During a global health crisis, policy makers and practitioners have the power to leverage information technology to avert and control the spread of disease.
One example of this was seen during the Ebola outbreak in West Africa. Panelist Christopher Fabian, co-creator and co-leader of the Innovation Unit at the United Nations Children’s Fund (UNICEF), deployed a text-messaging service that was used across the region to educate residents about the disease.
In the following Q&A, Fabian discusses his work and how technology can be a useful tool in reducing the harms of a global health crisis.
Q. During the Ebola outbreak, you helped launch a text-message platform called “U-Report,” which allowed residents to access information about Ebola from basic phones. How did this help to control the outbreak?
Fabian: In October 2014, the Ebola outbreak in Liberia showed that there was a need for UNICEF and other emergency responders to have better information about the epidemic, as well as for citizens to have actionable and real information about how to keep safe.
In a country like Liberia, infrastructure deficits prevent information from moving. For instance, people have trouble getting access to basic information about how to prevent Ebola, or what kind of services are available near them. They need a simple solution to connect them to resources.
In Liberia, working with the Ministry of Health and other local and international partners, UNICEF was able to set up U-Report to aid and accelerate the response efforts.
U-Report is a program designed to empower youth in developing countries to speak out on issues they care about in their communities, encourage citizen-led development and create positive change. The data is mapped and analyzed in real time and creates a web-based aggregation of the results, giving government and development partners insights into the needs of their citizens.
Setting up U-Report in Liberia enabled UNICEF and partners to better target their work. It created a two-way communication system that helped decision makers understand what people needed in minutes, rather than in months. For example, we learned where in the country people knew about Ebola, ways to prevent Ebola and what issues were bothering them most. We could then quickly see how to target additional response efforts. U-Report also allowed members of the emergency response to ask directed questions of populations, enabling leaders to make decisions with up-to-date information, such as “In your district, are schools re-opening?”
As of September 2015, U-Report is live in 17 countries with more than 1.6 million registered U-Reporters.
Q. In what other ways did UNICEF respond to the Ebola crisis? How were other technological platforms helpful?
Fabian: The U-Report system mentioned above is developed on RapidPro, UNICEF’s open-source software that allows anyone to easily build and scale mobile-based applications. RapidPro powers governments and development partners to connect, engage and collaborate directly with the most important – and often most marginalized – voices in their communities. Having RapidPro enabled UNICEF to quickly set-up and deploy U-Report in a matter of weeks.
In addition to U-Report, UNICEF also launched mHero, a system that allows the Ministry of Health to instantly send critical information to health workers’ mobile phones. mHero enables reporting on emerging cases; identification of who is still reachable, healthy and able to work; and the sharing of reference and training materials that improve the knowledge of health workers.
Q. What lessons have been learned from the Ebola crisis in terms of technological response?
Fabian: This is not a new lesson, but emphasizes that we need information fast – even if it’s in a different form than we expect. UNICEF has seen that adherence to a clear set of principles helps the organization and its partners work together more smoothly. These principles include: building solutions using local people and local resources, designing solutions with the end-user and creating open-source public goods that can be quickly adapted as the emergency develops and can be extended into reconstruction and rebuilding efforts after it has subsided. Below I break down each principle.
Build solutions using local people and local resources. In emergencies, hundreds of actors – local and foreign, many without expertise or context about a given country – rush to get information, setup networks and build supply chains to provide emergency relief support. Although these are well-intentioned efforts, they don’t always translate into useful contributions.
In the Ebola response, companies offered to donate several thousand smartphones to efforts in Liberia. The problem is that 3G and 4G networks in Liberia are very thin outside of the capital city, power sources for energy-hungry devices are hard to come by and a $400 handset is worth more than two months of wages in Liberia. Instead of bringing in outside technology, a better way to drive immediate change is to work with technology that is already accepted by its ecosystem such as voice and SMS on feature phones. Solutions on established technologies scale quickly. U-Report was able to launch and scale quickly in Liberia because it operates on basic mobile phones, which, as of 2014, more than 70 percent of Liberians have access to.
Design solutions with the end-user. Technology alone is not enough to make an idea successful; you also need a community of users. That’s why the U-Report questions that were sent to all U-Reporters were designed with a group of teenage girls from Westpoint, Monrovia – to ensure the topics addressed are what really mattered to the people on the ground and that the language and tone was appropriate.
