UNISA - MobileApp for malaria drugs

Empirical evidence of ACTs distribution and management shows a highly embedded supply chain coordination (SCC) problem that cut across macro, market and the micro levels. The embedded complex SCC problem is tied to the unavailability, understock, and or over stock of ACTs in general hospitals. lack of Information and Communication Technology (ICT) amplified the problem of multi-embedded SCC of ACTs which require a huge investment.

Our mobile application manage, monitor and improve availability of ACTs to address the needs of different stakeholders at micro, market and macro by focusing on the parameters that hospitals cannot directly afford, namely, the technology needed.

It is worthwhile applying the novelty of our innovation to manage stock outs and over stock, improve health care necessary to avert malaria impact in Africa where 90% of all malaria deaths occur to pregnant women, and in children under 5 years, who account for 78% of all deaths.

The availability of medicines is a necessary component under universal health coverage and is in line with Goal 3 of the United Nations’ Sustainable Development Goals that aims to ensure the health and wellbeing of people of all age groups. Nonetheless, its achievement poses a formidable challenge, more so in developing countries where coordination of the supply chain is wanting, at least with inconsequential solutions to the dilemma of the availability of medicines (Leung et al., 2016; Yadav, 2015). The challenges are that applications are not integrated and most of the processes are a manual making it difficult to be responsive to an emergency. In some areas, the applications are available but do not cover the end-to-end processes.

According to the World Health Organization, malaria considerably contributes to child morbidity and mortality. In 2018, SSA accounted for 94% of world malaria deaths, of which 67% were children under five (WHO, 2019).  In 2018, there were 213 million malaria cases and 360,000 related deaths in the African region, accounting for more than 90 percent of cases worldwide. It is estimated that malaria costs Africa US$12 billion per year in direct costs and reduces GDP growth by 1.3 percent annually. 

The innovation is a practical mobile application tool or software for use by general hospitals in Sub-Saharan Africa and other developing economies with coordination and technological challenges of artemisinin-based combination therapies (ACTs). 

The innovation presents value proposition of all in one centralised mobile innovation features by using unique features built with inventory management logic such as economic order quantity (EOQ), production order quantity (POQ), integrated dashboard, live tracking features, multi-stakeholder interface, network transparency protocol, overstock-understock alert features, ABC analysis et cetara. It is the first affordable integrated mobile health application that covers end to end health care supply chain to market.

The technology that underpins the centralised mobile platform is Xamarin and asp.net for app. Xamarin is a free and open source mobile app platform for building native and high-performance iOS, Android, tvOS, watchOS, macOS, and Windows apps with .Net with native API access. Being a comparatively new tool, its database is based on the Microsoft technology stack and is hosted by Microsoft Azure.

Our innovation elevates mobile health applications beyond what might normally be expected of library of health care supply chain information systems. 

The solution serves micro (rural and township healthcare centers, communities, and healthcare workers), markets (suppliers, manufacturers, pharmaceuticals, distributors), and macro (donors, governments) supply chain stakeholders.

Using the micro, market, and macro to structure the population, please find below elaboration of their challenges, their needs, engagement, and proposed solution.

1. Population segment 1: micro such as hospitals and clinics (serving women, children and vulnerable communities)

Stock-outs of essential medicines at the clinic level are an important and widely acknowledged public health problem in sub-Saharan Africa (SSA) with a recognized negative impact on morbidity, mortality and disease epidemiology (Cameron, Ewen, Ross-Degnan, Ball, Laing, 2009:  Pasquet Messou, Gabillard, Minga, Depoulosky, Deuffic-Burban , et al. 2010). In Rwanda, the classification of stock-out levels was based on the range of stock-out levels seen that was between 0.0-24.2% (Nditunze, et al., 2015).

The burden of access to malaria drugs is carried mostly by poor, rural families that have less access to current prevention and treatment services. At worst, the mobile application health systems are not centralised in sub-Saharan Africa. 

• Engagement in needs analysis and development

The innovation was a response to a health care supply chain coordination challenge observed during a four-year PhD study by Dr Nagitta Oluka who was under my supervision. The study was conducted in healthcare centers in Uganda with DTMC committee responsible for ACTs distribution and management. Their inputs were crucial for micro requirements analysis.

