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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

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Improving Childhood Immunizations with Cellular Technology

Sanjay JainJohns Hopkins UniversityBaltimore, Maryland, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

Sanjay Jain of Johns Hopkins University School of Medicine in the U.S. and colleagues in the U.S. and India will develop a cloud-based platform to record the location, caregiver relationships, and immunization records of infants in developing countries, and provide personalized reminders and incentives via mobile phone to improve the coverage of childhood immunizations. Low immunization coverage has been linked to inaccurate or incomplete records, and the difficulties of encouraging follow-up immunizations and identifying those who miss them. Their platform will store data in a cloud to ensure universal access to records, and use fingerprint identification of the caregiver for accuracy. It will also document each child's care network and location, and use this to send multiple text message reminders, and manage group and combined vaccinations to improve efficiency. They will test their approach in a low-resource rural community by training health workers equipped with mobile tablets, and recruiting around 800 mothers with infants or pregnant women provided with mobile phones.

Neo-PATch: Plasma Analyte Transdermal Wearable Sensor for Newborns

Patricia ConnollyUniversity of StrathclydeGlasgow, United Kingdom
Grand Challenges Explorations
Wearable Sensors
1 Nov 2017

Patricia Connolly of the University of Strathclyde and colleagues in the United Kingdom will develop a low-cost, wearable skin patch that can continuously monitor metabolite levels in newborns without the need for blood sampling, and can alert mothers and health workers to potential problems via mobile phone. Changes in metabolites such as those of hemoglobin and bilirubin are used to assess many aspects of newborn health, but current methods require invasive blood sampling and access to laboratory analysis, which is often unavailable in low-resource settings. To address this, in consultation with users in Sierra Leone, Vietnam and India, they will develop a flat patch incorporating their new technology, which painlessly enhances the flow of analytes through the skin for detection, and a Bluetooth connector that can communicate levels to a smartphone. The prototype patch will be laboratory tested to refine the design.

A Marketplace App for Connected Pathology Services in Africa

Jacob McKnightUniversity of OxfordOxford, United Kingdom
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Jacob McKnight and Mike Wilson of the University of Oxford in the United Kingdom will develop a simple application that contains information about the quality, location, and the nature and cost of services provided by the different pathology laboratories in Kenya so that doctors and patients can choose the one that best suits their needs. They will conduct surveys to collect key information on the pathology laboratories in the Nairobi area, and consult with doctors and medical associations to find out how they use those laboratory services and what needs to be improved. They will build the application using these data and in collaboration with users. Ultimately, the system should also help to improve the overall quality of services.

Confidential Order and Delivery of Contraceptives Using Mobile E-Commerce for Urban and Rural Areas of East Africa

Joanna BichselKashaKigali, Rwanda
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Joanna Bichsel of Kasha in Rwanda will adapt their mobile ecommerce platform to enable women in Kenya to confidentially order health products such as contraceptives and sanitary pads by mobile phone. There are many social barriers preventing women in developing countries from accessing products at health clinics. Their platform, Kasha, requires only a mobile phone to order and pay for products that are then delivered to local pick-up points. They have successfully implemented Kasha in Rwanda and will now perform a pilot study in several counties in Kenya. They will customize the platform to the language and existing technology in Kenya, and develop private and public partnerships to tap into existing distribution networks, thereby minimizing costs. Their pilot study will evaluate how well the platform is received by Kenyan women, and how effective it is at delivering products.

Last Mile Healthcare Delivery by Unmanned Aerial Vehicles in Senegal

Daniel PepperVAYU inc.Ypsilanti, Michigan, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Daniel Pepper of Vayu in the U.S. will assess the value of using unmanned aerial vehicles integrated with existing healthcare supply chains to transport healthcare products and diagnostic samples in Senegal. Healthcare supply chains are critical for saving lives but are restricted by poor road infrastructure in developing countries. Unmanned aerial vehicles can overcome these restrictions and ensure rapid transport in temperature-controlled conditions. They will engage stakeholders from the Pharmacie National d'Approvisionnement (PNA) to National laboratories, the Expanded Program of Immunization, the National Blood Bank and the Ministry of Health to explore the feasibility of using unmanned aerial vehicles for delivering vaccines, essential medicines, contraceptive products and blood, and also to pick up tuberculosis samples for diagnosis. They will perform a test over a three- to four-month period to evaluate the impact of their approach on delivery and costs, and gather feedback from users.

