Technology brings pandemic solutions to the developing world

A variety of technologies are being used in different parts of the world to educate and inform communities about appropriate hygiene measures during COVID-19.

“Giving people knowledge through technology can make a huge difference,” says Christy Gombay, who is global health coordinator of the Tula Foundation, a philanthropic organization based in Campbell River, British Columbia, and assistant director of the global health program at McMaster University in Hamilton, Ontario.

Tula started using phones in 2004 to deliver distance education to doctors and nurses in the far reaches of Guatemala, beginning with just 4 health centres and 28 phones. Financing from Global Affairs Canada (GAC) in 2016 helped the foundation to scale up the program that focuses on maternal and child health.

Today there are some 4,800 of the devices in use in 4 of the country’s 24 departments, Gombay says. COVID-19 has become a key “add-on” in the micro-training and the overall e-health system, given the need to disseminate material about the virus in Spanish and the Quiché language to frontline workers.

Sharing information and dispelling myths about COVID-19 is also a major element of the mobile health platform that Amref Health Africa uses to bridge the gap between the formal health-care system and underserved communities in Kenya, Ethiopia, Malawi and Tanzania. Amref, with headquarters in Nairobi, Kenya, partners with Canada to deliver digital programs focused on maternal, newborn and child health, as well as on reproductive health and rights. This focus has now broadened to include information about COVID-19, from symptoms of the virus to explanations of physical distancing.

“This crisis has highlighted the importance and the relevance of the existing technology solutions we’ve developed,” says Graham Atkinson, director of programs for Amref in Canada, based in Toronto. Its system, called Leap, uses basic cellphones, which don’t require an internet connection, to send text messages, audio recordings, quizzes, exercises and group chats to connect medical professionals and community health workers with one another and with experts in the field, he says. “This is an incredibly cost-effective tool that can deliver hands-on support, in the moment, where people are, in this current global crisis.”

Leap training has reached some 70,000 community health workers in Kenya, who have learned to identify, isolate and refer suspected cases of COVID-19, and to carry out preventive measures, such as installing handwashing stations. Winfred Luyeku, a community health worker in Kakamega in western Kenya, visits remote households to educate them on proper handwashing. “The children are excited to practice and share the information with their friends,” she says.

“Messages about the virus come directly from each country’s health authorities, and they can be translated and adapted as necessary,” Atkinson says. Restrictions in movement and gatherings necessitated by the pandemic—as well as expectations that this could be “the new normal” in the years to come—underscore the usefulness of such agile technologies, he adds. “As information changes, it can be spread quickly.”

Adapting technology to address the COVID-19 crisis is at the heart of WelTel Inc., which uses patients’ basic mobile phones for direct monitoring and support. Dr. Richard Lester, an infectious disease physician in Vancouver, co-founded the technology in 2005 to improve drug adherence among patients in Kenya with HIV, who are sent automated “check-in” text messages asking how they’re doing.

“If you ask someone ‘How are you?’ they get to tell you what matters to them and you discover new things,” explains Lester, WelTel’s scientific director. The answers are categorized and analyzed using artificial intelligence, and any concerns or queries are dealt with in a follow-up phone call or video chat with their healthcare providers.

WelTel, which is supported by a grant from Grand Challenges Canada with funding from GAC, has expanded to maternal and child health text check-ins. Lester saw a perfect opportunity to use it for COVID-19, and a platform was quickly developed to reach out to people who have the virus or are under quarantine.

That system is up and running in Rwanda, where it has been credited with keeping the number of COVID-19 cases relatively low, Lester says. It’s been extended to Kenya and even to the developed world, such as a pilot project in the United Kingdom. It is also used in some programs in Canada and the United States, as a way to safely distance from, yet still interact with, COVID-19 patients.

“If we’re asking people to home isolate, we need to be able to monitor and support them, using technology that reaches those most at risk,” Lester comments. “This keeps them in touch so they can have any issues managed.”

