Access to Medicines
Join us for a conversation about innovations in ICT that are improving access to medicines. Let's discuss how to scale these innovative solutions. Our host Yvonne Nkrumah of the World Bank, is joined by three experts, manager Mandy Sugrue of mHealth Alliance, Dr. Shelley Batra of Operation Asha, and Dr John Munyu of KEMSA. Each expert shares their innovative approaches to ensuring Access to Medicines and we invite you to join the conversation. Please help identify promising innovations, and explore ways to overcome barriers to scaling.
Photo © Copyright The World Bank. All rights reserved.
In 1960, in Patna, Bihar in India a young mother of 25 died in a clinic of a curable disease. She died because the critical medicine she needed to save her life was not available in her hospital or in any of the surrounding clinics. She left behind two children, one of whom currently works at the World Bank Group. The absence of Katie’s mother dramatically impacted the course of her life.
53 years later, this is a story that is replicated in nearly every village in the world’s poorest countries. The World Health Organization (WHO) estimates that nearly 13 million die annually because they are unable to access essential lifesaving medicines for curable diseases.
Increasingly, information and communications technologies (ICTs) are being used to create inroads in attempts to improve access to medicines, especially in rural communities. The power of electronic and mobile technology, pilots like mPedigree, Stop Stockouts Campaign, SMS for Life, and others, have helped showcase the tremendous potential for innovative use of technology to improve access to medicines.
However, many of these pilots have not managed to scale up even in places where they showed promise. The key focus of this debate is to explore the potential for scaling up such innovative approaches to sustain ICT-driven interventions in access to medicines, and to better understand the bottlenecks to scalability.
Can ICT in access to medicines also help bridge demand and supply-side interactions and ensure greater transparency and accountability in the processes? Join us to discuss this and the following questions:
- Can ICT applications and software help ensure sustained improvements in access to medicines?
- What are some of the reasons why pilots have failed to go to scale? Are there any critical lessons learned? What could be done differently?
- What is the next generation of ICT driven innovations and interventions to improve access to medicines? How would they be different?
- What should different stakeholders roles be in using ICT to improve access to medicines? Is there a role for bringing both demand and supply-side actors together through ICT platforms?
When thinking how ICT enables public-private partnerships and citizen engagement at the community level, it's important to clarify that these are two separate, but connected, discussions. ICT (Information Communication Technology) is a tool that can be leveraged to enhance civic engagement. This engagement can be further advanced through the support of public-private partnerships. Each, however, requires a different type of thinking when considering their connection to ICT:
1. ICT for civic engagement can range from leveraging social media platforms to create connections within a community and encourage collective action to providing an individual in a rural area with a mobile phone that allows them to play a more active role in their healthcare. At the mHeath Alliance, we focus on driving positive change in global health through mobile technology. To leverage ICT effectively, you must understand the landscape of where it’s being used, what technology will be supported by the existing infrastructure, and you must have the user in mind when creating the platform. Assess the NEED of the user/community and create from there. ICTs are incredible tools for connecting individuals and communities, but generally the simpler the technology the more likely it will be used on a scalable level.
2. As opposed to leveraging ICTs for public-private partnerships, I like to switch my thinking and consider leveraging public-private-partnerships (PPPs) for ICTs in order to reach individuals and better support community engagement. For example, the mHealth Alliance is involved in several PPPs, such as mPowering Frontline Healthworkers, an initiative designed to improve child health by accelerating the use of mobile technology by millions of health workers in low-resource and rural communities. To do this effectively, it requires multiple players in both the private and public sector to help individuals access the tools and learn how to use them effectively. By engaging multiple sectors and actors, it becomes easier because you can rely on the diverse expertise of partners. These partnerships enable effective integration of ICT on the community level and ensure the ability to provide access to those who need it most.
ICT can be leveraged in a multitude of ways, but a key point I want to make is that it’s not a silver bullet. It’s a tool that can help connect people and communities globally, but generally only if it’s developed and implemented with the user in mind. There is always a new shiny tech platform, app, device, etc. to laud. But without thinking through how a user or community will adapt it into their daily lives, it won’t make a meaningful difference in people's lives.
OpASHA has established a local, deep model, the crucial “last-mile” connectivity deep within marginalized communities, creating a dense, decentralised network of TB treatment centers. Strategic locations in densely populated urban areas allow one urban treatment center to serve 5,000-25,000 people . In rural areas, where patients are scattered, OpASHA Providers travel from village to village on a motorcycle providing TB medication and testing. Patients never have to travel far – sacrificing valuable work time and transportation costs – to receive their treatment, nor need to miss work and wages.
TB treatment is long and tedious: it requires a TB patient to visit a centre 60 times over 6 months and take medicine under direct observation. Medicines are not given for home consumption, so accessibility is the biggest need. Incomplete treatment leads to the horrifying Drug Resistant TB: MDR/ XDR/ TDR.
TB patients often lose their jobs and livelihood. Each year 100,000 TB-infected women are thrown out of their homes and left to die, this is due to the stigma attached to TB.
Technology, added to community empowerment, has shown outstanding results. We use eCompliance, a biometric initiative. Terminals consist of an Android phone and a fingerprint reader, both “off-the-shelf” components. We use fingerprints to ensure patient attendance and prevent the development of drug resistant TB. Health workers are alerted whenever a scheduled dose is missed, for prompt follow up and patient retrieval. Patients’ finger prints are taken whenever home visits are done, this prevents ‘gaming’ of the system. The system has reduced missed doses, prevented data manipulation, digitized attendance records, ensured multi-level accountability and transparency, and remarkably improved the psyche of patients and health workers.
In an effort to ensure supplies to all medical institutions in the country are available on time and at an affordable cost, the Kenya Medical Supplies Authority (KEMSA) is leveraging ICTs to increase its operational efficiency, and improve service delivery to its customers. Working with a variety of partners, KEMSA has designed the e-Mobile platform, which allows stakeholders to access vital information on medicine stocks and delivery schedules. This increased access to KEMSA’s logistics management systems helps enhance transparency and accountability, and helps bridge the gap between KEMSA and its key stakeholders and customers.
To assist the County Public Health Facility Workers, who are responsible for ordering, and reporting on essential commodities on a regular basis, the e-Mobile platform enables ordering from KEMSA and reporting on consumption levels via mobile phones. It also enables them to query drug availability and drawing rights at the facility level and report on the condition of supplies received.
Counties Health Management Teams including doctors, in-charge’s, and management teams can use the KEMSA e-Mobile system to query facility drawing rights, drug stock levels at facility, and order status.
Partners in the Health Sector including Ministry of Health staff, donors, and project partners, who need access to information on drug supply at the facility level and at the national scale can use KEMSA’s system through both mobile and web access to generate reports on Facility consumption and view stock levels of program specific supplies.
Finally, Kenyan citizens are able to access information on drug stocks at their local facility, and also report integrity issues through the m-Integrity application, which allows the public to anonymously report suspicious activities at staff, facility, and national level. In addition, citizens of specific chronic diseases (such as diabetes, HIV/AIDS) are able to determine the availability of prescribed medicines at health facilities, using their mobile phones. The convenience of this system limits the amount of time typically spent in traveling to various pharmacies or public dispensaries to find specific medications.
KEMSA’s goal is to increase accessibility of quality medicines at reduced costs through improved bulk procurement networks, stringent profiling of suppliers, and the e-Mobile platform to ensure transparency and efficiency. KEMSA also seeks to reduce the challenge of counterfeit medical supplies, estimated at 40 per cent of all supplies especially medicines.