• How the solution will address their needs

The system will reduce stock outs by 20-40% through our live tracking, expiry alert, and EOQ features. The lead time will significantly reduce from 15 days to 3 days because of our EOQ aleart feature and visibility to suppliers. The hospitals will mine data to quantify and forecast for the different seasons from our system. 

Beyond the management and economic value of saving costs, access to information across all supply chain members; control over various logistics activities like procurement, quantification, dispensing, forecasting; the system offers social value of saving life, especially vulnerable groups such as children and pregnant women, 

2. Population Segment 2: (market stakeholders) Suppliers and distributors of malaria drugs.

Local suppliers and chemists abound in rural parts of sub-Saharan Africa operate independently of the hospitals and have less visibility to stock management and have no affordable technology to help them manage. The high costs that needs to be invested for these systems are highly unattainable for most of the independent suppliers that are mainly dependent on tight budget. Providing digital power to independent suppliers chemist in rural areas will ultimately increases digital social inclusion, employment, and digital poverty reduction. Access to medicine will ultimately improve the well-being of the society for a better work force.

• Engagement in needs analysis and development

We are working with African Applied Chemical in the pilot phase of the innovation to ensure alignment with needs and practicality of supplier's value chain.  The inputs of the supplier will inform adjustment necessary for levels 5 and 6 technology readiness levels.

• How the solution will address their needs

Production order quantity is one of the key input data for every supplier. The lack of data usually leads to over or under production. The intelligence will assist the supplier in accurate allocation production resources such as labour, machines, raw materials etc.

3. Population Segment 3: DoH (government), Donors and funders (macro)

The role and finances of governments are shrinking, and NGOs are struggling to raise funds, some of the social problems cannot be addressed without participation of every segment of the society including corporations, business professionals and academics. Government have less visibility to stock management at provincial and local levels, and have no affordable technology to help them manage. The high costs that needs to be invested for these systems are highly unattainable for government that is dependent on donors’ aid, and tight budget. Providing digital power to the government digital social inclusion, employment, and digital poverty reduction. Access to medicine will ultimately improve the well-being of the society for a better work force. 

• Engagement in needs analysis and development

 The conceptual design, requirements analysis, and process flow embedded in the system were validated and confirmed by the chief Pharmacist and district medicines management supervisor involved in the healthcare supply chain of ACTs products in Uganda. At the pilot phase we are working with the Minister of Health in Uganda to pilot the innovation to ensure alignment with needs and practicality of government.  

• How the solution will address their needs

The system will offer DoH/ donors 99% actual data of consumption patterns per healthcare center, 99% increase in stock availability, 99% inventory management, 20% waste reduction, and 20% cost reduction, which is necessary for efficient and effective allocation of financial budget or resources. Our dashboard and live tracking system will assist DoH with value leaks across the different stakeholders. This value is added through integrated dashboard that can be accessed from a mobile phone, live tracking (inventory levels) feature, multi-stakeholder interface, EOQ, network transparency protocol, and overstock-understock alert features.

Problem alignment: The problem bridges the digital divide, increase access to malaria drugs, and limit impact to women and children in rural-townships areas.

Solution alignment: The system equips township-rural health centers with the technology to improve efficiency in the deployment of drugs, track supply across the value chain and enable users of the system, to effectively co-ordinate available supply to meet demands and react to outbreaks quickly. And subsequently, limit impact of malaria to women and children. 

Population alignment: We increase access of drugs to pregnant women, children, and communities who are mostly affected by malaria in African rural-township areas.

The system has reached level 4 of technology readiness (validated in computer laboratory).The University is finalizing memorandum of agreements with African Applied Chemicals (small malaria supplier) in South Africa and the National Malaria Control Centre in Uganda who expressed interest to pilot the technology. The National Malaria control gives us access to both our micro and macro customer segments (township and rural hospitals, clinics, vulnerable groups); hence African Applied Chemicals represents our supplier market segments. The feedback from the pilot phase will help us reach levels 5, 6, and 7 of technology readiness. As soon as the technology is validated in a real environment, our system will be released for use by rural and township health centers and communities.

It is the first affordable integrated mobile health application that covers end to end health care supply chain to market. The unique features are built with inventory management logic such as economic order quantity (EOQ), production order quantity (POQ), integrated dashboard, live tracking features, multi-stakeholder interface, network transparency protocol, overstock-understock alert features, ABC analysis etc.

