Integrated SMS & QR Code Solution for Combating AMR in Nigeria

• Antimicrobial resistance (AMR) is a major public health threat, which has been estimated to cause at least 700,000 deaths yearly globally. In Africa, this problem is aggravated by several factors, including indiscriminate use of antibiotics suboptimal healthcare systems with crude diagnostic practices and inadequatenational surveillance programs.

The team is lead by Melissa Bime who is the CEO and founder.

According to the  WHO, In Nigeria in 2019, there were 64,500 deaths attributable to AMR and 263,400 deaths associated with AMR. The country has the 185th highest age-standardized mortality rate per 100,000 population associated with AMR across 204 countries

It was also identified among the countries without established AMR surveillance systems. This lack of quality data often leads to treatment guidelines that are not adequate for the local situation. The absence of national AMR surveillance programs in this country raises questions about the reliability of reported data, especially because some countries do not fully capture actual AMR data due to illegal sales and undocumented imports of antimicrobials Health.

The emergence of antibiotic-resistant pathogens has threatened not only our ability to deal with common infectious diseases but also the management of life-threatening complications. 

All across Nigeria, antibiotics are overused and misused in people and animals and are often given without professional oversight. Examples include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals and fish.

Our solution is designed to serve multiple stakeholders in the fight against antimicrobial resistance, in Nigeria. 

1. Patients: Especially those in remote or rural areas with limited internet connectivity can use a simple SMS to report and participate in this project.

1. Healthcare Personelle: Need efficient ways to report antibiotic prescriptions, and resistance cases, and to access up-to-date information on AMR trends. The QR code provides a platform for detailed data reporting, which is essential for healthcare professionals in urban or better-connected areas. We engage with healthcare professionals through continuous training and feedback sessions to ensure the system meets their operational needs.

2. Public Health Authorities and Policymakers: Require accurate, real-time data to make informed decisions and policies regarding AMR. We provide a comprehensive dashboard for data analysis and report generation, addressing this need. We engage with policymakers and health authorities through regular briefings, presenting data trends, and insights gained from the system.

To understand and address the needs of patients, we conduct community outreach for healthcare feedback, organize workshops to train healthcare professionals on our system, gather insights on its practicality, and work closely with public health authorities and policymakers, we ensure our system's data aids informed decision-making on antimicrobial resistance issues.

1. Open-Access Data and Knowledge Sharing:

• Real-Time AMR Data Dashboard: The cornerstone of our public good provision is the real-time dashboard that aggregates and displays AMR data collected through our system. This dashboard is freely accessible to healthcare professionals, policymakers, researchers, and the general public, fostering an open environment for knowledge sharing and informed decision-making.

• Research: Regular analysis and research based on the collected data will be published in the form of white papers or peer-reviewed publications. These documents will be made openly available to facilitate global awareness and understanding of AMR patterns, especially in regions where data has historically been scarce.

2. Educational and Awareness :

• Public Health Education: The system serves as a platform for disseminating educational material about AMR and responsible antibiotic use. By leveraging QR code technology, we provide easy access to this vital information, which is crucial for altering public behavior and reducing the misuse of antibiotics.

3. Supporting Policy:

• Informing Public Health Policy: The data and insights derived from our system are instrumental in shaping effective AMR-related policies and public health strategies. By providing a detailed understanding of AMR trends and patterns, our system aids policymakers in crafting targeted and evidence-based interventions.

1. Healthcare Providers:

• Informed Treatment Decisions: Access to up-to-date AMR data allows healthcare providers to make more informed treatment decisions, reducing the misuse of antibiotics and improving patient outcomes.

2. Policymakers:

• Data-Driven Policy Making: The comprehensive data provided by our system supports policymakers in developing targeted AMR strategies and policies. This is crucial for implementing effective public health interventions and resource allocation.

• Evidence-based Interventions: Policymakers can utilize the data to identify hotspots of AMR and direct resources to areas most in need, thus optimizing the impact of health interventions.

3. General Population:

• Empowering Communities: By involving the community in data collection and dissemination of information, the system allows individuals to make informed health decisions, fostering a proactive approach to health management.

Links between Activities, Outputs, and Outcomes:

• Activities: Implement the data collection system on AMR, which we have piloted in Nigeria with over 30,000 patients using this to report AMR incidence.
• Outputs: The real-time AMR data dashboard is currently being used by the monitoring agencies of public health to help them make better public health decisions.
• Outcomes: Improved AMR surveillance, evidence-based policy-making, and interventions as evidenced by policies being put in place by public health officials in Enugu.

Year 1: Expansion and Consolidation

• Geographic Reach: Initially, we will focus on expanding the system’s deployment to additional communities and healthcare facilities, especially in regions in Nigeria most affected by AMR but lacking in surveillance infrastructure.

