On a recent trip to Africa, I saw two simple but powerful examples of lifesaving protocols enabled by mobile phones. In the Ghanaian village of Bonsaaso, part of the Millennium Village Project, a simple phone-based system is lowering maternal mortality during childbirth. Community health workers (CHWs) with basic training, a skilled midwife, an ambulance driver and a receiving hospital use mobile phones to coordinate as a team. Ever more deliveries now take place in the clinic rather than at home; in the event of complications, the mother is whisked to a receiving hospital about 10 miles away. Mobile phone connectivity among community, clinic, ambulance and hospital makes possible a once unthinkable degree of coordination.
In the Kenyan village of Sauri, also part of the Millennium Village Project, CHWs are pioneering the application of expert systems for malaria control. In the past, suspected malaria patients had to walk or be carried to a clinic, often miles away, have a blood smear read under a microscope by a trained technician and, if positive, receive a prescription. With clinics few and far between and with trained technicians and microscopes even scarcer, untreated, lethal malaria ran rampant.
In the new approach, CHWs visit households on the lookout for fevers that may signify malaria. They carry rapid diagnostic tests that examine a drop of blood for the presence of the malaria pathogen. Then they send an SMS (short service message) text with the patient’s ID and the test results. Seconds later an automated text response informs the health worker of the proper course of treatment, if any. The system can also send reminders about any follow-up treatments or scheduled clinic visits for the patient. The new system of malaria control includes insecticide-treated bed nets made to last for five years and a new generation of combination drugs based on a traditional Chinese herbal treatment, artemisinin.
This full set of tools constitutes a remarkably effective malaria-control system. Already a partial deployment of the system is reducing the malaria burden dramatically in several parts of Africa. Modest international financial support could greatly accelerate the deployment of the full system, and if it were scaled up throughout Africa, hundreds of thousands of lives could be saved annually at around $7 per person a year in the malaria-transmission zones.
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