Further, the innovation has a database exclusive to the ACTs project and have not been published and offers a high amount of data and intelligence necessary to achieve the desired coordination goal.

Considering the rate of malaria impact to Africa, and the lack of affordable technology to improve accessibility and availability of artemisinin-based combination therapies, our mobile application can be catalytic that induces health technology equilibrium, increase access to medicine, which is crucial for quick response to humanitarian crises, and malaria outbreaks. 

It is designed with a great understanding of limited ICT infrastructural (i.e. laptops) resources and scarcity in Africa, and enables micro, market, and macro stakeholders to maximise the strength of mobile application penetration in Africa where 67% of the population (approximately 1.13 billion people) have mobile phones (Adepetun, 2015). 

Moreover, the application has transferability and application to other drugs, and markets, subjects to customization. In May 2021, the department of Small Businesses in South Africa approached the University of South Africa and Prof Mkansi to pilot the system beyond healthcare centers to include spazashops (kiosks) and their suppliers in townships and rural areas.

There are 98093 health care centers in Africa, and within the healthcare centers, there are 11 people that deals with the management and distribution of drugs (referred as the DTMC committee). The implies that our target market offers us eleven (11) users per hospital, multiplied by 98093 healthcare centers in Africa. 

We are under the incubation of the BioPark at the Innovation Hub who monitors our monthly progress. We have specific funding to pilot with African Applied Chemicals which need to be done early next year and report upon completion to be completed. We provide report to the University of South Africa every quarter regarding progress. At the end of the incubation period will be be close to UN Sustainable Development Goal 9 of Industry, Innovation and Infrastructure.

We are partnering with the Ministry of Health in Uganda, African Applied Chemical in South Africa, and exploring partnership with the Institute of Sustainable Malaria Control will link us to key suppliers and health officials in the Limpopo province of South Africa towards impact of UN Sustainable Development Goal 3.

We are under the University of South Africa, and the spinoff company for the launch of the system will be under the University.

The team is currently composed of three members, namely Prof Marcia Mkansi, Dr Nagitta Oluka, and Mr Tshilio Ramovha. 

Prof Mkansi is the lead project leader who initiated the innovation, The innovation is based on findings from Dr Nagitta hence she is the co-inventor. Mr Ramovha is the softwareM engineer.

The tacit knowledge behind ACTs innovation the sum of separable outputs between Prof Mkansi and Dr Nagitta who are supply chain and operations management experts.

  Professor Mkansi is senior academics with PhD and industrial experience in the broader interdisciplinary fields of supply chain, operations management, and information systems applied across three business sectors, namely: health, e-grocery retail, and education. Her cross-fields blend of hands-on practical industry experience and academic insight avail the joint lead applicant as a rare arsenal of notions, materials and approaches that enhance healthcare supply chain knowledge-transfer effectiveness.

Dr Nagitta Oluka is a PhD holder in Management Studies (UNISA); MBA Maastricht School of Management, Netherlands). She is an international consultant with over 12 years of experience. She engaged with UMI as lead consultant for International procurement trainings for projects funded by the DANIDA and African Development Bank (ADB).

 Mr Tshililo Ramovha is a manager business systems administrator at the University of Limpopo. He has almost 20 years’ experience in the IT industry which started as an IT technical support and Information Systems 1 PCL leader and has climbed the ladder until the current position. He holds Bachelor Degree Information Technology (UNISA 10/2017), National Diploma Information Technology (Software Development) (UNISA 10/2008), National Certificate Information Technology (Technical Support) (ISETT/SETA 2005). He has also undergone additional professional training in the following subject: HP OpenView Service Desk 5 Admin, Microsoft Operational Framework Essentials, MS SQL 2000, SAP Courses: ADM940, ADM950, ADM960, ADM100; Oracle 11g SQL and PL/SQL.

As a largely youthful continent, a great emphasis is on developing sustainable youth employment opportunities as well as employment opportunities for rural females and gender minorities. 

Our mandate is to work with diverse teams to be able to navigate the cultural nuances that exist from area to area.

Working with youth, will also necessitate the effective upskilling and capacity building of those young people to be able to efficiently conduct their daily tasks under employment with our system.

We would like to raise further funding to improve the offering and back end support of the system for our customer organisations following pilot study. 

