In a country where the Ebola crisis hit most forcefully, it was found that one half the doctors who were being paid for by donors did not exist. The money that was being donated to pay for these doctors was being siphoned off through corrupt practices by bad leaders. Here is the story of a group, TrueFootprint, and the way that they are going about trying to combat this kind of corruption by bringing bottom-up information-sharing to the fore.
One of the goals of TrueFootprint is to prevent the types of corrupt activities that took place during the Ebola crisis from happening again as the Covid-19 pandemic is addressed.
Today the technology and processes being developed by TrueFootprint are being used to fight the Covid-19 pandemic that is affecting frontline workers. Health service monitoring was not the technology’s original goal, but when the pandemic struck, TrueFootprint decided to apply it to the emergency. In July 2020, TrueFootprint launched the "Covid-19 Care Monitoring Coalition” (CCMC). The coalition is helping facilitate self-advocacy and a constructive dialogue between healthcare providers, ministries of health, and population groups at high risk because of Covid-19. What the coalition fosters is reporting from the frontline on the very basic question of whether health facilities are safe and accessible. In the context of the Covid-19 pandemic, reports are sent in by coalition “monitors” about whether health facilities are safe for the people who work and visit there. The monitors also help collect and share information about whether these same facilities have Personal Protective Equipment such as masks and eye protection, and whether they have separate places for Covid-19 patients and those who do not have the disease.
The CCMC is growing organically, having passed 90 partners in 53 countries by the end of November 2020.
Partners in twelve countries are already working on national scale-up strategies after they completed their pilots. Ministries of health in these countries are being very supportive and several more plan to follow in the coming weeks.
TrueFootprint developed the app not to be a contact tracing technology. Nor is it simply a data gathering solution. It is a tool and set of resources for self-organising and self-advocacy.
Two-week pilots have been conducted in 25 countries in Africa, Asia, Central and South America, and in Europe since the project launched in July.
Once the whole process is up and running, this approach will produce real-time data driven by people and communities who have the most at stake to ensure that health services are safe and accessible. This will enable:
• Descriptive analytics -- For example, the solution tells whether: 1) health services are delivered safely and whether they are accessible to those who need it; and 2) early warnings are needed to pre-empt crises. In addition, the solution answers the questions of where, how and by whom problems are being solved
• Predictive analytics: e.g. where are there likely to be problems, and where are there likely to be fewer issues? The aim with this project is ultimately to contribute to safer access to healthcare in as many facilities as possible in as many countries as possible.
The strategy for reaching this goal is twofold:
• Make the technology and method freely available to any group interested in making use of this approach in any country; and
• Systematic and sustained deployments in a small number of countries, contingent on funding, with the goal of covering all relevant health facilities in a country/district/province (depending on the country’s size), and with 25% of facilities randomly selected as control locations to test the extent to which this approach contributes to improved health outcomes and lower mortality rates among health workers.
The CCMC is a network supported by a set of self-advocacy tools for health workers, at-risk populations, and local communities. It enables this by:
• Providing granular data dashboards that are easily customised to address the specific needs and entitlements of at-risk groups, which helps to facilitate their self-advocacy with the policy makers and local officials with whom groups often already have prior relationships
• Sharing insights across the network of how specific problems were solved
• Providing a live data feed (and PDF reports) to relevant health officials.
Crucially, it provides a real-time data feed and knowledge sharing of:
• The resolution-rate of identified problems
• Where they are being solved and how problems are being solved (and then sharing these experiences across the network so that they can be replicated and emulated elsewhere)
• As well as eventually identifying who is doing the solving and giving these people or organisations recognition for this if they are open to receiving it.
All the emphasis and all the incentives are geared towards solving problems, not just identifying them.
Problem-solving is ultimately what empowers and motivates self-advocacy and is what will contribute to better health outcomes for affected workers, populations and communities.
Health workers are the core users. In many countries, health workers are not allowed to speak up. The CCMC is a constructive, evidence-based advocacy solution for this critical population.
