Ghana is a country in West Africa with approximately 23,000,000 people. 51% of these people live in rural areas, where only 45% of rural households have access to a health facility, compared to 92% of urban households.

Because of the lack of facilities in rural areas, chemical sellers are the primary point of contact for the healthcare needs of the population. This is a large issue; when people are sick, they go to chemical sellers for drugs to make them feel better instead of health care professionals. This demand has created a black market of chemical sellers, and when malaria and diarrheal diseases - both preventable diseases if treated appropriately and in a timely manner - account for a high proportion of a country's disease burden, the role of the chemical seller is pivotal to a country's socioeconomic development. The country now faces a huge problem of chemical sellers prescribing medication on a "trial and error" basis only 15% of LCS are able to administer malaria medication correctly.

There is, therefore, a market need for a tool that can supply chemical sellers with the proper information on drug medication appropriateness and effectiveness, possible adverse effects and drug interactions, and the potential for reducing drug-related morbidity.

Text for Health fills this market need by offering a new, innovative diagnosis system for licensed chemical sellers in rural Ghana. Through a mobile phone network, licensed chemical sellers can submit a number code based on particular symptoms and receive proper diagnoses and therapy information. At 25% coverage of the rural population, the total benefit to the nation is $12.8million per year, with significant reductions in sick and productive work days.

 The Market

The country wide market potential for Text for Health is all LCS (approximately 8000) in rural areas. In the first year of Text for Health, the rollout will target three villages within the West Akim municipality of the Eastern region: Okurase, Asuotwene and Asikasu. In year 2, the service will be expanded to 6 more villages, and the goal is to increase the number of villages by 6 each year between the third and fifth years after implementation. Because Text for Health increases access to drug-related information to rural areas with the utilization of mobile communication, chemical sellers who service rural communities are able to develop a reputable service without previous geographic barriers that hindered information access. Showing that drawing health services towards rural areas is possible, a recent intervention demonstrated a remarkable 250% increase between 1989 and 2002 in the number of pharmaceutical facilities throughout the non-urban areas of the Eastern region. This suggests a strong assumption that Text for Health can create performance incentives for chemical sellers, who dispense different classes of drugs than pharmacists, to continue serving the rural by making it more possible to develop a reputable service in underserved areas. This is particularly the case in Ghana, where 51% of its total population resides in rural areas.

The Product

The Text for Health service is a new, innovative diagnosis system for licensed chemical sellers (LCS) in the rural areas of Ghana, based on the steady increase in cell phone use in Ghana. Our product is a service via text messaging over a mobile phone network, that can provide rural LCS with better diagnosing information to sell appropriate drugs to the public. The steps for using our product are as follows:
1.       Customer goes to chemical seller
2.       Chemical seller completes a purpose built questionnaire with the customer to identify a constellation of symptoms and some demographic markers.
3.       This constellation of symptoms is then translated into a proprietary text for health code using an on-premise manual.
4.       Chemical seller texts the appropriate code to our system.
5.       An automatic response from the server at the Text for Health center recommending what drugs should be sold to person, and also suggesting one or two alternatives if first drug is not available, is sent to the chemical seller. A response for transportation to the nearest medical center will also be sent if the constellation of symptoms suggests that the patient requires medical attention.
6.       Chemical seller sells drug to customer.
7.       Chemical seller then confirms to our system the following: which drugs he/she has in stock including quantity and which drug he/she sold including quantity.

