027: Making Malaria No More with Text Messages

Service icons_podcastJosh Tabb is the Global Digital Strategist at Malaria No More. In the US, Josh is using web analytics and assisted conversions to drive increased donations. In Africa, Malaria No More is leveraging text messaging to keep medication stocked and to fight the spread of fraudulent medicine.


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Episode 27

George Weiner: This is “Using the Whole Whale”, a podcast that brings you stories of data and technology in the nonprofit world. My name is George Weiner, your host and the Chief Whaler of WholeWhale.com. Thanks for joining us.

Malaria has plagued humankind for thousands of years, literally. This is first documented going back to 2700 BC, in China. They originally used herbs and distilled quinine from trees to fight it, then, later realizing, closer to the 20th century, of the impact of mosquitos as a carrier for malaria, leading to bed nets and mosquito control, and now, I’m particularly excited because Malaria No More has evolved to using text messaging and web data to fight malaria, and finally stamp out this disease that has plagued humankind for quite some time. I’m incredibly excited. As you all know, I do love me some data and technology, but we’re talking with the Head of Global Digital Strategy, Josh Tabb, at Malaria No More, and we’re going to see exactly how they’re doing this.

Speaker 1: I’m excited today because we are talking with Josh Tabb from Malaria No More. Josh, how ya doing, man?

Josh Tabb: George, thanks for having me today. How’s everything on your side?

GW: Oh, you know, just hanging out, podcasting. I’m excited, though, but, tell folks what you do at Malaria No More and what exactly, the goal, really, with Malaria No More is.

JT: My position is the Global Digital Strategist, and for those of you who aren’t quite as fancy, that just basically means I’m the web guy. So that means I’m helping with our email strategy, building and refining our websites, our social media strategy; anything that touches the web. And with that new global title thrown on at the beginning there, really, recently trying to expand on my efforts and take it outside of our marketing to donor countries in the US and the UK and really focus on malaria endemic regions, in Africa, in Asia, and really sort of digitally nascent areas where technology is just starting to take the form that it is here, in the US.

GW: Great, so I’m going to divide this up into two sort of buckets: one, the US and your work in the US where, clearly, no one is really suffering from malaria and the plague of mosquitos really isn’t quite as harsh as it is abroad. So, talk to me about the US and how you look at web data and how you track what matters.

JT: In the US I’d say that our digital focus has two specific objectives. The big one is really awareness. As you said, no one here is dying from a mosquito bite, so it’s very easy to neglect the scourge of malaria when it’s totally not even present here. The US is actually the world’s biggest funder of the malaria fight, so it’s pretty important that people here is the US understand what it is that we’re funding and sort of rally behind the US government when we’re making those sort of funding decisions.

Secondly, it is fundraising. So obviously we need to fundraise to keep our own lights on, but we also run a program called The Power of One, where we’re actually fundraising directly for malaria treatments for children in Zambia. It costs $1 to provide a test and a treatment to a child with malaria that may make the difference between them getting back on the soccer field in three days or potentially losing their lives. So for us, those are our two main objectives that we’re doing online, and that’s pretty much my focus on a day to day basis when dealing with the US.

GW: So, tell me a little bit more about, for example, that campaign. It’s really smart to itemize your donations. How do you think about web conversions in tracking? What makes you happy?