During the design process the teenagers thought our questions were boring and re-wrote them. For example, “Are you aware of the Ebola disease?” became “do pple no abt Ebola.” Once it was designed, it was beta tested in Monrovia, and, once it was revised, it was promoted and integrated further outside of the city. Once it was live, registered U-Reporters engaged daily around Ebola-related questions such as signs and symptoms of Ebola, proper hand-washing techniques, safe burial practices and stigma around survivors.
Build entirely open source. One of UNICEF’s fundamental principles in developing new mobile technology has been to ensure that it is entirely in the public domain. But this isn’t just about principles; open business models are actually stronger than proprietary models. Given the rapid pace at which technology changes, being open source allows for easier integration and technical enhancements. For example, governments and mobile network operators who use open source tools created during an emergency can know what technology they are receiving from us. It gives them equal “ownership” of the source code to test, modify, adapt and improve on. They can use it for other purposes after the emergency response. They can work with local technologists to extend it. They can improve on it. Proprietary technologies do not give this level of ownership or adaptability.
Q. In what ways can we use technology to educate populations at risk for disease? How can these efforts help to control global health crises going forward?
We use technology to strengthen health and communication systems so it becomes easier to find up-to-date and relevant information. Health and communication systems need to be able to communicate with frontline workers, know where to send supplies, know if those supplies have arrived and know what’s working and what’s not in order to provide the right tools. This flow of information is key to preventing and treating diseases.
We also can use technology to fill an information vacuum to communicate directly with young people. For instance, U-Report enabled us to create effective messaging that was responsive to rumor and questions that were circulating in the public discourse. By reading through questions received via U-Report in Nigeria, we realized we needed to tell people: “Bathing in salt water does not cure Ebola.”
In Zambia we used U-Report to help increase youth’s participation in, knowledge of and demand for HIV-related counselling, testing and treatment services. Through U-Report, more than 50,000 young Zambians were referred to anonymized counselling services. In just over a year, voluntary HIV testing rates among registered U-Reporters rose to 40 percent – significantly higher than the national average of 24 percent.
Q. What new technologies are being developed to fight future epidemics? For example, can we expect to see drones being used to provide aid to hard-to-reach places?
Fabian: UNICEF scans the near-future horizon to prepare for new challenges children will face in a rapidly changing world. UNICEF works with the private sector and academia to reveal the potential to do good and do good business. We help identify market potential by exploring emerging areas that bring value for businesses while simultaneously improving access to essential services and information for children and their families. Some future areas we are exploring are listed here.
- Logistics and transport: UNICEF is utilizing mobile technology to send information and make systems more trackable and accountable, eliminating the days and months that were previously needed to share information such as lab samples and test results.
- Identity and personal data: In Nigeria, UNICEF has helped create a system where all births are reported via SMS – more than 17 million in the last three years. In the Philippines, South Sudan and Uganda, social workers use smart phone devices to register children that have been separated from their caregivers.
- Learning and education: UNICEF is piloting some approaches to improve access to education in difficult situations including: eLearning devices; solar-powered, rugged computers; and non-curriculum coding/gaming lessons for Syrian refugees.
- Mobile financial services and digital currencies: In Nigeria, UNICEF is prototyping a system to send mobile payments to community mobilizers in remote and rural areas.
- Sensor and wearable technology: UNICEF has partnered with ARM Holdings and frog design on the global “Wearables for Good” design challenge to discover applications for wearable and sensor technology that can enhance and potentially save lives. To be fit for purpose and fit for the intended end-user, ideas must be cost effective, power efficient, rugged and scalable. The four types of wearable and sensor technology we are focusing on for this challenge include solutions that can alert and respond; diagnose and treat; change behavior; and collect data.
Christopher Fabian is a panelist at the upcoming Princeton-Fung Global Forum, “Modern Plagues: Lessons Learned from the Ebola Crisis,” to be held Nov. 2-3, 2015, in Dublin, Ireland. Fabian believes that technology is not the end-product of innovation, but a principal driver of new ways of thinking about development problems. He was recently recognized as one of TIME Magazine’s “100 Most Influential People.”