RapidPro would probably be a good name for an over-the-counter painkiller. The name fits, and as we’ve repeatedly found in Sierra Leone it gets to work….fast. And, its latest incarnation has been aptly medical – we wanted to know if we could use it to track the nationwide distribution of free health care drugs and supplies that takes place every quarter.
On Independence Day 2010, H.E. President Dr Ernest Bai Koroma added to the usual national celebrations by launching the Free Health Care (FHC) initiative for children under 5, and pregnant and lactating mothers. With support from DFID, the European Union, Irish Aid, UNICEF, USAID and other partners, the aim was to bring down the country’s tragically high levels of maternal mortality (the worst in the world) and child mortality (among the worst). Nearly six years on, the results prior to the 2014-15 Ebola epidemic looked promising.
But free health care entails more than just taking off the price tags. It requires a massive logistics effort to make sure the free medical supplies are in stock at all of the country’s more than 1,100 public health facilities. There’s no point offering medicines for free if they are not in stock. In a country with challenging infrastructure, where landscapes range from the rugged Loma Mountains of Koinadugu to the mangrove swamps of Bonthe, this is no mean feat.
When it comes to the Free Health Care initiative, UNICEF Sierra Leone remains a key partner to the Government of Sierra Leone and to the National Pharmaceutical Procurement Unit (NPPU), backed up by regular support from donors.
In November 2015, in preparation for the following month’s drug distribution, we decided with USAID support, to put in place a real-time feedback on the distribution, including helping us to spot and fix issues as quickly as possible. RapidPro provides a free-to-user SMS reporting service that allows people to send us data from their basic phones with a minimum amount of training. It’s straight-forward to use and doesn’t involve complicated hardware. It’s become a cornerstone of many of our programme activities in Sierra Leone over the past 18 months, from helping track supplies for schools to open safely during Ebola, to monitoring the numbers of children in Ebola care centres.
The list of drugs and other medical supplies disbursed for FHC runs to around 200 items, and the idea of reporting via SMS on all of them seemed cumbersome. With UNICEF’s Health team, we selected 20 lifesaving medicines (tracer drugs) to report on. If any were absent from deliveries at the Peripheral Health Units (PHUs), we knew we’d have to investigate and act.
The next stage was to build a RapidPro report flow, and test it in the field. Staff at PHUs near Freetown supported us by submitting dummy responses via SMS. Their feedback was good; it seemed to work. Next was a national training workshop for the Ministry of Health and Sanitation and NPPU’s District Pharmacists. The training went ahead on 9 November 2015. The DLOs went back to their districts and assembled all those who would have responsibility for receiving the delivery of drugs, and organised further training sessions. We set up a demo version of the RapidPro report so everyone could familiarize themselves with the reporting process. Back in Freetown, we were encouraged as we watched the demo reports come in.
In October, the first of two 85 MT plane deliveries of FHC supplies – funded and transported by USAID – arrived at Lungi International airport. From national warehouses the supplies were sent out to district medical stores, and then all was set for the final supply to PHUs, which started on 3 December. We received the first completed FHC RapidPro report that day at 16:31 from Masongbo Limba Community Health Post (CHP) in Bombali district. Over the distribution period 1,129 PHUs countrywide reported on receiving their FHC supplies using RapidPro.
Each day we collated all the submitted reports and shared results back with the relevant DLO for information and action as required. The results were overwhelmingly positive, but some issues were highlighted. In a handful of cases we saw that PHUs reported not receiving Amoxycillin or Paracetamol, though we knew from our colleagues in Supply section that they had been delivered. When UNICEF DLOs followed up with PHUs, they found that the packaging of Amoxycillin and Paracetamol were very similar, which confused people. This could have led to the incorrect supply of medicine, but thanks to the swift feedback from PHUs and response by the UNICEF team, this was avoided.
Free Health Care supplies continue to save young lives in Sierra Leone, and with RapidPro, we now have a tool to improve monitoring to be extra sure that the supplies end up where they are supposed to be.
Shane O’Connor is a Technology for Development officer with UNICEF Sierra Leone