Digital Community Malaria Control

According to the World Health Organization (WHO), in 2022 malaria posed a threat to nearly half of the world's population, causing sickness to 209 million people and claiming 608,000 lives. Africa accounts for 95% of all malaria cases and deaths, with the remainder of cases occurring in India (2% of the global burden) and in various countries in South America and Asia. Malaria is the number one cause of death and disease in many developing countries, where pregnant women and children under the age of five are the groups most affected. In addition, it is responsible for the loss of millions of workdays and school days. It has been estimated that malaria severely impedes economic development, to the extent that countries affected by malaria have a per capita income only 30% as high as non-affected countries.

Currently, the most common methods for fighting malaria are insecticide-treated nets (ITNs) and indoor residual spraying (IRS), both of which have significantly decreased malaria cases in the last few decades, but whose effectiveness has been dwindling due to mosquito adaptation to outdoor biting and their growing resistance to the insecticides used in these methods, as well as limited uptake and compliance and other reasons. 

Decades ago, many countries eliminated it using an environmentally benign method known as larviciding, namely, treating the water bodies in which mosquitos breed. However, in order to achieve malaria eradication, it is necessary to find and treat a very high percentage of the millions of water bodies (in many cases, puddles) around people's houses. Studies have shown that even experienced fieldworkers miss about 40% of the water bodies in the areas they are assigned to search. 

Digital tools have significantly enhanced the cost-effectiveness of larviciding operations in urban and semi-urban areas, streamlining the identification and treatment of mosquito breeding sites. However, in rural areas, the scenario is markedly different. The challenges here are compounded by the vast distances between remote communities and operational centers, leading to increased costs related to transportation and the additional working hours field workers spend in transit. While drones have demonstrated potential in improving coverage and detection of breeding sites, they cannot always be applied effectively in these settings and, by themselves, do not constitute a comprehensive solution. Therefore, there is a pressing need for a tailored solution that addresses the unique challenges faced by rural communities. These areas are in particularly acute need of such interventions, as they carry the main burden of malaria, suffering higher incidence rates and facing more significant obstacles in accessing healthcare and preventive services.

Our solution is a comprehensive initiative designed to empower women in rural areas for effective malaria control through community-based larviciding, leveraging a designated mobile app. This project will train women to utilize the app for identifying and treating mosquito breeding sites, deploying traps and monitoring results. It will harness the pivotal role women play in their communities, particularly in healthcare, by equipping them with the digital tools and skills necessary for sustainable, eco-friendly mosquito control.

The methodology will involve recruiting capable women from the community, providing them with smartphones, and offering condensed training. This training will cover understanding malaria transmission, mosquito breeding habits and the use of WHO-approved larvicides. The app, central to our solution, will employ GPS technology for tracking and reporting larviciding activities and mosquito population data. This information will be uploaded to an online dashboard for remote monitoring by project managers, facilitating real-time support and assessment of the initiative's effectiveness.

By focusing on water bodies as potential breeding sites, women will apply larvicides, cover or dry these areas as needed, incorporating domestic mosquito control advocacy within their communities. Compensation for their work will be based on hours recorded by the app, with additional bonuses for achieving benchmarks in mosquito and malaria reduction. This approach will not only address public health concerns but also promote socio-economic development and empowerment of women in these communities.

Moreover, the project will emphasize gender equality and human rights, ensuring the safety and well-being of participants throughout. It will include pre-training gender assessments, secure training environments, selection of communities with consideration for women's safety and provision of appropriate safety gear for field activities. This initiative is about empowering women with digital skills and tools for malaria control, fostering their economic growth, personal development, and enhancing their roles in healthcare and community leadership.

Malaria is almost exclusively a disease of the underprivileged. To begin with, it affects developing countries, almost all of which in Africa, and many of which with a large proportion of the population living in extreme poverty (i.e., on less than $1.90 per day). Within these countries, rural communities bear the brunt of malaria, with vulnerable populations disproportionately affected by the disease: children under the age of 5, pregnant women and–more than any other significant health issue–impoverished people. Not surprisingly, malaria is profoundly underfunded. According to the WHO, the annual resources needed in order to reach its malaria control milestones for 2025 were estimated at $6.8 billion in 2020. However, the actual funding was a mere $3.5 billion, and the funding gap is ever growing. Based on a Lancet article from 2016, the average expenditure of an African country on controlling malaria was $3 PPP. 

