SMS For Life Demonstrates That Digital Doesn’t Have To Be Difficult

With all our talk about innovation, it's easy to forget that sometimes you don't need cutting edge gadgets and widgets to make sweeping changes, sometimes the simplest ideas are still the most effective...



“It's simple. If there are no malaria treatments, someone will die. It is very likely to be a child.” Prof. David Mwakyusa highlights the dangers of stock-outs in sub-Saharan Africa in the starkest of terms, reminding us that the most rudimentary of administrative tasks can be a matter of life and death. Or, more likely, just a matter of death: Mwakyusa claims a child is lost every five minutes to malaria. For a preventable disease, this is a shocking statistic.

But until recently, this was a statistic without a solution. And a particularly depressing one considering that the meds were available. The problem was, they weren’t there when the patients needed them due to simple stock issues. Even more depressing: this wasn’t a simple case of negligence or incompetence. That would be easier to deal with – replace the incompetent workers with competent ones. Instead, the problem was more endemic. Mwakyusa’s statistic simply reflects the reality of sub-Saharan infrastructure, particularly in rural areas. An extreme difficulty in forecasting demand for the drug was exacerbated by a ‘very poor IT and communications infrastructure’, which resulted in sporadic, paper-based ordering and consumption reporting. It looked like a problem in need of a seriously innovative solution.

Step up ‘SMS for Life’. Seriously innovative or seriously simple? Maybe, as perhaps all the great ideas are, both. With the continuing leaps technology makes, it’s easy to get caught in the maelstrom of progress. There is a constant urgency in the digital world to be seen embracing the ‘next big thing’. Marketing managers often wax lyrical about the newest online tool, sometimes forgetting that the technology already exists to demonstrate true innovation, you simply need to keep it simple, stupid!

Led by Novartis, the pilot project was a public-private partnership 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 exploited the fact that mobile phone coverage outstrips other communication infrastructures in the region. Every Thursday the system sent a stock request message to the mobile phones of all registered health facility workers who would reply with their stock levels via a free text message. If they fail to reply by Friday the system sent them a reminder.

The project even included a carrot: free airtime for stock request responses. The information was then automatically sent to the district management officer on Monday, who could then order or redistribute medicine between sites accordingly.

The response was phenomenal. Stock count data was provided in 95% of cases with data accuracy at an impressive 94%. And most importantly, the proportion of health facilities with no stock of one or more antimalarial medicine fell from 78% at week 1 to 26% at week 21. 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%. And in Lindi Rural district, stock-outs were eliminated by week 8 of the pilot with virtually no stockouts thereafter. The pilot has now been rolled out across Tanzania, with pilots being implemented in Ghana and Kenya, and being considered in the Democratic Republic of the Congo. With such an impressive return, small surprise that it has been recently recognised with 21st Century Achievement Award in the Innovation IT category of the 2012 Computerworld Honors Program.

The simplicity of the solution is such that it can be conceivably tailored to fit any med in any country. But beyond a simple copycat scenario there are more wide-ranging lessons that can be learnt from this success.

The first is, where appropriate; consider the benefits of a collaborative approach. It seems likely that making the texts free and offering free airtime for responses had a significant impact on response rate; as austerity continues to bite, spreading costs and sharing rewards looks increasingly attractive. And on the same theme, the success of such a low-cost solution is a timely reminder, in an era of flashy apps and games, that sometimes, basic really is best.