UNISA - MobileApp for malaria drugs

The availability of medicines is a necessary component under universal health coverage and is in line with Goal 3 of the United Nations’ Sustainable Development Goals that aims to ensure the health and wellbeing of people of all age groups. Nonetheless, its achievement poses a formidable challenge, more so in developing countries where coordination of the supply chain is wanting, at least with inconsequential solutions to the dilemma of the availability of medicines (Leung et al., 2016; Yadav, 2015). The challenges are that applications are not integrated and most of the processes are a manual making it difficult to be responsive to an emergency.

In some areas, the applications are available but do not cover the end-to-end processes.

 According to the World Health Organization, malaria considerably contributes to child morbidity and mortality. In 2018, SSA accounted for 94% of world malaria deaths, of which 67% were children under five (WHO, 2019).  In 2018, there were 213 million malaria cases and 360,000 related deaths in the African region, accounting for more than 90 percent of cases worldwide. It is estimated that malaria costs Africa US$12 billion per year in direct costs and reduces GDP growth by 1.3 percent annually. 

The innovation is a practical mobile application tool or software for use by general hospitals in Sub-Saharan Africa and other developing economies with coordination and technological challenges of artemisinin-based combination therapies (ACTs). 

The innovation presents value proposition of all in one centralised mobile innovation features by using unique features built with inventory management logic such as economic order quantity (EOQ), production order quantity (POQ), integrated dashboard, live tracking features, multi-stakeholder interface, network transparency protocol, overstock-understock alert features, ABC analysis et cetara. It is the first affordable integrated mobile health application that covers end to end health care supply chain to market.

The technology that underpins the centralised mobile platform is Xamarin and asp.net for app. Xamarin is a free and open source mobile app platform for building native and high-performance iOS, Android, tvOS, watchOS, macOS, and Windows apps with .Net with native API access. Being a comparatively new tool, its database is based on the Microsoft technology stack and is hosted by Microsoft Azure.

Our innovation elevates mobile health applications beyond what might normally be expected of library of health care supply chain information systems.

The solution serves micro (rural and township healthcare centers, communities, and healthcare workers), markets (suppliers, manufacturers, pharmaceuticals, distributors), and macro (donors, governments) supply chain stakeholders.

Using the micro, market, and macro to structure the population, please find below elaboration of their challenges, their needs, engagement, and proposed solution.

• Population segment 1: micro such as hospitals and clinics (serving women, children and vulnerable communities)

Stock-outs of essential medicines at the clinic level are an important and widely acknowledged public health problem in sub-Saharan Africa (SSA) with a recognized negative impact on morbidity, mortality and disease epidemiology (Cameron, Ewen, Ross-Degnan, Ball, Laing, 2009:  Pasquet Messou, Gabillard, Minga, Depoulosky, Deuffic-Burban , et al. 2010). In Rwanda, the classification of stock-out levels was based on the range of stock-out levels seen that was between 0.0-24.2% (Nditunze, et al., 2015).

The burden of access to malaria drugs is carried mostly by poor, rural families that have less access to current prevention and treatment services. At worst, the mobile application health systems are not centralised in sub-Saharan Africa. 

• Engagement in needs analysis and development

The innovation was a response to a health care supply chain coordination challenge observed during a four-year PhD study by Dr Nagitta Oluka who was under my supervision. The study was conducted in healthcare centers in Uganda with DTMC committee responsible for ACTs distribution and management. Their inputs were crucial for micro requirements analysis.

• How the solution will address their needs

The system will reduce stock outs by 20-40% through our live tracking, expiry alert, and EOQ features. The lead time will significantly reduce from 15 days to 3 days because of our EOQ aleart feature and visibility to suppliers. The hospitals will mine data to quantify and forecast for the different seasons from our system. 

Beyond the management and economic value of saving costs, access to information across all supply chain members; control over various logistics activities like procurement, quantification, dispensing, forecasting; the system offers social value of saving life, especially vulnerable groups such as children and pregnant women.

