This project was done as part of the How to Change the World (HtCtW) program, an experiential education program that aims to empower people, organisations and communities to collaboratively tackle the worlds most important problems using the United Nations Sustainable Development Goals (SDGs) framework. This program was hosted by the Faculty of Engineering at the University of Western Ontario and administered by the How to Change the World Organization from November 2nd, 2021 to November 5th, 2021.
The given task was as follows:
"You and your team have been asked by the Government of Uganda with its capital in Kampala to develop a proposal for how the community can respond to the challenges and opportunities associated with "good health and wellbeing". This is a core element of UN Sustainable Development Goal #3 which is centered on ensuring healthy living and promoting well-being for all ages. SDG #3 takes into consideration the dilating economic and social inequalities, climate and environmental impacts of urbanization and industrialization as well as the continuing burden of HIV and other communicable and non-communicable diseases. Additionally, the impact that the COVID-19 crisis has had on the health care system cannot be overemphasized with many cities having their health care infrastructure completely crumbling in the attempt to combating the pandemic. Similarly, the economic impact of the pandemic is enormous. We would like your team to evaluate and consider these implications within your process. Your team's proposal can engage or encourage any part of the community (e.g., its residents; its community organisations; its local government; businesses; [social] entrepreneurs; etc.) and broader stakeholders invested in supporting the community (e.g., the local governments; large corporations; non-profit foundations and organisations; etc.) to seize specific opportunities and take specific actions."
This project would not have been possible if it weren't for the generous contributions of various consultants including local stakeholders, faculty members, industry experts, and the HtCtW educational/support team.
Problem Statement[edit | edit source]
Rural communities in Northern Uganda are adversely and unequally burdened by Malaria due to an inequality in access to malaria prevention nets as their location, remote from larger cities, inhibits transportation of healthcare supplies. Consequently, this has caused a significant burden on both healthcare resources and the general wellbeing of rural communities.
Understanding the Problem: Distribution of Resources[edit | edit source]
Despite the continuous efforts by the Government of Uganda and partnering organizations such as the Bill and Melinda Gates Foundation that have distributed up to 27 million mosquito nets to families across the country, Malaria is still a prominent concern for Ugandans, posing as the leading cause of mortality. Those who reside in rural regions are especially vulnerable to the viral disease due to weak distribution chains connecting National/Joint Medical Stores, which are Pharmaceutical product suppliers in Uganda, to smaller communities up north. In return, environmental factors posed by their latitude in congruity with poor distribution chains cause a significant inequality to access to nets and other healthcare resources, leading to an observed greater vulnerability to and thus cases of malaria, leading to higher mortality and morbidity rates.
The Stakeholders Involved[edit | edit source]
Community Leaders[edit | edit source]
For rural Ugandans, agriculture is a way of life. We have identified the disruption of their existing way of life as a possible significant barrier to implementation, leading to the complete rejection of our proposals. Community Leaders would be vital in assisting with assuring synergy between local communities and our organization. Community leaders are trusted individuals who are able to provide insight into the local culture and way of life, but also spread awareness and acceptance of our solution.
Local Citizens[edit | edit source]
The successful implementation of a solution requires empathizing and cooperating with local Ugandan citizens living in northern rural communities. We must implement a low-cost solution that is affordable, accessible, and effective at protecting them from Malaria while also considering other ways to add value to their life. They are the most important stakeholder to our solution as it impacts their health and wellbeing. Certain local citizens will also be hired by our organization as operators, details will follow.
Government & Public Health Entities[edit | edit source]
Without government support, the implementation of our solution would not be possible. The Ministry of Health would be a key source of funding, assisting in covering general operational costs, including the funding and thus provision of fibre processing equipment. Additionally, District Health Officers would be vital to the provision of local knowledge, including knowledge of the current wellbeing of certain rural communities, thus aiding in identifying the best candidates for the introduction of our solution. District Health Officers would also assist with all communications, acting as a medium and translator. Additionally, government certified professionals in health and safety standards, as well as the operation of organizational equipment will be hired for training purposes of operators. This will ensure efficient and effective use of organizational equipment, as well as avoid health and safety issues surrounding the use of machinery. Local contractors would be vital to this in order to overcome language and educational barriers.