Introduction of Vaccines Supply Chain Downstream Delivery to Improve Availability of Vaccines at Health Facilities in Lesotho

Bulara MpitiClinton Health Access InitiativeBoston, Massachusetts, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Bulara Mpiti of the Clinton Health Access Initiative (CHAI) in the U.S. will use the clinical sample transportation network in Lesotho to increase the efficiency of delivering viable vaccines to local health facilities. Most health facilities in Lesotho experience stock-outs of essential vaccines, which are caused by weak supply chains from the stores at district offices. The health facilities are also visited at least once per week by motorcyclists from delivery agencies to pick-up clinical samples for rapid transport to diagnostic laboratories, which are located in the same district offices as the vaccine stores. They will engage these delivery agencies to also manage the ordering and transport of vaccines in the other direction, from district stores to health facilities. To test their approach, they will perform a pilot in selected districts and train vaccine supply managers, health workers, and sample transporters.

FutureStock Solution

Shahnoza EshonkhojaevaSinostream ABStockholm, Sweden
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Shahnoza Eshonkhojaeva of Sinostream AB in Sweden will use machine-learning algorithms to predict the amount of medicines and supplies needed at individual health clinics in low-resource settings, and to inform medical stores for delivery. Their approach involves obtaining daily consumption patterns that are recorded on smart paper stock cards at rural health clinics, which requires no training, internet access, or electricity. These cards will then be scanned at district health service centers, the data digitized, and algorithms used to calculate consumption patterns and waste, and automatically predict future demand. They will build a prototype system and field test it in Uganda to evaluate how well it avoids under- or overstocking products, and the cost-saving and time-saving benefits of having an automated stock management system.

Inventory Visibility Using Radio-Frequency Identification Tags and Near-Field Communication

Mitesh ThakkarArthify IncJohns Creek, Georgia, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Mitesh Thakkar and Harsh Shetty of Arthify Inc. in the U.S. will use radio-frequency identification tags (RFID) on vaccine packages that can be detected by near-field communication (NFC) now found on most smartphones to better track vaccines and improve supply chains in developing countries. They will develop an application for health workers to automatically read the tags and store the data in a cloud, which can then be used to take inventories. They will also build a website so that the data can be easily monitored by supply chain managers to analyze performance and predict demand. They will test their platform for accuracy, feasibility, and cost in a network of 20 primary health centers with 100 sub-centers.

Blockchain: A New Backbone for the Vaccine Supply Chain

Roice FultonDenominator GroupGeneva, Switzerland
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Roice Fulton of the Denominator Group in Switzerland will test the value of blockchain, which is a decentralized secure database, for stakeholders such as distributors and health workers to record and monitor the movement of a vaccine along a supply chain, to ensure the availability of sufficient levels of working vaccines. Following the route of a vaccine from the producer to the patient would ensure its safety and allow for better monitoring of stock and supply chain performance, which would improve vaccine availability and help identify ways to increase efficiency and lower costs. Blockchain is an efficient and secure way to share information. They will test their approach in Tanzania, which has a fairly robust supply chain, by tailoring blockchain to integrate with existing platforms, and evaluate its ability to reliably monitor vaccines.

Engaging Local Shopkeepers for Last-Mile Delivery of Medical Supplies in Hard-to-Reach Areas

Zawadi MageniIfakara Health InstituteIfakara, Tanzania
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Zawadi Mageni of the Ifakara Health Institute in the United Republic of Tanzania will train local shopkeepers to deliver essential medical supplies to remote areas. Delivery of health products to hard-to-reach areas is problematic due to the poor surrounding transport infrastructure, which suffers further during the rainy seasons. This often means that essential products are out of stock. However, shopkeepers in these areas, with their local knowledge and support, still regularly travel to their central suppliers to maintain their own stocks. These shopkeepers could also be used to deliver medical supplies. They will identify test villages in Tanzania, and the location of medical stores for pick-up points. They will develop a database to map the local health centers and establish an inventory of their medical supplies. Selected shopkeepers will be enrolled and trained, and they will evaluate their approach for avoiding stock-outs of medical products.