In addition to health workers, the CCMC is also working to include other at-risk and highly affected people:
• People living with HIV and TB in Indonesia, Zambia, India and Ukraine
• Community health organisers in Harlem, New York
• Grassroots health organisations working with Native Americans in the US Midwest and Native Hawaiians in Hawaii
• Parents of children with serious disabilities in South Africa
• Families with children with severe nutritional deficits in Sao Paulo
• Tribal people in the Brazilian Amazon
• People living in UNHCR refugee camps in Uganda
• Incarcerated people in the UK
• Homeless people in Brazil, Malawi and other countries
• Internally displaced people in Kenya
• Sex workers in India
• Workers and people living in care homes in France
• Youth organisations in many countries
As an example of how this self-advocacy can be organised on the ground, the CCMC partner in the Democratic Republic of Congo (DRC) is already working on creating multi-stakeholder collaborative meetings that will allow monitors, patient groups, community members and health officials from a health area to constructively work together, negotiate and to mutually agree on an action plan to improve healthcare services. They will use insights and evidence collected by health users and health workers to lead discussions and high-level advocacy on priority problems.
Emphasis will first be placed on solutions which can be tackled at the local level with available resources, as well as on advocacy actions towards higher level authorities that can be taken to improve health outcomes. These advocacy actions can sometimes be jointly conducted by representatives of health users and health workers and local health officials towards subnational-level health officials and then to national-level officials. These action plans are then translated into concrete actions, responsibilities are determined, deadlines are set, and donors and required resources are identified.
With the support of local senior health officials, this CCMC partner is already laying the groundwork for institutionalising TrueFootprint’s solution and advocating for its adoption by health users monitoring in both provinces and across DRC as part of the development of a ‘’new normal” which hopefully covers other disease burdens, not just Covid-19.
The monitoring is supported by the use of the Covid-19 FieldApp developed by TrueFootprint, a technology company based in Cambridge, UK.
The app is a mobile application that is installed on people’s phones. The current version was created for Android phones, by far the most widely used mobile phone operating system. Future versions will also work on iOS and may also be developed for other mobile operating systems if there is a need for this. The training requirements for using it are minimal: healthcare workers require little to no training and patient monitors may require as little as 5 minutes of training to understand the purpose and function of the app. The app has training support built-in so that people understand what to do with the data and how they can contribute to addressing identified problems. It generally takes less than 2 minutes to complete a daily report by answering a standard set of questions that are based on the WHO Covid-19 guidance. The app can be used in offline mode when someone with a phone does not have mobile data, no mobile reception, or Internet access. Reported data will sync the next time the phone is connected.
Sustainability of the FieldApp Beyond Covid-19
TrueFootprint’s aim in building this technology is to enable wide adoption by users who have a voice but are often not heard.
The commitment in the context of this project is that the partners in the CCMC will have ongoing and free access to the app and that they can re-use and adapt the app for other projects and topics if they are interested in doing so. TrueFootprint is also committed to providing the FieldApp for free to the members of certain groups that have been helpful to the CCMC. The eventual goal is to provide the app and all its key features for free to organisations that work directly with communities, including to governments in Middle Income and Less Developed Countries.
There are three main ways of generating revenues for TrueFootprint to sustain this technology and still be in a position to provide it for free to end-users and the organisations that service and support them. TrueFootprint’s core value proposition is to provide better impact and sustainability data for the financial services industry, large corporates and through them their key suppliers. These services are provided on a commercial basis. TrueFootprint is testing a business model wherein systematic data collection, for example in projects funded by aid donors, foundations and corporate CSR, will include micro-payments to certified monitors, and more significant payments to people who qualify as “Supermonitors”; in such a scenario, TrueFootprint would charge a transaction fee as a percentage of those payments. A third revenue stream comes from commercial arrangements on large projects, such as projects with more than 1,000 users. All the tech built in the context of CCMC is instantly reusable for non-Covid-19 use cases in support of these self-funding value propositions.
If you are interested in funding the work of TrueFootprint, through grant resources or other means, please contact Fredrik Galtung at email@example.com
Safety is defined in terms of the guidance provided by WHO on “Critical preparedness, readiness and response”, see https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications