Using AI for zoonoses surveillance and to empower women-farmers

A proactive approach to track and detect existing and novel zoonoses emergence whilst simultaneously offering holistic support to sustainably empower women-farmers in Niger Delta (Nigeria) - using internet-free mobile technologies and a multi-level Artificial Intelligence (AI)-driven support framework.

Dr Tomiwa Erinosho, Chief Technology Officer, Towntalk and Principal Investigator, Social Science Academy of Nigeria

Nigeria is one-of-four countries contributing 44% of the world’s poorest livestock keepers. Diseases such as anthrax and rabies are widespread among livestock keepers, but their neglected nature provides a false perception of health-security. Nigeria’s passive, indicator-based (sentinel) approach also makes it susceptible to existing (e.g. Lassa fever and Ebola) and novel zoonoses. 

In particular, the Niger Delta region of Nigeria (comprising 9-of-the-36 states) has abundance of key drivers of zoonoses resulting from constant toxicity from anthropogenic factors (e.g. crude oil exploration and refining), natural factors (e.g. animal migration) and climate change. Coupled with the socioeconomic challenges in the region such as insecurity, gender-based-violence and poor-healthcare, which mostly impact women’s productivity and livelihood, the Niger Delta has become a hotspot for zoonoses. 

Noteworthy, agriculture employs >50% of labour in the region, comprising ~70% women, operating at the interface of disease-transfer from animals-to-humans (zoonoses). However, limited real-time health-intelligence and empowerment initiatives to support women-farmers necessitates this solution to apply a multi-level AI-driven support framework to actively track unusual/disruptive events (e.g. multiple livestock death) which are typically the early manifestations of zoonoses. Also, for resilience building and sustainability, we will empower women-farmers in the Niger Delta to improve their health, social and financial-security.

This project targets women-farmers in the Niger-Delta region of Nigeria and addresses their need for health, social, and financial security because:

• Women-farmers, because of their vulnerability to disease-transfer from animals-to-humans (zoonoses), need support to strengthen the resilience of the environment, local food-systems, and the family;
• Women in the Niger Delta region account for >90% of the family’s food supply. In particular, women at the grassroots regularly interact with environmental elements (e.g. using polluted water from streams for cooking), making them ready vectors for transmitting zoonoses (e.g. to their family). Thus, regular health-related information empowerment from this project will improve awareness of healthy living practices in line with Sustainable Development Goal (SDG) 3 on “Good health and well being”; and
• Offering holistic support to enhance women’s health, social and financial wellbeing remains a sustainable approach to give the power and control that women need to make them thrive, and likely to have longer term impact. 

Ultimately, this project will directly target ~40,000 women-farmers in the region by providing holistic specialist-support (i.e. psychosocial, health and financial). It will also indirectly reach  >1 million women, girls, men and children (e.g. through economic empowerment of families).

Non-sensitive datasets will be made available to researchers for research-purposes only. Data on disease detection will also be available via Application Program Interfaces (APIs) to existing disease surveillance systems such as the Global Outbreak Alert and Response Network by the World Health Organisation (WHO), BlueDot etc. 

The project will also share information via its location-specific virtual platform (Pulse) to support the use of its findings and other related non-sensitive data by different audiences (e.g. research institutions; policy-makers; health security leaders; public health experts; community representatives/advocates; private sector; development practitioners; government). 

In addition, solution team member, the Nigerian Institute of Medical Research (NIMR), is strongly affiliated with the state and national ministries of health in Nigeria, and other legacy partners such as the Nigerian Center for Disease Control and its non-Nigerian regional affiliates. NIMR is also Nigeria’s point of reference in basic, applied and operational research for the promotion of national health and development in Nigeria. Thus, regular communication (peer review, bulletins etc) will be shared by NIMR with the general public and, with key partners (e.g. WHO, Africa Centres for Disease Control and Prevention etc) to ensure the strengthening of data systems for enhanced detection and response to potential pandemics.

Specifically: 

• Data collected on land, air and water pollution, loss of biodiversity and other natural factors will provide critically-needed evidence to support decision-making on environmental sustainability by health-security leaders and other policy-makers; 
• Empowerment information on health and social issues will mitigate “disruptors” to women-farmer's productivity; 
• Access to psychosocial support will improve social security of the women-farmers; and
• Subsidized health insurance and zero-interest short-term emergency agri-loans will enhance financial security whilst deepening financial inclusion of the women-farmers.

Although the project directly targets ~40,000 women-farmers, it will indirectly reach >1 million women, girls, men and children e.g. through economic empowerment of families. Furthermore, the Niger Delta, with a 50 million population, comprises socially marginalised, economically disadvantaged and medically underserved communities. This project will: 

• Protect the livelihood of a fragile population by providing health, psychosocial and financial support to women in agriculture who are normally marginalised and engage in a vulnerable livelihood; 
• Enhance the resilience of local food, environment, and health systems in communities that experience increased vulnerabilities (e.g. zoonoses); and 
• Promote a shift in attitudes at the individual, community and national levels towards good health, well-being and financial security.

