Malaria Kills: Distributing 63 Million Bednets in Nigeria with RapidSMS

Posted by PenelopeChester on May 25, 2010

The human and economic cost of malaria in Nigeria is staggering. There are currently 110 million clinically diagnosed cases in a population of 151 million.  Malaria kills 250,000 children under five years old in Nigeria every year, and is the cause of 11% of maternal deaths. 60% of out-patient visits and 30% of hospitalizations in the country are malaria-related.

In addition to the enormous toll malaria takes on public health, it is also expensive. 132 billion Naira (USD $870 million) is lost every year in the form of malaria prevention and treatment costs and from the loss of overall economic productivity.

 And yet in spite of the risk malaria poses to the Nigerian people, health surveys from 2006 to 2008 indicated that only 8% of households in the country owned at least one insecticide-treated net (So-called ITNs).

Needless to say, there is an urgent need for ramped-up malaria prevention efforts in Nigeria. 

The Nigerian government has been collaborating with a variety of international organizations, including the World Bank, World Health Organization, UNDP and UNICEF on a campaign to “Roll Back Malaria.”  This effort has led to the creation of the National Malaria Control Program (NMCP) that seeks to unify all of the disparate pieces of the Nigerian malaria control strategy at the national, regional and local levels.

In its 2006-2010 strategic plan, the NMCP sets out the goals of “a reduction of [the] malaria burden by half (50%) by the year 2010 compared to the year 2000.” UNICEF is a key partner in the Nigerian anti-malaria campaign, supplying “safe, effective and affordable anti-malaria interventions.”  NMCP and UNICEF have called for the distribution 63 million insecticide-treated bednets to Nigerian households by the end of 2010. According to Naawa Sipilanyambe, UNICEF Nigeria's Chief of Health and Nutrition, by February 2010, 80% of households in 10 states had received ITNs through the initiative. As of March 2010, 16.5 million ITNs have been distributed in 11 states.

No Data Means Decision Making in the Dark

“Often, we feel we’re making decisions in the dark.” According to Tim Akinbo, a local software developer who works with UNICEF in Nigeria, this is the feedback UNICEF field staff would offer when asked about the challenges they encountered in doing their work. Indeed, when rolling out a logistically complex initiative like the large-scale distribution of bednets, implementation teams constantly need to find ways to work around the constraints in large-scale aid delivery. Poor infrastructure, issues related to transportation and communication, difficulties of accessing and working in remote locations all test the supply chain management of aid organizations.

UNICEF Innovation, working with its country offices, launched a mobile technology initiative in 2008 to address the challenges in on-the-ground data collection and supply chain management in aid delivery. RapidSMS, on of the products that orginitated with the Innovation team,  is a free, open-source framework for dynamic data collection, logistics coordination, and communication. The software was introduced as a tool to resolve a common problem in the delivery of aid projects: How can relevant be collected and accessed data faster?

RapidSMS in Supply Chain Management

RapidSMS was developed by UNICEF Innovation in partnership with the technology company Dimagi, along with members of the Open Mobile Consortium.  RapidSMS implementations across Africa capitalize on the growing prevalence of mobile phones on the continent, and the ease and cost-effectiveness of text messaging to allow for better and more timely coordination of aid delivery projects. Following a famine in Ethiopia in 2008, UNICEF carried out a large-scale food distribution program with the help of mobile phones targeting malnourished children at more than 1,800 feeding centers. RapidSMS was first used to track the real-time availability and delivery of food aid in remote locations, helping to eliminate the kind of delays a paper-based data collection system creates.

A quasi-instantaneous data collection system allows for more rapid response and more immediate distribution of food and other aid. The availability of timely and accurate information dramatically increases UNICEF’s ability to identify and resolve problems as they arise and translates into a more efficient and rational allocation of resources.

 RapidSMS is more than just a data collection tool, however. Erica Kochi, a communications specialist on the UNICEF Innovation team, says it’s a “two-way system.”  RapidSMS allows for an end user (most likely a field monitor) to report data. But there is also a “pull aspect,” Kochi explains, so a field worker can quickly access important information from a central, web-hosted database.

UNICEF first deployed RapidSMS in Nigeria in mid-2009 to track and collect data from the Immunization Plus days, a polio eradication initiative of the National Primary Healthcare Development Agency. In order for RapidSMS to be used in the first phase of the bednet distribution program, new features had to be created, says Akinbo, UNICEF’s local software developer.  Because it was designed with flexibility and scalability in mind, RapidSMS is relatively easy to customize for specific projects with technical expertise.

Scaling Up in Nigeria

As we previously described, 

RapidSMS was piloted during the first phase of the campaign to distribute 63 million insecticide-treated nets in Kano and Anambra states in 2009. The aim was to compile data on the flow of the nets from state stores to local distribution points, and to position supplies based on the information reported in real time by field monitors via RapidSMS. RapidSMS was also deployed to monitor bednet distributions in Sokoto and Kebbi states, and plans call for it to be used throughout the rest of the country by the end of 2010.

