ALMA

Each year, approximately 760,000 children under-five of age die from diarrheal diseases, a leading cause of which is unsafe drinking water, mostly in sub-Saharan Africa, where only 24% of the population has access to safe drinking water. Chad is particularly afflicted, as less than 1 in 2 children have access to safe drinking water. Contaminated water usage leads to increased vulnerability to water-borne diseases including diarrhea, cholera, and typhoid. In 2018, Chad had the highest rate of diarrhea mortality (499 deaths per 100,000) among children under-five years of age globally. 

While diarrhea is the most widely known disease linked to contaminated water, the lack of access to safe and clean water affects communities in the long term, as many studies have shown that people without clean water were at risk of decreased school attendance, missed workdays, malnutrition, and poverty. Additionally, girls and women are further affected, and their education suffers as they bear the imbalanced burdens of domestic labor. This exacerbates the inequality between men and women.

Therefore, by providing clean and safe drinking to remote populations, we can end extreme poverty, increase shared prosperity, and promote sustainable development throughout the world.

ALMA has designed a two-pronged solution, informed by previous research, which provides service delivery with an on-going supply of chlorine (that includes solar motorized pumps), and engagement with community wash officers (CWOs).

On-going service delivery: our operating model that puts CWOs at the center of our activities.

• CWOs in villages notify the call center whenever the stock of chlorine is low to avoid shortages (which can negatively impact the uptake of chlorinated water);
• Call center operators contact the warehouse closest to the village in need so that a motobiker can deliver the requested products directly;
• The call center confirms the delivery with CWOs, confirming a set delivery window.

For the technology piece, we have partnered with a local Chadian research center, and developed a system of motorized pumps that draw and store water in a tank connected to collective taps. A valve in the tank uses an automated system to deliver the right amount of chlorine in the tank as the water is piped to collective taps. This technology is environmentally friendly and can be used in remote communities, as the system runs on electricity generated through solar panels.

This technology operates in the context of collaborative community-wide involvement, which is essential to the continued success of ALMA's intervention. This is why we are closely working with CWOs in each village. As mentioned above, CWOs are vital to tracking chlorine shortage and promoting behavior change. The integrated mobile health application (SIM app) allows our CWOs to collect data on key outcomes, including reliability (% functional water pumps) and health assessments (cases of water-borne diseases). This entire information is stored into a database that can be visualized in real-time to improve performance, outcomes, and resource allocation to the effected population. 

We believe that the newly developed pump technology and data monitoring system can improve the population's health, especially childhood mortality.

As diarrhea mortality is a serious health system issue in numerous low- and middle-income countries, we are proposing a complex health innovation. Our intervention has an equity impact, which we can be categorized in three levels:

• The solution is for one of the poorest countries in the world.
• At country level, huge inequities exist, and the individuals affected by water-borne diseases.
• Through geo-mapping and use of digital data and solutions, ALMA will focus on the poorest communities in rural areas through highly targeted interventions.

Providing clean and safe drinking water is an effective way to create stronger and resilient communities. As this issue impacts all parts of society in Chad, we believe our innovation will have a positive impact across the country, and in Africa. 

Our team includes two co-founders, including Laetitia Walendom and Esias Bedingar who are both native of Chad. Growing up in many African countries throughout our childhood gives us three significant advantages:

• Cultural and geographic fluency – as a team largely composed of native Chadians, we have ready access to overlooked local expertise and institutional knowledge. These include community leaders in individual locales as well as professional experts in public health and infrastructure. As ALMA’s success depends in large part on its thorough adoption by local communities, our cultural and linguistic familiarity will allow us to craft and more readily cultivate a sense of ownership among local partners and target communities.
• Network and resource access – professional credentials allow us to engage with providers and domain experts on both sides of the Atlantic. As urban development and public health professionals working between the United States and West/Central Africa, our networks will enable us to more readily source domain expertise, staff, and funding for ALMA’s success.
• Lean operations – massive decentralized interventions have unsurprisingly had varied degrees of success in the Chadian context. Piecemeal, incremental WASH interventions tested in other African regions can prove successful when applied to the Chadian context. Additionally, with a recent influx of infrastructure funding, we can boast a first movers advantage by anticipating a field that’s more receptive to relatively new players. With relatively limited corporate and bureaucratic constraints, ALMA can concentrate on the logistical and community needs in order to reach all corners of the nation.

We are applying to Solve to have access to mentorship, coaching, strategic advice, and technical assistance as we are building our digital technology.

