Crosscut

Crosscut is an easy-to-use planning and mapping application providing rapid decision-support to respond to health emergencies in developing countries.

Coite Manuel, CEO and Founder

Health emergencies come in many forms and have many causes including disease outbreaks, natural disasters, or armed conflicts. Health systems on the frontline of responding to these incidents are generally set up for delivering routine service and must quickly adapt to new demands and pressures. Planning a health emergency response thus has two key requirements that are difficult to achieve:

• Need for speed: Planning an effective response to a health emergency is difficult because there is immense pressure to act quickly. Several questions must be answered rapidly to inform decisions. How many people are being impacted in the affected area? How much in emergency supplies are needed to treat patients? There is no time to commission GIS mapping studies and analysis consultants to answer such questions, but this is often what is required. This tension often leads to either delayed health campaigns with a good plan or timely health campaigns that are poorly planned. 

• Need for equity: The equity impact of where emergency supplies are distributed, where finances are allocated, and how different populations are affected by emergency response decisions often go unconsidered until after the dust settles. Ultimately, it is often the most marginalized communities that are most impacted.

Our solution eases the pressure faced by health program personnel during emergencies by giving them the support that would come from a team of GIS and analytics experts without the cost and delays associated with arranging contracts for such services. In a matter of minutes, these users can have access to high quality forecasts, service areas, and accessibility maps. This frees up their time to focus on more strategic matters and/or direct service delivery activities. 

The users that our solution targets belong to two main groups--health planners and managers working at government agencies in developing countries (e.g., Ministries of Health) and implementing partner organizations supporting emergency response.

We place great weight on features requested by users and pay significant attention to their needs when deciding where to focus efforts. Over the course of multiple health campaigns in 2021, we are working with users in three countries to shape the user experience of the app.

Our hope is that the ultimate beneficiaries of our app are the millions of people who are currently missed by health interventions in the sometimes chaotic context of emergency response.

Crosscut has formally committed to Global Access for our app as detailed in the Gates Foundation’s humanitarian license, which ensures our work is made available to people most in need in developing countries. Persons anywhere in the world can create an account free of charge and upload their own data in order to produce microplans and equity heat maps for countries where our service is offered. Most country users can use the Crosscut app without a cost per use, with additional costs only being necessary should a user wish to contract with us for higher levels of customization.

Most of the impact of the platform will come from it increasing the number of people who are reached by an emergency health response. There are a variety of intermediate outputs that in turn lead to this increased reach. These include the following:

• Identifying population “hot spots” that have a high likelihood of being under served by responders. Once identified, planners can implement contingency measures to ensure that these populations receive services such as deploying temporary health sites for the group.

• Clarifying areas of responsibility for teams of responders. Having precise and clearly defined service areas reduces the likelihood of populations near service borders being missed. 

• Optimizing the positioning of supplies. This allows allows managers to ensure that they get the most use out of scarce financial resources and to optimize impact (e.g., reducing travel time to reach services for the most people) while balancing equity (e.g., ensuring that a percentage of people are within a set distance of an emergency distribution point). 

• Streamlining the process of response planning. By reducing the amount of time it takes to produce robust plans, health programs will be able to take immediate action to respond to emergencies without leaving vulnerable populations waiting.

The Crosscut app is highly scalable, and we are continuing to bring new countries online each month over the course of 2021-2022. One challenge we have seen with slow adoption of technology occurs when use cases are unclear and the technology requires extensive training to use. But how is WhatsApp able to scale across the globe without having to deploy consultants to assist users with training? We would argue that this is because there is a clear use case and because the app is very easy to use. We are following this same playbook with our app (clear use case, easy to use). The Crosscut app is extremely easy to use, in local languages where possible, and is designed with clear use cases in mind. Because of this highly specific use case of planning for a health emergency response, we are able to create a straightforward user experience that promotes adoption. Wherever health emergencies arise, our vision is to be there to support the response.

We have two major outcome indicators we use to measure the impact of our tool. The first is “coverage”, which we define as the number of persons reached by a particular health service divided by the targeted number of persons that should receive that service. The second is “equity”, which we measure by calculating the percentage of target persons living within a specified distance from a site providing emergency health services. Our theory of change draws a clear line from better planning leading to better outcomes.

We will be actively measuring these metrics during the 2021 health campaigns as well as the various output metrics to understand the uptake of the Crosscut app by users (registered users, microplans generated, health emergency scenarios, etc.). We support these with in-depth user interviews to shape our solution and deepen our ultimate impact.

The demand for expediency during an emergency could be a barrier to taking any time for analysis and limit Crosscut’s impact. Although Crosscut can be used to quickly help shed light on the right course of action, we are not decision makers for what path is ultimately taken. The “infodemic” environment can be chaotic with no clear decision criteria for what is to be done. Often what is expedient can rule out over what is best, which leads to suboptimal responses. The Crosscut app is not immune to such challenges, but our hope is that we can provide rapid clarity in chaotic situations to inform decisions when they must be made quickly.

Another limiting factor for us is financing. We are a social enterprise that is providing core features at zero cost, with more advanced users helping to provide funding. We are in a startup environment in a market with limited financial prospects, and are relying on grant funding to help incubate us as we find sustainability. Our underlying technology can operate sustainably with limited cost to maintain, but our ability to expand our features and reach new users depends on securing financing.

UNICEF, The Gates Foundation, End Fund, Emory University, The Carter Center

The Trinity Challenge, being a coalition including some of the world’s preeminent technology and global health providers, presents us with a promising opportunity to expand the visibility of our solution and to establish the financial backing that we need to grow. We previously mentioned that limited financing was one of the barriers that could limit the impact of our platform, and we believe our proposal speaks directly to the goals and objectives of The Trinity Challenge.

We are interested in expanding our partnerships with other implementing partners who do not want to make the large investment in GIS processing but would like the functionality as part of their existing programs and technologies.