Since its first inception supporting house to house malaria campaigns in southern Africa, Reveal has been through numerous phases of growth. Originally named “mSpray,” the tool debuted in 2015 and was used exclusively to support indoor residual spraying (IRS) campaigns by using geospatial data and a suite of tools to improve coverage rates. In some cases, coverage rates improved by as much as 20-30 percent. (1)
In 2019, Akros received development funding to expand the tool and rebranded mSpray as “Reveal”—a platform to assist in the micro-planning, delivery, and management of a wide variety of health campaigns. Reveal is an open-source digital global good that uses smart maps and technology appropriate for resource-constrained settings to monitor coverage of interventions in real-time and optimize available resources.
Reveal’s mobile application spatially guides field teams to planned areas and households for service delivery. This mobile application allows offline data collection and captures indicators to inform critical field decisions. Reveal also includes a web user interface with real-time dashboards to provide program managers with helpful coverage data that informs current activities and guides teams to achieve true coverage targets.
Reveal was initially built on the OpenSRP trunk, but in late 2021 was shifted to a more appropriate backend solution. Through this monumental phase of growth, now called Reveal 3.0, the efficiency, stability, adaptability, and sustainability has improved significantly.
All in all, Reveal has impacted 3.6 million people across the 10 countries where Reveal has been deployed. (2)
Reveal, an open-source Digital Global Good, claims Southern Africa (specifically Zambia) as the region which nurtured its development throughout its formative years and many phases of expansion. After six years of optimizing the delivery of household-level interventions in Southern and Eastern Africa, 2020 marked the first year that Reveal made its way to the western edge of the continent to augment malaria prevention programming in Senegal. Building on the success of their partnership in Zambia, PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) alongside Senegal’s Ministry of Health and Social Action collaborated with Akros to conduct enumeration and mapping in 7 districts, 4 of which used these maps to support indoor residual spraying (IRS) microplanning and delivery in 2020. With a better understanding of how granular geospatial data can support IRS planning in the second phase of this collaboration, these 4 districts used the Reveal mobile application to enhance their ability to deliver an effective IRS campaign and to more accurately understand spatial gaps in achieving campaign effectiveness. Notably, this was also the first opportunity for Reveal’s user interface to be made available in French so that francophone teams in Senegal could effortlessly make use of its features.
No matter the health campaign or tools used to implement the campaign, “mopping-up”–that is, bringing health resources to those people that did not receive them during the primary campaign–is critical.
“Mop-up” can be necessary for a variety of reasons, but the most common causes are inclement weather that impacted the ability to achieve the desired level of coverage, people not being at home when the field teams came knocking, or field teams ending delivery too soon. Mop up campaigns can be costly, so the need for accurate, real-time spatial data to inform these mop ups and protocols to drive them is critical. Reveal, a digital Global Good that equips field teams to reach the last mile, assists in these efforts by providing digestible maps and tables to mid- and high-level managers in near real time. Managers use these maps to understand areas which were missed in order to redeploy teams to those areas that did not receive sufficient coverage before the campaign concludes. For interventions such as indoor residual spraying (IRS) for malaria and immunization campaigns, this can mean the difference between a community attaining “herd immunity” or having gaps in coverage that render the intervention less effective.
Nigeria encompasses a unique and significant role in Africa. Not only is it the continent’s most populous country, clocking in at 206 million people, but it also is also the continent’s largest economy (with a total GDP of $441 billion in 2021). However, it also maintains a less desirable superlative title, which is that it bears the highest burden of malaria deaths on the continent, and 27% of all malaria deaths worldwide in 2020. In raw numbers, this amounts to an estimated 64.5 million cases annually. As a result, the public health challenge of malaria in Nigeria is enormous, and the stakes are high. Though Nigeria’s National Malaria Elimination Program (NMEP) has risen to meet this challenge consistently throughout the years, attaining the goal of reducing malaria morbidity to less than 10% parasite prevalence and mortality attributable to malaria to less than 50 deaths per 1,000 by 2025 is far from guaranteed. One key in realizing this goal is seasonal malaria chemoprevention (SMC), which typically consists of routine administration of two antimalarial drugs to children 3 to 59 months of age during the peak months of malaria transmission. Malaria Consortium and Akros worked with the Nigeria NMEP to support the planning, tracking, and delivery of SMC in six rural health facility catchments in the Shagari local government area of Sokoto State, Nigeria in 2021.
