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How Cell Phones Are Helping Fight Malaria

Community health workers receive new cell phones as incentives to continue their malaria rapid reporting.

Photo of Yue Shen
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LIVINGSTONE, Zambia –Tokozile Ngwenya-Kangombe, a project coordinator with Akros Research, knows first-hand how dangerous malaria can be for pregnant women and children under the age of five. Roughly half of the world’s population is at risk of contracting malaria and more than 200 million people are infected annually, according to the Malaria Control and Evaluation Partnership in Africa.

UNICEF estimates that in Zambia, malaria accounts for 20 percent of maternal deaths and that of all people who die from the preventable disease, 50 percent or more are children under the age of 5.

Malaria is a disease caused by a parasite and spread by mosquitoes. Zambia is home to the deadliest form of the parasite: Plasmodium falciparum and malaria affects more than 4 million Zambians annually and results in almost 8,000 deaths per year.

Ngwenya-Kangombe once traveled upwards of 100 miles per day to reach community health volunteers in southern Zambia’s heavily impacted areas. She would spend several hours copying health volunteers and clinic staff notebooks documenting malaria trends. Now, with the use of mobile technology, Ngwenya-Kangombe and health workers have been able to double the number of clinics and patients they visit per day.

At the Siakasipa Clinic located approximately 30 miles from the famous Victoria Falls in southern Zambia, head Nurse Ruth Nghlove serves approximately 8,000 local residents. During the rainy season (November to April) malaria cases are higher than during the dry season (May to October) as the mosquitoes breed in water.

Several key interventions have been implemented since 2000, including distributinglong-lasting insecticide-treated bed nets, indoor residual spraying and antimalarial medicines to curb the disease. The introduction of rapid reporting systems, using mobile phones to provide real-time data and the detection of high-infection areas, has health workers and volunteers excited about ending malaria deaths for good.

“With my mobile phone, I can get updates from health care volunteers while they are out in the field instead of waiting hours, sometimes days, for them to make it back here to the clinic with their reports” said Nghlove.

Community health volunteers are not paid a salary in Zambia. Instead, the Ministry of Health and partnering NGOs, such as PATH supply them with incentives including mobile phones and bicycles for their time and efforts. Even so, some health care volunteers are still in need of “talk time” — or cell phone minutes — to continue their work.

“I am grateful for the free phone but without talk time, I cannot afford to send in my reports electronically,” remarked one community health volunteer, Anna.

Others, such as Kdnele, who has been a community health volunteer for 18 years, is grateful for his phone and bike. “I’m able to visit 6 to 8 patients instead of 3 to 4 with my bike, and I didn’t have a mobile phone until I was given one to file my reports,” he said.

PATH, in partnership with the Republic of Zambia Ministry of Health, has developed athree-step approach to eradicate malaria, including rapid reporting, mass testing and treatment and active surveillance. These steps are being implemented in Zambia on the pilot level with the goal of creating “malaria-free” zones which will then be duplicated in other sub-Saharan African countries.

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Photo of Abiola Oyebanjo

Yue Shen .Great post. Mobile technology is changing everything. It might take the place of Dog as man's best friend as we approach a new era. It is believed that we are just in the very beginning of the digital age and the next few years will turn out innovation that will make everything we have now so dated. However, all these will be driven by mobile tech. I think this will work better if we are able to develop simple apps that can be easily learned and used by all mobile user. An app that doesn't have the usual interface of popular apps  but with one or two key functions where vital signs and information on malaria and its control can be disseminated to users. This will be necessary to ensure the some innovative possibility for disease control that might not be compatible with the usual phones available that might not be smart. Well done

Photo of Neshani Jani

Hi Yue Shen, have you seen Tatiana 's post on using cell phone data to predict disease spread?  The cell phone tactics that researchers in West Africa are using to track Ebola that she highlighted made me think of your great post. Incorporating unique cell phone “pings” from towers could be a good accompaniment to the cell method that you highlighted.

https://challenges.openideo.com/challenge/combatzikafuturethreats/research/using-cell-phone-data-to-predict-disease-spread

It is great that mobile tech has been able to help health workers in Zambia double the number of clinics and patients they visit, but the talk-time issue you mentioned definitely needs to be addressed for this model to keep health workers engaged. Do you know where else in Sub-Saharan Africa PATH is thinking of implementing this approach? 

Photo of Lindsay Vignoles

Thanks for the post and good discussion. Like Neshani, I found the lack of "talk-time" troubling. While using foreign aid funding to provide talk-time and then managing the use of that time for project-based purposes is challenging, experience tells us that when the incentives to participate are misaligned with local demand, sustaining and scaling programs is highly unlikely. The body of research on effective incentive structures for community health workers (CHW) is vast. While no one size fits all solution is available, there is broad consensus that some form of sustained, meaningful incentives are required for program impact. One organization fighting TB in India, BRAC, used a variety of financial incentives to retain its cadre of CHWs. From providing female CHWs with a financial reward for each patient that completed the 6 month course of TB medicines to supporting income-generating opportunities while distributing medicines and checking on patients, BRAC achieved impressive rates of detecting and curing TB. 

http://opinionator.blogs.nytimes.com/2011/02/18/what-makes-community-health-care-work/?_r=0

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Congrats on being today's featured contribution

Photo of Minh Nguyen

Thanks Yue Shen have you heard of the rapid malaria testing startup? i'm wondering it can be incorporated as another tool for the community health workers. 

http://mitsloan.mit.edu/newsroom/articles/malaria-testing-startup-wins-mit-100k-accelerate-contest/

Photo of Ruby H

Hi Yue Shen,

Thanks for sharing this. Here's an another article on cell phone location data to fight malaria (and terrorism too). https://www.technologyreview.com/s/522281/cell-phone-location-data-can-fight-malaria-and-terrorism-too/

check this out Minh! Minh Nguyen