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Postcard #15 - sharing Project Marvelous in Accra

Last week we were invited to share Project Marvelous at Wellcome's CTA conference in Accra. The conference represented a great convening of a range of experts and pioneers working on the challenge of AMR, and it was a pleasure to take part.

We spoke as part of the behaviour change segment, alongside Elizabeth Long, who gave a brilliantly relatable overview of what behaviour change theory is. We followed her talk by framing Project Marvelous as an experiment to see whether taking a Human-Centred Design approach to AMR could be successful at inspiring behaviour change. To do that, we focused on sharing with the community the elements of our co-creation approach that helped us navigate the challenge, the learnings that inspired us, as well as feedback from doctors who used the concept (SmartPrescriptions) for several weeks.

A couple of the learnings we shared:

Around identifying Doctors as an opportunity
Around identifying commonalities as a starting point in India and Kenya

We made a video of the doctors sharing their perspective of the challenge of AMR, which you can find here:

We also played a short video demo of the concept:

And shared first-hand feedback from doctors using SmartPrescriptions:

We had a number of conversations following the session that were of interest:

- Talking to pharmaceutical companies (i.e. GSK, Pfizer) about the opportunity to fund more research. Could we use SmartPrescriptions as a platform to collect data not only on drug prescribing, but drug quality (potentially via outcomes) and drug resistance patterns?

- Talking to Ministries and Academics about why we focused developing a solution for doctors and not pharmacies. This came up a lot and indicates the need to share the insight that drove our decision more widely, around how we found that many people working in pharmacies are not in fact pharmacists, and that financial motivations by these people eclipsed any duty of care.

- Doctors, as well as other providers within the broader healthcare system (i.e. dentistry) and others (e.g. leaders in the agriculture sector) asking if there are ways to take the SmartPrescriptions concept or platform and apply it to their settings and objectives.

- The need for a single platform where funders, innovators, academics, and experts can convene and continue to share ideas, action and progress. There was a particular interest in how the community might share best practice on designing practical bottom-up approaches, measuring the impact of small but exciting projects/experiments, and approaches to funding/financing work in this space in a way that will move it forward.

In relation to the last point, we had several interesting conversations with Tim Evans from The World Bank following his panel discussion. Tim continued to emphasise the cost of inaction on AMR, specifically that "by 2050 AMR will be 4% of GDP and will have a significant impact for low/middle income countries". And that from an ROI perspective there is "a 10-27 trillion dollar net value for the same time horizon; and an individual 33-88% rate of return depending on the intervention." Tim highlighted the lack of participation by, and conversations with, funders and about financing so that many of the strategies discussed at the conference have the opportunity to move off the page and drive impact more significantly.

Other ideas we were particularly inspired by:

Superheroes for Superbugs - a small initiative by DBT/Wellcome to host workshops for children and have them author comics that share the issue of AMR

The children who created Superheroes for Superbugs

Virtual platforms for improving infection prevention - Kenyan Ministry of Health. This was an example of a simple, practical idea (using Zoom conferencing) to provide virtual training and mentorship in hospitals on AMR and IPC guidelines. We were inspired to see another initiative focused on encouraging interaction with guidelines, outside of books and in the clinical setting.

Developing a network of Accredited Drug Dispensing Outlets in Tanzania, which was shared by Marian Wentworth of Management Sciences for Health. This is a brilliant initiative to provide training to upskill and accredit unregistered drugs shops and their owners, recognising that they are a first line point of care in rural areas, yet often selling drugs illegally. It has now been rolled out countrywide.

An ADDO in Tanzania

Up next....

We are now in the process of pulling together all of the insights, concepts, learnings and recommendations from the past 20 weeks of work. Next week we'll be having a generative workshop with participants from both IDEO and Wellcome to discuss next steps and potential outcomes for the progress we've made towards better understanding and tackling AMR.

Missed out on our previous postcards? Find them here:

Postcard 14

Postcard 13

Postcard 12

Postcard 11

Postcard 10

Postcard 9

Postcard 8

Postcard 7

Postcard 6

Postcard 5

Postcard 4

Postcard 3

Postcard 2

Postcard 1