We are applying to Solve to help us move the innovation from readiness level 4 to readiness level 5, 6, and market towards our desired impact towards UN SDG goals 3, 9, and 10. We can use the funds to pilot with hospitals and healthcare centers in both South Africa and Uganda. And most importantly, to cover the estimated expenses which are critical for us to pilot and rollout to market.

We would need local partners in each geographic area we start operating in. Partners who would understand the market and key organisations to approach to have them as customers.

Though we know what our system offers and which challenges it solves, we may find markets that use the system in a different application to our intended use, and for that, we would like support in identifying further and wider product-market-fit niche markets in these geograhies.

Due to the divers legal frameworks, systems and laws in a number of African countries, we would need the services of partners well versed and experienced in the rules of engagement in these markets.

MIT faculty and Solve members would be great partners to help us with future versions and enhanced performance beyond our current standard. Africa is a huge continent and to service supply chain stakeholders in different countries, include our pilot countries South Africa and Uganda will demand more cloud, security, and technical support.

Further, we have been approached by the department of Small Business who wish to pilot the system beyond health to include spazashops (townships and rural kiosks) to up to 19 000 small partners and we will need human capital and more digital resources to deliver.

We are aligned with Robert Wood Johnson Foundation objective, and if we are successful, our system can be used by our MIT or Solve partners to directly address issues of small health products suppliers in the US. 

Problem alignment: The problem bridges the digital divide, increase access to malaria drugs, and limit impact to women and children in rural-townships areas.

Solution alignment: The system equips township-rural health centers with the technology to improve efficiency in the deployment of drugs, track supply across the value chain and enable users of the system, to effectively co-ordinate available supply to meet demands and react to outbreaks quickly. And subsequently, limit impact of malaria to women and children. 

Population alignment: We increase access of drugs to pregnant women, children, and communities who are mostly affected by malaria in African rural-township areas.

The co-inventors in this project are women who are using their knowledge and skills as a voice to address digital health inequalities in the continent. Our innovation represents our humble needs to contribute towards eradication of health issues in Africa, One of our greatest challenge is to use our knowledge in a manner that drives transformation in the ground, especially disadvantaged areas and for vulnerable groups in rural and township areas. The mobile application, if funded, we help us to drive transformation and shed a light for women to aspire and boldly use their knowledge for the greater good of the society.

The increase of stock visibility across different supply chain stakeholders such as donors, government, hospitals, and suppliers will create a mutual understanding of utilisation of resources (finance and medicine). The mutual understanding will lead to trust necessary for maintaining peace and stability in the continent. The higher the access to healthcare products, the higher the health security of the nation. In areas where there’s value leaks (i.e. misappropriation of funds and medical stock), the system will highlight which stakeholders, how much stock lost, information which is crucial for enhancing the security of medical distribution.

Empirical evidence of ACTs distribution and management shows a highly embedded supply chain coordination (SCC) problem that cut across macro, market and the micro levels. The embedded complex SCC problem is tied to the unavailability, understock, and or over stock of ACTs in general hospitals. lack of Information and Communication Technology (ICT) amplified the problem of multi-embedded SCC of ACTs which require a huge investment.

The innovation presents value proposition of all in one centralised mobile innovation features such as integrated dashboard, live tracking feature, multi-stakeholder (micro, market, and macro) interface, economic order quantity alert, network transparency protocol, and overstock-understock alert. 

It is worthwhile applying the novelty of our innovation to manage stock outs and over stock, improve health care necessary to avert malaria impact in Africa where 90% of all malaria deaths occur to pregnant women, and in children under 5 years, who account for 78% of all deaths.

The increase of stock visibility across different supply chain stakeholders such as donors, government, hospitals, and suppliers will create a mutual understanding of utilisation of resources (finance and medicine). The mutual understanding will lead to trust necessary for maintaining peace and stability in the continent. The higher the access to healthcare products, the higher the health security of the nation. In areas where there’s value leaks (i.e. misappropriation of funds and medical stock), the system will highlight which stakeholders, how much stock lost, information which is crucial for enhancing the security of medical distribution.

The innovation can contributes to the preservation of cultural values, and indigenous knowledge. For example, in cases where indigenous treatment medicine has been approved for use, the system can be adapted to help such producers of medicine to supply and distribute to new markets and to monitor consumption in their language. Although a future plan, such adaptation will contribute towards the preservation of cultural values and will support diversity of suppliers and health care products.