Malaria is responsible for three out of every five outpatient visits in Nigeria [ 1 ]. An average Nigerian adult experiences at least one episode yearly, while an average under-five year-old child records up to 3 5 incidences annually [ 2 ]. On a broader measure, malaria infection represents 30% of hospitalisation cases in Nigeria as at 2016 while also constituting major cause of unintended pregnancy loss and maternal deaths annually. A recent government statistics indicate that malaria is responsible for as much as 11% of the total maternal mortality cases in the country [ 3,4 ]. This places Nigeria as one of countries with most worrisome burdens of malaria in the world, with as much as 97% of Nigeria’s population being at the risk of malaria.

Nigeria updated its national first-line malaria treatment policy in 2005, which advocated for full the use of Artemisinin based Combination Therapies (ACTs) because of the widespread resistance to chloroquine. Two years after the policy kick-off, the nation’s drug regulatory body stopped the registration of Artemisinin mono-therapies to safeguard the efficacy of ACTs. This has also been complemented with large-scale national awareness campaign and multi-sectoral stakeholder engagement under a holistic “Roll Back Malaria” program. The intervention is in alignment with the global initiative by the World Health Organization (WHO), which recommends the use of Artemisinin Combination Therapy (ACT), for uncomplicated malaria confirmed with either microscopy or rapid diagnostic test (RDT).

However, while there are evidence of significant funding by the Federal Government of Nigeria on mass education aimed to drive the policy message to the prescribers as well as the suppliers, the reality on ground indicates poor compliance.Independent researchers confirmed a significantly lower-than-average level of adherence to the national antimalarial drug policy, especially in the rural and semi-urban areas, where more than seventy percentage of the population lived [ 3 ]. The most evident explanation for this is the absence of a robust, inclusive and transparent surveillance system to monitor the implementation of the policy. This is further heightened by the lack of structures for drug distribution, regulation and control, especially in the informal sector where most drugs are sold in the country. The nature of access to centres for the treatment for malaria is another nightmare. The healthcare delivery channels are a diverse range of outlets, dominated by unregistered service channels like private hospitals, pharmacies, patent medicine dealers and roadside drug hawkers. These unregistered and informal channels represent as much as eighty percent in most states of the country [ 6 ].

Available studies suggest that fifteen years after the introduction of ACT policy as first line treatment, inappropriate prescription of antimalarial drugs persist, at both public and private health facilities across the country [ 6 ]. A study by [ 7 ] indicates that low compliance among local drug vendors in a Northern State (Jigawa) in respect of stocking and selling of first-line antimalarial. The research also indicates that more than 80% of the outlets visited were ignorant of and lacked training about new treatment guidelines. In the same vein, [ 8 ] revealed that out of a total of 110 informal drug retail shops engaged in an interview, as much as 43:1% were unaware of the government policy on malaria recommended first-line treatment.[ 9 ] indicated as much as 88% of non-compliance rate in recommended antimalarial sold through private drug stores, with further insights on how huge variation in pricing makes the cheaper brands of non-ACT the preferred option by the customers who self-medicate. The current situation portends a huge risk if not curtailed. This presents a huge national emergency, hence our proposal to explore easy, fast and affordable means for real-time surveillance to assess the levels of policy compliance across the country in order to drive for accountable and targeted policy enforcement. 2

Crowdsourcing in healthcare delivery has been identified as an effective way for real-time insight gathering [ 10 ]. Its ability to offer complementary insights for public policy making for government and institutions have also been noted [ 11 ]. Varied use cases have been explored in advanced economies[ 12,14 ], with examples as simple as its use for price transparency tracking [ 13 ]. The proprietary data collection application,DataCrowd,is a simple Android-based survey tool designed to facilitate real-time data collection in the form of text, picture, video and sound. It has capacity for offline data capture and geo-fenced data collection capture that validates the physical presence of the volunteer data collector at the specified drug sales outlet.The volunteer data collectors belongs to a curated data collector community managed by the organization the authors work with. 2.2

This works presents a fast, cheap and alternative method to track implementation of health policies especially in low resource health systems where the budgetary allocation may not make room for such checks.One of the advantage of adopting this method of policy implementation tracking is that better and faster decisions about this type of data can be made without assumptions policy failure when it is simply a non implementation issue.

This project leveraged community relationships to access data from drug sales outlets. Drug sales outlets is only a subset of a larger healthcare ecosystem where policies are being implemented 1Link to sample virtual training content for crowdsourcing community https://www.youtube.com/ playlist?list=PL0mGkrTWmp4s1hs5mHpDUfz8y55UFCzSt