COVID-19 Response - Digital Technology Part 1

CORE Group convened a panel of presenters from a variety of organisations to discuss current digital technologies being used in the COVID-19 response. As the recordings and presentations capture, these presenters addressed issues such as disease self-assessment and triage, aggregation of multiple data systems, information sharing and exchange, disease surveillance, and contact tracing.

One of a series of weekly calls (see Related Summaries, below), this call (#5) featured Lisa Hilmi, CORE Group's Executive Director, providing updates on risk communication and community engagement. Magnus Conteh, Executive Director, Community Health Academy, Last Mile Health, facilitated the presentations and discussions.

The presentations are as follows:

1. Presentation: CORE Group Community-Based E-surveillance for COVID-19 Response
By: CORE Group Polio Project Kenya
Summary: This presentation describes how community-based e-surveillance - used as part of the CORE Group Polio & Global Health Security Agenda (GHSA) Project (CGP-GHS), working in hard-to-reach nomadic and cross-border communities around Kenya - is being adapted to the COVID-19 response. As explained in the presentation, community-based surveillance (which involves community participation in detecting, reporting, responding to, and monitoring health-related events) helps to detect diseases early so that appropriate and timely action can be taken to prevent further spread of the disease, mitigate against future occurrence of the disease, influence health-seeking behaviours, and help to understand local diseases affecting communities. It is currently being widely used to track diseases such as polio and measles, as well as diseases affecting animals. It makes use of community health volunteers who report to a local health facility. The presentation describes the surveillance workflow - how data is collected by mobile phone; how the data is collated and processed; what tools, equipment, and platforms are used; and the kind of information that becomes available for use by health officials. The system is currently being adapted to track COVID-19; however, the challenge is how to protect communities and volunteers in the surveillance process. To respond to this, some adjustments have been made, such as using social media to provide information to households, training community volunteers through mobile phones (no longer in big groups), and developing safety protocols for house-to-house visits.

2. Presentation: Zenysis Support to the COVID-19 Response
By: Zenysis Technologies
Summary: Zenysis is an interoperability platform that allows for the integration of different information systems into a single platform for easier analysis. As explained in the presentation, the biggest problem/challenge is that there are often multiple activities taking place, which are managed by different organisations. This creates different information streams, making it difficult for decision-makers to make sense of the information. Zenysis works with countries to take any number of information sources - laboratory data, contact tracing data, supply chain system data, Excel files, and District Health Information Software (DHIS2) information - and brings it into one unified "COVID-19 Control Room". The system is currently being used in countries in Africa and Asia in 3 main ways: (i) helping governments bring together their contact tracing data, such as data from flight manifests and ride-hailing apps; (ii) integrating supply chain systems with health systems to help ensure that health equipment is reaching the places with the greatest demand; and (iii) integrating COVID-19 information with other routine health information on, e.g., malaria and HIV, so they can monitor the strain on the health system and allocate resources accordingly.

3. Presentation: National COVID-19 - Disease Surveillance System
By: Sri Lanka Ministry of Health
Summary: The Sri Lanka Ministry of Health developed the COVID-19 tracker app, My Health Sri Lanka, to accelerate case detection, situation reporting, active surveillance, and response for COVID-19. It uses DHIS2, a large health management information system, which has been in use in Sri Lanka for many years. It is now being optimised for mobile use through a DHIS2 Android app to incorporate and integrate all disease surveillance activities. These include case management, quarantine case management, contact tracing and relationship mapping, community response to manage suspects/contacts, resource management in hospitals, and intensive care unit (ICU) bed availability management.

4. Presentation: COVID-19-Communication Inspiration Challenge
By: OpenIdeo
Summary: OpenIdeo (part of Ideo, a global design and innovation consultancy focusing on human-centred design) organised the COVID-19 Communication Inspiration Challenge to bring people together from all over the world to answer this question: How might we rapidly inform and empower communities around the world to stay safe and healthy during the COVID-19 outbreak? OpenIdeo received hundreds of submissions from around the world and from a range of fields, including health, design, research, and communication. The crowdsourced information specifically sought to find out what information is resonating with audiences, what is effective, and where the gaps are in order to understand people's needs, emotions, and behaviour to better design communications around COVID-19. The presentation discusses some of the findings, including who is currently not being addressed by COVID-19 information (such as digitally disconnected populations, the elderly, and the homeless). Findings in 3 main areas are discussed, which point to the need to link credible information with emotions, the need to contextualise and translate information accurately, and the need to make the invisible visible when developing communication materials.