Low-Cost Technology Solutions to Connect the First and Last Mile and Redefine Medication Supply Chains Across East Africa

Jessica VernonMaisha MedsPalo Alto, California, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Jessica Vernon of Maisha Meds in the U.S. will develop a smartphone-based point-of-sale system and online ordering platform to better supply medications to the private healthcare markets across sub-Saharan Africa. Local private pharmacies supply important health care products to a large number of people, particularly those without employer-funded health care. However, they are often understocked, or stocked with poor quality or expensive medicines, and require cash payments. Because many pharmacy owners have smartphones, they are developing a point-of-sale system for Android devices that records information associated with each sale such as price, brand, and patient phone number. This will enable the shop owners to better manage their inventory and predict future demand, thereby improving their performance. They will also leverage partnerships with trusted suppliers and develop an e-Marketplace so that pharmacists can order stocks electronically based on these predictions. They will test their platform over nine months in selected pharmacies in Kenya.

Machine Learning for a More Efficient Supply Chain

Drew ArenthMacro-Eyes, Inc.Fall City, Washington, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Drew Arenth, Benjamin Fels, and Suvrit Sra of Macro-Eyes in the U.S. are applying a statistical machine learning approach to the immunization supply chains of health facilities in Tanzania that accurately and continuously predicts demand to ensure the right vaccines and levels are being stocked. Currently, vaccine supply is largely fixed or driven by depleted stocks. This leaves children unable to be vaccinated due to stock outs at clinics, as well as often high levels of waste, which could both be overcome by better forecasting vaccination needs for individual clinics. In Phase I, they worked with an NGO and the Ministry of Health to access routinely-collected daily vaccination data from 710 health facilities spread across Tanzania. These data were then used to train algorithms to identify predictive patterns that were tested on independent datasets. This led to a model that could accurately forecast future vaccine consumption. In Phase II, they will work out how best to integrate their approach as an automated component within the existing supply chain infrastructure in Tanzania and develop tools and train advocates to demonstrate its value and encourage implementation and adoption.

Demand Sensing and Digital Tracking for Maternal and Child Health in Uganda

Yuehwern YihPurdue UniversityWest Lafayette, Indiana, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Yuehwern Yih of Purdue University in the U.S. will develop a cloud-based digital tracking tool to record data from local health centers in Uganda on the health status of pregnant women and the turnover of their stock, as well as diagnostic laboratory data, to optimize ordering and improve the availability of medical supplies. They will develop applications mimicking the current time-consuming paper-based registry formats to digitally record the relevant data, and adapt a material requirement planning system, which is used in manufacturing to track parts and maintain stocks. They will test their approach in two Ugandan hospitals to evaluate its effect on the efficiency of ordering and maintaining supplies, and on patient health.

Bacterial Factories for the Production of Diagnostic Enzymes

Andrew EllingtonThe University of Texas at AustinAustin, Texas, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Andrew Ellington of the University of Texas at Austin in the U.S. and the Alliance for Global Health will create stable enzymes that can be produced in developing countries and used directly in diagnostic assays to reduce costs. Enzymes are required in many diagnostic tests to detect pathogens such as malaria and HIV. However, they can be very expensive to buy and require refrigerated transport, making the tests prohibitively expensive in many developing countries where they are often most needed. Current enzymes, which are made by bacteria, can only be produced in sophisticated laboratories. They will adapt a novel, heat-stable enzyme to enable simple, on-site production for diagnostic tests at low cost and with minimal infrastructure. These features will facilitate accessibility and use in resource-poor conditions.

