Help For Malaria Erin J. Engelson, University of Washington Michael 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: 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

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 RDTs and 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 Services Blair Sterner Peace Corps Lauralea Gilpin Mike Sterner Cathy Seeley Sue Duvall Pharmacists without Borders Help For 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

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 * *

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 Operating Costs$122,420$450,100$4,231,000 Net Profit ($106,420)$133,900$1,609,000 Program Budget Need To Raise $865,000

RiskImpactLikelihood/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 RiseMedium 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 Washington Nono Ayivi-Guedehoussou, Harvard University

Sensitivity Analysis # 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 + Test RDT tests Drug Sales Logs Overseen 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 l Globalis Ranks Malaria Related Mortality Fifth Highest l 292 Deaths per 100,000 people For children under 5, 1,444 per 100,000 Rate of almost 5 times more l Malaria is the #1 killer of children Entire Classrooms such as this per week Photo Credit: unicef