The flipside of this grim situation is that even incremental improvements result in multiple lives saved. Indeed, contributing to malaria prevention efforts results in one of the most lives saved per dollar donated. Our solution, which, as mentioned, has been shown to be twice as cost-effective as today's leading anti-malaria intervention, thus holds the potential of saving more than 140,000 lives annually even with existing funding.  The benefits of fighting malaria extend beyond saving lives, since they also contribute to the improvement of education and economic conditions. When children suffer from malaria, they often miss school days, which hinders their educational progress (this is particularly true for girls, who are often required to stay home to take care of sick family members). By reducing the incidence of malaria, children can attend school more consistently and concentrate better in class, ultimately leading to better educational outcomes. In addition, the economic situation of affected communities improves as healthier individuals can work more efficiently, boosting productivity and overall economic growth. Furthermore, in the case of digitally managed field operations to combat malaria, there are additional benefits to the community. Not only do these operations support local labor, but they also promote the acquisition of digital skills. The use of modern technology in these operations helps empower local communities, fostering self-reliance and resilience, while simultaneously providing valuable tools and resources to improve the overall effectiveness of malaria prevention initiatives.

Zzapp was founded in 2016 by Arnon Houri-Yafin after he spent three months in hospitals in India conducting research on a malaria blood test. Witnessing the devastating impact of the disease, Arnon decided to use technology not only to diagnose malaria but to eradicate it. Zzapp team members are highly skilled professionals that are deeply committed to the cause and possess years of field experience. Zzapp’s team members hold advanced degrees, including two PhDs, from prestigious universities such as the London School of Hygiene & Tropical Medicine, Georgetown University and the Hebrew University. With a wealth of experience in diverse fields ranging from operation management and data analysis to software development and community engagement, our team has received numerous academic excellence awards and grants. Several team members have either contracted malaria themselves or lost siblings to the illness.

Despite our extensive professional and personal experience, we acknowledge that effective and sustainable solutions require a community-driven approach. We therefore continuously gather feedback through formal and informal methods. Feedback collection, led by our implementation expert, Alexandra Wharton-Smith, starts during the 3-day training that we offer fieldworkers. Based on our experiences in these sessions, we have enhanced our system, guidance materials, and teaching methods. During operations, we encourage managers and fieldworkers to share comments and suggestions via a designated WhatsApp group. We also actively seek their input during field visits, casual conversations, and structured interviews and focus groups. Overall, we have received overwhelmingly positive feedback from both managers and workers. They have reported finding the app useful and even fun (similar to a scavenger hunt or a game of Pokémon GO…). In some instances, workers voluntarily continued working after hours to complete their assigned "chunks," even after being assured that it was not expected of them. Many workers also uploaded photos of themselves standing next to water bodies they had identified, demonstrating a clear sense of pride in their accomplishments.

These are a few of the reviews that we received:

“Despite the technology’s sophistication, the app and the dashboard are very intuitive and user-friendly. In an operation in the Amhara region in 2019, we located all the water bodies, which is usually a great challenge. Fundamentally, the technology helped us in saving time and energy. It also helped us in prioritizing severely affected villages.” (Dr. Abebe Asale, the International Centre of Insect Physiology and Ecology [ICIPE], Ethiopia, 2019  "The app has come at the right time. The app comes in handy in terms of helping us map all the municipality and also find the breeding sites for treatment." (Kwame Desewu, entomologist, AngloGold Ashanti Malaria Control[AGAMal], Ghana, 2017).

We have a field-tested, fully functioning system – in the development of which more than $1M has been invested – whose core principle is applying local data, micro planning and thorough management on a nation-level scale. We continue to improve our tools, refine our working protocols and deepen our entomological, epidemiological and operational knowledge,  As determined by an external consultant for scalability, we are well prepared to scale up to protect hundreds of districts and towns with a population of hundreds of millions across Africa, thanks to several factors: the atomization our system facilitates; the outstanding results we have already achieved; the highly competitive price we offer; our strong ties with research institutions, implementing partners and governments; and high market demand. 

Our forthcoming solution, a women-led larviciding initiative guided by our existing digital app, represents a critical innovation that will enable the scaling of our efforts to rural areas, unlocking the full potential of larviciding in combating malaria on a national level.