• Strengthen Partnerships: We will collaborate with local health authorities, NGOs, and international health organizations. These partnerships are crucial for gaining insights into specific regional needs and for logistical support in implementing the system.

• Public Awareness Campaigns: Launching educational and awareness campaigns in collaboration with community leaders and health workers to increase understanding and engagement with the system.

Years 2-3: Deepening Impact and Technological Advancements

• National Integration: Work towards integrating the system with national health databases and AMR surveillance programs. This step is vital for ensuring that the data collected through our system contributes to national and global AMR monitoring efforts.

• Incorporate Advanced Technologies: Implement AI and machine learning algorithms for predictive analytics, helping to forecast AMR trends and potential outbreaks. This will enhance the decision-making capabilities of health professionals and policymakers.

• Sustainability and Funding: Secure sustainable funding sources through grants, partnerships, and possibly a tiered payment model for more affluent regions to subsidize deployment in low-resource settings.

We have created a comprehensive monitoring and evaluation plan designed to track specific, measurable indicators that reflect the effectiveness and reach of our solution. some of these include;

1. Number of Reports Collected Through the System: Here, we track the total number of AMR-related data points (antibiotic usage) reported through SMS and QR codes. Our goal is to see a steady month-over-month increase in reports. During the pilot phase, we observed a 12% MoM increase in usage in the 1st 12 Months, indicating growing user engagement.

2. Geographic Reach and User Base; The number of communities, healthcare facilities, and users actively utilizing the system. We started a pilot in Enugu and then moved into Ibadan.

3. Accuracy and Reliability of Data: We conducted regular Quality checks on the data collected for consistency and accuracy and observed less than a 5% discrepancy rate in data accuracy. 

6. Policy Influence and Decision Making; So far, we have been able to contribute to at least 3 significant policy decisions in our 1st year mostly around prescription practices. While still early, additional discussions with policymakers have been initiated to integrate findings into broader AMR strategies.

• 1. Financial: Funding for Expansion: Scaling the system to new regions requires substantial funding. We are pursuing grants from health-focused organizations, NGOs, and governments. Additionally, we are exploring a tiered payment model where more affluent regions or organizations subsidize costs for lower-income areas.

• 2. Technical:

  • System Scalability and Reliability: Ensuring the system can handle increased user load without compromising performance. We are investing in robust cloud infrastructure and conduct regular system stress tests. 

• 3. Legal and Regulatory:

  • Data Privacy and Compliance: Navigating countries' data protection regulations will be complex. We Work with legal experts to ensure compliance with local and international data protection laws. Implement stringent data security measures to safeguard user information.

• 5. Policy:

  • Alignment with Health Policies: Ensuring our system aligns with national health policies and priorities. We enage with health authorities and policymakers from the beginning to align our approach with existing health strategies and demonstrate its value in enhancing AMR surveillance.

• 6. Infrastructure Challenges:

  • Internet Accessibility: Limited internet access in remote areas can restrict the use of QR code functionality. This is why we Leverage the SMS component of our system in areas with limited internet and explore partnerships with telecom companies to improve connectivity.

The Challenge provides a gateway to secure much-needed funding for our solution. This additional funding will provide us with the crucial resources we need to refine our infrastructure, ensuring system scalability and reliability under increased user loads. It will also provide us with the resources to navigate complex data privacy and compliance issues across different countries. 

Regarding policy alignment, the credibility we will gain from the trinity challenge will help facilitate conversations with policy makers and health authorities. 

We will be able to gain access to much needed personallles to help us negotiate crucial partnership with telecom providers to overcome infrastructure challenges such as minimal internet access in remote areas. 

Lastly, I believe that the Trinity Challenge will connect us to mentorship opportunities as we navigate complex technical and other infrastructure challenges.

• National Health Ministries: Partnerships with health ministries will ensure our solution aligns with national health policies and priorities. This will facilitate smoother integration into existing healthcare systems and enhance the system’s legitimacy and adoption. We already have ongoing collaborations with the Ministry of Public Health in  Cameroon which grants us access to over 908 public hospitals and plan to utilize this same strategy in Nigeria.

• Non-Governmental Organizations (NGOs) in Public Health: NGOs working in public health, particularly in low-resource settings, will provide on-the-ground insights and support for implementing the solution in diverse communities. Their experience with community engagement can significantly boost user adoption and participation. Some of the NGOs we have collaborated with in the past include USAID and the Gates Foundation, and we intend to leverage these existing partnerships as we grow.

• Technology and Telecommunications Companies: Partnerships with mobile communications companies will improve the system’s technical robustness and scalability. With SMS being our primary data collection tool, Our main targets will be partnering with leading telcos such as MTN, one of Nigeria's largest telecom companies. Partnering with MTN will ensure we reach millions of patients and communities with our SMS-based patient feedback service.