Last month, the World Health Organization (WHO) sent joyous shock waves through the global health community and the Global South by officially recommending that the new RTS,S/AS01 (RTS,S) malaria vaccine be adopted into widespread use among children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria incidence. Now the international community, through Gavi, the Vaccine Alliance, has just stepped forward to help finance the rollout of the world’s first malaria vaccine.
It has been true for some time that sub-Saharan Africa bears the largest malaria burden in the world, with children shouldering the largest proportion of deaths. Over 90% of global cases are on the continent, with children under the age of 5 years constituting a staggering two-thirds of all malaria deaths. This is due to a confluence of factors, not least because of the widespread prevalence of P. falciparum (the most deadly species of malaria parasite), and a very efficient mosquito that spreads it (Anopheles gambiae). The economic impact of malaria is estimated to cost Africa $12 billion every year—a figure that also factors in costs of healthcare, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The introduction of an effective vaccine offers a beam of hope in the fight to mitigate the massive toll this centuries-old disease inflicts on Africa.
In recent years, countries within the Southern African Development Community (SADC) region of Africa have been making outstanding strides toward the challenging goal of malaria elimination. This commitment to elimination is the guiding mandate of Elimination 8 (E8), which focuses on the following countries: Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe. Through E8, these ministerial bodies have resolved to coordinate their efforts to collaboratively work toward the shared regional goal of malaria elimination.
To that end, in 2017, E8 contracted with MENTOR to deliver indoor residual spray (IRS) in border districts of southern Angola. The MENTOR Initiative is a registered nonprofit organization devoted to reducing deaths and suffering from tropical diseases. In Angola, MENTOR has been a stable National Malaria Control Program (NMCP) partner supporting vector control, case management, and surveillance activities since 2004. MENTOR has established offices across Angola and has full country reach in its operations, making it the ideal partner for E8 to engage for expanded IRS interventions. Since 2017, MENTOR has implemented IRS with reported high coverage rates in all campaigns conducted. For its 2020 campaign, MENTOR aimed to improve IRS reporting systems and increase accountability to donors and NMCP. To realize this goal, they chose to pilot Reveal—a digital global good and open source spatial intelligence platform used to drive the delivery of life-saving interventions. MENTOR collaborated with Akros to configure and support the field pilot of Reveal v. 1 in Menongue District (Cuando Cubango Province).
The first Reveal Forum of the year was held virtually on Wednesday, 23 June 2021. The Reveal Forum is a community event that takes place several times a year, which includes government partners, implementers and developers from ~ 28 organizations who are currently implementing Reveal, or are tracking the roadmap and are interested in using Reveal to improve the impact of health campaigns.
The objectives of the Reveal Forum are to provide community members with the opportunity to:
give an update on any new features that have been developed, or are in the process of being developed, and what we as community members can expect as a result;
share valuable lessons learnt through new or ongoing implementations, and why these are important in the context of operationalizing and scaling Reveal; and
based on implementation experiences, provide a view on what is most needed, technically or otherwise, to better operationalize and scale Reveal in the future.
The goal of the Reveal Forum is to bring community members together so that all have a common understanding of the current and possible future state of Reveal; to understand who is doing what, where and how; and ultimately, to learn from and support each other in a collective ambition to scale and sustain the Reveal platform to help health and other campaigns achieve their intended impact.
The recent Reveal Forum was attended by approximately 35 community members. Kyle Hutchinson, Reveal Coordinator, opened the Reveal Forum by providing participants with an overview of the goal and objectives of the Reveal Forum, along with an update on some additional community building efforts, including the establishment of both Steering and Technical Committees.
