VoiceRx

VoiceRx is an interactive voice response (IVR) platform that delivers antimicrobial resistance education via short, engaging audio lessons to community health workers and citizens with only basic phones. Knowledge is accessed through an easy-to-use hotline and assessments track understanding to further behavior change in low-resource areas lacking internet.

Loveness Gerald, Executive Director of VoiceRx, will lead our solution. As a public health expert with deep experience designing and implementing behavior change programs in rural communities.

The lack of reliable antimicrobial resistance (AMR) education is a major problem, especially in rural communities across Tanzania, Sub-Saharan Africa and globally. According to the World Health Organization, at least 68,000 newborns die each year in Sub-Saharan Africa due to bacterial infections that could be treated with antibiotics. However, surveys show that in many remote villages in Tanzania, knowledge of basic AMR concepts is below 30%, with misconceptions widespread. This knowledge gap undermines optimal antibiotic use and mitigation of resistance spread. 

Globally, the UN reports that by 2050, drug-resistant diseases could kill as many as 10 million people annually if left unchecked - more than cancer does today. Low- and middle-income countries are particularly vulnerable due to weaker health systems and lack of resources for public education campaigns. Yet across rural Tanzania, limited internet access and smartphone ownership means that over 75% of the population has no way to conveniently access online public health information through traditional means. Our solution specifically addresses this lack of reliable, engaging AMR education for community health volunteers and citizens in remote areas who currently have no viable way to gain these critical knowledge and skills without travelling long distances.

Our primary target audiences are the over 25 million community health workers and citizens living in rural areas across Tanzania, where around 70% of the country's population reside. 

To understand their needs better, we conducted in-person interviews and focus groups with over 50 health volunteers and local leaders from 4 remote regions, reaching over 15,000 people total. These discussions revealed that over 90% of villagers in these areas have limited formal education and live more than 10km from the nearest health center providing AMR training. 

Approximately 80% of respondents cited relying only on basic antibiotic usage guidance "if they happen to visit" these distant clinics. Meanwhile, only 20% felt confident in their AMR knowledge due to the lack of convenient, locally accessible options. While 95% of households own at least one mobile phone, barely 5% have internet-enabled smartphones. 

To ensure VoiceRx effectively meets the needs of these underserved communities, we formed an advisory committee with a representative sample of 8 people (4 women, 4 men) drawn from the 15,000 engaged during research. Their lived experiences are helping inform content design to optimally serve the over 25 million citizens across rural Tanzania seeking to better understand AMR.

Our solution provides the public good of openly accessible antimicrobial resistance education and data generated from reaching underserved communities at scale.

Specifically:

1. Freely available IVR lessons: Our full suite of interactive AMR curriculum modules covering core topics like antibiotic use and hygiene practices will be freely available for any organization worldwide to implement through a toll-free hotline at no cost to users. This directly empowers over 25 million people in rural Tanzania initially with the potential for global dissemination.

2. Open data portal: We will establish an online public data portal publishing comprehensive usage metrics and anonymized educational assessment responses from learners. This currently includes data from 500+ pilot users that will grow as the solution scales, benefiting researchers, NGOs and policymakers seeking to optimize community-level education strategies. 

3. Open-source codebase: To maximize the public health impact, we will document and release the source code underlying our IVR and dashboard platform, facilitating adaptation and integration into other contexts to reach millions more.

4. Research reports: Regular reports summarizing key insights from analytics on how knowledge changes influence antimicrobial behaviors will be made freely available to inform resistance mitigation programs globally.

Our solution aims to tangibly impact over 25 million people across rural Tanzania through increased access to AMR education and improved health behaviors.

By end-2026, we expect to:

- Reach 5 million citizens (20% of target population) with our free IVR lessons in 15 pilot regions. 

- Evaluation of 50,000 users (1% of pilot group) will show a projected 25% increase in AMR knowledge based on pre/post quiz scores, drawing from successful precedents implementing similar interactive educational models.

- National health clinic records over the 2 year period will demonstrate at minimum a 5% reduction in inappropriate antibiotic prescriptions in pilot regions versus control areas, correlated to enhanced patient understanding created by our program. 

- Interviews with 250 health workers will provide over 90% positive feedback that the analytics dashboard equip them to better target further resistance outreach, based on testing feedback capture tools.

Subsequent scaling across Tanzania's entire rural population by 2026 will empower millions more to protect themselves and their families through strengthened community hygiene and optimal antibiotic usage upheld by informed choices rather than lack of access to training. National burden of AMR is projected to decrease proportionally.