2. Population Segment 2: (market stakeholders) Suppliers and distributors of malaria drugs.

Local suppliers and chemists abound in rural parts of sub-Saharan Africa operate independently of the hospitals and have less visibility to stock management and have no affordable technology to help them manage. The high costs that needs to be invested for these systems are highly unattainable for most of the independent suppliers that are mainly dependent on tight budget. Providing digital power to independent suppliers chemist in rural areas will ultimately increases digital social inclusion, employment, and digital poverty reduction. Access to medicine will ultimately improve the well-being of the society for a better work force.

• Engagement in needs analysis and development

We are working with African Applied Chemical in the pilot phase of the innovation to ensure alignment with needs and practicality of supplier's value chain.  The inputs of the supplier will inform adjustment necessary for levels 5 and 6 technology readiness levels.

• How the solution will address their needs

Production order quantity is one of the key input data for every supplier. The lack of data usually leads to over or under production. The intelligence will assist the supplier in accurate allocation production resources such as labour, machines, raw materials etc.

3. Population Segment 3: DoH (government), Donors and funders (macro)

The role and finances of governments are shrinking, and NGOs are struggling to raise funds, some of the social problems cannot be addressed without participation of every segment of the society including corporations, business professionals and academics. Government have less visibility to stock management at provincial and local levels, and have no affordable technology to help them manage. The high costs that needs to be invested for these systems are highly unattainable for government that is dependent on donors’ aid, and tight budget. Providing digital power to the government digital social inclusion, employment, and digital poverty reduction. Access to medicine will ultimately improve the well-being of the society for a better work force. 

• Engagement in needs analysis and development

 The conceptual design, requirements analysis, and process flow embedded in the system were validated and confirmed by the chief Pharmacist and district medicines management supervisor involved in the healthcare supply chain of ACTs products in Uganda. At the pilot phase we are working with the Minister of Health in Uganda to pilot the innovation to ensure alignment with needs and practicality of government.  

• How the solution will address their needs

The system will offer DoH/ donors 99% actual data of consumption patterns per healthcare center, 99% increase in stock availability, 99% inventory management, 20% waste reduction, and 20% cost reduction, which is necessary for efficient and effective allocation of financial budget or resources. Our dashboard and live tracking system will assist DoH with value leaks across the different stakeholders. This value is added through integrated dashboard that can be accessed from a mobile phone, live tracking (inventory levels) feature, multi-stakeholder interface, EOQ, network transparency protocol, and overstock-understock alert features.

Growing up, we (Marcia, Tshililo, and Nagitta)were often caught up in between the summer heat and the whining sound of mosquitoes in the Limpopo region of South Africa and Uganda respectively. If you cover up it’s a furnace and you open up it’s a risk of catching Malaria.

The catch 22 is still a reality for us, our families and many Africans today. In 2018, there were 213 million malaria cases and 360,000 related deaths in the African region, accounting for more than 90 percent of cases worldwide (WHO). The burden is heaviest in sub-Saharan Africa (our geographical location), and at worst, in children aged under 5 years, who account for 78% of all deaths.

As scholars, we asked ourselves that why is’t that Africa accounts for 90% of malaria cases worldwide, yet there’s’ a medical breakthrough such as ACTs, and Nobuzz by the African Applied Chemicals? 

One of the critical challenges for African growth is to contribute to the development of a shared agenda for the transformation system of Higher Education and to re-position the institutions in this sector to play more meaningful role in the transformation of Africa.

If we observe the practice of leading universities in the UK, US, Germany, it is clear that they are quick to respond to national and global challenges. For example, Covid-19 vaccine was pioneered by scholars in Germany, US and the UK.

Hence, we asked ourselves as to how can we use our research to make a difference to our communities. We used our empirical findings to develop a mobile application for SC that connects suppliers, donors, governments, hospitals and clinics to help improve visibility of stock and better access of ACTs.

