Entry 11

M&E (Monitoring & Evaluation) Plan and the Social Return on Investment for Our Project

Our inputs include a variety of people and materials. Specifically, we as the GSIF team are working with our advisor, Prof. Cheng, and a TE capstone group to contribute bioengineering expertise towards the development of a low-cost, point-of-care, sickle cell anemia screening device. For this development, we are utilizing Lehigh University lab resources and funding (which will hopefully be expanded by health-related grants). Additionally, we will be getting local and healthcare system expertise from community members in Sierra Leone established through our partnership with World Hope International. In the future, we also hope to include business students, in order to get expertise on distributing the final product.

In addition to these inputs, our team focuses on several activities. Currently, our activities involve designing the device, and learning about the local context so that we can best implement our device. In the future, our activities will focus on distributing the test strip, training healthcare workers on using the device, and working with other NGOs to make sure our device is implemented alongside a treatment regime.

With these inputs and activities, we will create several outputs. Our primary output will be a physical test strip product. Additionally, we will develop jobs for locals in Sierra Leone who will be charged with distributing the device. Finally, our outputs will also include the participants we reach, specifically the healthcare providers who are conducting the testing, and community members who are getting tested. These outputs are directly measurable. We will determine the number of test strips that need to be developed and shipped/distributed to the healthcare providers and ultimately the community members by the amount of funding we receive and projected number of people who will be seeking the test. Once one shipment has been sent out, more concrete numbers for the amount of test strips that need to be delivered at one and how frequently to specific locations will be determined after statistics on the number of people tested and where they got tested have been collected. These statistics will be provided by the medical professionals stationed in different locations throughout the country who will be offering and administering the test.

Finally, our project will also have several short-term, intermediate, and long-term outcomes or impacts. Within a few years, we will hopefully have created a new and usable product which can be used to diagnose people in Sierra Leone with sickle cell anemia. After that, we hope to make a direct impact on community members by allowing individuals to get screened for sickle cell anemia at an early age, and access those potentially life saving preventative treatments. In the intermediate, we also hope that this product can also be expanded in to other low-resource settings, particularly throughout sub-Saharan Africa, where sickle cell anemia is prevalent. These intermediate impacts then have the long-term potential to reduce child mortality due to sickle cell anemia. Once we are able to implement screening for sickle cell anemia with our device at birth or at a young age (before 5) we will be able to take/track statistics around child mortality and determine if child mortality due to sickle cell anemia is going down. If the child mortality, due to sickle cell anemia, rate does not decrease this could be due to the lack of people getting screened or the lack of treatment after being diagnosed. We do not foresee the lack of treatment being a problem for there are cheap penicillin based treatments available. If the child mortality rate does not go down we will need to rethink where and how we have implemented the device and try/decide if it’s possible to make sickle cell screening mandatory at birth.

Additionally, we hope that by working with other NGOs, this product can be used to help bring about policy and social action changes. For example, although hydroxyurea is proven to reduce the symptoms of sickle cell anemia, and has been used successfully for patients in the US for years, it is not currently available in sub-Saharan Africa (original due to concerns that this treatment could increase the risk for malaria, which has recently been disproven). With the effective implementation of a low-cost, point-of-care sickle cell anemia diagnostic tool, we can hopefully initiate a push for health NGOs to make policy changes, getting this treatment to individuals in Sierra Leone. The data stating the number of people being screened and the information around how people are being treated for sickle cell anemia after being diagnosed can and should be presented to NGOs funding medical treatments. Once presented the data these NGOs will hopefully push for policy changes to allow for more options for treatment, like hydroxyurea, that will hopefully reach and affect more people positively.

In order to estimate the social return on investment of our project requires several assumptions. The value of every person who is screened will be equated to the average cost of sickle cell screening in the United States ($50 will be used as a very rough estimate of this price). We would also have to know what the value of each strip would be. To estimate this we would have to assume that one strip accounts for all labor, transportation, materials and other costs associated with eventually delivering the test. For the purpose of this estimation let us say that the total cost per test strip is $0.50. If we make these assumptions, then we can say that for every dollar that is given to the project we generate $100 dollars of social value. One dollar would equate to two test strips which would be used to screen patients. These two screenings in turn would equate to the value of being screened in the United States.

Making the assumption that the $50 test value is the only social value created by our project is false. In reality, the ability to understand and get treatment for sickle cell is very valuable but is not able to be monetized.