Trusted & Compensated Community Liaison (TCCL)[edit | edit source]
Regional employees of our organization who oversea general operations over the long run. Trusted & Compensated Community Liaisons will be responsible for general operations, commerce of nets, quality assurance, initiative observation, and maintenance requests.
Designing for Success[edit | edit source]
The primary goal of our organization is to reduce Malaria's mortality and morbidity rates in rural Uganda, attempting to combat the observed inequalities in healthcare service distribution. However, in order to achieve so in the long run, multiple metrics must be followed and achieved which are outlined in the below headings.
Long-term Sustainability[edit | edit source]
A critical component to achieving long-term success of our efforts is by seeking to incorporate sustainable sources to reduce negative impacts on the surrounding environment and ensure that Ugandan communities will be equipped with the necessary knowledge/skill to continue the efforts of reducing Malaria infections when we step away from the scene after (timeframe) of implementation in a new district. Combining these key factors will generate an optimal distribution strategy to sustain universal coverage.
Accessibility[edit | edit source]
Currently, 75.05% of the 47 million total Ugandan population reside in rural regions of the country. Although it is not realistic to target every community that lacks proper accessibility to mosquito nets, our efforts should be concentrated in regions experiencing the highest risk of contracting malaria and require the most amount of medical attention. As seen in Figure 1, the highlighted districts are our area of focus which consists of a population of just under one million. Our goal is to deliver 2000 nets within the first year and continue to grow that number as more equipment is gathered and able to implement in other communities.
Effectiveness of the Nets[edit | edit source]
It is important that the solution to unequal access of mosquito nets also prevents further contractions of Malaria in rural districts of Uganda. To measure the effectiveness of our efforts, mortality and morbidity rates in those specified districts will be examined and would require a 10-15% reduction over the course of 2 years. This criteria will be monitored through the collection of data provided by the Ministry of Health on annual mortality and morbidity.
Our Proposal[edit | edit source]
Implementation of our proposal will be conducted on a community by community basis. Stages will be followed appropriately, and time taken for completion of a stage will vary drastically according to on the ground circumstances.
Stage 1: Establishing Relations[edit | edit source]
This stage involves connecting with community leaders that are trusted and well respected by the local citizens that are the primary source of overcoming cultural/language barriers when interacting with the citizens and to welcome our visit. This is crucial to ensuring our presence does not disturb or alarm the community.
At the same time, Uganda's Ministry of Health will be contacted to appoint a member as one of our Trusted & Compensated Community Liaison and would be employed to work under a contract (see Responsibilities of Trusted & Compensated Community Liaison below).
Local citizens will also be employed as labourers for our initiative, operating organizational property. These individuals will experience training facilitated by expert contractors at the cost of the organization. Operators will be trained in the efficient and effective use of hardware, and be tasked with production quota goals per month, paid under a commission basis, as covered below. Operators state of employment will be held liable if misconduct regarding organizational property is observed.
Responsibilities of Trusted & Compensated Community Liaison[edit | edit source]
TCCL's will be responsible for general operations of the proposed solution, including ensuring compliance with local regulative committees such as the Ministry of Health and Police, managing operators, and routine communication with organization. The TCCL will also be responsible for the termination of this initiative. Once a surplus of nets is achieved within a community, or a lack of demand is observed, TCCLs will discontinue purchasing nets from operators, and operators can begin direct commerce with their respective communities. Operators can retain organizational equipment on the good faith agreement that they will continue to produce and service existing nets. At this period in time, a significant reduction in malaria morbidity and mortality cases should be observed, that being the maximal or near maximal contribution possible of untreated, woven mosquito nets. Donated hardware may be used for alternate purposes of income, including weaving fishing nets and other useful items. At this point of discontinuity, our organization's relationship with the community will be terminated.
