MasterApp for AMR

MasterApp for AMR is the first World Bank-supported 3-in-1, 5 module, digital public health, tiered-access mobile app and web-based dashboard featuring a reinforcement learning hub for community health education, GIS-integrated field reports that collect and analyse community-based data, and an end-to-end medical consumable supply chain manager for the last mile. 

Opeoluwa Ashimi, a Pharmacist, Digital Health expert and CEO of Promane and Promade with over 15 years experience in digital public health with pruned expertise in access, surveillance and accountability. 

Since the development of the first antibiotic, arsphenamine, in 1908 to the discovery of penicillin in 1928, antibiotics have extended the human lifespan by 23 years. Today, 1.27 million deaths of the 4.95 million associated with antimicrobial resistance (AMR) annually, are due to ineffective antibiotics. 

AMR could be:

1. Intrinsic AMR due to naturally occurring trait in a pathogen.
2. Acquired AMR by mutation- resistant mutants rapidly replacing sensitive population by faster growth e.g. COVID-19 geographic mutants.
3. Acquired AMR by DNA acquisition- This is when a pathogen acquires AMR DNA from one host to another (transduction) or from a dying bacteria in the same host (transformation). Also called transferable AMR, it is can occur between different pathogen species (sulfonamide resistance from Shigella transferred to E. coli) hence the most important to control AMR. 

Transferable AMR occur in human and animal hosts' gut during dysbiosis -an imbalance in gut bacteria composition, metabolism and distribution due to maladministration of antimicrobials (fake, substandard, adulterated, incomplete use and wrong administration). In the pharmaceutical supply, environment and food chains, MasterApp solves supply chain porosity (quality and access) and wrong administration (use) of antibiotics while collecting community-based data on transferable AMR genomic and phenotypic biomarkers.

MasterApp for AMR Learning Hub provides community based AMR, AMA, AMQ and AMU reinforced education in compliance with WHO AWaRe guidelines to pharmacists, pharmacy technicians, veterinary medicine store managers, patent medicine venders and community health workers with relevant citizen information passed on at the point of procuring antibiotics.

MasterApp for AMR Supply Chain Manager serves manufacturers of genuine antibiotics, pharmacies, patent medicine vendors, veterinary stores and community health workers by providing a traceable, foolproof supply chain of antibiotics, hence assuring AMQ for the general population.

MasterApp for AMR field reports serves public health authorities, antibiotics focused pharmaceutical research organisations, farmers and the informed public through public health and pharmaceutical microbiologists who are provided access to antibiotic procurement, use and mobility data, allowed to design bi-directional human and animal use surveys, record observations and collected biomarker samples and analysis to generate identify trends, record inferences and provide evidence for preventive and corrective public health interventions.

Regional access via Pharmacy and Veterinary councils map the custodians of antibiotics (manufacturers, registered pharmacies, the pharmacists and their pharmacist technicians, veterinary medicine stores and managers, patent medicine vendors and community health workers), farmers and recruited microbiologists to engage in an initiation focus group conference.

MasterApp for AMR provides

1. A globally accessible white paper published for public use on the importance on building super apps (3-in-1 features of MasterApp for AMR) for low income, low resource contexts in public health interventions.

2. Data inferences from MasterApp for AMR web dashboard to public health authorities for preventive and corrective intervention on AMR intersection with AMA, AMQ and AMU at the community level.

3. At cost procurement of all antibiotics listed on its MasterApp for AMR supply chain manager to ensure access to quality antibiotics at affordable prices in the community and stem the use of fake, substandard and adulterated antibiotics.

4. Free-to-access Masterapp for AMR learning hub content and infographics to enlisted antibiotics custodians and the general public respectively.

5. Free-to-access MasterApp for AMR field reports on novel observations for new antibiotics development.

MasterApp for AMR's SDG impact, activities, outputs, and outcomes are below:

SDG 2- access to education on learning hub about AMQ and AMU, a foolproof AWaRe supply chain manager and continuous monitoring of AMR microbiota genetic phenotypes via field reports (activity) leads to increased animal-based food production in farms (output), and a sustainable and resilient food system with increased income for farmers and pastoralists (outcome).

SDG 3- safe access (AMA) to quality (AMQ) antibiotics used (AMU) in line with WHO AWaRe guideline (activity) strengthens developing countries' capabilities for risk reduction (output) and ensures preventable deaths due to infectious diseases like tuberculosis including tropical and communicable diseases in vulnerable populations like mothers, newborns, children under 5 years stops (outcome).

SDG 9- contributing a 3-in-1 SuperApp to the digital health domain (activity) strengthens public-private healthcare infrastructure (output) for sustainable resource efficiency (outcome).

