Tracking medicine deliveries from their central warehouses to the point of treatment is a difficult task in rural Africa. Logistical challenges as well as a high prevalence of counterfeit medicine in Kenya prevent medical deliveries as well as medical aid programmes from being fully efficient. A new tool developed by Merck, in collaboration with its partners in the Neglected Tropcial Disease (NTD) Supply Chain Forum addresses these inefficiencies and offers a much-needed solution for transparency.
In May 2016, Christian Schröter and his working group co-created a tracking prototype called “Value Chain 4.0” during the lab of tomorrow. This prototype built on the existing structure of NTDeliver and added simple tracking of medication throughout the remaining supply-chain in the endemic country. Together with the local authorities it was possible to test Value Chain 4.0 within Kenya’s existing school-based deworming programme. The new system benefits from the high-density of mobile connectivity even in rural areas of Kenya. In order to make use of the typically available feature phones the system relies on text messaging communication. After treating their children at school, teachers send a text message stating the drug batch number and the amount of tablets used directly into the system. This data is automatically added to the cloud-based platform where a dashboard gives stakeholders enhanced visibility and unified control of the supply chain.
Antonia Asche, specialist in Merck’s Praziquantel Donation Programme, describes the project’s added value as follows: “The solution is very valuable for our donation programme, and also those of other companies, because it allows better control of the application of our tablets.” According to Asche, leftover tablets from one treatment wave are currently being taken to nearby health care centers for routine care, which does not draw the donation’s full potential. The end-to-end tracking tool enhances easier matching of supply to demand, enabling actors to bring the tablets back into the same project and thus reach more children in the future. If one school reports the distribution of only a very small amount of tablets, Merck, together with its local partners, is able to investigate the cause of the low distribution – e.g. the lack of food prevents a school from providing children with a meal as required before treatment. Hence, the solution’s real-time feedback allows stakeholders to react to certain circumstances immediately and to remove obstacles.
The pilot phase of Value Chain 4.0 was completed in the second quarter of 2017 and due to its success all stakeholders decided to continue with a real rollout in Kenya. In 2018, two treatment campaigns of the school-based deworming programme where fully tracked using NTDeliver and generated over 8,900 datasets, meaning the number of responsive schools. The tracking tool is implemented for the whole programme, hence including albendazole treatments. The process has been further improved and is fully integrated into the Kenyan school-based deworming programmetoday. Therefore, it has dropped its initial name “Value Chain 4.0” and is now referred to as “NTDeliver last-mile tracking”.
Merck is donating up to 250 million praziquantel tablets per year to treat school-aged children in Africa against schistosomiasis, one of the most severe neglected tropical diseases. The company has shown a strong commitment to tracking of donation medication over the past couple of years. They especially focused on finding a solution within the school based deworming programme in Kenya, where nearly 2.5 million people are affected by schistosomiasis according to the World Health Organization (WHO). Implementing such donation programmes is challenging as for example import procedures are complex and time-consuming and local infrastructure is weak. Many parties such as the donors, logistic service providers, the WHO and local authorities are involved to deliver the tablets where they are ultimately needed – the point of treatment in rural Kenya. “If the collaboration between those partners does not work seamlessly, we face delays in the shipment and potentially miss a treatment campaign”, explains Dr. Christian Schröter, Senior Director of Pharma Business Integration at Merck. In response to the need for reliable tracking of donations, the NTD supply-chain partners worked with digital experts to create NTDeliver (www.NTDeliver.com), a tool that tracks shipments from the original donation to the first warehouse in the beneficiary country. The measures taken had already minimised the lack of transparency. However, tracking of donation medicines between the port of arrival in the country and the designated treatment centre still did not exist. This was the starting point for Merck to enter the 3rd lab of tomorrow in 2016 with the overall focus on “Access to medicines and diagnostics in Kenya”.
According to Christian Schröter, the lab of tomorrow, run on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), was able to provide valuable support especially in the beginning of the last-mile project. Introducing the solution as the result of an innovation process backed by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH facilitated the negotiations with the Kenyan Ministry of Health and other authorities. Schröter considers this a “great help” and a “win-win” for all parties involved. "Also, it is remarkable how technically simple the idea is”, Schröter adds. “We did not reinvent anything, but used things that were already there - the teacher's simple feature phone, the SMS feature, the cloud. Somebody even said during the Guinness World Record challenge, ‘It's so easy!’, and that is true. You just have to dare and do it. The current challenge is that there is a different mix of stakeholders in each country, but technically, we could track all of Africa tomorrow.”
The smooth collaboration with all partners in the NTD supply chain forum is one of the project’s particularities. The coalition’s strong partnership can also be seen in their achieval of a Guinness World Record on 30 January 2017, when Uniting to Combat NTDs accomplished to donate the most medication in 24 hours.In September of 2018, the NTD Supply Chain Forum met again and agreed on further rollout with everyone contributing ideas on how to expand. “It would be nice if the system could be quickly rolled out in another five to ten countries”, says Schröter, “even if that's optimistic.” It is sure to say that the project’s journey has just begun and more success stories – or even Guiness World Records - are to be expected soon.