In a recent article in the Scientific American entitled, “Expert Systems Fight Poverty“, Jeffrey Sachs, Director of the Earth Institute, wrote about how appropriate information communication technology paired with community involvement can save lives. In the article, Sachs mentions how mobile phones are being used in Ghana to coordinate teams of ambulance drivers, midwifes and CHWs to refer emergency pregnancies and save lives. He then goes on to talk about how ChildCount+ along with rapid diagnostic tests (RDTs) are being used in Kenya to improve home based treatment of Malaria by CHWs.
In the Kenyan village of Sauri, also part of the Millennium Village Project, CHWs are pioneering the application of expert systems for malaria control. In the past, suspected malaria patients had to walk or be carried to a clinic, often miles away, have a blood smear read under a microscope by a trained technician and, if positive, receive a prescription. With clinics few and far between and with trained technicians and microscopes even scarcer, untreated, lethal malaria ran rampant.
In the new approach, CHWs visit households on the lookout for fevers that may signify malaria. They carry rapid diagnostic tests that examine a drop of blood for the presence of the malaria pathogen. Then they send an SMS (short service message) text with the patient’s ID and the test results. Seconds later an automated text response informs the health worker of the proper course of treatment, if any. The system can also send reminders about any follow-up treatments or scheduled clinic visits for the patient. The new system of malaria control includes insecticide-treated bed nets made to last for five years and a new generation of combination drugs based on a traditional Chinese herbal treatment, artemisinin.
This full set of tools constitutes a remarkably effective malaria-control system. Already a partial deployment of the system is reducing the malaria burden dramatically in several parts of Africa. Modest international financial support could greatly accelerate the deployment of the full system, and if it were scaled up throughout Africa, hundreds of thousands of lives could be saved annually at around $7 per person a year in the malaria-transmission zones.
It will be interesting to learn of progress outside of MVP also. I suspect there is already a huge social treatment effect on behavior as a result of MVP activities that may be leading to more effective home based care eg the impact of expert systems in “real world” settings needs to be studied as well. If the positive results can be generally said to be significantly influenced by larger MVP context then we may encounter some scaling challenges. That said, great to read of progress on any front.
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