SDG 10- reducing wastage in antibiotics supply chain through the end-to-end supply chain manager and loss from antibiotics maladministration (activity), economic savings reduce outcomes gaps for developing countries (output); strengthening political will for adoption of AMR equitable policies (outcome).

SDG 11- MasterApp for AMR in vulnerable communities (activity) reduces infection-related deaths and economic losses (output); protecting the poor (outcome).

In the next year, we will

1. Custom MasterApp for AMR learning hub content to WHO AWaRe Book guideline; integrate antibiotics' custodian (manufacturers, registered pharmacies, the pharmacists and their pharmacist technicians, veterinary medicine stores and managers, patent medicine vendors and community health workers) data, conduct community-based baseline survey in on AMA, AMU, AMQ for targeting citizens and farmers (small and large scale). 
2. Engage antibiotics' custodian, public health authorities, microbiologists and partners at the focus group-initiation conference, presenting citizen-generated data and signing supply chain partnerships for AMQ and AMA with approved, participating custodians for hub-and-spoke foul-proof supply chain.
3. Gleaning insights from conference, the design of new data collection tool incorporating mobility data will be completed with established protocols for informed consent.

In the next 3 years, we will

1. roll out MasterApp for AMR in 100 target communities in Nigeria
2. continue to consult Trinity Challenge members and partners on insights, data analysis, necessary information exchange and guidance including leveraging support from Wellcome, Clinton Health Access Initiative, Institute for Health Metrics and Evaluation, Bill and Melinda Gates Foundation, Reckitt Benckiser, Microsoft and Palantir.
3. Release white papers and relevant public good commitments (data inferences and novel observations)
4. Sign cross-country agreement to scale MasterApp to Ghana.

Metrics to Measure MasterApp for AMR Output:

• Number of AMA, AMU and AMQ content compliant with WHO AWaRe Book guideline
• Number of antibiotics custodian enlisted with access to MasterApp for AMR
• Number of antibiotics custodian actively engaging learning hub
• Number of antibiotics custodian signed up on MasterApp for AMR antibiotics end-to-end supply chain manager
• Number of "Access" (first line) Antibiotics per WHO AWaRe Book guideline on MasterApp for AMR supply chain manager
• Value of hub-and-spoke procurement transacted via supply chain manager quarterly and annually.
• Number of consenting point of sale buyers of quality antibiotics through spokes of MasterApp supply chain manager
• Number of verifiable and traceable users of antibiotics traced through point of sale data
• Number of inferences generated from field report associated with preventing AMR.
• Number of AMR alerts including heat-mapped communities generated from field reports.
• Number of genetics-linked novel observation from field microbiological reports
• Number of AMR mobility related insights 
• Number of white papers released on MasterApp
• Number of cross country agreement signed for use of MasterApp for AMR

• To address the challenge of AMR which I have first hand experience 
• Owning a solution (MasterApp) with demonstrated effectiveness gives confidence to apply and contribute to a new narrative
• Opportunity to improve visibility of MasterApp for more use-cases in the public health space
• Opportunity to grow MasterApp's impact within the public health domain with a different use-case
• To establish a sustainable pathway to fund and scale MasterApp 
• To overcome industry bias against digital solutions in low income, low-resource contexts by proving relevance and economic sustainability
• To improve my team's dexterity in multi-disciplinary, multi-stakeholder one-health domain 
• To network and explore potential partnerships with trinity challenge members and partners

Potential Partners identified include Wellcome, Clinton Health Access Initiative, MIT, Institute for Health Metrics and Evaluation, GSK, Bill and Melinda Gates Foundation, Reckitt Benckiser, Microsoft and Palantir from the Trinity Challenge, as well as local stakeholders and antibiotics' custodian.

In particular:

• Wellcome, GSK and Reckitt Benckiser mentorship to interpret community observations for new antibiotics/antimicrobial development, 
• Microsoft's cloud support and experience in multi-platform integration,
• Palantir's expertise in data mining for enterprise-wide decision making especially with Foundry's impact in healthcare and NHS for inference with  multi-layered data,
• Bill and Melinda Gates Foundation, and Clinton Health Access Initiative, both experienced global health organisations with Nigerian footprint skilled in scaling solutions,
• Institute for Health Metrics expertise on key performance indicators beyond the SDGs or a logic framework,
• and MIT/Solve, my go-to-partner since 2021 (when I became a solver) and the tremendous dexterity impacted on my organisation through academic partnerships 

are all important mentorship and collaboration opportunities to grow new capabilities, uncover scaling pathways, improve performance metrics and the overall outcome of MasterApp for AMR.