Technology is also helping deal with the economic and social impacts of COVID-19. Radio is being used to educate children shut out of schools by the pandemic in the Democratic Republic of Congo (DRC). The Making Waves program offered by War Child Canada, which was originally developed to reach girls with little access to formal education, has now pivoted and been extended during the COVID-19 lockdown. In partnership with Education Cannot Wait and GAC, Making Waves is now available to as many as 870,000 children aged 12 to 17 around the country.

Asha Gervan, DRC country director for War Child Canada, says this interactive radio instruction (IRI) model accelerates learning. The subjects range from math and history to languages and life skills, and gender-sensitivity is embedded in the curriculum. She says the 90 minutes of recorded IRI radio lessons each day are introduced by educational assistants, who are available on air afterward for toll-free calls from parents and children looking for follow-up.

“It’s very accessible, very engaging and fun for young students to listen to,” Gervan says. Making Waves is also developing radio spots with COVID-19 health information and messages about gender-based violence.

Chantal, 16, who lives in Uvira, a small city in eastern DRC, says that before the radio program, “I was already thinking about marriage because I was tired of staying at home.” The lessons have made her more comfortable with technology and interested in current events. “I am no longer thinking of getting married but rather of studying and becoming someone in society,” says Chantal, who hopes to pursue a career as a doctor.

There are still families who can’t afford something as basic as a radio, Gervan allows, so War Child distributes them as needed. There have been suggestions for more advanced technologies, she says, “but it’s just not feasible to go and hand out thousands and thousands of tablets.” The cost and availability of electricity and the internet are also a problem, says Gervan, who believes the radio education program enhances long-term resilience in places where school can be interrupted by natural disasters, health crises and conflict.

Maude Olivier, an international development officer in the Partnerships for Development Innovation Branch at GAC, says that Canada is “open to new ideas” and committed to advancing innovative solutions to development challenges. These can involve technology, financing mechanisms and different ways of delivering service, which bring better results and greater impacts.

“At the end of the day, innovation is about solving problems,” she comments. “It doesn’t have to be completely new, completely disruptive…Problems are evolving, they’re complex, and we have to continuously reflect on appropriate solutions.”

Olivier says the COVID-19 crisis has exacerbated development problems and prompted a number of technology-driven solutions, which are supported by Canada and other donor countries and organizations through the International Development Innovation Alliance. The Global Innovation Exchange, a global development technology platform that helps find funding to scale promising innovations, has a special hub to support innovations related to the pandemic.

“We need to adapt, adjust and scale the solutions we have already found,” Olivier says, through partnerships and academic alliances, for example, “which catalyze our investment to have more impact.”

Innovation must also be locally driven, she says, “because those who are closer to the problems know how to solve them.” Beneficiaries themselves can be innovators, especially women and girls, Olivier stresses. “It has to be an inclusive process.”

Innovation that is more impactful and improves efficiency increases the value of Canada’s investments in development, Olivier adds. And technologies developed for the Global South can be scaled up and used worldwide.

Dr. Richard Lester of WelTel foresees applications of technologies used in the developing world, like WelTel’s text message check-ins, working here at home in Canada.

“The digital landscape is evolving, and we’re learning what works and what doesn’t,” he says. “It’s important to find what reaches the most people, and especially the most vulnerable people, everywhere.”

Christy Gombay of the Tula Foundation says technology allows aid organizations to “tailor information to what’s reasonable” in local contexts. Tula plans to develop a micro-training program on COVID-19 and malnutrition, for example, and it is working on a virus chat group and frequently-asked questions for health professionals.

The organization has been contacted by the Guatemalan government to see about extending its COVID-19 digital health service to more districts, even nationally. In the absence of comprehensive testing, Gombay says, the technology can identify COVID-19 hotspots where containment measures should be kept in place or stepped up.

Canada’s support for the Tula program has been vital, Gombay adds. “This pandemic is going to get worse before it gets better, and we need to make sure that people get the information they need, when and where they need it.”