As a Business-to-Government (B2G) company, we work with governments, but also with donors, NGOs, and policymakers, including the WHO. The involvement of multiple and varied stakeholders often results in a complex and extended sales cycle. We believe that Solve can help us surmount these challenges by facilitating vital partnerships to accelerate our efforts, validate our business model's impact and sustainability, and ultimately broaden our solution's reach to more communities in need. In addition to addressing these technical and market barriers, we seek networking opportunities to assist in completing a funding round. We have secured a term sheet from an investor (who is actually not an impact investor), contingent on the involvement of another VC in the round. We are confident that Solve can aid in identifying and connecting us with a suitable investor (VC or angel) to participate in our funding round and further advance our mission.

Our solution is distinguished in the battle against malaria by its integration of approach, functionality and technology, underpinned by a strong emphasis on community-driven efforts.

Approach: Moving beyond the prevalent reliance on insecticide-treated nets and indoor residual spraying, our strategy focuses on community-led larviciding at outdoor water sources. This method draws on the successes of historical eradication campaigns. By mobilizing community members, in these initiatives, we leverage local knowledge and commitment, significantly boosting the impact and durability of our efforts.

Functionality: Traditional larviciding operations often face challenges with efficient management, which our solution overcomes through the strategic use of mobile technology. Our app facilitates precise coordination of treatment areas and real-time progress monitoring, ensuring comprehensive coverage and the collection of dependable data. The engagement of community members, guided by our technology, ensures an organized and effective approach, markedly improving operational performance.

Technology: Our system employs cutting-edge neural networks to analyze satellite imagery for accurate mapping of dwellings, then scrutinizes various satellite data to identify areas suitable for mosquito breeding. Armed with this data and an optimization algorithm, we meticulously plan larviciding activities, delegating manageable tasks to community-based teams. Additionally, our spatial-agent-based malaria simulator fine-tunes intervention strategies, enabling each action to achieve maximum efficacy. This technological sophistication supports community operatives, enabling them to make informed decisions, even without internet access and maintain momentum and data accuracy.

By centering our efforts on community involvement, our solution not only innovates in malaria prevention but also empowers local populations, providing valuable skills and job opportunities while tackling a major health issue. This community-centric approach seeks not just to significantly cut down malaria transmission but also to foster broader positive changes, advocating for community empowerment and collective action in public health endeavors. Our model aims to revolutionize the market landscape, showcasing the power of community-led, technologically empowered health interventions on a broad scale.

Goal 

Reduce malaria within a large population of rural communities by at least 50% for a cost of no more than 40 cents per person, thereby improving public health, enhancing economic productivity and increasing the quality of life among these populations.

Assumptions 

1. Larviciding is highly cost-effective compared with other mosquito control methods, especially in urban areas (Worrall & Fillinger, 2011).

2. Effective larviciding can significantly reduce malaria (Damabach et al., 2020; Fillinger et al., 2009). 

3. Zzapp's digital tools increase the effectiveness of larviciding operations (Vigodny et al., 2023). 

4. Women play an important role in fighting malaria. 

5. Community involvement increases the effectiveness of larviciding operations.  

Input

1. Financial Resources: Funding for purchasing larvicides, developing and maintaining the digital monitoring platform and covering operational costs. 

2. Human Resources: Recruitment of women as primary agents for identifying and treating mosquito breeding sites. In addition, a dedicated team comprising program coordinators, health educators, data analysts and trainers. 
3. Technological Resources: Adaptation of our existing mobile app so as to support remote management of fieldwork in rural communities. 
4. Training Materials: Educational and training materials designed to effectively convey information about malaria prevention, the use of the app and the application of larvicides.  
5. Community Access: Cooperation with local authorities and community leaders to ensure program access to all areas and households within the target communities. 
6. Logistical Support: Transportation and logistical arrangements to facilitate the distribution of larvicides, deployment of training teams and organization of community engagement sessions. 

Program Activities
1. Training Community Members: Women from rural communities will be recruited and trained in using a mobile app and in identifying and treating mosquito breeding sites using eco-friendly larvicides, with a focus on regular and widespread coverage.

2. Digital Monitoring and Data Collection: The program team will utilize digital tools to map breeding sites, track larvicide application and monitor mosquito population dynamics, ensuring real-time data availability and accuracy. 

3. Community Engagement and Education: Health educators and community leaders will conduct awareness sessions on malaria prevention, symptoms and the importance of environmental management.

Outputs
1. Increased Capacity for Malaria Control: A network of trained women capable of identifying and treating mosquito breeding sites.

2. Enhanced Monitoring System: A digital platform that provides real-time data on mosquito populations and larvicide application effectiveness.

3. Improved Community Awareness: Increased knowledge and proactive behavior among community members regarding malaria prevention and environmental management.