Stage 2: Delivery and Setup of Machinery[edit | edit source]
In order to allow the production of mosquito nets to be sourced directly from rural communities, proper equipment and general expenses must be considered. All operational expenses will be financed through the Ugandan Ministry of Health and international donors sourced through methods such as GoFundMe. Funding would include:
- Fiber Extractor
- Loom
- Transportation Costs
- Wages of District Health Commissioners and Maintenance Contractors
- General operational costs
In conditions where additional building space is not available in the community, subsidized huts will be set up in open areas to provide a safe operating space and protect to the equipment against weather situations. A secure container will be provided to store the produced nets before the Ministry of Health comes and collects them.
Stage 3: Training[edit | edit source]
Operators are trained by Banana Fire Extractor and Loom machine experts appointed by Uganda's Ministry of Health to pass on their knowledge and expertise, ensuring the proper use of equipment and safe practices. These operators will receive a certificate indicating their capability and only individuals who are certified are allowed to run the machines. It will be the responsibility of the TCCLs to ensure this requirement is followed.
Stage 4: Production and Storage of Nets[edit | edit source]
Once the operator is comfortable running the machinery, they will begin the production of mosquito nets. The amount of nets produced will be determined by many factors such as the availability of raw resources (banana tree waste and bamboo plants) but will approximately be around 5 nets for every 100 persons per month. The finished nets will then be stored in the containers provided until it is collected by the TCCLs which they would pay the operator for.
Stage 5: Distribution of Nets[edit | edit source]
The distribution of nets will be under the onus of TCCLs. Near the commencing of the operation, when demand for nets far exceeds supply, TCCLs will be responsible for equitably distributing nets according to priority. Pregnant mothers and children under 5 years of age will receive nets first, followed by the rest of the community. Once TCCLs observe that initial demand has been met, nets can be left in communal distribution sites such as healthcare outposts or religious/community leader homes to facilitate further distribution, up until the termination of the initiative.
Role of TCCL: Commerce of Nets[edit | edit source]
At the forefront of this initiative, TCCLs will be responsible for the trade of the nets. Through monthly or more frequent community visits, dependant on production rates and demand, this individual will purchase and thus compensate, and distribute nets. Nets will be purchased from producers by TCCL's at flat rates, acting as a commission wage for their efforts. Wage funding will be from our organization and will be categorized as operational costs funded through donations. TCCL's will then proceed to equitably distribute nets throughout communities through observing families in desperate need, such as those with pregnant mothers and children under 5, and distribute accordingly. Alternatively, once initial demand has been met, nets can be left at communal distribution points for individuals to collect themselves.
Role of TCCL: Quality assurance[edit | edit source]
Nets will be produced by communities using looms calibrated to mosquito net specifications (<1.0mm between each strand). This specification must however be measured and verified before each purpose to ensure efficiency of machinery, and to avoid any exploitation of resources such as tampering of calibrations.
Stage 6: Continual Operations[edit | edit source]
At this stage, stages 4 and 5 will be repeated till the termination of our relationship with the community. TCCLs will likely conduct biweekly to monthly visits to communities, and operational costs may be expected to increase as maintenance costs will be incurred.
Role of TCCL: Initiative observation[edit | edit source]
TCCL's will ensure that each region equipped with organizational equipment is effectively and appropriately using equipment through fulfilment of monthly production quotas. Quotas will be determined as a percentage of community population, dependant on on the ground factors such as abundance of raw resources and capacities for production, however will remain around 5 nets per 100 persons per month.
Role of TCCL: Maintenance requests[edit | edit source]
Inevitably, hardware, especially through use, experiences ware and tare. Over time provided machinery will become obsolete if not effectively used, maintained and managed. TCCLs will be responsible for routine inspection of organizational property, including the contacting of trained maintenance contractors when necessary. TCCLs will be trained in general examination procedures.
Visualizing the Process[edit | edit source]
Inevitably, hardware, especially through use, experiences ware and tare. Over time provided machinery will become obsolete if not effectively used, maintained and managed. TCCLs will be responsible for routine inspection of organizational property, including the contacting of trained maintenance contractors when necessary. TCCLs will be trained in general examination procedures.
In addition, a flow chart depicting a standard process from raw materials to finished goods commerce has been created below.