The main diseases that would be diagnosed by the Text for Health system include malaria and diarrhea, two of the most common diseases that affect both adults and children in the rural areas in Ghana. These diseases have been chosen for the initial start of the Text for Health service because the drugs for these conditions are classified as Class C drugs, and can therefore be sold over the counter by licensed chemical sellers, our target consumers. The benefits of the Text for Health service as compared to the current system of drug dispensing practiced by the LCS is as follows:
• Reduced trial and error in dispensing drugs, as recommendations provided are based on a constellation of symptom and information from database

• Higher potential for increased traffic for chemical sellers using service as they have better results

• Potential for point-of-sale information tracking for Pharmaceutical Companies, to provide real time information on how a particular drug is being sold and used

• Reduced adverse health effects, and preventable deaths

The Text for Health service will be marketed to licensed chemical sellers by first offering them an initial 3-month free trial subscription to the service, with the chemical seller being charged a fee per text message sent at the end of the trial period. Additionally, the licensed chemical sellers will be provided training on how to check for symptoms, and how to input the information on the symptoms into the text message format, so the server at the Text for Health center will be able to easily identify the information. A training manual will also be provided to the LCS for easy reference whenever they need it. Once the chemical seller receives the message with information on the diagnosis and the appropriate steps to take, the seller would be asked to send a text mentioning what drug was sold to the customer, and the quantity sold. Additionally, the LCS will be required to text to our system the names of any drugs they sell and the dosing information, even when patients do not present with symptoms but come in to request a particular drug, to enable us collect that point-of-sale drug information.

Implementation

Before Text for Health can be rolled out to the first three villages, some things that need to be put in place include forming liaisons and alliances with various stakeholders, purchasing equipment for the project, and hiring staff to run the project on the ground. We will be negotiating for sponsorship and price reduction of the text messages from the cell phone companies, forming an alliance with the Ghana Pharmacy Council and the Ghana Licensed Chemical Sellers Association, and discussing possible networking with the Ghana Health Services, who are also interested in providing health information to health workers and hospital staff. On the product development side, we will be working closely with a software engineer to design and test the database program that will be interfacing with the text messages. As the database is being developed, an accompanying manual with codes for disease symptoms and drug symptoms for LCS use will also be in development. With these two things completed, a server and computer for the project will be purchased, and a program manager to run the project will be contracted. The project will be rolled out in two stages: the initial rollout will be to the three villages of Okurase, Asuotwene and Asikasu, and the second stage will expand services to districts across the region, and to several rural districts across the country. To monitor our success, we will be keeping track of the kind of drugs that the LCS will be selling to the customers, to verify that the proper drugs have been given out.

Section I: Product Development

A computer program/database system that responds to text messages and employs an algorithm to match various symptoms in order to recommend a diagnosis will be the backbone of our service. Currently, the computer program is in the initial development stages, with a prototype being worked on by Geoffrey Asare, a software engineer who has volunteered his services for this section of development. The program is able to receive text messages and send a response via a GPS system using a SIM card. The timeline for completion of the computer program is as follows:

Project Stage       (Estimated Completion Date)
Completion of prototype       (April 2009)
Acquisition of symptoms and drugs list for database       (April 2009)
Testing of and modification of prototype       (May 2009)
Transition of prototype to working model/web-based model       (June-July 2009)
Develop LCS reference manual       (July 2009)
Purchase server and computer to host program       (August 2009)
Develop website for project       (September 2009)

The success of the program will be measured by its ability to receive text messages, accurately decipher the symptoms coded for in the text message, and respond with a correct diagnosis (90% of the time) and recommend the appropriate drugs (90% of the time). To check for accuracy, the same constellation of symptoms will be presented to a volunteer panel of Ghanaian pharmacists, to verify whether their diagnosis and recommendations correspond to those sent out by our system. The system will be tested with text messages sent from different carriers, using symptoms of different diseases already uploaded into the system, to ensure that the system is able to accept different combinations of symptoms in order to come up with a fairly accurate diagnosis.

