Real-time data from the field

In many countries health authorities lack reliable, readily-available facility-level data.  Incorrect numbers relating to clients, patients, health workers and health products can lead to avoidable sickness and death.

Our mobile-app powered solution centers on frontline data. Self-advocacy is the key ingredient in our method. Data is a by-product.

We work with community engagement partners (such as the Kenya Red Cross, faith-based organisations and patient groups) to give people on the ground (health workers, patients, community health volunteers) agency through self-advocacy. We provide them with our mobile app that crowdsources problem-solving and data collection from the frontline to produce real-time data.

Together with health authorities we define the questions and topics shown in the mobile app, e.g. regarding availability and quality of PPE or adherence to health policies. The answers can be seen by stakeholders such as health authorities, using dashboards that update in real time for insights and better decision-making.

We work to protect people vulnerable to infectious diseases (patients, healthcare staff). This includes millions of people.

Three challenges put these populations’ safety at risk:

1.    Unreliable data: Incorrect numbers relating to patients, healthworkers and health products can lead to avoidable sickness and death. During the 2014-16 Ebola crisis, thousands of ghost healthworkers were reported to be responding to outbreaks, when in fact nothing was being done. In the midst of the Covid-19 pandemic, we see mis-procurement, price-gouging, fake patients and falsified patient data.

2.    Conflicts of interest: Reporting can be compromised through political interference, administrative incentives, and safety concerns.

3.    Not ‘closing the loop’: Many employee or citizen reporting systems exist but suffer from structural and technological shortcomings: they may start out well, but then data flows dry up. If their reports do not result in change, people stop reporting issues.

These data challenges prevent health authorities from making the right decisions, healthworkers from providing quality services and beneficiaries from accessing those services. We address these challenges by providing these stakeholders with reliable, facility-level, real-time data.

Once firmly embedded in the daily worklives of health authorities, healthworkers, and patients, our method helps communities be prepared for the next emergency.

Reliable, readily available data lies at the heart of efforts to keep vulnerable populations safe. Our solution centres on frontline data. Self-advocacy is the key ingredient in our method. Data is a by-product.

Our solution is an investment in the demand-side:  We work with community engagement partners (such as the Kenya Red Cross, faith-based organisations, and patient groups) to give people on the ground (health workers, patients, community health volunteers) agency through self-advocacy.  We provide them with our mobile app that crowdsources problem-solving and data collection from the frontline to produce real-time data.

Together with health authorities we define the questions and topics shown in the mobile app. For example, FieldApp app asks a health worker if infected patients are kept separate from other patients. She answers “No: in the waiting room infected patients are mixing with others.” She solves the problem by creating a second waiting area and by having a staff member screen people outside the building, directing people one way or another. She shares her problem and solution with others on the platform. Because she takes ownership of finding and solving issues, data keeps flowing as a by-product. Using a real-time dashboard health authorities can make better decisions.

Our solution serves the needs of 3 groups:

(a)   Health authorities: TrueFootprint’s approach yields real-time, reliable data that can be used by decision-makers to inform policy and resource allocation. The data provides assurance that health products have not only been distributed but are also accessible and in use. Problems with the application of policy can be corrected in real time, failures adjusted, and outcomes measured. We engage with the local authorities to understand their needs and present options so they can decide what questions they should ask and whom they should address through FieldApp.

(b)   Healthworkers: TrueFootprint’s method engages frontline health workers to improve working conditions through self-advocacy by the people who have the most at stake to ensure safe working conditions. Many country partners we have worked with to set up a pilot are health workers and community health volunteers themselves, allowing us to find out their needs in particular country contexts.

(c)    Patients: TrueFootprint’s method engages vulnerable patients and community members as positive agents of change. Working with patient groups (e.g. people living with HIV, malaria, TB, people living with disabilities) directly in a country has allowed us to define questions and topics in the app of greatest concern to the beneficiaries of health services.

