Help For Malaria

Erin J. Engelson, University of WashingtonMichael Sterner, University of Washington

Nono Ayivi-Guedehoussou, Harvard University

Help for Malaria Mission

Mission:

Reduce mortality and morbidity due to malaria, especially in children

Solution:

Greater access to rapid diagnostic tests (RDTs) and combination drugs through our Community Health Workers (CHWs) employees and an Avon-like Distribution Network

Malaria: Worldwide

Problem: 300-500 million Cases Annually

Great Mortality: 1 to 3 million deaths

Lack of Access to Diagnostics and Treatment

Need Novel Distribution Solutions

Malaria Stunts Development

Low Human Development Index

High Malaria Mortality Rate

Burkina Faso: Higher than Neighbors

Deaths Per 100,000

050

100150200250300350

Countries in sub-Saharan Africa

# o

f D

eath

s

Burden in Burkina Faso

1.9 million cases

262,000 very serious cases

35% of all health consultations

40% of hospitalizations

37% of all deaths

Child Mortality Is Five Times The Rate Of Adults

Need For Accurate Diagnosis

Currently Malaria diagnosed by Symptoms

Symptoms Overlap: Leads to Misdiagnosis

Rapid Diagnostic Tests For Diagnosis

Market Need

High Pre-existing Demand

1.6 million out-of-pocket payments

1 in 6 people

From US$0.82 to US$4.21 a case

Suffer From Malaria

Willingness to Pay

87% Won’t Travel

Will Pay for Diagnostics

Target Market

Morbidity, Mortality and Loss of Productivity

Due to Parasites

Population In Need of RDTsand Combination Drug Regimens

Limited Access to Diagnostics and Trained Health Care

Providers

Client Incentives

Locally-based CHW Builds Credibility

Avon / Living Goods Distribution Model

RDT is Free and Appropriate Technology

Saves Patient Travel Costs

These Drugs are Affordable and Highly Effective

Drugs Sold in Regimen with Blister Packaging

Organizational Partners

Community in Need

PLAN International

Population ServicesBlair Sterner

Peace CorpsLauralea GilpinMike Sterner Cathy Seeley Sue Duvall

Pharmacists without Borders

HelpFor

Malaria

Ministry of Health Dr. Kambire Chantal

Dr. Moyenga Laurent

Organization

In-Country Administrators Recruit and Train CHWs

Each CHW will be assigned 5 to 10 villages

Travel a circuit by moto & bike

Paid a base salary to do tests & sell Rx + incentives

Monitor CHW tests, sales & propriety

Reach Community

Administrator

CHWCHW

CHWCHWCHW CHWCHW

Launch District

Koupela Health District

•Located 120 kilometers outside of the capital

•Population 32,000

•Clinics serviced by nurses, i.e. few trained staff

•Microscopy services in Nouna and Bobo Dioulasso

Rapid Diagnostic Tests

Employees will be trained to use RDTs

Provide Accurate Diagnosis

Reduce Use of Unnecessary Drugs

Benefits of Rapid Tests

Easy to Use

Easy to Read

Specific

Sensitive

Fast

Drug Regimens

ACT still too expensive

No Government Channels

SP + AQ Combination Proven

Endorsed by WHO and WARN

0

2

4

6

8

10

12

Child ACT ACT Child SP+AQ SP+AQ

Drug Regimen

Pri

ce in

US

$

* *

Projections

Profits Expected in Second Year

RDTs sold at $1.05 profit

Drug Regimens sold at $1.32 profit

In Later Years of a National Program:

Sales: 3 million RDTs, 1.3 million regimens

FY 2008(Koupela)

FY 2009 (5 Districts)

FY 2010 (National)

FY 2011(National)

Revenue$16,000 $584,000 $5,840,000 $5,840,000

Operating Costs $122,420 $450,100 $4,231,000 $4,231,000

Net Profit

($106,420) $133,900 $1,609,000 $1,609,000

Program Budget

Need To Raise $865,000

Risk Impact Likelihood/Mitigation

Failure to convince clients

High Medium/ Use of CHW who know the local languages and culture

Non-compliance of CHW

Medium Medium/ Paid Well, Trained, Monitored

Clients will not test positive

Low Medium/ CHW will work for 6 months

Gas Prices Rise Medium Medium/ Use Bikes and Mopeds

Clients will not properly use SP+AQ

Low Medium/ Blister packs with language and pictures appropriate to doses

CHW also know several languages

Social Impact (SROI)

Per Year of our National Program

256,266 Sick Days Avoided $842,518 Increase in GDP

785,920 Cases of Parasitemia

3000 jobs created

39,000 Lives Saved: Opportunity Cost$36.8 million GDP increase for the nation

Help For Malaria

Erin J. Engelson, University of Washington

Michael Sterner, University of WashingtonNono Ayivi-Guedehoussou, Harvard University

Sensitivity Analysis

1 2 3 4 # of Tests Sold (In Millions)

Using the Same Sales Assumptions

Economy of Scale

If we meet our expected # of tests and drugs sold, we reduce our costs to the consumer

Allows us to have different prices in different markets to meet the needs of the community

Client Outcome Metrics

CHW Logs: Ensure Drugs are Not Sold without a + TestRDT testsDrug Sales LogsOverseen by In-Country Administration

Client Satisfaction: Clients surveys

Ministry of Health:# of Cases# of Cases properly diagnosed with RDT# of Cases treated with antimalarials

Need for Health Care Staff

Severe Shortage of Trained Health Care Personnel

Doctors: 249 (1 per 30,080)Nurses: 3370 (1 per 1,800)Health Workers: 1319 (1 per 3,711)Pharmacists: 51 (1 per 370,000)*

*2006, According to the MoH in Burkina Faso, the National Health Sector

Train CHW

Malaria-Related Mortality Is High

Globalis Ranks Malaria Related Mortality Fifth Highest 292 Deaths per 100,000 people

• For children under 5, 1,444 per 100,000 • Rate of almost 5 times more

Malaria is the #1 killer of children

Entire Classrooms such as this per weekPhoto Credit: unicef