In Malawi, 80% of the population lives in rural areas where access to clean water, sanitation, and health care facilities is extremely limited.  Per capita health expenditure is only US$14 per person and preventable illnesses such as malaria and diarrheal diseases are major health problems.

In 2008, VillageReach started a rural health systems strengthening program in the Malawian community of Kwitanda combining efforts to strengthen the network of community health workers, interventions to reduce malaria and diarrheal diseases, and introduction of SMS mobile phone technology as a tool to manage information critical to health system performance.  Kwitanda is a poor, rural area with a close proximity to the Shire River that increases rates of malaria and other infectious diseases.

Field Program

VillageReach’s program aims to reduce levels of malaria and diarrheal disease in Kwitanda by 35% by 2011.  To accomplish this goal, VillageReach facilitates distribution of existing cost-effective preventative measures, manages community health worker training and provides infrastructure support for the health center and community.  Activities include:

• Malaria Prevention and Treatment—Distribution  of long-lasting  insecticide treated mosquito nets, expanding access to treatment, and improving diagnosis
• Diarrhea Prevention – Build and maintain sources of safe water and implementation of community-based sanitation and hygiene program
• Community Health Worker Training—Hire and train Health Surveillance Assistants (HSA),strengthen community-level diagnosis and treatment activities, establish peer support and supervision groups, facilitate HSA work with transportation
• Transportation—Facilitate community based road improvement project, strategically place ambulances to serve rural health emergencies
• Infrastructure Support—Provide health center with refrigerator for vaccine storage and assist with providing essential equipment and building repairs and maintenance

SMS Solution for Malaria Medicines Venture in Malawi

In 2009, Medicines for Malaria Venture (MMV) and VillageReach conducted a pilot project in Malawi that used cellular communications networks and simple SMS technology to collect last mile data on anti-malarial medicine distribution. MMV turned to VillageReach as an expert in the management of medical logistics and supply systems in remote communities.

There is a tremendous variety of anti-malarial medicines in use in developing countries, however data collection from isolated communities is extremely challenging due to poor communications infrastructure. This data is important for policy makers interested in expanding access to effective and affordable anti-malarial medicines.

For MMV’s pilot program, VillageReach developed a routine data collection system in collaboration with the Malawi Ministry of Health in Malawi, utilizing SMS technology to transmit and record information about the type, volume and price of anti-malarial medicines distributed in the Kwitanda region.

VillageReach developed an easy to use website which displayed data directly reported from small-scale medicine vendors and clinics. The routine sales and distribution data provided valuable market information and pushed the frontiers of how routine data collection can be conducted using SMS.

To operate the project, VillageReach Malawi staff were trained to operate the website in order to monitor messages coming into the system, produce reports of the data, manage the vendor network air time, correct messages with errors, and manage the vendor and drug information.

SMS data sent to the internet application by vendors in remote locations was instantly recognized online and registered. Responses were sent back confirming message receipt, and the online charts and graphs displaying the recorded would be updated. The system was designed to be flexible in order to be relevant for a variety of health system programs operating in challenging physical environments. The system can support tracking and recording of any type of drug or vaccine, scale to large volumes of vendors, and health clinics, and account for whatever SMS charges are incurred. For the MMV program, the system additionally provided an incentive by sending SMS top-up value as a reward to vendors for successful reporting.

The pilot program now serves as a leading example of data collection and data processing that can efficiently and effectively leverage the expanding presence of cellular-based communications networks throughout the developing world.