RxBot

Clinton Health Access Initiative (CHAI) Nigeria

RxBot

RxBot: A Multilingual, WhatsApp-Based Solution for Quality Surveillance of substandard and falsified oral antibiotics in LMICs

Abuja, Nigeria.

NGA

Nonprofit

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Antibiotic resistance (AMR) is an escalating global health threat, projected to cause 39 million deaths over the next 25 years, disproportionately affecting low- and middle-income countries (LMICs) (O’Neill, 2016). AMR has been described to be “a silent, invisible, evolving pandemic and One Health threat” (WHO). Sub-Saharan Africa bears one of the largest burdens in respect to AMR mortality. In Nigeria, the WHO (based on 2019 estimates of studies conducted) stated that 65,500 deaths are attributable directly to AMR, with 263,400 deaths indirectly due to bacterial AMR alone. 20% of deaths among U-5 children (MMR, IMR) are attributable to AMR, as well as an antibiotics prescription rate of 60-98% across Health Care Facilities (PPS), and misuse of antibiotics. Despite national efforts, including numerous policy and guidance documents on AMR like the Country Cooperation Strategy (2023-2027), the People Centered Approach to addressing AMR in Human Health, the National Actional Plan 2024 –2028 (NAP 2.0) and the One Health Strategic Plan (2019-2023), routine surveillance and tracking of available antibiotics remain weak, especially at the last mile, hence the need for a scalable, low-cost technologies that can bridge limited or no visibility into the quality of antibiotics distributed at the community-level.

With over 2 billion WhatsApp users globally and increasing smartphone penetration in LMICs, WhatsApp technology presents a unique opportunity to reach pharmacists, health workers, and patients in several communities, RxBot, is a low-cost, community-centered WhatsApp chatbot which will leverage WhatsApp platform to crowdsource real-time data from communities, no app download required, making it ideal for underserved populations. This will complement the existing Mobile Authentication Service (MAS), using SMS technology, deployed by the National Agency for Food and Drug Administration and Control (NAFDAC) in 2012 for all anti-malarials and antibiotic medicines imported into or manufactured in Nigeria, as one of its anti-counterfeit strategies to detect substandard and falsified (SF) medical products. The RxBot will leverage QR codes, WhatsApp prompts or similar identification numbers printed on antibiotics packs for the MAS scheme, to empower consumers to verify the authenticity of antibiotics at the point of purchase. The consumer scans the QR code, sends the code through RxBot to MAS authentication server which validates the genuity of the product, additionally the RxBot will support rich media including text, images, videos and location sharing, which is crucial for SF antibiotics reporting, location metadata will allow for geospatial analysis of antibiotic quality issues and disparities.

According to WHO estimates (2019), Nigeria experiences 65,500 direct deaths and 263,400 indirect deaths annually due to bacterial AMR. Alarmingly, 20% of deaths among children under five are linked to AMR, making this a critical public health concern. Contributing factors include misuse of antibiotics, limited awareness, unregulated access, and a high prescription rate (60–98%) across healthcare facilities, often without proper diagnostics or adherence to treatment guidelines. Target Population: • Children under five: High mortality rates due to inappropriate or ineffective treatment of infections, often driven by substandard or falsified (SF) antibiotics. • Adults with infectious diseases: Risk of treatment failure due to resistance and counterfeit medicines, leading to prolonged illness and complications. • General population has limited access to tools or systems for verifying drug authenticity and poor awareness about proper antibiotic use. • Health regulators lack real-time and community-level data to support timely interventions and policy enforcement. The RxBot will enable patients, caregivers, pharmacies, and community members to verify the authenticity of oral antibiotics before use, report suspected substandard or falsified medicines in real-time, receive guidance on appropriate antibiotic use, including adverse reaction reporting and help regulators identify hotspots of SF medicines and take corrective action promptly.