Maximal coverage defines the effectiveness of vaccination campaigns. Over one year after the start of the devastating COVID-19 pandemic, countries around the globe are vaccinating those ages 16 and older, while vaccine-producing companies are conducting vaccine trials for children. Positivity and hope infuse vaccine distribution efforts, but as these initiatives ensue, attention is being drawn to the challenges of vaccine distribution, namely, those left behind.
Mass vaccination campaigns are critical to the introduction of new vaccines, to providing doses to those who may have missed routine doses, and to giving a second opportunity to those who may not have developed immunity. In each instance, with greater coverage comes stronger, more resilient communities. However, zero-dose children, or children who have not received any routine vaccinations, are often missed by these campaigns. With every child left unvaccinated, communities’ vulnerability to vaccine-preventable diseases escalates. Fortunately, in bracing for future vaccination efforts, we can look to previous initiatives to guide our efforts. In particular, the potential of geospatial data and technology to ensure all, including zero-dose children, are included.
From June through to December 2020, Akros, in partnership with Johns Hopkins University, Macha Research Trust, and the Zambia Ministry of Health, utilized spatial intelligence and the Reveal platform to identify and vaccinate zero-dose children following a nationwide Zambian vaccination campaign for measles and rubella.
We are thrilled to announce Akros has been awarded a Grand Challenges Explorations Grant, an initiative of the Bill & Melinda Gates Foundation! Grand Challenges Explorations (GCE) grants support impactful innovations striving to remedy critical global health and development problems. With this grant, Akros will incorporate into Reveal the ability to integrate data from human movement models. Reveal is a web-based mapping platform which uses spatial intelligence to ensure all receive life-saving interventions. With the ability to integrate human movement models with Reveal, decision makers and field teams will be better able to predict where people will be at different times of the day and seasons to ensure no one is missed with lifesaving resources.
The existing Reveal Platform, improves health campaign coverage by utilizing spatial intelligence and context-appropriate technology. Presently, Reveal maps communities at the household level and offers intervention teams a streamlined interface to plan, implement, track and monitor campaign coverage. Relative to traditional approaches in which local health teams aggregate population data by hand and process it in hard copy, Reveal’s user-centered technology offers a more accurate population count and implementation system—designed to include even the most remote of households.
Delivering health campaigns at high coverage rates can be challenging—particularly in places where frequent movement is common. Permanent relocation may swell or shrink a population, influencing critical resource distribution. Seasonal migration may redistribute a population for months at a time. Daily or weekly movements may make certain individuals more likely to be left out of a campaign. In these situations, health workers may arrive at a household to deliver interventions, but instead find the family has shifted, for even just a few months depending on fishing or farming needs. Take for instance, Nchelenge District in Northern Zambia.
At the time of writing, 33.7 million cases of COVID-19 have been reported worldwide. Regardless of socioeconomic standing, health systems around the world have shuddered beneath the weight of an international pandemic; leading to overflowing ICUs, overextended health care resources, and disrupted critical supply chains.
Accordingly, international attention and funding has turned to global public health and preparedness. The World Health Organization (WHO) has estimated approximately US$1.7 billion total funding is needed to adequately respond to COVID-19 until December 2020. As of September 21, 2020 WHO reports receiving 79.5% of their goal, with an additional 4% expected from pledges—a combined US$1.51 billion raised in the span of a few months. Resources have been rightly and urgently mobilized to offer aid now, but as a responsible global health community, we must look toward the future and set in motion plans to meet anticipated gaps and needs.
If we are to respond effectively and reach the most vulnerable populations, our future interventions to protect people from COVID-19 transmission will inevitably rely on community health structures to disseminate aid and vaccines. If the systems in place are not adequately equipped to respond, those interventions will fall short. Further, if we lack good data on the population and location of communities, getting resources to all those in need will be even more challenging. However, presently, population data are often inconsistent, outdated or quite coarse. Compromised by unclear boundaries or moving populations, the resulting data typically offers only a blurred picture of communities, making it challenging for public health teams to allocate resources effectively.