Today, we are busy piloting with African Applied Chemicals, a SME manufacturer of malaria products in SA. In Uganda, we have partnered with the Ministry of Health to test the impact of the mobile application in reducing stockouts. Our efforts and contribution were recognized by the National Accelerator Program where we received 1st prize.

We believe that if more and more scholars were to transform their research into innovation, Africa could have more innovations that helps transform Africa, reduce unemployment, and solve some of our economic and social challenges.

Our universities are gold mines for local solutions, and we believe that innovation from universities have the potential to transform Africa. We are letting our research to be the innovation Africa needs tomorrow.

Partnership and collaboration

• We wish to expand our pilot to the entire Africa. We have the support of Africa Resource Centre (the Bill and Melinda Foundations for health care supply chain in Africa). We can appreciate further links to other African governments and key suppliers to pilot and consider the application.
• Target to the continent’s regional formations like SADC, EAC, ECOWAS, 
• We also wish to work with doctors beyond boarders (MSF), and other non-profit organisation that focus on expand access to rural and township areas such as Trek Coalition, WHO, HBM Healthcare investments. We can appreciate connection and introduction to the aforementioned organisation.
• Mentorship from organisations in the space and potential partnership with key information system companies that embrace grass roots innovation.
• Following our pilot phase is the actual launch and commercialisation of the mobile application. In this phase, issues of sales (transport, sales, partnership and profit sharing models, operations (salaries, stationery, bank charges), and professional fees (accountant, auditors) comes to effect. Hence we can appreciate links to funding bodies.

It is the first affordable integrated mobile health application that covers end to end health care supply chain to market. The unique features are built with inventory management logic such as economic order quantity (EOQ), production order quantity (POQ), integrated dashboard, live tracking features, multi-stakeholder interface, network transparency protocol, overstock-understock alert features, ABC analysis etc.

Further, the innovation has a database exclusive to the ACTs project and have not been published and offers a high amount of data and intelligence necessary to achieve the desired coordination goal.

Considering the rate of malaria impact to Africa, and the lack of affordable technology to improve accessibility and availability of artemisinin-based combination therapies, our mobile application can be catalytic that induces health technology equilibrium, increase access to medicine, which is crucial for quick response to humanitarian crises, and malaria outbreaks. 

It is designed with a great understanding of limited ICT infrastructural (i.e. laptops) resources and scarcity in Africa, and enables micro, market, and macro stakeholders to maximise the strength of mobile application penetration in Africa where 67% of the population (approximately 1.13 billion people) have mobile phones (Adepetun, 2015). 

Moreover, the application has transferability and application to other drugs, and markets, subjects to customization. In May 2021, the department of Small Businesses in South Africa approached the University of South Africa and Prof Mkansi to pilot the system beyond healthcare centers to include spazashops (kiosks) and their suppliers in townships and rural areas.

The diagram below shows our key steps/ impact goals. We are currently in step 4 of the flowchart. Stage 1 and 2 of ACTs system are complete, but stages 3 to 6 are outstanding (see flowchart below):

Step 4: Adjust system and re-test (key activities) Following the pilot results and feedback with AAC and the Minister of health in Uganda, there will be adjustments to the system, which will in turn, require re-testing. 

• Step 5: Marketing and redistribution

Once all re-test and adjustments are complete, our spin-off company will  target the continent’s regional formations like SADC, EAC, ECOWAS, and other to introduce the product with the hope that the regional ministries of health would spread the word to their respective countries whilst we are also leveraging on the network that we have developed through the research that the team has done throughout the continent.

• Plan to 1500 market users (partners, channels, resources, and activities)

We envisage access to both macro and micro (healthcare centers) through our ministry of health partner in Uganda. Hence, the Institute of Sustainable Malaria Control will link us to key suppliers and health officials in the Limpopo province of South Africa. African Apllied Chemicals provide us an opportunity to leverage on the host of other suppliers and partnership involved in the combat of malaria. Prof Mkansi serve as a board member of Africa Resource Centre (Bill and Melinda Gates) initiative or foundation for healthcare supply chain. Further, coopetition with companies such as MicroSoft, with conditions to use their Azure cloud space as our host, which in turn, translates into traffic for them as more and more users subscribe to our service.