JT: Obviously, like most people, I think the more money in the door, the better. That’s the more children that we can treat; the better impact we can have on the continent. But data can be very misleading, and so I think the important thing for us is to really look at not being covered with vanity metrics so much, like web traffic, but really looking at those impact metrics, figuring out how to really optimize our solution to make sure we get the most money in the door so that we can provide the biggest impact. There’s a couple different way that we look at that. The one big thing for me lately, that I’ve been leading on, is a metric called assisted conversions. It’s easy to look at your fundraising and say, ‘Social media isn’t really providing us any sort of impact in terms of the fundraising. We’re getting 1% of our donations straight from Facebook and Twitter.’ People might not really look into the whole story. The whole story is there in the consumer journey and it’s seeing people don’t just visit your website one time. What we’ve found by looking at the assisted conversions metric is that, in fact, social media is providing a huge amount of our income, but it’s just not on that last visit. So typically what happens is someone will find our site through social media, learn about The Power of One, and sort of take time to understand it, and maybe a couple of days later they’ll come back and donate, but they come back via a Google search. So we were very misled by this, and close to cutting the cord on really putting a lot behind social media. But when we discovered assisted conversion, what we found was maybe 1% of our fundraising only came from social media, but in fact, when you look at assisted conversion there’s actually 10% of the fundraising value came from people who learned about the site from social.

GW: I need to jump in and make sure that you caught that. Malaria No More understands the importance of assisted conversions. They’re not falling for the ‘last click’ fallacy. Another way to understand this is thinking about a romantic comedy. They start off, first date, something weird happens, there’s some strife, working toward a climax, then conclusion, happily ever after. If you only watched the last twenty minutes of every rom-com, happily ever after. There’s a whole story there, that’s what makes it fun, that’s what makes it interesting. Your users are the same way. They’re not falling in love with you on that first date. There’s a lot of these interactions that Google is able to track and tell you, how many interactions did it take? Which were the ones that contributed, maybe closer to the end, or maybe toward the beginning of the relationship. Understanding this user journey is incredibly important if you want to increase the goals and impact of your site. I use the word ‘goals’ very specifically, because if you do not have goals set up in Google Analytics; this is not out of the box. If you do not have them set up, when someone clicks ‘donate’, when someone gives you their email, you really can’t even look at assisted conversions. So let’s go back and see how they’re using these.

JT: It was really an impactful discovery for us and is one of those ‘impact’ metrics that we’ve found to help us optimize our campaign.

GW: And that’s a perfect example of saying, ‘Let’s understand the forest from the trees in the user story’. In your mind you’re like, ‘Social media must matter in some way because we’re building relationships’, but it’s not related to last-click conversions, which you have tracked on your site. Do you guys use Google Analytics?

JT: Absolutely.

GW: Awesome. Love that kind of stuff. So that’s the US. But you mentioned before that, you know what, a lot of folks where you are trying to fight malaria, they don’t have the ‘interwebs’. Talk to me a little about your mobile strategy with regard to fighting malaria.

JT: When we opened our doors in 2006, mobile wasn’t even part of the discussion for us. We were really focused on radio stations, billboards, to get our health education messages across, to make sure people were using their bed nets correctly, and going to a clinic at the first sign of fever. But now the landscape has totally changed. In Africa there is estimated to be about 1 billion mobile phones by the end of the year, almost equivalent with the number of people on the continent. And in India alone, 930 million mobile phones, so crazy, crazy numbers. Everyone has a cell phone. Now whether or not they have internet access is another question, but there are certain capabilities like SMS that can provide really amazing data and amazing communications that we’re really leveraging to make progress in the malaria fight.

A really key example: Novartis, a few years ago, piloted a program called ‘SMS for Life’, which we’ve now joined up. Basically, the pilot program was in three villages, and before the program came in the clinics in these villages had a stock-out rate of malaria treatments of about 26%. So what that meant was essentially, if your child was sick you could go to the clinic, there’s a one in four chance that there is no treatment on hand, and your kid may not be able to live very much longer. A really, really sad story, and really ineffective use of the clinics and the stocking system. Novartis saw an opportunity here, and Jim Berrington, one of their employees, pioneered a system called ‘SMS for Life’, where by using text messages they were able to keep a stock management inventory and database, and keep better use of where the actual treatments were going, and where the stocks were headed. Quickly, what they found was just by implementing this SMS program stock-out rates declined to 1%. So now, ninety-nine out of a hundred times that parents went to a clinic, their child would get the treatment on hand, would be fine three days later, and would be back in class, back on the soccer field kicking butt, and living up to their true potential. It’s a really incredible story about how data has really shaped a major problem that faced a continent. And as a result, Malaria No More is now signed on to help bring the program nationally to Cameroon, so we are in the process of getting that program off the ground across the entire country.

