Going Mobile for the Last Mile Feature Phone Data from the Source

Recently, The Neglected Tropical Diseases Supply Chain Forum (NTDSCF) was honored with a Guinness World Record for the most medication donated in a 24-hour period. But before that was possible, the NTDSCF reached out to partner with us and we worked with them to create a better way to track their medicine; from the moment a county requested the medicine to where and when the medicine was distributed. That customized solution built on top of Secure Data Kit is called NTDeliver, and it allowed them to track billions of drugs across the globe.

After those tracked medicines end up in the country, we move to the next step that we refer to as “The Last Mile.” This term described the process of working with local ministries of health and NGOs to track supplies from the port where they land to the schools and district-level pharmacies where they are used. The people taking care of treatment campaigns are skilled at planning and coordinating treatments, but they aren’t supply chain experts. That’s why we worked with KEMSA (Kenya Medical Supplies Authority) to track medicine from national warehouses to sub-county warehouses all the way to the students who needed the treatment.

Problem: Inability to Track

When tablets arrive in the warehouse of a receiving country, pharmaceutical donors have very little clarity when it comes to what is happening to their shipments and inventories. The main issue is that they are unable to track medicine from delivery into the country to disbursement of the medicine to the students who need it. This lack of clarity also causes improper inventory tracking so sometimes local inventories are tracked too late, and donors end up with too much, too little, or even expired medicine. Plus, there’s also uncertainty regarding where the remaining supplies of medicine are stored.

Kenya had difficulty efficiently tracking the distribution of the medicines. Teachers would report deworming data by filling out a form and sending it to the school’s head teacher. That head teacher consolidated all the teacher’s forms into a single form and sent it to someone in the sub-district office. That person in the sub-district office consolidated all the forms from all head teachers into one form and sent it to someone at the district level. Confusing, right? But we’re not done yet. This process keeps going up and up until this form finally reaches the Ministry of Health office. This paper-based process left lots of room for error, and it took several months at minimum to get the data into the hands of the pharmaceutical donors who wanted to know how and where their donations were being used.

Solution: Mobile Reporting

The backcountry of places like Mozambique where medicines are donated is hard to reach, to put it mildly, plus we’re working with people in diverse areas that speak a wide array of languages and have limited internet connectivity.

However, they have a surprising capability that made it possible for them to input and share data: mobile connection. Nearly 80% of the population in the developing world has a feature phone, a mobile phone that has the functionality to access the internet and store certain information, but lacks some of the features found in smartphones (less than 40% of this population owns smartphones compared to 80+% in the US). So, we built a tool that allows us to interact with anyone who has access to a feature phone via short message service (SMS); allowing real-time communication with the people on the ground who have the most reliable information.

SMS, however, does require a certain level of training and on-going management when being used in the field. Past failed attempts were alleviated by SMS-based training, dramatically increasing participation and the amount of feedback received from the field.

Results: Increase in Feedback, Decrease in Time

Secure Data Kit’s SMS feature was implemented for a deworming campaign in Kenya with almost 1,500 teachers. Medicines were tracked from the warehouse to teachers across the country. Once the teachers treated the children in schools, they sent a text message with the batch number that correlates to the shipment as well as the number of tablets used, which allowed us to track where surplus medicine was located. We were present for each step of the implementation—working with them to build training documents, visiting the country to interview stakeholders, improve the process to improve response rates, and build reporting required by the donor and ministry of health. The pilot was successful and we are currently working on a fully integrating the reporting process into Kenya's deworming MDA:

  • The total implementation time only took three months in Kenya.
  • Response rates were improved by 39%.
  • Response data was accessible in real-time through the NTDeliver tool.
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The Kenyan Ministry of Health and donors now know the number of tablets that are used and what remains in near real-time. They know the inventory in the country down to the batch, which allows them to monitor the expiration dates of surplus medicine and make better decisions on how the surplus is used. The ministry of health and donors can now react immediately to issues that arise. For the first time ever, donors have end-to-end visibility of shipments from the initial donation to the final treatments, all in one place.

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