In Malawi, 80% of the population lives in rural areas where access to clean water, sanitation, and health care facilities is extremely limited.  Per capita health expenditure is only US$14 per person and preventable illnesses such as malaria and diarrheal diseases are major health problems.

In 2008, VillageReach started a rural health systems strengthening program in the Malawian community of Kwitanda combining efforts to strengthen the network of community health workers, interventions to reduce malaria and diarrheal diseases, and introduction of SMS mobile phone technology as a tool to manage information critical to health system performance.  Kwitanda is a poor, rural area with a close proximity to the Shire River that increases rates of malaria and other infectious diseases.

Field Program

VillageReach’s program aims to reduce levels of malaria and diarrheal disease in Kwitanda by 35% by 2011.  To accomplish this goal, VillageReach facilitates distribution of existing cost-effective preventative measures, manages community health worker training and provides infrastructure support for the health center and community.  Activities include:

• Malaria Prevention and Treatment—Distribution  of long-lasting  insecticide treated mosquito nets, expanding access to treatment, and improving diagnosis
• Diarrhea Prevention – Build and maintain sources of safe water and implementation of community-based sanitation and hygiene program
• Community Health Worker Training—Hire and train Health Surveillance Assistants (HSA),strengthen community-level diagnosis and treatment activities, establish peer support and supervision groups, facilitate HSA work with transportation
• Transportation—Facilitate community based road improvement project, strategically place ambulances to serve rural health emergencies
• Infrastructure Support—Provide health center with refrigerator for vaccine storage and assist with providing essential equipment and building repairs and maintenance

SMS

VillageReach has partnered with FrontlineSMS Medic, a California based nonprofit, to implement an SMS communication systems and run a study evaluating the effect of the system on pediatric diarrheal and malarial diseases by integrating SMS mobile phone technology into the health system. SMS health technology is gaining popularity in the developing world, but this is the first scientific study measuring the impact of SMS on disease diagnosis and treatment rates.

VillageReach and FrontlineSMS Medic have developed a pilot project that will allow rapid communication between Health Surveillance Assistants (HSA) and the community health center using FrontlineSMS.  In Malawi, HSAs are the primary source of healthcare in rural communities, but they are often as disconnected from local health centers as the patients they serve due to a severe lack of transportation and communication infrastructure.  FrontlineSMS is an open source software program that enables two-way communication between SMS users and a lap-top computer. The HSAs will communicate and receive information and statistics about ambulances and emergency transport, supply stockouts, pediatric health, and disease diagnosis and treatment.

Medicines for Malaria Venture

Medicines for Malaria Venture (MMV) and VillageReach are starting a pilot project in Malawi that uses SMS technology to collect last mile data on antimalarial medicine distribution.  MMV has turned to VillageReach as an expert in management of medical logistics and supply systems in remote communities for project design and implementation support.

There is a tremendous diversity of antimalarial medicines in use in developing countries but data collection from isolated communities is extremely challenging due to poor communication infrastructure.  This data is important for policy makers interested in expanding access to effective and affordable antimalarial medicines.  MMV’s pilot program developed in cooperation with VillageReach will use SMS technology to transmit and record information about the type, volume and price of antimalarial medicines distributed in Kwitanda.  The pilot program will inform future antimalarial data collection efforts usingthe model to collect distribution data regarding various antimalarial medicines from both public and private final distribution points throughout Sub Saharan Africa.