1SMILE

1SMILE Initiative is a use case of the Public Health Gateway in Uganda; taking the form of a one million smiles campaign called “1SMILE” (One Square Mile Infrastructure Leveraged for Emergencies). This is a project developed under the auspices of the African Science Gateway (Sci-GaIA) project funded by European Union’s Horizon2020; it is a brainchild of ECAI and TLC Global Missions. The focus here is on ‘Boda-Boda’ (commercial motorcycles) that are the preferred means of transportation in Kampala city of Uganda.

Boda-bodas have been dubbed Uganda's silent killers. Boda-bodas, the country's ubiquitous motorbike taxis, snake through gridlocked traffic, navigate potholed roads and provide much-needed employment for young people. They are also maiming and killing thousands every year, monopolising hospital budgets and wiping out livelihoods. Road accidents are the leading cause of disability and death of young people worldwide especially in developing economies.

The 1SMILE initiative’s Blackspot Detective mobile application (BDA) enables first responders in highway communities who want to eliminate boda boda road accident deaths on the Northern Bypass highway of Kampala by reducing emergency response time from 90 to 10 minutes and brokering 1,000,000 smiles of beneficiaries in 1000 days. The BDA centres on strategic information on health architecture in 10 communities with the primary Access metric being 10 minutes response time from the local points of care thus contributing to the overall health system outcome of Responsiveness. The concept of Boda Boda Ambulances is used since they’re a relatively cheap and effective option for referral of patients in developing countries. Nineteen motorcycle ambulances can be bought for the price of one Toyota land cruiser car ambulance.

The endpoint is the provision of definitive care within 10 minutes of impact. The three key milestones of our social promise are: launch 10 Ambulance Response Teams (ARTs) in 10 months; curate 100 value stories in 100 weeks; and create 1000 artefacts in 1000 days. Time-wise, head-injured patients must receive surgery within four hours of injury, while those with severe hemorrhage require surgical intervention within 20 minutes. The mortality rate triples for every 30-minute increase from time of injury to definitive care therefore, the first hour after injury will largely determine a critically-injured person’s chances for survival; or more specifically, the first golden fifteen minutes are a vital period.

The Blackspot Detective targets the bystander mindset challenge that is prevalent among the Boda Boda riders by repurposing them into first responders; they become Blackspot Detective doing BlackOps that save lives.

The physical blackspot will be geo-referenced within a square mile grid manned by an ART and the app will warn commuters, drivers and riders about blackspots nearby and direct the first responders to nearby health facilities to seek medical assistance. The App is hosted by the African Science Gateway e-infrastructure. The proof of concept is the Northern bypass before rolling out all over Africa.

There is therefore need to improve response time of the emergency health care system at three stations: the first responder at the last mile, the Emergency rooms at the Trauma Centres and at community-level where the survivor recovers with atleast 5 months of home-based care.