Adapting Tech-Enabled Incentives for Fevers in Children
Country: Uganda
Amount: $1,200,000
Duration: 2 years
Problem
In many African countries, private pharmacies are the first place parents go when a young child has a fever. However, pharmacy staff often assume any fever is malaria and give antimalarial drugs without proper testing. This can be dangerous when the fever is actually due to a bacterial infection or other illness – the real illness goes untreated, and the child’s condition can worsen.
In Uganda and neighboring countries, thousands of children under five die each year from treatable illnesses because they don’t get the right treatment in time. The root issues are lack of diagnostics at pharmacies and lack of incentives for pharmacy owners to follow standard treatment guidelines. If pharmacies had better tools and motivation to correctly manage fevers, many of these deaths could be prevented.
Approach
Digital Incentive System: Maisha Meds, a health technology nonprofit, has developed pharmacy management software used by 2,900 private pharmacies in East Africa. With our support, Maisha Meds is adapting its software in a new initiative to improve treatment of childhood fevers in Uganda. The system will include a reimbursement program that rewards pharmacists for following proper fever treatment protocols – for example, performing a malaria test and then either referring the child to a clinic or providing appropriate medication based on the result. This creates a financial incentive for pharmacists to avoid the default “malaria pill for every fever” approach and ensure more serious illnesses are recognized and treated correctly.
Testing Two Solutions: The project will run a randomized controlled trial (RCT) to compare two strategies for under-5 fever cases: one group of pharmacies will be incentivized to refer sick children with non-malarial fevers to higher-level care (clinics or hospitals), while another group will be incentivized to treat those fevers on the spot with appropriate antibiotics when needed. By experimentally evaluating referral vs. on-site treatment, the project will learn which approach saves more lives and is more cost-effective in this context. The RCT will involve large numbers of pharmacies and patients, providing robust evidence for policymakers.
Path to Scale
Maisha Meds’s software is used by 2,900 private pharmacies and will be scaled to over 1 million new patients in Kenya, Uganda, and Nigeria.
Because this solution piggybacks on existing private pharmacies and uses software to drive behavior change, it can expand quickly without massive new infrastructure. If the trial shows strong results, Uganda’s health authorities and pharmacy chains can integrate the incentive program into standard practice. Maisha Meds already operates in Kenya and Nigeria as well, so a successful model in Uganda could be exported to those countries’ pharmacy networks with relative ease. The long-term vision is a region-wide improvement in the treatment of childhood illnesses, using technology and smart incentives to make sure children get the right care at the right time.
Why we think the grant is cost-effective
Correct treatment using the antibiotic Azithromycin could prevent 514 deaths of children under 5, with a marginal cost of only $1 per patient, and a marginal cost per DALY (healthy year of life) saved of $154.