It’s common in rural communities to run out of stocks of medicine. These “stock-outs” have life-threatening consequences—Especially when the pregnancy is term and there is need to induce labour but the pharmacy has a stock out of misoprostol. Community Health Workers (CHWs) in a village in Malawi may travel 20-50 miles to deliver a stock-out report to the nearest facility and request more medication. But a pilot study at St. Gabriel’s Hospital in Malawi across ten districts showed that only 35% of facilities submitted a report about medication stock. Medic Mobile, a non profit technology company, aims to change that.
The Medic Mobile team builds mobile and web tools that help CHWs combat stock-outs and other gaps within health systems. In Malawi, they trained health workers to use SMS on a feature phone to report stock-outs. Within a couple of months, reporting to St. Gabriel’s increased from 35% to 80%. It was also 134x faster and 4x less expensive than using paper-based reports. Reports that normally took 8 hours to deliver were submitted in 3 minutes. CHWs also reported more self-confidence and noted that mobile tools helped increase trust between them and their communities.1
Partnering with Amref
Medic Mobile’s work in Malawi continues to grow thanks to a recent partnership with Amref Health Africa. Amref Health Africa is an African health and development non-governmental organization founded in in 1957 with vast experience and reputation in working with marginalized and vulnerable communities across sub Saharan Africa to create lasting health change. Historically, Amref Health Africa has tested and harnessed locally available technologies, such as airplanes (then called Flying Doctors), radio (Dr Amref radio program), computers (eHealth) and now mobile devices (mHealth) such as mobile phones to improve the health of communities and strengthen health systems.
In Malawi, they’ve joined forces with Medic Mobile to collaboratively design, develop and implement a stock monitoring system for Mangochi District where a regional maternal health project called Staying Alive is being implemented. Medic Mobile was tasked with solving a communication gap between the district pharmacy and the 32 clinic pharmacies in Mangochi. The system is designed to flag low stocks and stock outs. This will prevent clinics from running out of stock while another clinic has an excess of the same medicine.
“The district needs to supply the drugs in time to prevent maternal death,” says Madalitso Tolani, Monitoring and Evaluation lead for Amref Health Africa Malawi. “It starts with the data. I value data so much. By using Medic Mobile we will identify the challenges that facilities are facing.”
Formerly, when a clinic ran out of medicine, a Health Surveillance Assistant (HSA) would drive, walk, or bike to the district hospital about 3 hours away. The district pharmacy would often be out of the requested medicine, leaving the HSA to wait or come back later. Despite the urgency, the patient had no choice but to wait.
“You need to help the rural guys, especially the underprivileged no matter what the challenges,” says Tolani.
Through discussions and site visits, the Medic Mobile team recommended the use of basic phones to make the tools as accessible as possible. All district pharmacies in Mangochi have access to at least a limited cell signal. Basic phones as opposed to smartphones have a long battery life (at least a full week on one charge) and most HSAs know how to use the tools eliminating the need for technical mobile phone use-training.
The HSAs use Medic Mobile’s SIM app on basic phones for routine monthly reporting and general low stock/stock out reporting. The SIM app is loaded onto a basic phone via a parallel SIM—a paper-thin wafer that sits underneath any ordinary SIM card. The parallel SIM loads a menu with custom drop-down lists, instant data validation, and skip logic. The information submitted is accessible by the Ministry of Health through our analytics platform. The data will help redistribute stocks between facilities, track supplies at the health facility level and help order new stocks at the district level.
For more information on Medic Mobile, visit www.medicmobile.org
1Bema, Thokozani & K4Health. 2011 Evaluation report.