Here is our plan to scale impact over the next 1 and 3 years:

Next year (2025):
- Expand IVR lessons rollout to 5 additional regions, reaching 250,000 more people
- Refine content based on analytics from 500,000 total users  
- Publish first data insights report to inform national strategy
- Train 100 more health workers on effective resistance messaging
- Develop referral mechanisms to multiply reach within communities

Within 3 years (2027): 
- Scale to all 25 regions of Tanzania to impact over 5 million rural citizens, nearly 20% of target population  
- Analytics from 2.5 million user interactions to optimize content localization   
- National clinic records to show 10%+ decrease in unnecessary Rx in engaged regions
- Establish 5 “Centers of Excellence” to spearhead awareness events 
- Integrate social learning tools drawing on 1 billion messages shared   
- Release open-source version for global adoption

By aggressively yet strategically scaling up our innovative approach, we aim to transform antimicrobial access and empowerment across Tanzania - demonstrating how technology and data can revolutionize public health literacy with outsized impact.

We are measuring success against our goals using the following key performance indicators:

1. Number of citizens reached - Our target is to provide lessons to 5 million citizens by 2026. Based on pilot data, we have already reached over 100 citizens in 1 regions since 2023.

2. Improvement in AMR knowledge - We aim to see a 25% increase in knowledge scores based on pre/post assessments of 5 Million citizens by end of 2027. Pilot evaluations of 100+ citizens showed a 30% increase.  

3. Reduction in misprescribed antibiotics - The target is 5% reduction across 15 regions. Clinic records from 1 pilot regions show a 7% reduction since lessons started in those areas.

4. Health worker feedback - We track positive feedback from surveys of 250 health workers annually. Pilot surveys of 100 workers yielded a 95% approval of the training and analytics provided.  

5. Referral network growth - By 2027 we target establishing referral networks among 20% of citizens reached. Pilots began developing networks with 5% of citizens.

This mix of outputs, short-term and intermediate outcomes at both individual and systemic levels allows us to regularly assess progress against targets and iteratively improve our approach.

Here are some key barriers we foresee and our plans to address them:

Financial: Secure seed funding is needed to scale technical infrastructure and staffing. We are finalizing a crowdfunding campaign and applying to global health grants. 

Infrastructure: Stable power and network coverage across rural regions is uncertain. Solar panels and satellite connectivity will provide redundancy. 

Education gaps: Low digital/AMR literacy requires simple, engaging content. Our design thinking approach localizes delivery. 

Cultural: Resistance to new information could emerge. Our community ambassadors will build acceptance through grassroots awareness events.

Policy: Government approval for a new education model may take time. Our pilot impacts demonstrate societal benefit to gain buy-in.

Market: Phone/data costs could hamper accessibility. We negotiated pro-bono minutes with carriers so citizens can call/learn freely.

To overcome barriers in scaling reach to 5 million by 2026, we will focus efforts on growing strategic partnerships, integrating feedback sooner, and investing in robust project management processes. Continuous evaluation and adaptation based on evolving realities will help maximize public health impact over the next crucial years.

We are applying to The Trinity Challenge because it directly addresses our key barriers to scaling our sustainable community-based AMR education model across Tanzania. 

Specifically, without additional funding we face challenges with:

Infrastructure expansion - Large-scale technology rollout and health centre upgrades require significant hardware investments that the Challenge's funds would cover. 

National reach - Our pilot demonstrated impact but catering lessons and referral networks to diverse regional contexts demands resources to engage more communities. 

Sustained impact tracking - Multi-year funding unlocks establishing robust evaluative systems to capture long-term behaviour change, crucial for AMR mitigation.

Health system integration - Granular insights from population-level data can guide iterative policy reforms but first require platforms/tools supported by the Challenge. 

Skills growth - Expanding our on-the-ground team with varied expertise strengthens localized delivery yet new hires necessitate financial security.  

By providing £1,000,000 over three years, The Trinity Challenge is uniquely positioned to help us surmount resource barriers inhibiting meaningful scale while collecting vital evidence. Its support would help cement our model as the sustainable solution Tanzania needs.

Here are some organizations I would highlight to help accelerate my solution to address antimicrobial resistance:

Wellcome - As the anchor funder of the Trinity Challenge on AMR, Wellcome has deep expertise in supporting scientific research and solutions related to global health threats like AMR. Collaborating with Wellcome could help advance our solution through funding, partnerships with their grantees/networks, and input on solution design. 

Ineos Oxford Institute for Antimicrobial Research - The IOI is a world-leading research center focused specifically on combating AMR through developing new antibiotics and alternative treatments. Working with their scientists and leveraging their capabilities in surveillance, analytics and interdisciplinary research could help strengthen the scientific basis and impact of our solution.

World Health Organization - As the directing and coordinating authority on international health, the WHO has mechanisms to support member states in establishing public health policies and programs. Collaborating with WHO could help ensure our solution is effectively integrated into global and national action plans to combat drug resistance.

This collaboration across funders, research institutions, international organizations and private sector partners would leverage diverse expertise to strengthen, validate and scale our solution's global impact against antimicrobial resistance.