Outcomes
1. Reduced Mosquito Population: A decrease in the mosquito population of at least 50% due to the consistent application of larvicides, as evidenced by data collected through the digital monitoring system.

2. Increased Community Engagement: Community members actively participate in malaria prevention efforts.

3. Improved Health Outcomes: A reduction in malaria incidence as community members adopt preventive behaviors and benefit from a decreased mosquito population.

Final Outcome

A sustainable reduction in malaria cases by 50%+ in the targeted rural areas, demonstrating that the technology and community-led approach can be scaled nationally with cost-effectiveness significantly better than existing solutions. 

Our primary impact goal is to significantly reduce malaria incidence in rural areas by at least 50% on average, at a cost of less than $0.45 per person protected, demonstrating our solution's scalability and cost-effectiveness. This target reflects our commitment to transforming lives through innovative malaria control strategies, aligning with the UN Sustainable Development Goal (SDG) 3.3 to end the malaria epidemic by 2030. We aim to showcase our technology's potential for national-level application at a cost-effectiveness that doubles that of today's leading solutions. Moreover, our approach is poised to unlock the potential for nationwide malaria elimination at the average expenditure an African country currently allocates to merely control the disease.

Measuring progress towards impact goals:

1. Malaria Incidence Reduction: We rely on official data regarding malaria incidence per 1,000 population, aligning with the UN's indicator for SDG 3.3. This allows us to directly measure our impact on reducing malaria cases in the communities we serve.

2. Mosquito Population Control: Through before, during and after comparisons of mosquito trap catches, we assess the effectiveness of our larviciding operations in reducing the adult mosquito population.

3. Mosquito Larvae Reduction: By comparing water body sampling results from mosquito breeding sites, we gauge the success of our interventions in diminishing mosquito larvae populations.

4. Cost-Effectiveness: The cost per person protected is a critical metric for us, ensuring our solution remains affordable and scalable. Achieving our goal of less than $0.45 per person underscores the financial viability and broader applicability of our approach.

The core of our technology comprises an AI planning tool, a spatial-agent-based mosquito simulator, a mobile app and an online dashboard. First, our AI component extracts from satellite images the location of houses and demarcates the general area for the intervention. Then, integrating data on climate, topography and land use, it runs numerous scenarios in the simulator. Based on predicted effectiveness outcomes, it selects the specific strategy for each village, recommending where to scan for water bodies, which houses to spray, where to place mosquito traps and what implementation order to employ. The system assists with implementing the selected strategy using a GPS-based mobile app that allocates treatment areas to workers, monitors their location in the field to ensure they cover the entire area, and tracks schedules for water body treatment and other tasks. The app was designed to work in Africa’s field conditions: it has a low battery consumption, works well even on simple smartphones and can operate offline. Information from the fieldworkers, as well as that which has been obtained from drones, is automatically uploaded to the dashboard, allowing managers to monitor the operation in real time. The dashboard also produces issue-specific reports – for example, fieldworkers’ productivity or the correlation between water body type and positivity – that improve monitoring of the operation and facilitate post-operation analysis and lesson learning.

Full time: 7 

Part-time: 4

Zzapp has been engaged in the fight against malaria for seven years. Although we have incorporated community engagement in all of our efforts, we have not yet executed a large-scale operation of the type outlined in the current proposal.

Diversity serves as a catalyst for innovation. It generates multiple perspectives on issues and fosters the development of creative solutions. Moreover, the ability to understand and empathize with others enables better addressing of the needs of customers from various cultural backgrounds. And, simply, it helps everyone feel comfortable with who they are. As a company operating in diverse cultural settings, with solutions that significantly benefit from community engagement, it is only natural that our team reflects the advantages of diversity. Our team members represent diverse genders, sexual orientations, religions, religious observances and nationalities. In this context, adopting a gender lens when addressing malaria is particularly important. Women are not only disproportionately affected by malaria (e.g., they face higher risks of mortality during pregnancy and often care for sick family members), but they also play a crucial role in malaria control efforts. Women make up 70% of the community health worker force and are instrumental in adopting malaria control practices. These practices range from ensuring that their children receive seasonal preventive medications and use bed nets, to seeking medical care at healthcare facilities when their children fall ill. It has been shown that gender integration improves malaria control. Acknowledging the importance of this perspective, we took part in writing the Gender & Malaria Community of Practice Advocacy Agenda (“Eradication Through Equity: An Advocacy Agenda for a Gender Transformative Approach to the Fight Against Malaria”). We also apply a hiring policy in which if one of two equally competent candidates is a woman, she will receive the position. Indeed, women have been holding leading positions in Zzapp with regards to AI, policy and operations. Gender equality extends beyond hiring and staffing; it also involves creating supportive working conditions. For example, when our employee once had a work-related trip to a field operation in West Africa, Zzapp covered the full costs of flights and accommodations for the baby and her nanny.