The project will initially focus on three states in the Niger Delta - Abia, Edo and Delta. Notably, these states feature in the ongoing Project SAFE implemented by two members of the consortia - using AI to track and support survivors of gender-based-violence. This will provide a pathway to pilot-test the proposed project in a soft roll-out prior to scaling up. 

We aim to grow a sample pool of 40,000 women-farmers across the nine States in the Niger Delta over a two-year data collection period, reaching about 4,500 persons per state. An initial market opportunity assessment highlights that the proposed recruitment channels have the potential to reach 190,000 users within 2 years. Thus, assuming a modest recruitment conversion rate of 25%, given the incentives received from participating, it is reasonable to reach 40,000+ persons. 

Moreover, the focus on women, who are critical to the resilience of local food systems and the family unit in the Niger Delta region further implies additional indirect impact of the project. We estimate that >1 million men, women, girls and boys will be impacted by the women-farmers and, >50 million in the region will be impacted by a safer, more resilient and healthier environment.

The project provides clear support channels for a relatively vulnerable demographic in the Niger Delta region (i.e. women-farmers). Specifically, the project aims to achieve: 

• 70% completion rate in the Interactive Voice Response System (IVRS) sessions in Year 1 among the randomly selected participant pool each week, increasing to 80% in year 2 – achieving increased participation; 
• Minimum of 40,000 recruited women-farmers across an inclusive demographic (e.g. age spread, geography) over the project’s duration with at least 4,500 per state;
• Clear evidence of strengthening existing zoonoses surveillance in Nigeria using data (e.g. adoption of the project's Pulse Platform for disease surveillance); 
• Evidence of enhanced financial security of women farmers e.g. >90% short-term emergency agri-loan repayment; 
• Improved social security e.g. continuous decline in stigmatised insecurities reported by women-farmers to state support channels such as the police; 
• Capacity building particularly for researchers in niche areas such as genomics, health informatics etc; 
• Post-project access to anonymised data to support ongoing research; and
• A significant shift in attitudes towards health security and holistic support at the levels of government, community and individuals (especially the women-farmers).

• First, health surveillance requires buy-in from critical stakeholders such as the ministries of health. This barrier is mitigated by the support from Nigeria’s Federal Ministry of Health (FMoH) which oversees parastatals such as the Nigerian Centre for Disease Control and exchanges information with regional partners such as Africa Centres for Disease Control and Prevention (Africa CDC). Noteworthy, the attached support letter from Nigeria's FMoH, and Goal 1 of Africa CDC’s disease surveillance and intelligence thematic area highlights the importance of this project's active, event-based (symptom-data) surveillance approach as a strengthening mechanism to the passive, indicator-based (sentinel) surveillance approach currently adopted in Nigeria. 
• Second, the difficulty in accessing remote riverine communities and other hard-to-reach locations (e.g. due to insecurity) in the Niger Delta Region is addressed by leveraging the project's technology tools, community-based organisations and community health extension workers (recommended by the Federal Ministry of Health) that already operate in the region. Grassroot marketing channels such as radio, television and cooperative societies will also be utilised. 
• And finally, the financial barrier to operationalize a multisectoral, coordinated approach to health intelligence gathering and support for a vulnerable population, will be resolved through the funding from The Trinity Challenge.

• Social Science Academy of Nigeria (SSAN)
• Nigerian Institute of Medical Research (NIMR)
• Federal Ministry of Health, Nigeria (FMoH)
• Towntalk Poltech Limited (Towntalk)
• American International Insurance Company (AIICO)
• International Development Research Centre (IDRC)

Although “holistic” health intelligence gathering and support-provision is attractive, significant barriers prevent its implementation particularly in low and middle income countries where other health and development priorities compete for attention and funding. 

Today, the COVID-19 pandemic continues to demonstrate that health intelligence gathering can be impeded by factors such as political interference, resulting in the non-reporting or misreporting of zoonoses that could have global ramifications if they escalate to epidemic or pandemic levels. In Nigeria, for instance, despite the ongoing COVID-19 pandemic, hitherto structures to track and support identification of new cases are being moderated, as funding is diverted to other governmental priorities. Notwithstanding, marginalised populations such as women-farmers who have been impacted by the COVID-19 pandemic require holistic support. 

Therefore, the Trinity Challenge can provide the critically-needed funding to operationalise this holistic intelligence gathering and support for typically-marginalised women-farmers in a zoonoses hotspot such as the Niger Delta region of Nigeria. 

The solution team would like to partner with BluDot to enhance the proposed solution's scalability and to derive learning from BlueDot's operationalisation of Collective Intelligence. Note, the conceptual framework for the proposed project also draws on the Principles of “Collective Intelligence”, generally termed as “wisdom of the crowd". A partnership with BluDot will significantly enhance the dissemination of this project's findings, contribute to strengthening existing data systems for pandemic preparedness and response, and provide added visibility to this solution's approach to operationalising collective intelligence in low and middle income countries.