Solving the Sample Transport Problem with a Sharing Economy

Lee SchroederUniversity of MichiganAnn Arbor, Michigan, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Lee Schroeder of the University of Michigan in the U.S. will develop a smartphone application that can be used by health centers in Ghana to request independent drivers to transport patient samples quickly and at low cost to laboratories for diagnostic testing. Current courier services in resource-poor settings, when available, can be unreliable or expensive. A 'sharing economy' approach to delivery, by hiring independent drivers online, could improve services and reduce costs. They will develop a simple application for different devices, and recruit and train health workers and drivers to use the application, and package and transport the samples. They will then pilot test their approach for timely delivery of excess samples to two district level hospitals.

A Smart and Safe Biosample Transportation and Banking

Cheikh Tidiane DiagneInstitut Pasteur de DakarDakar, Senegal
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Cheikh Tidiane Diagne of the Institut Pasteur de Dakar in Senegal will enable real-time remote sensing and monitoring of specimens during transport to laboratories in low-resource settings to facilitate diagnosis and assist researchers and health workers. Containing outbreaks during epidemics requires the early detection and rapid identification of pathogens, which means quickly and carefully collecting and transporting samples to laboratories. They will develop smart biosample preservation and transportation tools that can be monitored in real time with a remote digital interface. They will evaluate their platform for delivery of samples from several rural locations to a centralized laboratory.

Information Chain Management System (ICMS) for Low- and Middle-Income Countries

T.J. CorcoranHemalytics, LLCGoshen, Ohio, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

T.J. Corcoran of Hemalytics LLC in the U.S. will create a platform incorporating a web portal and smartphone application to track patients and their samples during diagnostic testing in low-resource settings to ensure they receive the results, and in a timely manner. They will develop a suite of mobile health tools for storing encrypted patient and sample data, capturing test results in the laboratory, and notifying patients and health workers of the results. They will test their platform using patients, laboratories, and administrators located in different cities in the U.S. This approach will help interconnect patients, health workers, and diagnostic laboratories, and thereby improve disease management.

Flexible, Two-dimensional Nucleic Acid Preparation, Storage, and Shipping Device

Catherine KlapperichBoston UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Katherine Klapperich of Boston University in the U.S. will develop a simple device that prepares and stores nucleic acid molecules from the blood for diagnostic testing without the need for a cold chain. Current costs for tests such as those to detect HIV are high, due largely to the need to keep the samples cold during transport to district laboratories. Removing the cold chain would also enable samples to be taken at more widespread locations and transported in batches to further reduce transport costs. They will develop a flexible, layered plastic and paper fluidic card that uses a specialized lysis buffer to extract the nucleic acids from small volumes of blood that are then cleaned and dried on a membrane for transport. The nucleic acids can be easily extracted from the membranes, reducing processing costs in the laboratory, and the flexibility of the materials means that they can be processed as reels to reduce manufacturing costs. They will test the cards using blood spiked with HIV and assess the heat stability of the samples.

Utawaleza - Rainbow Transport

Jónas JónassonMassachusetts Institute of TechnologyCambridge, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Jónas Oddur Jónasson of MIT Sloan School of Management in the U.S. and collaborators will develop a more cost-effective method for transporting clinical samples between health centers and diagnostic laboratories in low-resource settings. In most countries in Southern Africa, sample transport is uncoordinated and leads to regular unnecessary trips, resulting in higher costs and long delays in disease diagnosis. They will develop an algorithm that uses the numbers and locations of samples needing to be transported each day to design optimal courier routes, and test its effect on cost and turnaround times using historical data in Malawi. They will also evaluate hardware devices for health workers to communicate collection requests to sample transport operators. They will run a pilot test of their system in Malawi to evaluate usability and the value of optimizing transport routes.

Ride-Sharing for Sample Transport

Ruth BetchelVillageReachSeattle, Washington, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Ruth Betchel of VillageReach in the U.S. will create a hub to coordinate and track the transport of clinical samples from health facilities to laboratories for diagnosis in Mozambique so that diseases such as HIV and tuberculosis can be identified and treated earlier. Timely diagnosis of disease is also critical for preventing spread. In Mozambique, the existing transport system for patient samples relies on outside providers and is largely uncoordinated, unreliable, and inefficient. They will create a transport coordinating center equipped with an information system to enable dispatchers to match the planned transport routes of a network of existing drivers with samples waiting to be transported. They will also build a sample tracking tool that works via a smartphone application for health workers to request transport and to monitor samples during transport. This will help identify ways to increase the efficiency and speed of delivery.