If health authorities knew exactly what was going on at each facility in terms of patients’ health and safety, they could protect them better. But in many countries health authorities lack reliable facility-level data. A typical question might be whether the PPE that was ostensibly distributed is actually used - or was it redirected or resold? Our pilot results in 27 countries show that the latter is often the case. Another question might be whether protective policies are being followed? Our pilots show that too often the answer is no. However, our pilots also show that health workers can come up with their own solutions to solve these issues locally.

Reliable, real-time facility-level data, which is a by-product of our method, helps save lives in vulnerable groups. It allows health authorities to make the right decisions, on time, health care workers to provide quality services and beneficiaries to access those services. 

Our solution saves lives in the current pandemic, and by firmly embedding it in the processes and daily lives of the people using it now, it can help save lives in future health emergencies.

Our solution provides authorities with the data from the ground about their actions and policies. This helps them quickly coursecorrect in their efforts to
detect, slow, or halt future disease outbreaks. Is the PPE that was shipped actually used? Is it used properly? Is the vaccination programme working? Are there any unknown unknowns the authorities should know about?

Even though our method is actually mature and at the Scale stage (used in 3,000 projects in 14 countries and a decade of finetuning), we conservatively selected Pilot stage, because our app and platform were built from scratch in 2019. They are now in production stage version 1.0, live in 27 countries and containing over 10,000 data points. Our pilots are mainly in Sub-Saharan Africa and typically involving between 25 and 50 monitors, have proven that they work well, with few issues. In the pilots we measured success by the number of active monitors, but ultimately the issue resolution rate is a key metric for us.

There isn't anything new in our tech. Plenty of apps allow for rapid and remote configuration of surveys. Plenty of apps that allow for peer-to-peer communication. Plenty of apps that automatically sync data to the back-end once an offline user comes back online. And real-time dashboards are commonplace.

What is new is our method of agency, with a focus on problem-solving
and ownership, and how it provides data as a by-product. Thousands of
projects have been done without lasting change because of a lack of
ownership in the community. It is done to them, for them, but not by
them. We believe people closest to the problem have to be engaged for
the sustainability of any solution. This is more than just a belief: we
have put this to the test in over 3,000 projects across the world and
seen success, even once we left the area.

Since July we have run pilots in 27 countries. These pilots typically lasted between 2 to 4 weeks. They included between 25 to 50 active people. We are currently running 2 pilots with Covid-19 vaccination programmes in western Kenya. These involve a dozen health workers and 30 community health volunteers interviewing people after they have been vaccinated. A total of 1,500 people have been interviewed so far. Collectively across all pilots in the 27 countries we have data from over 2,000 people. But the number of beneficiaries is a bigger number: other people at the health facilities besides the monitors also benefit from any issues that are resolved, so that is patients, staff, most likely 10 to 100 times the number of active users.

1 year: 10+ million. We are planning, with the Global Fund local chapters, 3 national roll-outs, in Guinea, Mali, Zambia most likely. Using the same approach of improving health care per health facility, we impact all the people going there.

5 year: 100+ million. National roll-outs in another 25 countries.

To get robust proof of the impact of our method we are working with 3 academics (Professors Nancy Qian and Erika Deserranno from the Kellogg School of Management at Northwestern University, and Dr Tali Regev from the IDC in Israel).

Using randomised controlled trials, they will test their hypothesis that TrueFootprint's method provides better outcomes for key stakeholders on a cost-effective basis - and under what conditions the best results are achieved. 

In addition, we look at our internal metrics. One metric we use is the issue resolution-rate: how many of the issues Guides flagged up were solved by them? 

Although one could argue that any issue resolved is already a success, we set our standards higher and aim for an overall minimum 25% resolution-rate in healthcare. The target is dependent on how centralised processes being monitored are; the more localised they are, the higher target we set.

We also work upfront with local ministries of health to define what success looks like for them. We anticipate they define success in terms of:

●      Reduced fatality rates among health workers.

●      Better health outcomes for patients and health workers, particularly in vulnerable populations where data is a scarce commodity.

●      Reduced fraud and corruption, e.g. stolen materials, ghost workers, ghost materials.