Our business model focuses on providing value to the populations we serve in terms of impact and revenue through comprehensive anti-malaria vector control and surveillance services. We tailor our solutions to each location's specific needs and budgets, offering services at a competitive cost while maintaining effectiveness and profitability. 

We provide our customers, which include governments, municipalities, local authorities and implementing partners, with products and services that support the implementation of operations ranging from the municipal to the nationwide scale. Besides the software, we offer a wide gamut of services, including training, operational management, quality assurance, monitoring and community engagement. Our resources comprise digital technology, materials and equipment, logistical centers, offices, entomological labs, human resources, data and company know-how. 

The gains for citizens in affected countries are immense, as large-scale prevention or elimination of malaria can significantly improve public health, reduce morbidity and mortality and contribute to economic growth. Implementing partners benefit from our AI-generated tailored strategies, automated cost estimation and budgeting, improved management, highly cost-effective outcomes, increased accountability and post-analysis insights, addressing their main pain points in planning, execution and results analysis. 

We establish customer relationships through various channels, such as conferences, embassies, direct engagement and contact with funders like The Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Malaria Initiative (PMI). Our pre-sales process involves analyzing customers' budgets and needs and tailoring solutions accordingly. We offer a range of sales options, including district pilots, nationwide elimination, surveillance, and additional services such as modeling and consultation. 

Our services are delivered to citizens in collaboration with governments, local/municipal authorities, and implementing partners. We generate revenue as a B2G company, charging quarterly fees based on the number of licensed workers involved in an operation and the amount and level of services we provide. Our cost-effective solutions enable us to offer competitive pricing to our customers. 

Our goal is to achieve financial sustainability through a revenue stream from paying customers. Our primary service, accounting for 95% of revenues until EOY 2026 and 81% of gross profit, is nationwide malaria elimination operations—a unique offering in the market. Additional services include district control for low-burden countries, urban larviciding for comprehensive city water body coverage and future platforms to combat mosquito-borne diseases like dengue and Zika.

Our nationwide malaria elimination operations will typically begin with an eight-month, single-district paid pilot to showcase the effectiveness of our method within the client's local context. The pilot helps us tailor our system and methods to the country's specific ecosystem and society, facilitates government decision-making and bidding processes, and aids in obtaining loans from the World Bank. Following a successful pilot, we plan a three-year, two-stage nationwide campaign: a first-year "blanket phase" and a two-year "targeted phase." The final cost and structure depend on factors such as area size, population and climate. 

Based on our experience and mathematical models, we estimate that a typical 3-year nationwide elimination operation will cost the government an average annual $3.33 PPP, from which we will deliver immediate annual governmental cost savings of $1.67 PPP and major additional long-term cost savings. We will form a joint venture together with a selected implementing partner that will manage the whole sum ($300M in the case of a typical 30M population country), with which we will hire labor and transportation (70% of cost), buy aerial imagery and insecticides, run labs, and cover all the other operation costs. We will actively manage all the operational aspects of the operation. For this service, our gross profit will be $0.43 PPP or $39M (13% of the operation's total 3-year cost; according to service providers with whom we spoke, including companies and NGOs, the typical gross profit of service-givers for World Bank-funded projects is 25% of the project’s total expenditure. We aim for gross profit of between only 7% and 17% depending on the type of service and program complexity working in close concert with profit-sharing local implementation partners). 

So far, our efforts to achieve financial sustainability have been met with positive outcomes, as evidenced by various grants, loans, investments and awards that we have received over the years. In 2018, we were awarded a $0.08M non-dilutive grant from the Bill and Melinda Gates Foundation via the Innovative Vector Control Consortium (IVCC). In 2019, we received a $0.18M loan from the Israel Innovation Authority (IIA). Between 2016 and 2019, our parent company, Sight Diagnostics LTD, invested a total of $0.36M in equity. In 2021, we won $3.015M in non-dilutive prize money from the IBM Watson XPRIZE AI for Good competition and an additional $0.25M from the Cisco Global Problem Solver challenge. In 2022, we received a $0.3M grant investment from the Future Fund Regranting Program. We are currently in the process of completing an investment round to further support our financial sustainability efforts.