Improved Sample Collection Method for Dried Blood Spot Cards

Charles MaceTufts UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Charles Mace of Tufts University in the U.S. will develop paper-based cards to improve the collection, storage, and transport of blood samples from remote areas to diagnostic laboratories in low-resource settings. Dried blood spot cards are a low-cost and simple method for collecting and storing blood samples for analysis. However, they have a very basic design, which makes it difficult to control sample volume and elute specific types of molecules, which are needed to properly perform many diagnostic tests. To address this, they will improve the design and fabrication of the spot cards by patterning them with a specialized network of channels to trap the samples, and incorporating complementary materials to separate specific components of the blood. They will evaluate the manufacturing, storage capacity, and performance of their device using clinical samples in the laboratory.

Development of a Digital HIV Self-testing Support Platform

Natasha GousSystemOneSpringfield, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Natasha Gous of SystemOne in the U.S. will develop a mobile application and digital platform to support people testing themselves for HIV by sending them reminders, offering guidance, and reporting the results. Simple and rapid diagnostic tests and self-testing are now being used across low-resource settings to improve the diagnosis of HIV infections. However, results need to be interpreted manually, which can be difficult for uneducated users, and linked with health facilities so the appropriate care can be given. To address these issues, they will develop a downloadable application so that users can enter their personal data, such as age, sex, and location, and receive instructions on how to perform the test. They will also develop a secure, online database that collects the test results, provides custom reporting, and integrates with the existing laboratory information systems so that health coordinators can monitor testing uptake and disease incidence, and HIV positive users can be informed of where to receive care. They will pilot test their approach for usability and accuracy of reporting with 300 individuals in a clinic in South Africa.

Large-Volume Clinical Sample Stabilization Cassettes

Bhushan ToleyIndian Institute of ScienceBangalore, , India
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Bhushan Toley of the Indian Institute of Science in India will develop a device that protects DNA specimens from destruction during transport to laboratories for diagnosis of infectious diseases. Sputum, urine, and blood contain the DNA of infectious agents that can be used to diagnose diseases to aid treatment and help prevent spread. Diagnosis is generally performed in specialized laboratories, but the DNA can be damaged during transport from remote locations due to the length of time it takes or exposure to high temperature. Drying the samples would help protect the DNA but this requires a sterile method that can handle larger volumes of multiple types of specimen. They will develop a device incorporating microfluidics for spreading out large-volume samples onto a porous paper membrane for rapid drying. They will test various agents for coating the membrane to stabilize the DNA and keep it sterile. They will optimize the design and test its ability to detect tuberculosis in clinical sputum specimens from infected patients.

A Demand-Driven Supply Chain Technology Demonstrator

Sara GrobbelaarStellenbosch UniversityStellenbosch, South Africa
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Sara Grobbelaar of Stellenbosch University in South Africa will develop a platform that can analyze existing real-time data on the stocks of health products at clinics across South Africa and present it to all players in the supply chain to ensure products are available when needed. In partnership with a Northern academic institution they will collect and sort relevant data, analyze trends, and develop decision-making tools. The platform will allow analysis, modeling, and forecasting in the health product supply chain so that unexpected changes such as supply disruptions or epidemics can be accommodated.

HealthSIM: A Supply Chain Simulator for Supply Chains

Jim DugganNational University of Ireland GalwayGalway, Ireland
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Jim Duggan of the National University of Ireland, Galway, in Ireland will develop a simulator for public health supply chains in low- to middle-income countries that incorporates the stakeholders and steps needed to provide health care products from the manufacturer to the individual under different conditions, to optimize their performance and ultimately improve health. A key challenge is to ensure that the right medicines are available when needed, particularly when demand is high, for example during epidemics. The supply chain model will be built using the systems dynamic tool and tested in collaboration with public health professionals for its ability to improve the supply of health care products, and to support information sharing and decision making.

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