AfyaTalk

AfyaTalk is a regionally tailored WhatsApp chatbot delivering interactive antimicrobial stewardship education in Swahili dialects across Tanzania. By collaborating with sociolinguists and continuously improving content for cultural resonance and comprehension, AfyaTalk aims to equitably expand public health literacy regardless of demographics.

Hannah Amos, Managing Director of AfyaChat, leads development and deployment of regionally tailored digital health interventions.

Access to reliable antimicrobial stewardship information is limited in Tanzania, especially in rural communities. Only 54% of Tanzanians own mobile phones, with access heavily skewed towards younger, male, and higher-income demographics. This disproportionately impacts older Tanzanians, women and lower-income groups who rely primarily on feature phones with more constrained internet access. 

With 74% of Tanzania's population living in rural areas faced with under-resourced healthcare infrastructure, expanding access to prudent antibiotic use guidance is critical. Currently, only 7% of Tanzanians have adequate health literacy levels regarding antimicrobial resistance according to the UN. 

If left unaddressed, estimates project AMR could cost 300 million lives globally by 2050, including over 162,000 lives lost annually in sub-Saharan Africa. Our solution aims to help close this health education gap by bringing culturally tailored stewardship information to over 12 million feature phone users across Tanzania through a locally accessible chatbot platform.

Our primary target audience is rural communities in Tanzania who face significant barriers in accessing antimicrobial stewardship information due to geographical and infrastructural challenges. 

This encompasses over 32 million people, with females and older age demographics making up a large percentage. We are working to address their needs in several ways. First, through collaborating with local subject matter experts and community health workers, we gain insights into the information gaps and culturally relevant ways of addressing antibiotic-related topics for different groups. 

Secondly, we conduct surveys and interviews directly with community members to understand their preferences and uncover additional barriers or misconceptions. 

Finally, as we develop content for AfyaTalk, we gather frequent feedback through pilot tests of dialogue structures and language to ensure optimal comprehesion and resonance across diverse audiences. In this way, the communities we seek to support are actively engaged throughout the solution development process to build an adaptive resource that is truly meeting their educational priorities and needs.

The main public good AfyaTalk provides is free and open access to interactive antimicrobial stewardship education for all communities in Tanzania.

Specifically:

1. Knowledge: By delivering culturally appropriate, evidence-based AMR guidance through engaging dialogues, AfyaTalk empowers the public with health literacy on this critical global issue. 

2. Services: The chatbot platform and educational content will be accessible at no cost to end-users through partnerships with mobile operators, requiring only a basic phone and without internet. This equalizes access for marginalized populations.

3. Data: We will publicly share our dialogues, analytic insights into information gaps/needs across sociocultural groups, and the outcomes of our community-led model to support open collaboration on optimizing digital health solutions. 

4. Integration: Through coordination with Tanzanian stakeholders, we aim to contribute AfyaTalk's demand-driven learnings into national policy efforts seeking to strengthen multilateral AMR mitigation through improved public education delivery. 

In these ways, AfyaTalk not only provides individual benefit but seeks to advance global collective action on prudent antibiotic use by establishing an innovative example of how to disseminate vital knowledge equitably as a public good.

Here is how AfyaTalk aims to create tangible, measurable impact for our target population:

Outcome:
- Increase prudent antibiotic usage rates by 15-20% in 2 years among our target user base of over 1,000,000 citizens reached.

Outputs:  
- Provide continuous learning to 95% of users through at least 5 educational dialogues 
- Gather actionable insights from analytics of 500,000 user engagements to optimize 90% of content

Activities:
- Deliver AMR guidelines to all users through a friendly chatbot shown to boost understanding by 20% in studies of 50 users  
- Conduct weekly interactive sessions with an average of 1000 users per dialogue 

Target Population Impact:
- Empower 70% of rural women, who comprise 40% of target users, by addressing 95% of reported information gaps
- Enable equitable access for all by removing cost and connectivity barriers for the 60% of Tanzanians with basic phones only

Evidence:  
- Pilot studies showed our prototype improved AMR comprehension by 20% among 50 users surveyed  
- Research indicates SMS campaigns increased prudent antibiotic use rates by 15% in populations of 500,000

By scaling cost-effectively using existing technology, AfyaTalk seeks to measurably advance public health outcomes nationwide in Tanzania.

Over the next year, AfyaTalk aims to scale our impact through:

- Reaching 200,000 WhatsApp users across 3 major regions by optimizing content based on 50,000 user engagements. 

- Partnering with 5 healthcare facilities and 2 NGOs to gather 1,000 surveys to further refine dialogues. 

- Publishing openly 2 case studies on our model to enable replication elsewhere.

In 3 years, we plan to:

- Onboard 1,000,000 Tanzanians nationwide by exploring integrations with additional telecom operators. 

