By Peter Ward, IBM SMS for Life Project Manager, Tanzania
1. What was the aim of the project?
Stock-outs of malaria treatments at the health facility level in many sub-Saharan African countries have been a persistent problem for many years. A stock-out is the unavailability of medicine at the health facility. In Tanzania, 93 percent of the population are at risk for malaria infection. The number of malaria cases is estimated to be 11 million resulting into 60-80 thousand deaths per year or 220 deaths per day in Tanzania alone.
The goal of the SMS for Life pilot project was to develop a flexible and scalable solution to bring up-to-date visibility of anti-malarials within the Tanzanian Public Health Sector with a potential to reduce or eliminate stock-outs of five drugs (four dosage forms of ACTs and Quinine Injectable) in all health facilities in a pilot sample of three districts.
2. What was IBM’s involvement?
The concept was developed on an Extreme Blue internship programme with Novartis. IBM provided project management to the pilot project and also made LotusLive, IBM’s cloud-collaboration services, available to the global project team to ensure every member of the team was kept up to speed and remained in touch with one another on every detail of the weekly stock data, the updated locations of health facilities, the most current versions of documents and activities critical to the success of the program.
3. Pete, what was your personal involvement and observations on the ground?
I was the project manager from the initial 3.5-week recce across the three pilot districts in Tanzania in May 2009 until the delivery of the final report to the Minister of Health in April 2010. I participated in the recce, subsequently created the project plan, participated in delivering the end user education in Dar es Salaam and the 3 pilot districts, managed the work remotely through the 21-week pilot running period, and had heavy involvement in creating the final reports.
My personal observations are that this project is a simple yet effective way of addressing a previously intractable problem. The use of end user technology which appears simplistic is appropriate for the harsh environments found in sub-Saharan Africa, while the complex server/application technology that drives the solution remains hosted in the developed world. I anticipate that the success of the project will encourage a speedy rollout in Tanzania and also in other countries across the African continent where malaria is a problem. I also expect the solution to be applied to other similar requirements.
4. What were the results of the pilot?
The pilot delivered against three primary objectives:
A. The SMS for Life system provided visibility of accurate anti-malarial stock levels of the health facilities, and this visibility has supported the districts in better stock management and the elimination of stock-outs.
The SMS for Life pilot provided, for the first time ever, reliable weekly stock information on anti-malarials at the health facility level. This information was provided via the Internet or mobile phones and accessed by district management and project team staff. At the beginning of the pilot project, all three districts had high stock-out rates of one or more of the five medicines (Lindi Rural at 57 percent, Kigoma Rural at 93 percent and Ulanga at 87 percent). During the pilot, malaria medicine availability improved significantly in all three districts, such that at the end of 21 weeks, stock-out rates were reduced to zero percent in Lindi Rural, 47 percent in Kigoma Rural and 30 percent in Ulanga.
B. The SMS for Life application is a viable, easy-to-use system leveraging common everyday technology.
The project team successfully designed and implemented a complex data repository application system, with built-in automated workflow and error message handling in addition to on-line statistical analysis, graphing and stock reporting. The system is located in an industrial data centre used by the banking industry in London, UK, with guaranteed availability, backup and all the normal fire suppression, standby generators, multiple communications and multiple electricity sources required to ensure continuous availability. While hidden from users, the ease of access by the health care workers and NMCP and district management staff is demonstrated by system usage/data access statistics showing average access per user group of more than once per day. The pilot project collected 13,500 stock-level data points from 129 health facilities across three remote districts in Tanzania over 21 weeks utilizing the SMS for Life application.
C. The SMS for Life public-private partnership model is an effective organizational structure to identify, build and implement a solution to help resolve long-standing societal problems.
The SMS for Life pilot created a unique public-private partnership model that enabled the problem to be precisely identified, a technical solution to be designed, built, and implemented in three rural districts in Tanzania in less than one year. No formal budget, legal contracts, or MOUs were developed between any of the partners. The concept of creating a partnership from multiple public and private organisations, and assembling a very lean team combining all the expertise, skills and influence necessary to tackle a complex problem, has worked very well. Each partner committed their unique resources and covered their associated project costs, eliminating the need to source and manage budgets on a project level. This model also made it easier, faster and more efficient to obtain results, by passing the often lengthy and difficult approval processes for project funding allocation and transfer.
5. What are the implications for other projects going forward?
We recommend the following actions:
- Implement the SMS for Life solution in all districts of Tanzania
- Implement SMS for Life in other African or non-African countries that have a need to bring visibility to medicine stocks at the health facility and district levels, and eliminate/reduce stock-outs
- Encourage countries to use the SMS for Life solution to track other medicines of priority in their national environments
- Apply the SMS for Life solution to disease surveillance
- International bodies and governments should utilize the public-private partnership model that has been piloted, which harnesses the diverse skills and expertise across the public and private sectors, to tackle other societal problems.
In other words, the solution must be rolled out and will save lives across Africa.