5. Fighting Ebola with Information: Learning from the Use of Data, Information Flows, and Digital Tech in the West Africa Ebola Response
By: United States Agency for International Development (USAID)
Summary: This presentation is based on a report published in 2016 that looks at how important information and data were to the Ebola response - in particular, to being able to understand how a disease is spread and to respond effectively. It looks at some of the initial challenges, such as the fact that digitisation was primarily through manual data entry at a district/national level, which created errors and delays, and the fact that the different digital tools and systems that were deployed were uncoordinated, which complicated data management and use. The presentation briefly refers to the recommendations outlined in a data use cycle put forward by USAID, but discusses in more detail a new USAID draft policy document called "USAID Digital Health Vision" to highlight some key considerations for funding and investing in digital programmes for global health. These draw on the lessons learned from Ebola and are relevant to the COVID-19 response. They cover 4 key priorities: (i) understanding country-level capacity for digital health in order to, for example, ensure that investments align with capacity; (ii) understanding digital strategies of countries and how they can be strengthened; (iii) understanding the digital health architecture to make sure that investments are sustainable and align with a country's policy and regulatory environment; and (iv) recognising that global goods, which applies to content and software, are a priority to consider so that digital investments align with digital systems that are already being used. In the context of an emergency, this will help countries get to scale quickly without needing to build capacity from scratch. Finally, from a user perspective, the role of trust is highlighted as a key priority to consider for any digital strategy.

6. Presentation: COVID-19 Personal Triage, Education and Surveillance Monitoring Tool
By: THINKMD
Summary: THINKMD has released a mobile-based COVID-19 screening and educational tool that is designed to address 3 main challenges: the demand on clinics and healthcare personnel who need to screen patients, the need to disseminate public health information, and the need for epidemiological data. The presentation explains how the tool responds to these 3 issues by firstly offering users a guided COVID-19 self-risk assessment tool to help determine if an individual has none, some, or many of the clinical symptoms associated with COVID-19. Secondly, the tool provides an individual with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) educational information on how and when to seek medical care, as well as recommended protective and preventive measures. Thirdly, it makes time-specific population health and epidemiology data available for disease surveillance analysis that can provide health ministries and international health agencies with data for developing and monitoring response strategies to mitigate the spread of COVID-19 and to maximise appropriate testing and healthcare delivery to those who need it the most. The content and technology can be distributed through a website, mobile network operators, and frontline healthcare workers using a smart or feature phone.

7. Presentation: CommCare for COVID-19 Response
By: Dimagi
Summary: Dimagi's CommCare mobile app was used in the Ebola response and is now being used to respond to COVID-19 in a variety of settings, including in Nigeria and the United States. The presentation explains how CommCare is able to build and deploy custom mobile applications for every phase of a COVID-19 response, including prevention and education for frontline health workers, triage/testing, tracking via mobile case management features, quarantine management, in-hospital management, and post-care management and support. CommCare is currently looking into developing a rapid remote training app, an app that can assess facility and supply chain readiness, and an app that can support mental health.

8. Presentation: Medic Mobile and The Community Health Toolkit
By: Medic Mobile
Summary: The Community Health Toolkit (CHT) is an an open source project for which Mobile Medic is the technical steward. CHT's Core Framework is designed to enable the building of scalable digital health apps that equip health workers to provide better care in their communities. A highly configurable framework, it runs on a range of devices, supports multiple hierarchies and users in a health system with integrated care workflows, and is interoperable with other systems. Based on priorities emerging from their partners in Asia and Africa and the broader global community, CommCare is focusing their COVID-19 work on: surveillance; patient assessment, testing, and referrals to care; and support for community healthcare workers. The presentation highlights 2 projects in particular: (i) the COVID-19 Port of Entry Screening app, which was designed and launched in partnership with the Ministry of Health and Population (MoHP) in Nepal to support the enrolment of all incoming travellers at ports of entry, COVID-19 screening, and follow-up for the self-quarantined; and (ii) the Rapid Diagnostic Test app, which can be adapted to different rapid tests as they emerge. It is designed to walk community health workers through clinical protocols to administer the tests, ensuring that proper safety measures are taken. The presentation also looks at an app for self-symptom screening that is about to be launched.

9. Presentation: Communication to counter the COVID-19 'info-demic'
By: BBC Media Action
Summary: With a grant from the H2H Network, BBC Media Action has been producing social media content in 6 countries in Asia: Bangladesh, Cambodia, India, Indonesia, Myanmar, and Nepal. The focus has been on social media due to the speed at which social media content can reach communities and the fact that this is where a lot of the disinformation and misinformation is found. The presentation explains the 2 approaches being used for creating content: The first is to make content that is generic enough so that it can be shared across Asia and easily adapted to any country and language, and the second is to develop country-specific content that may deal with more localised rumours or use local music and social influencers to provide reliable information and counteract rumours. Facebook has proved to be the most popular platform to disseminate content, although BBC Media Action is also using YouTube, Twitter, and Instagram. The presentation also looks at the next phase of the project, which includes: scaling up to the Middle East, North Africa, and Sub-Saharan Africa; focusing on understanding the impact of the social media content using social listening analytics and other methodologies; and addressing some of the social, economic, and psychological effects of COVID-19, possibly through web dramas.

On February 6 2020, CORE Group began a series of weekly calls (see Related Summaries, below) to convene members and partners to discuss their institutional positions around a range of topics related to COVID-19 in an effort to coordinate and support the global pandemic response. During each call, people who signed up for the discussion have the opportunity to ask questions and give input, and these discussions are also included in the recording. To receive updates and coordination call announcements, subscribe to CORE Group's One Health Interest Group listserv or email the listserv using: onehealth@lists.coregroup.org.