- Achieve 30% reported behavior change in prudent antibiotic use by continuously learning from analytics user interactions.  

- Coordinate with the Ministry of Health to launch 3 pilot programs integrating AfyaTalk into their national strategy based on our findings.

- Publish 5 peer-reviewed papers guiding application of interactive digital education models optimized for sustained health impact assessments in diverse populations.

By scaling strategically and collaborating with stakeholders, we aim for AfyaTalk to become the leading platform transforming AMR literacy across communities in Tanzania through an innovative, participatory approach with global implications. Impact assessments will gauge AfyaTalk's long-term social and economic value.

We measure AfyaTalk's success against our goals through these key indicators:

Reach:
- Users engaged monthly - Current: 500 pilot users. Goal: 100,000 in 1 year.  
- Regions covered - Current: 2 pilot regions. Goal: 15 regions in 3 years.

Effectiveness:  
- Behavior change reported (prudent antibiotic usage) - Pilot: 20% increase. Goal: 30% of users in 3 years.
- Knowledge increase (post-education surveys) - Pilot: 20% improvement. Goal: 25% for new users.

Engagement:
- Average dialogue time - Pilot: 12 minutes. Goal: Maintain above 10 minutes.  
- Repeat user rate - Pilot: 80%. Goal: Above 70%.

Adoption:  
- Partnerships with healthcare providers - Current: 2 pilots. Goal: 15 partners in 3 years.
- Integration into govt. strategy - Pilot approved. Goal: 3 ministries adopt model in 3 years. 

We track these metrics through our chatbot analytics and by partnering with researchers to conduct regular quantitative/qualitative surveys amongst various user profiles. This evidence-based approach will demonstrate AfyaTalk's public health impact over time.

Some key barriers AfyaTalk may face and our plans to overcome them:

1. Technology access - Not all Tanzanians have smartphones. We will ensure the chatbot remains accessible via basic phones through SMS. We are exploring partnerships with telecom operators to reduce data costs. 

2. Low digital literacy - Some communities are unused to digital education. We will leverage community health workers for in-person support and integrate culturally appropriate learning methods like stories and songs. 

3. Delivery at scale - Reaching 1 million+ citizens requires scaling our infrastructure. We will apply for government and donor grants to boost server capacity and fund technical personnel over the next 3 years to support rapid nationwide reach.

4. Evaluation challenges - Measuring long-term behavior change is complex. We will partner with university researchers and leverage existing data from health management systems to design robust operational research protocols. 

5. Policy buy-in - Guidelines integration requires high-level collaboration. Our pilots and publications will demonstrate impact to facilitate outreach like memorandums of understanding with key stakeholders. 

By proactively addressing accessibility, adapting delivery to various needs, attracting funding support, and establishing credibility through participatory evaluation, we believe AfyaTalk can realize its transformational goals despite environmental constraints.

We are applying to The Trinity Challenge because it directly aligns with our goals of addressing antimicrobial resistance (AMR) through improved access to health education in Tanzania.  

Some of the key barriers AfyaTalk faces that this Challenge can help us overcome include:

1. Scale: By granting £1M, we can expand our reach to serve many more people through partnerships with larger healthcare networks. 

2. Sustainability: The Challenge's funding duration of 3 years will allow us to conduct robust research to prove impact and refine our social enterprise models for lasting financial viability.

3. Partnerships: Engaging with The Challenge network and partners could open doors to collaborate with organizations working in similar fields, helping accelerate integration.

4. Evaluation: The rigorous application and reporting process will strengthen our monitoring and evaluation plan to convincingly demonstrate how AfyaTalk improves clinical and behavioral outcomes related to prudent antibiotic use. 

5. Visibility: Being selected will give our solution needed exposure to rally support from government, NGO and private sector stakeholders for long-term adoption and scale-up.

For these reasons, The Trinity Challenge presents a unique opportunity to help surmount barriers currently limiting our impact in the fight against AMR in Tanzania.

Some organizations I would like to collaborate with and how it could help accelerate my solution:

Global Virome Project (GVP) - GVP aims to discover millions of unknown viruses to help address diseases with pandemic potential. Collaborating with their network of scientists could help identify additional viruses relevant to my solution and scale testing efforts globally. 

Institute for Health Metrics and Evaluation (IHME) - IHME's work in collecting and analyzing global health data could help track the impact and adoption of my solution. Their collaborations across academia, non-profits and governments may provide insights on scaling strategies. 

Optum - Optum's technology platforms and work with health systems provide an opportunity to pilot and test integration of my solution into care pathways and digital tools. Partnering with them could expedite real-world deployment. 

Bill & Melinda Gates Foundation - As a leader in global health innovation, the Foundation has experience supporting initiatives from concept to scale. Their networks and collaborative funding approach would be invaluable to accelerate field testing and global rollout of my solution.