According to this case study

“Over the course of 14 days, RapidSMS captured data for the distribution of 141,773 coupons, or 283,546 ITNs in total. During this time, 232 stock transfers were tracked, spread out over 226 unique locations. NMCP calculated that RapidSMS directly monitored distributions that met 69 percent of the projected demand in Kano State, or 652,919 beneficiaries. This targeted real-time data allowed NMCP to later follow up on vulnerable pockets, delayed shipments and other irregularities.”

Akinbo notes that about 500 local health workers and government employees were trained to use RapidSMS on their mobile phones to send and receive information to assist them in their work. An advantage of RapidSMS is that it’s designed to be used with even the most basic mobile phones. Considering that there are more than 80 million cell phone users in Nigeria according to Wireless Intelligence most recent data from Q4 2009, this represents a fantastic opportunity for UNICEF to use RapidSMS at scale.

UNICEF Nigeria is planning to use RapidSMS on a variety of projects beyond bednet distribution, such as the Community Management of Acute Malnutrition initiative and a maternal, newborn and child mortality reduction program. For field teams in Nigeria, the rapid scale-up of RapidSMS is translating into real program management and coordination benefits, generating and delivering critical data for decision-making that field workers and program managers can leverage on a daily basis.

In Nigeria, the field implementation team there modified the software to inccrease usablity and lower data errors:

• Developers in Nigeria are working to ensure that as little misreporting of data occurs with RapidSMS, as well as on improving the usability of the technology. With each monitor responsible for collecting hundreds of bits of information and data and reporting them in real time, human errors inevitably occur in reporting at the end-user level. The goal of local software developers is to simplify the functionalities for each specific role.

• A mobilization team leader tracking the issuance of coupons will have access to specific reporting and query forms, while warehouse stock managers or distribution point team leaders each have their own suite of tools available. This micro-customization allows for a greater degree of data reliability by decreasing the number of variables monitors have to contend with.

The Nigerian RapidSMS development team also teamed up with the private sector to address cost issues. Field monitors, who rely on their personal phones for reporting, often had to use their own airtime for the purpose. This was particularly problematic considering that reporting often occurs on a nationwide scale. To decrease this cost, two of the mobile carriers, MTN and Zain – which together control more than half of the Nigerian mobile market, with roughly 50 million connections -- are now providing toll-free numbers for RapidSMS field users.

The Role of Tech in Development - Good Ideas and Good People First

The deployment of RapidSMS in Nigeria coincides with a broad push for greater inclusion of technology in Nigeria’s development agenda. Goodluck Jonathan, Nigeria’s newly minted president, officially launched the Information and Communications Technology for Development (ICT4D) plan at the opening of the e-Nigeria 2010 summit. The Nigerian president said the technology “is a major tool for driving the Vision 2020,’ and urged all government ministries and agencies to begin implementing the ICT4D agenda.

Amid this backdrop, RapidSMS is positioning itself as a relevant, useful and innovative tool that has the potential to benefit a variety of development projects across Nigeria.


Commenting on the current trend of leveraging technology for development purposes, Owen Barder, a British development economist who has worked in both IT and development, says “asking about leveraging technology for development is like asking about using telephones for management. The technology is irrelevant; what matters is whether the development ideas are any good.”

While RapidSMS is a valuable tool that can provide time and costs-savings in data collection, logistics coordination and communication, it isn’t a silver bullet. Challenges remain when it comes to how to translate data availability into concrete actions. RapidSMS helps to relieve some of the constraints of information-based decision-making, but it can’t solve all inefficiencies. Erica Kochi notes that the mobile-for-development sphere is still relatively restrained. Most projects that leverage mobile technology are still on a small scale and have yet to attract significant investments.  

“Technology is only the smallest part of the project,” Kochi says, echoing Barder’s sentiment. “You still have to coordinate all the different moving parts, and deal with the inherent complexity of multi-stakeholder initiatives. That is the toughest aspect.”

RapidSMS is proving to be useful, though, by helping to eliminate some key inefficiencies associated with implementing large-scale, complex and data-rich programs in remote locations. As demonstrated in the case of insecticide-treated bednet distribution in Nigeria, RapidSMS’ flexibility and openness make it a versatile tool which organizations can customize depending on the specific needs and context.

  By enabling fast and informed decision-making, RapidSMS is meant to, first and foremost, “support the workers on the frontlines,” Kochi says. Whether it’s food aid delivery logisticians in a remote village in Ethiopia getting access to critical information concerning food availability, or community health workers in Zambia and Malawi having HIV/AIDS test and diagnosis results at their fingertips, RapidSMS is ensuring frontline workers no longer have to make their decisions in the dark.

Penelope Chester is a contributing writer to 

Photo credit Flickr user attawayjl


Malaria Kills: Distributing 63 Million Bednets in Nigeria with RapidSMS data sheet 10381 Views
Countries: Nigeria

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