By Ambika Samarthya-Howard
FOR MORE THAN A DECADE, the South-Africa based non-profit Praekelt.org has been nurturing relationships with the World Health Organization and health ministries around the world, leveraging mobile platforms to disseminate vital health information.
But the novel coronavirus pandemic has introduced an urgency for the U.N.'s global health agency and several countries to launch a messaging service on WhatsApp in collaboration with Praekelt.Org and its social impact offshoot Turn's machine learning technology. The WHO HealthAlert reached 10 million users within four days of their launch on March 20.
"There's this hunger for information that can be adapted really quickly," says Debbie Rogers, managing director of Praekelt.org. "How do you get information to people that changes on a daily basis, that is personalized, and to as many people as possible with as little cost as possible? Our tools have been building up to this point."
Australia launched the COVID HealthAlert on March 29, New Zealand on April 2, and as of April 7 the team was in discussion with 26 other countries to launch the service. It is specifically relevant in places where governments don't have a clear way to communicate to all their citizens.
"They (governments) might be using Twitter and Facebook or the news (media) and all of those sorts of things but they don't have something tailored to their needs to communicate and that's the common denominator," Rogers says.
Before COVID-19, Praekelt.org first used WhatsApp messaging at scale on MomConnect, the South African Department of Health's nationwide effort to support maternal health through mobile phone technologies.
Many digital health initiatives in low- and middle-income countries are focused on specific topics, such as maternal health or HIV. The COVID-19 pandemic presents an opportunity for governments and nonprofits to use existing tools in immediate ways to quickly communicate verifiable health information to large audiences with low levels of literacy. Public health NGOs and technologists, particularly those with experience from the Ebola crisis, are collaborating to meet this demand.
Magnus Conteh, executive director of the Community Health Academy at Last Mile Health, a nonprofit organization working to bridge the rural health gap globally, says the digital technology employed for Ebola was crucial in bending the curve and ending the epidemic. Digital tools in disease outbreaks are vital for surveillance, contact tracing, supply chain management and referrals, Conteh says. "The disease can be different but you can use the same tools to provide the same functions without much adaptation."
The international nonprofit organization Internews works with residents and local media in more than 100 countries to provide people with reliable information. Their collaborative information dashboard responds to misinformation and helps to analyze trends. In the Democratic Republic of Congo, the dashboard, which incorporates community feedback and rumor tracking, quickly pivoted from Ebola to COVID-19.
"We learned how to follow emerging cure and treatment misinformation … and the importance of ensuring that rapid responses to this misinformation could be generated while adhering to rigorous data protection and privacy protocols," writes Em Winters, a humanitarian data specialist at Internews.
Adds Alison Campbell, Internews' vice president for global initiatives: "You can't limit people. The platform pivots because it is a reflection of what people are talking about." The region saw its last Ebola survivors just weeks before it saw its first COVID-19 cases.
Ebola also taught the public health and digital communities lessons. "One of the challenges with the Ebola response was that people were rushing to deploy technology without fully assessing the compatibility of the tool with the problem," Conteh says.
Health care experts need to consider four issues in considering digital tools to help fight a disease outbreak, Conteh says:
- The appropriateness of the tool for the solution being addressed;
- Its accuracy;
- Its cost (if it's open-source or proprietary);
- Data security.
Prioritizing Trustworthy Information
The Ebola crisis also showed the importance of diagnosis, and Conteh says health care workers need to focus on rapid testing kits and technology developments for diagnostics. HealthAlert messaging will soon offer self-assessment tools to reduce the load on health systems.
To have effective communication, trusted information is key, and that is where government and WHO endorsements become critical. "We jump in with good intentions, create havoc, and then we lose valuable time because we don't align with ministries and local communities," Conteh says. "We need to design in a more intentional way."
For example, South Africa's Department of Health named the service COVID-19 Connect and it is now offered in five languages including English, Zulu, Xhosa, Sotho and Afrikaans. South African network operators are also supporting the awareness of the helpline via SMS to their clients.
"The government is heavily involved in the South African version in terms of the content and what needs to be there." Says Pippa Yeats, Turn's Product Manager. "I think it's more a matter of what technology they can leverage that they can get this stuff out quickly."
Other examples of health interventions moving to integrate COVID-19 messaging include the CORE Group's Polio Project that does electronic community-based surveillance in Africa; Zenysis Technologies, Dimagi's ComCare (a mobile data collection platform) which is used for contact tracing and was used in the Ebola crisis; ThinkMD's Triage App that aims to combine COVID data in a data repository that can be distributed to agencies around the world; and the Maternity Foundation, which is working to create a COVID-19 module for the Safe Delivery App.
Technology and communications are only one part of the fight. There's also the question of limited resources and a government's capacity to respond to increased needs.
For now, digital technologies are helping bridge an important gap – and are likely creating viable public health interventions that will be relevant long after COVID-19 passes.
"What most governments are thinking of at the moment is, yes, there's this immediate need for COVID-19 information and it's getting a lot of people coming to the platform and engaging regularly, but what will it be there after?," asks Rogers of Praekelt. "How do we then turn it into a place where people can find trusted health information?"
Anyone in South Africa can join the COVID-19 Connect conversation by typing the word 'Hi' to +27 600 123 456 on WhatsApp.
Join WHO's Health Alert on WhatsApp:
- Arabic: Send "مرحبا" to +41 22 501 70 23 on WhatsApp
- English: Send "hi" to +41 79 893 18 92 on WhatsApp
- French: Send "salut" to +41 22 501 72 98 on WhatsApp
- Hindi: Send "नमस्ते" to +41 22 501 73 41 on WhatsApp
- Italian: Send "ciao" to +41 22 501 78 34 on WhatsApp
- Portuguese: Send "oi" to +41 22 501 77 35 on WhatsApp
- Spanish: Send "hola" to +41 22 501 76 90 on WhatsApp
(Banner photo: People wearing face masks are seen using their mobile phones at a mall in Mamelodi, March 29, 2020, near Pretoria, South Africa. Credit: PHILL MAGAKOE/AFP/GETTY IMAGES)