As mentioned above, infant mortality due to diarrhea represents a serious health system issue in sub-Saharan Africa, which requires a complex health innovation. However, many organizations have not done it the right way. First, solutions for providing clean drinking water to remote communities are not a one-size-fits-all; they require a complex set of innovations that must be combined to become an intervention. Second, these interventions have not well been integrated within existing health systems. Health systems create a dynamic complexity since they are open systems with interlinked components that interact with the context within which the system is situated. This is why we have carefully designed our intervention to integrate it within the Chadian health system. For instance, our digital mobile application allows CWOs to report on health events (diarrhea cases, etc.), which feeds into the national health information system and provides the Ministry of Health with real-time community level information. Therefore, remote communities that were once left out of the system are provided with a direct connection to the health system; therefore, allowing an appropriate allocation of resources to the effected populations.

We divided our impact goals in two types, including service delivery and community-level impact. Within the first year, we hope to achieve these following impact goals:

-       Service delivery:

1. 95-100% successful calls made (includes all the calls received and made by the call center)
2. 90-100% successful tasks completed

-       Community:

1. 60-75% chlorine adoption rate

Within the next 5 years, we hope to achieve these following impact goals: 

-       Reduce childhood diarrhea mortality by 25% countrywide

-       Reduce the prevalence of water-borne diseases by 5% countrywide

-       Improve WASH-related KAP by 80% in targeted regions

These impact goals will be achieved through our CWOs who play a critical role in ALMA’s success. Below is a list of their responsibilities:

-       Raise awareness about WASH and safe drinking water

-       Promote the utilization of the solar motorized pumps

-       Alert the call center when chlorine tablet stock is low

-       Proactive case finding and doorstep care by visiting households every week and conducting a detailed survey (especially for water-borne diseases). 

For these impact goals, we have thought about our impact metrics, which include:

-       Point of use = bimonthly checks on chlorine and tank

-       Community survey = % of households that had used the chlorinated pump determined using a chemical test (total free chlorine residual) for the presence of chlorine residual in a random sample of household drinking water

-       Decrease in diarrhea and water-borne disease cases (as cases are recorded on a weekly basis through proactive case finding or survey assessment)

-       Reduction in childhood diarrhea mortality (as cases are recorded at the facility level and through survey assessment at the household level on a weekly basis)

Our input activities include solar motorized pumps, chlorinated water, training of CWOs and funding. The outputs include the number of villages with solar motorized pumps, as well as the number of villages trained CWOs. In terms of outcomes, we aim to increase the uptake of chlorinated water in households, reduce diarrhea cases in children under-five of age, and reduce carbon emissions. Finally, we aim to reduce childhood diarrhea mortality by 25% in the next 5 years as our impact.  

Our solution has been developed to address a global issue in a manner that fits the local context. Many studies have shown that in low- and middle-income countries, most contamination to drinking water occurs during collection and transport from waste penetrating the wells. Common solutions depend on the population actively deciding to add chlorine to their water after fetching it, which leads to low levels of adoption rates. ALMA has developed an automated system that provides already-chlorinated water to communities. The motorized system mitigates human contamination of water, and the real-time data allows a far more and reliable response to issues that may otherwise go undetected. We have integrated a dashboard that collects data on time and quantity of use, which becomes extremely valuable to optimize the supply of water and is cost-effective for rural populations. 


The second component of the innovation is the mobile SMS application utilized by our community health workers. Previously, all types of data collected by CWOs were done by paper, which delayed and prevented quick decision-making. CWOs may now collect data on their regular non-smartphone, which is then stored into a database with real-time dashboard that allows supervisors to track progress at the village level. For example, reports can be generated and shared during weekly meetings to improve performance and health outcomes. 

Chad has been a flyover state for social enterprise and interventions in Africa, and its health and sanitation sector is no exception. Being from Chad, we believe that it's doubly important that initiatives for inclusive growth doubly address regions that have not had a chance to participate fully in developing novel solutions for a brighter future. Additionally, we believe in gender parity in leadership positions, which is reflected in our co-founders since Laetitia and Esias are female and male respectively.

We plan to engage with government officials to develop a culture of disease prevention. In fact, we will advocate to direct a portion of funds currently allocated for disease treatment (e.g. cholera) towards Alma ’s cost-effective water access, sanitation and hygiene program. We will also work with global strategic partners to subsidize local ownership efforts. These include subcontracting with development partners with unmet drug delivery needs: Alma will deliver drugs to hard-to-reach communities using our service delivery system for a fee.

We have been selected as a D-Prize Winner in 2021 and have received $14,000 for the pilot stage. We anticipate grants from Global Innovation Fund, Harvard President’s Innovation Challenge and HBS New Ventures Competition.