GW: This is great because you’re using SMS for what it’s designed for, this messaging in areas where people don’t have access to computers, access to the internet. Functionally, it’s an SMS inventory system. Can you tell me a bit more about how you then potentially use SMS data to track movements of malaria or find some other insight when you looked at the big data behind what comes with an SMS system?

JT: Another really interesting initiative that we’re just getting off the ground right now. We announced a couple of weeks ago that Google has provided a grant for us for some of our work in SMS that’s happening in Nigeria. And the background there is Nigeria is a country with 25% of all the malaria in the whole world. It’s also the biggest market for fake malaria drugs. As much as 40% of the drugs that are sold in Nigeria are fake, so this is a massive problem. One of our partners has actually estimated that 700,000 people a year die from fake malaria and tuberculosis drugs, so massive issue, as you can see. One way we’re looking to combat that is through this new system of scratch offs that the Nigerian government has implemented to allow people to use SMS to figure out if their treatments are, in fact, real, or if they are counterfeit. So the way it works is you buy a malaria treatment, you use a scratch-off just like you would on a lotto ticket, and it will give you a unique code. Using your mobile phone, you can text in that code and you’ll get a response back to find out if it’s actually authenticated, and if it’s a real treatment. So not only does that provide massive benefits for the actual people who are taking this treatment, so that they can know that this is actually legit, but it really provides a ton of data for us to extract insights and conclusions and to learn a lot more about malaria in the country, and not just malaria, but also the black market for drugs. If you think about it, for every drug that’s fake or real, that’s a plus or a minus, a 1 or 0, it’s a bit of data that we can use, that we can geolocate, and we can start tracking migration patterns, we can track the movement of a source of fake drugs across the country and get to that source. So really incredible data. Obviously we, as a small organization, are not able to do, we’re not a data firm. But we’ve brought in some really heavy hitters to help us analyze this data, draw some conclusions and figure out what’s next. We’ve signed on the data firm Palantir, where working with Sproxil, the company that does the mobile drug authentications, and we’re working with a woman named Caroline Buckey from Harvard Public Health, who is going to really help us jumpstart and figure out where we can take this data to the next level.

GW: This is so much more complicated than ‘Let’s just get some nets to some families, and make sure the medication is in the right places.’

JT: Malaria is, at its simplest, a really easy disease to defeat. We defeated it in the United States in 1950 through a mass communications campaign and distribution of bed nets. And we’ve really had massive progress in Africa as well. The mortality rate is down 50% since the year 2000, since we really started scaling up nets.

GW: Wow.

JT: But what we find is, the closer we get to zero, the more need we have for improved data systems, for improved technology and next generation commodities. Because as the disease becomes more scattered it becomes tougher to track, it becomes less of a priority for governments, and it’s able to disguise itself more as it’s more hidden and scattered among the population.

GW: Yeah, it’s always that last 10% that can sometimes take 90% of the effort. Those easy wins early on, I feel like, it’s clear you’ve had over the past decade or so, but it’s huge to be able to use these types of tools to tell migration patterns, and then adjust your strategy as a result.

JT: 2015 is really a big year for us. It’s the end of the Millennium Development Goals, it’s really sort of a shift for us. Where we’ve been really focused on the scale-ups, now we’re really starting to turn the page a bit and focus on the future. We are about to see delivery of the one billionth bed net since the scale-up began and it’s really a great way to celebrate the success we’ve had and recognize the challenge that we have still ahead of us. 500,000 people a year, half a million a year, are still dying every single year from just a mosquito bite.