We work with Health Ministries to get agreement on the metrics needed and to source data where needed.

Full-time employees: 3

Part-time employees: 0

Contractors: 3

Country Partners (unpaid):12

Once we have funding in place we aim to hire technical and operational staff.

Our CEO has been in the social sector for 25 years. First employee of Transparency International. Founded the NGO Integrity Action. He invented our method there. In 2018 he founded TrueFootprint to apply the method on a wider scale, targeting multinationals aiming to improve sustainability of their supply chains. Our Chief Product Officer has worked at companies that scale, working with customers in 60 markets. We are uniquely positioned:

1. Having created and refined the method ourselves, we have a deep understanding of what it takes to make it work and what factors may limit its success. Having applied the method in many countries we understand how important local context and local buy-in are.

2. Having done many successful pilots in the context of Covid-19 with local partners means that we have the credibility to work with the local authorities to expand this and start having impact at scale.

Representative
team: our engineer is a Zambian living in South Africa. Our Rural
Development Specialist lives in Lira, Uganda. Our in-country partners
provide us with input on needs and agendas at a local level. This
partner network was built up over more than a decade in the social
sector.

One of our guiding principles in talent acquisition is that when all things are largely equal, we favour those candidates that help us become a diverse and inclusive team. We deliberately cast the net wide and do not simply hire UK based people. For example, during the recruitment process for our lead engineer we interviewed qualified candidates from Nigeria, Bangladesh, Madagascar, Kenya, France, the UK, and South Africa. We are well aware that through pure chance we ended up with 3 white male founders and have much to do to become the diverse and inclusive team. Our hope is to be able to hire extensively in the main areas we serve (the Global South), and provide the brightest stars a compelling career path.

The Financial barrier is the first one that Solve can help us overcome.

We also hope to be able to tap into the Solve network's experience in public health to help us expand into this sector, given that public health is not in any of our backgrounds. We hope the Solve network can advise us in how to build a strong health sector team.

Finally, we hope to find guidance on how to navigate the demands that some countries have put forward that the data can not leave the country. What have other Solve organisations done to address this issue?

We find ourselves lucky to have strong enough networks to get meetings with a big pharma and a major steel company, to get meetings with health authorities and even medical experts such as Dr Muyembe-Tamfum.

We are confident that these meetings will lead to clients. However, to expand the client base beyond our own network is a key concern and support is very much welcomed.

On the technology front, we need support to overcome the abovementioned issue of data sometimes not allowed to leave the country. We also have no experience in building tech for feature phones.

We would like to partner with public health experts and software experts experienced with feature phone development.

We have worked with the Refugee Innovation Centre in Uganda to run a pilot inside the refugee settlements. Refugees and health care workers used the FieldApp to monitor care in the context of the Covid-19 pandemic. The key ingredients of our method, agency and ownership, align very well with the Andan Foundation. If we were to win The Andan Prize for Innovation we would deploy our solution in refugee settlements in Uganda and neighboring countries.

In many of the projects involving our solution women have made outstanding changemakers. In Nepal for instance, our method was used to monitor the rebuilding of schools after the devasting earthquake in 2015. Most of the monitoring was done by girls who,armed with the knowledge of what building contractors were paid to do, felt empowered to stand up to those who tried to cheat. We provided them with certificates of completion afterwards whcih they proudly used to gain employment.

We would use the Innovation for Women Prize to deploy FieldApp alongside any of the initiatives that Vodafone Americas Foundation is currently running or planning to run. Or alternatively, we can source initiatives ourselves where women make outstanding monitors and local coordinators (e.g., public health, conservation or regenerative agricultural initiatives in Africa).

We already have done pilots with people living with HIV, TB and malaria. The results are promising: these people are engaged monitors that not only can proivde facility level data, but also are keen problem solvers.

We have made great inroads with local governments in a few countries (e.g. Guinea) but winning this prize would allow us to get the attention of those ministries of health we have not been able to reach (e.g. Rwanda).