It is well established that digital tools play a role in building resilience and improving health and well-being. Introducing new health technologies can enhance effectiveness of the supply chain and monitoring systems in the prevention and control of illnesses, such as malaria. The SMILE Malaria application, a newly developed feature on the Sistem Monitoring Imunisasi dan Logistik secara Elektronik (SMILE) or Electronic Immunization and Logistics Monitoring System, is one such tool that can help address how health workers can control and monitor the spread of malaria, and potentially help extend the lives of vulnerable communities in Indonesia. 

Developed by the United Nations Development Programme (UNDP) and the Indonesian Ministry of Health (MoH) in 2018, SMILE is a cloud-based digital solution which strengthens the immunization supply chain by providing a real-time and customized end-to-end tracking of the vaccine inventory. Notably, SMILE app has successfully helped to monitor the distribution of around 454 million doses of the COVID-19 vaccines at over 12,000 health facilities across Indonesia. This success has led UNDP and MoH to also leverage SMILE’s robust system in strengthening malaria control.   

The WHO’s World Malaria Report 2022 estimated there were 247 million malaria cases with 619,000 deaths globally. The African region accounted for around 95 per cent of the global cases and deaths whereas the remaining two per cent of cases was from the South and Southeast Asia region. To date, nine countries in the South and Southeast Asia are malaria endemic with the region’s top three highest cases were found in; India (79 per cent), Indonesia (15.6 per cent) and Myanmar (1.6 per cent). 

Having the second highest malaria burden, Indonesia recorded 399,666 cases in 2022 based on the MoH’s data. As of December 2022, 372 out of 514 districts (72.4 percent) in Indonesia were certified malaria-free. Yet, malaria elimination challenges remain in its highly endemic and terrestrial eastern provinces of Papua, West Papua and East Nusa Tenggara that make up over 90 per cent of cases in the country.

Various factors have hindered Indonesia’s aim to eliminate malaria, with the COVID-19 pandemic further impacting progress. Beyond geographical complexities, risky behavior and lack of digital health interventions to reduce disparities on malaria logistics have hampered efforts to eradicate malaria in Indonesia by 2030. 

To help address this, UNDP and the Access and Delivery Partnership (ADP) actively support the Ministry of Health to identify cost-effective interventions and easily accessible digital solution. One of initiatives is to assist the government's efforts in eradicating malaria through improving the supply chain management by avoiding stocking out of malaria drugs and diagnostic tools. It begins with digitizing the recording, monitoring and reporting of malaria logistics through the SMILE Malaria app. 

SMILE Malaria App Testing and Piloting

Effective adoption of a new digital solution into health system will require greater investment in  health care workforce capacity, and across health programs. With the ADP’s support, UNDP and MoH piloted the SMILE Malaria app to help combat malaria in Southwest Sumba district and East Nusa Tenggara province. About 47 health staff (52 percent of whom are women) of Pharmacy and Malaria program from 16 local community health centers, the District Health Office of Southwest Sumba, and the Provincial Health, Population and Civil Registry Office of East Nusa Tenggara, were trained on the SMILE Malaria app in March. 

In addition to the paucity of gender-intentional advocacy and digital health investment in malaria elimination, piloting of the SMILE Malaria app also aimed to increase women’s participation in program implementation. UNDP works with the national and local governments to create a more intentional leadership pipeline for women in decision making positions in the healthcare field, specifically in malaria response, including training of health workers, vector control, grassroots and civil society engagement, health system and at all levels of leadership for malaria control, prevention and advocacy. 

As we work towards leaving no one behind, developing and adopting more people-centered approached and gender responsive programming will also be critical to make significant strides towards eradicating malaria. It begins with promoting active roles of the trained women healthcare workers who will engage with communities and stakeholders to identify their needs and develop evidence-based malaria control strategies which address equality and inclusion.

Speaking at the training, Head of Malaria program at the Provincial Health, Population and Civil Registry Office of East Nusa Tenggara, Alfred Duka explained, “The East Nusa Tenggara province is Indonesia’s third highest malaria endemic with 15,825 cases and nine deaths in 2022. About 5,370 positive cases of malaria were found in Southwest Sumba district. Three high endemic districts are all located on the island of Sumba, which contributes about 80 per cent of cases in the province. We hope that by utilizing a digital solution such as offered by SMILE Malaria app will speed up our effort in eradicating malaria.” 

Through the SMILE Malaria app, health workers now can monitor, report and notify the providers on their current malaria drugs and logistics situation in real-time. This digital innovation will enhance determining stock outs, enable timely reporting of logistics distribution, and allow quick decision-making to optimize malaria supply chain management. 

“SMILE Malaria app reduces delays in reporting, as it is quicker than using the traditional paper forms. It ensures effective distribution of malaria drugs and logistics, despite long distances and mountainous areas we have here. Now, I can easily monitor the malaria drugs and logistics via my phone. It really saves time,” said Chendriani Dominika Fernandez, the Malaria Program Officer at District Health Office of Southwest Sumba.

Currently, seven out of 16 community health centers have done the record-keeping of malaria drugs and logistics, and started to place orders to the District Health Office of Southwest Sumba via SMILE Malaria app. Accelerating malaria elimination through wider intervention, UNDP and the MoH with the Global Fund support will soon roll out the SMILE Malaria app piloting in Papua and West Papua provinces. This adding one more innovation to drive down malaria cases among the most vulnerable. Also align with the World Malaria Day 2023 theme “Time to deliver zero malaria: invest, innovate and implement”. 

Text by Virgi Fatmawati, edited by Ranjit Jose and UNDP SMILE Project.