is the way forward, probably the only way for the very poorest countries.

    Will highlight this on adevelopingstory.org

  5. This started me thinking what would happen here in the UK if such stock outs occurred in Tamiflu for instance during a swine flu panic. The local and national media would get involved and the government couldn’t just insist it wasn’t happening. Not without looking even more incompetent. Isn’t the real problem a lack of democratic accountability to the electorate and maybe internatioanl NGO’s should be more willing to say so.

  6. Good point Ken. That question ‘what would happen here in the UK?’ is a simple but really useful one. Especially in the ICT for Dev field. Often ask myself the same question re. crisis response ‘services’ too. Helps highlight where the real problem is. Ushahidi in Cockermouth? That said, this is a particularly elegant project and the approach seems to be both simple and scalable enough to have much wider applications.

  7. Well I admit I had to google Ushahidi – very interesting. I’m still intrigued how we manage to have a free-market solution to this. Profit-minded journalists still manage to find space among the page 3 stunners to hold politicians to some sort of account. Maybe historically we had newspapers set up deliberately as campaigning and advocacy organisations too. It would be interesting to see the history of newspapers as agents of change

  8. Very interesting solution using mobile to map ‘stock-outs’. I wonder if there is any thought about using this to also reveal surplus quantities (if any), for more effective medicine distribution.

  9. A good posting – much of what we know today – especially about use of cell phones in Africa for health – is anecdotal. It would help the field to highlight research that documents the effects. Medline searches turn up a few things, but not much from Africa. Duncan Green ends his posting by asking us to share examples. Hopefully some of those will be from actual research that documents the value of mobile technology.

    There are very few recent published articles from lower and middle income countries but these include:

    J Telemed Telecare 2008;14:37-41
    2008 Royal Society of Medicine Press. A review of ICT systems for HIV/AIDS and anti-retroviral treatment management in South Africa. Tove Sørensen, Ulrike Rivett and Jill Fortuin

    Bulletin of the World Health Organization. Bull World Health Organ vol.87 no.8 – LESSONS FROM THE FIELD. Use of mobile phones in an emergency reporting system for infectious disease surveillance after the Sichuan earthquake in China. Changhong Yang, Jun Yang, Xiangshu Luo, Peng Gong

    The HAART cell phone adherence trial (WelTel Kenya1): a randomized controlled trial protocol. Richard T Lester, et al. in Trials (Biomed Central) http://www.trialsjournal.com/content/10/1/87

    AIDS Behav. 2010 Jan 7. [Epub ahead of print]Shet A, Arumugam K, Rodrigues R, Rajagopalan N, Shubha K, Raj T, D’souza G, De Costa A. Designing a Mobile Phone-Based Intervention to Promote ART Adherence in India

    The use of mobile phone data for the estimation of the travel patterns and imported Plasmodium falciparum rates among Zanzibar residents Malaria Journal 2009, 8:287. Andrew J Tatem et al.

  10. Who would have thought that mobiles phones would revolutionize the world in such two short decades? From the size of a toaster just a few years ago to sophisticated communication devices with amazing functionalities.

  11. Yes, this leap frog technology in the developing world is a golden opportunity to strengthen health services. We found that a simple low cost protocol using patient’s own cell phones improved ART adherence and suppression of HIV to undetectable levels in a multicentre randomized controlled trial in Kenya. We will present the findings at the IDSA conference in Vancouver in October and at the mHealth summit in Washington, DC in November. http://www.mhealthsummit.org

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