The project contributes to the United Nations (UN) sustainable development goal (SDG) 3 (good health and wellbeing) (Goal 3), whilst championing the public-private partnership development (UNSDG 17 and 9). We are currently using research to measure the following:

1. Examine how the use of the SCC mobile application software for MCPs contributes to the UN-SD 3 and 9. Specifically, the objective seeks to analyse the data from the application to find out how much under and overstock are reduced using the innovation. 

Solve alignment: The strength of the digital mobile application is its ability to aggregate data and offers an innovative infrastructure that enables small manufacturers, government bodies, and the townships and rural communities to address several multi-embedded health care stakeholders supply and distribution needs (UNSDG 9).

2.To conduct an assessment of how much township-rural health centres can be equipped to effectively coordinate available supply to meet demands and react to outbreaks quickly; subsequently limiting the impact of malaria to women and children (UNSDG 3). 

Solve alignment: The problem bridges the digital divide, increase access to malaria drugs, and limit the impact on women and children in rural-townships areas.

3. To identify the issues that hinder the diffusion of SCC mobile application software for MCPs (e.g., trust and transparency, service quality, privacy concerns, liability insurance) and experiment with various solutions to address them. This responds to UNSDG  9 and 17 on industry, innovation and infrastructure.

Solve alignment: The system equips township-rural health centres with the technology to improve efficiency in the deployment of drugs, track supply across the value chain and enable users of the system, to effectively avert waste and counterfeit across the supply chain.

One of the critical challenges for African growth is to contribute to the development of a shared agenda for the transformation system of Higher Education and to re-position the institutions in this sector to play more meaningful role in the transformation of Africa. The mobile health care supply chain coordination innovation for artemisinin-based combination therapies (ACTs) contributes to national and global universal health coverage (Goal 3 of the United Nations’ Sustainable Development) Priority 1: Economic transformation and job creation, and Priority 7: A better Africa and world.

Socially, ACTs innovation present opportunity to create social value and to contribute to SDG goal 3 that aims to ensure the health and wellbeing of people of all age groups and better living standards. The expression of interest by the Minister of Health in Uganda and small supplier African Applied Chemical (AAC) in South Africa is evident of social impact.

Economically, public services such as healthcare are very expensive (Pan et al., 2006; Riaz & Qureshi, 2017; Rose et al., 2015). Our innovation technology is increasingly enabling and driving transformation of these expensive services. The role and finances of governments are shrinking, and NGOs are struggling to raise funds, some of the social problems cannot be addressed without participation of every segment of the society including corporations, business professionals and academics. The affordability of ACTs technology for use both suppliers of all sizes and governments in developing economies is an exemplary role of how academic segment is contributing towards transformation of Africa and the health care system. Most importantly, the system created a job for the developer of the system, and more creation for data analyst who will support the different market segments are expected. A trademark has been filed since 2019 by the University of South Africa, thus contributing to the country’s intellectual outputs. Copyrights materials with technology transfer office.

A spinoff company is being registered by the university. A PhD student completed her studies and graduated in the year 2019. Also, there are numerous contributions to books, conference proceedings, and journal articles by the co-inventors (Prof Mkansi and Dr Nagitta).

The technology that underpins the centralised mobile platform is Xamarin and asp.net for app. Xamarin is a free and open source mobile app platform for building native and high-performance iOS, Android, tvOS, watchOS, macOS, and Windows apps with .Net with native API access. Being a comparatively new tool, its database is based on the Microsoft technology stack and is hosted by Microsoft Azure. The mobile app is built around the IoT framework (see diagram).

We are a spin off from a university. We are a hybrid model for profit and nonprofit. The university provide us legal protection, structural competence, for a 24% royalty fee in future profits.