Next steps[edit | edit source]
Proof of Concept[edit | edit source]
Banana trees are common crops farmed in Uganda in which farmers can only harvest bananas once, making the trees no longer useful. These trees are typically rendered as waste which may not even be composted due to a relatively high carbon content. There is an access amount of raw materials to extract fibres that can be used to aid the manufacturing of mosquito nets. Bamboo plants are also widely available in Uganda being a crucial material for the construction of houses and infrastructure and has an added benefit of being able to extract fibres from them. In recent years, initiatives have been launched attempting to promote Bamboo production. Since these natural fibres found in sustainable sources are already used by the Ugandan communities to make blankets, it is a durable material to have the mosquito nets be made out of.
Financing[edit | edit source]
The Ugandan Ministry of Health and international donors sourced through method such as GoFundMe would be the primary source of funding for this initiative. Funding would include:
- Fibre Extractor
- Modified Loom
- Transportation Costs
- Wages of District Health Commissioners and Maintenance Contractors
- General operational costs
In an effort to boost funding and media presence, international donors will be financially responsible for the purchasing of nets. When TCCLs purchase nets from Operators, funds would be sourced from international donors.
Nets will be purchased from operators at the fixed cost of US$1/m² of to specification net produced. The assessment of quality as well as transaction will be conducted by the regional respective TCCL. Conducting sales at US$1/m² under the assumption of 100m² of nets produced per month per operator would equate to a wage of US$100/month, which according to local experts is a living and competitive wage for the region.
Nets will be produced and sold at 3 sizes, corresponding to baby cribs, beds, and larger rooms.
- Small: 2m², purchased back at US$2
- Medium: 4m², purchased back at US$4
- Large: 8m², purchased back at US$8
Discussion[edit | edit source]
Some next steps for this project include:
- Researching and creating an open-source prototype for the fibre-extraction machine
- A more accurate and in-depth analysis of the associated costs and sources of funding for implementing this system
Future work on this page:
- Any additional relevant information that would improve the system and/or strengthen the case for implementing this system
- Inline reference numbering
References[edit | edit source]
C. O. Okwelogu, M. De Matas, N. D. Ifudu, B. O. Silva, and P. York, "Preliminary formulation of a fixed-dose paediatric combination of artesunate and amodiaquine hydrochloride," UNILAGSpace, 06-Nov-2009. [Online]. Available: https://ir.unilag.edu.ng/handle/123456789/2106?show=full. [Accessed: 04-Nov-2021].
E. Biryabarema, "Uganda start-up bets big on banana waste," Reuters, 16-Apr-2021. [Online]. Available: https://www.reuters.com/business/environment/uganda-start-up-bets-big-banana-waste-2021-04-16/. [Accessed: 04-Nov-2021].
J. Baffes, A. Heinemann, P. Nagle, and C. Biancotti, "World Bank Open Data," Data, 04-Nov-2021. [Online]. Available: https://data.worldbank.org/. [Accessed: 05-Nov-2021].
"Northern Region, Uganda," Wikipedia, 02-Aug-2021. [Online]. Available: https://en.wikipedia.org/wiki/Northern_Region,_Uganda. [Accessed: 04-Nov-2021].
Person and E. Biryabarema, "Uganda start-up bets big on banana waste," Reuters, 16-Apr-2021. [Online]. Available: https://www.reuters.com/business/environment/uganda-start-up-bets-big-banana-waste-2021-04-16/. [Accessed: 04-Nov-2021].
S. P. Kigozi, R. N. Kigozi, C. M. Sebuguzi, J. Cano, D. Rutazaana, J. Opigo, T. Bousema, A. Yeka, A. Gasasira, B. Sartorius, and R. L. Pullan, "Spatial-temporal patterns of malaria incidence in Uganda using HMIS data from 2015 to 2019," BMC Public Health, 14-Dec-2020. [Online]. Available: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-10007-w. [Accessed: 05-Nov-2021].
Contributors[edit | edit source]
- Cameron Brooks
- cbrook49@uwo.ca
- Kaven Wijeyekoon
- kwijeyek@uwo.ca
- Anita So
- aso44@uwo.ca