GW: Which is still way too many. As we move to the end here, I’m going to try to put you on the spot. Can you talk to me about a failure? Now this could be programmatic, this could be internal, however you wish to define it. Can you talk to me about a failure you had, and what you learned from it?

JT: We ran a campaign called ‘Malaria Sucks’ last year, and I would not say the campaign was a failure, but maybe we didn’t reach one of our goals. The campaign was about translating an orange lollipop as the symbol of what children in Africa may never have, which is, their happiness; and on the lollipop it said, ‘Malaria Sucks’. And we had celebrities galore participating, sharing their pictures of their lollipop, and taking part in this campaign on World Malaria Day. So while we got lots of numbers, we got a record number of twitter impressions, we really want to focus on what are the real actionable impact numbers and not just these vanity metrics. We had a short-lived spike in our Twitter chart, but what we didn’t see, necessarily was those people jump on board and become our next wave of supporters that are going to start fundraisers, that are really going to take the malaria fight to the next level. There were a lot of objectives that we were trying to fulfill, and we reached one of them while maybe were a little bit shortsighted on one of the others. So, maybe an orange lollipop and a celebrity holding it up isn’t the way that we’re going to get the billions of dollars that we need to wipe malaria off the planet, but it did raise awareness. So depending on how you look at it that might be a failure.

GW: That’s interesting, in managing the expectations up front, saying, ‘Hey, if our goal is to increase donations, if our goal is to increase these hard and fast metrics, then this type of campaign, you know, it sucks. It’s not going to hit those kinds of numbers. But you know, if you want more Twitter followers or you want to go trending, then that helps’. And that’s a tough conversation. Thank you for sharing that, Josh.

JT: Absolutely, no problem.

GW: All right, as we move to a close, how do people find you, and how do people help you, Josh?

JT: The number one thing that we ask of people is to educate themselves about malaria. It’s one of the biggest killers of kids in the world, so please take a moment to look at our website, malarianomore.org, and take some time to get the gravity of this issue, how many people are dying, but how easy it is to both prevent and treat this disease. You can find us at malarianomore.org, you can give one of those $1 malaria treatments at our Power of One campaign at po1.org, and of course, we’re on Facebook, we’re on Twitter, we’re on Instagram, and we’re always looking to connect with people who are interested in taking the malaria fight to the next level.

GW: You’re doing some great work, Josh, and I’m glad to hear someone like you is on the digital team at a great organization.

JT: Absolutely. It’s been fun talking to you, George, thanks so much, I really appreciate it.

GW: As you listen to this interview, I’m curious, what sticks out in your mind? Is it, ‘Oh, cool, they’re doing new things with SMS?’ Is it, ‘Oh, we should be tracking that sort of thing.’ Is it, ‘I wish our website could be used for more donations’? The most attractive thing to me when I look at what Malaria No More is doing is how they are leveraging the power of SMS, understanding how local cultures are using it and then pulling in experts to analyze the data and find the insights that they need to finally squash this disease. There’s no reason why preventable diseases should be killing in the hundreds of thousands. In this day and age I think that’s unacceptable. The ultimate answer here of the evolution of when we started with herbs, medicine, mosquito control, now finally data and understanding the essence of how diseases spread, I think is the final puzzle piece to not just stopping malaria, but many other preventable diseases. I hope you got something out of this. As always, you can find resources. This was episode 27, and it’s at WholeWhale.com/podcasts. Thanks for joining us.

This has been Using the Whole Whale. For more resources on today show, please visit WholeWhale.com/podcast, and consider following us on Twitter, @WholeWhale, and thanks for joining us.

Today’s music, as always, the intro and outro from Greg Thomas, you can find him by searching Greg Thomas Band on Bandcamp. And the cello covering Welcome to the Jungle by 2Cellos, a really fantastic duo. I recommend you finding them, a quick search on YouTube should do it. As always, thanks for following us. If you remember, and you don’t mind, do leave us a rating. We love those things, they help us.