Section II: Stage One- Rolling Out of Project to First Three Villages

      With the completion of the software program, the next step would be to negotiate and finalize the sponsorship deal with the cell phone companies, finalize the alliance formation with the Ghana Pharmacy Council, the Ghana Licensed Chemical Sellers Association, and the Ghana Health Services. Additionally, more start-up funding will be solicited from various foreign donor organizations and NGOs. Once these collaborations are formed, a program manager for the Ghana office will be contracted, and the development of advertising messages, flyers and brochures will commence. While the development of advertising materials is occurring, the chiefs and people of the three villages (Okurase, Asikasu, and Asuotwene) will be approached, and given various educational sessions about the project, in order to obtain their buy-in. Once their consent is obtained, the LCS will also be approached and educated about this program. The time period for developing these relationships and producing the advertising materials would be 3 months, ending in December 2009. The LCS will be encouraged to enroll in the trial 3-month period, starting from January to March 2010, and will be encouraged to text in every visit they receive during this 3-month period, so we can obtain sizeable information on common diseases the LCS attend to and the drugs that they often dispense. The LCS will be incentivized to text more by featuring the "LCS of the month" on a billboard, or profiling him/her on a radio announcement, in order to drive traffic to their stores. Additionally, there will be various announcements urging members of the public to request the texting service from chemical sellers.

Section III: Rollout to Regional and National Levels

      Once the three-month free trial period comes to an end, our aim is to have at least 2 LCS in each village signed up for our service. Quarterly visits will be made by the project manager to solicit an ongoing evaluation of the project from the LCS using it. At the end of the first year, the project will be evaluated to see how accurate the service was compared to regular diagnosis and dispensing by LCS. Based on the evaluation, the service will be reworked and the software program updated to incorporate any recommendations from the evaluation. The project will then be rolled out to other villages, expanding district by district in the Eastern Region, and then to other districts in other regions.

Management Team

Our management team has research and medical knowledge of the state of healthcare and access to healthcare in Ghana, as well as knowledge of health systems in international health.
•       Ada Kwan is a Master's student at the Johns Hopkins School of Public Health studying Health Systems in the Department of International Health. Ms. Kwan graduated from the University of Michigan with a Bachelor of Science in Neuroscience. She is most interested in ICT for development and public health - in particular, the ways that mobile phones can be used for disease surveillance, data collection, and as a device for health monitoring and real-time health information analysis in developing countries.
•       Yehoda Martei is a medical student at Yale University School of Medicine. Ms. Martei graduated Harvard University with a Bachelor of Arts in Neurobiology. She is interested in practicing medicine and building affordable healthcare programs in sub-Saharan Africa. She spent last summer doing research at the Korle-bu Teaching Hospital in Ghana. Ms. Martei is the currently the coordinator for the African Health Professionals Interest Group at Yale.
•       Denise Twum is a Master's student at the Johns Hopkins School of Public Health studying Social and Behavioral Interventions in the Department of International Health. Ms. Twum graduated from Amherst College with a Bachelor of Arts in Biology, and Women & Gender Studies. Ms. Twum is interested in improving the health outcomes of people in rural Ghana, and is especially interested in the sexual and reproductive health outcomes of young women and children. This past summer, Ms. Twum conducted a qualitative study in Okurase, one of the villages earmarked for the piloting of the Text for Health service.

Board of advisors  

•       Emmanuel Asiedu, CFA. Head of Stanbic Investment Management Services. Mr.  
Asiedu has a decade of experience in an emerging economy's financial markets. Emmanuel Asiedu works to boost Ghana's economic development through strategic assess management and investment initiatives.
•       Chilongo D. Mulanda MS. Senior software engineer, Oracle. Mr. Mulanda worked with MIT media lab to develop a texting system by which farmers in developing countries could obtain the going prices for their produce. The system was set to be piloted in Brazil and India.
•       Daniel Mensah MBA. Social Franchise Manager, Freedom from Hunger. Mr. Mensah has over 15 years in healthcare management and 8 years of experience in microfinance. He is currently playing a leading role in the design and implementation of FFH's new social franchise initiative in West Africa called MicroBusiness for Heath which involves community distribution of life-saving health protection products. Most recently, he managed the development process and the launch of the CareShop franchise in Ghana, West Africa. CareShop is an essential medicine franchise with over 300 franchised medicine sales outlets in rural and underserved areas of Ghana.