The gender dimension of this project considers three perspectives of equality involvement namely project investigators (male and females) perspective, the project partners (businesses, government and Non-Governmental Organizations (NGOs), and beneficiaries of the research project (women and children). From the perspective of project investigators, there are three main African project investigators responsible for managing project’s partnerships and output in Africa. Within these project investigators, two are females and one is male. The project partners equally reflect a statement of how the project seeks to impact the different gender groups. 

Expected impact of the project on people of different genders

Phase one of the project (pilot phase) offers limited direct impact  beyond project investigators and partners (Uganda hospitals and South African small firm for repellents). However, as the project progress, there are numerous potential direct beneficiaries to different gender groups from business owners to community users’ participating in different health centres (hospitals, clinics etc.). Hence, business owners (male and/or female) stand to benefit from technology and stock management system, which in turn, is expected to have a positive impact at the growth of their businesses. Communities from children, women and all other age groups will benefit from better access of malaria prevention products and visibility.

We adopt a business to business (B2B) model. Some of the conditions with our pilot partners negotiated by UNISA is promise to use the system for a fee following pilot phase. The agreement gives us a head start with two key customers for our products prior to formal entry to market. 

• Plan to 1500 market users (partners, channels, resources, and activities)

We envisage access to both macro and micro (healthcare centres) through our ministry of health partner in Uganda. Hence, the Institute of Sustainable Malaria Control will link us to key suppliers and health officials in the Limpopo province of South Africa. African Apllied Chemicals provide us an opportunity to leverage on the host of other suppliers and partnership involved in the combat of malaria. Prof Mkansi serve as a board member of Africa Resource Centre (Bill and Melinda Gates) initiative or foundation for healthcare supply chain. The details of the system and value proposition has been presented to the board members who are willing to assist in deploying the product for effective medical distribution across Africa.

Further, we are pursuing partnerships with big information system companies such as MicroSoft, who allows us to post our mobile application to their cloud space and access the host of their existing customer. The conditions is for us to use their Azure cloud space as our host, which in turn, translates into traffic for them as more and more users subscribe to our service (see the business model canvass below).

Value Proposition Beyond the social value of savings life, especially vulnerable groups such as children and pregnant women, the value that the central mobile platform would bring to our target customers include access to information across all supply chain members; control over various logistics activities like procurement, quantification, dispensing, forecasting, etc.; 99% increase in stock availability, 99% inventory management, 20% waste reduction, and 20% cost reduction. This value is added through integrated dashboard that can be accessed from a mobile phone, live tracking (inventory levels) feature, multi-stakeholder interface, EOQ, network transparency protocol, and overstock-understock alert features.

Subscription revenue model

 There are 98093 health care centres in Africa, from which 4303 and 3792 are from South and Uganda respectively. Within the healthcare centres, there are 11 people that deals with the management and distribution of drugs (referred as the DTMC committee). The implies that our target market offers us  eleven (11) users per hospital, multiplied by 4303 health care centres in South Africa, 3792 healthcare centres in Uganda, and 98093 healthcare centres in Africa. At R10 per user (subscription revenue model), South Africa offers us at least more than (i.e. 11*4303*10= R473 330) R473 330 market value a year, Africa offers us more than R10 million market value a year. Factoring all known and unknown constraints, we aim to recruit at least 1500 hospitals from our respective target market in year one and two of our official launch. 

Upgrades and extended license

Healthcare centres will need to integrate upgrades and extend their current offering with new features or extend their licences. Thus adding another line of revenue

The diagram below summarizes our financial sustainability model and source of funds:

Innovation Competition and grants won

• Reputation and monetary: Generated R300 000 (GAP medical competition by the National Gauteng Accelerated program), and R100 000 (the Innovation Support Program from the University of South Africa). \
• We have applied for research grant to help pilot the innovation across Africa and across different health product lines.
• Department of Small Businesses in South Africa requested to pilot the app with rural and township spazzashops (kiosks). Negotiation on-going for funding for the pilot.