“I couldn’t live without my mobile phone” is a well-worn phrase, but it takes on a new meaning in the countries fighting to eradicate Ebola in West Africa.
Since the World Health Organisation (WHO) recorded the first case of the Ebola virus in this epidemic in March 2014, organisations around the world have scrambled to fight the disease.
Mobile phones equipped with apps and digital platforms targeting health – popularly known as mHealth – have been on the frontlines.
Nigerian health officials credit a large part of their success in eradicating Ebola cases to the use of mobile technology in the country’s healthcare system.
Nigeria, the region’s largest economy, diagnosed its first case of the disease in July 2014. Public health officials worried about how quickly it could spread in this populous country. But Nigeria – in contrast to regional neighbours such as Sierra Leone, Liberia and Guinea – quickly contained and eradicated the outbreak.
Nigerian health workers deployed mobile phones loaded with mHealth apps soon after the first cases were recorded. This led to a significant reduction in the reporting time of Ebola cases from 12 hours to six hours initially. Uptake was rapid. Soon, the app was able to track reports made in real time.
Nigerian contact tracers used mobile phones equipped with GPS tracking to visit individuals suspected of being exposed to the virus. This allowed authorities to map the tracers’ visits in GPS coordinates.
Data from the Ebola Emergency Operation Centre in Lagos showed that more than 800 people were traced and roughly 18,500 houses and workplaces were visited during the Ebola campaign.
“Mobile health technology contributed hugely to our success,” says Daniel Tom-Abba, former senior data manager at the Ebola Emergency Operation Centre in Lagos.
“It helped us get data from the grassroots in real time and transmit it to the control centre significantly more quickly than if we had been doing it manually.”
In the end, Nigeria had only 19 cases, of which seven died and 12 survived, compared to the thousands of mortalities in other affected countries in the region.
This is not mHealth’s only success story.
In September 2014, UNICEF launched RapidPro – a free, open source software platform hosting multiple apps developed jointly by UNICEF Innovation Labs and Rwandan software firm Nyaruka.
mHero (Mobile Health Worker Ebola Response and Outreach), one of the apps on RapidPro, broadcasts messages about care and prevention and shares training information. The app played a key role in combating Ebola in Liberia.
Approximately 490 frontline health workers and Ministry of Health employees are currently using it. The app is in the process of mapping the activities of 5,100 community health volunteers.
To date, it has broadcasted around 12,000 care and prevention messages to users and has been rolled out in Sierra Leone, Guinea and Senegal.
The high mobile penetration in many African countries makes mobile phones an easy vehicle through which to transmit information – particularly in contexts where other systems and infrastructure are lacking.
According to Devex, a social enterprise for the global development community, there will be an estimated 1bn mobile phone accounts in Africa by the end of 2015. This equates to one for nearly every person on the continent.
“mHealth is going to continue to be a huge potential resource,” says Nicolas Pottier, CEO of Nyaruka. “Mobile penetration is massive across Africa.”
According to Mr Pottier, developers are only beginning to scratch the surface of what mobile platforms can be leveraged to do.
“While the story of mobile penetration has been the same for at least the past five years, we have not really done a good job of figuring out all the ways we can take advantage of it,” says Mr Pottier.
“But I see that improving with the implementation of RapidPro in more and more countries.”
It is a view shared by Chris Fabian, who co-leads the UNICEF Innovation Labs in New York and played a key role in its Ebola work.
“What we have seen is that, whether it is mHealth or just the general use of a basic mobile phone, we are now living in a much more connected world which means we can extract information from a population more quickly and analyse it in exponentially shorter amounts of time,” he says.
In Liberia, for instance, when UNICEF’s team arrived in October 2014 to assess crisis response to the epidemic, they quickly realised that the technological infrastructure to implement mobile-driven solutions was there .
The problem was that the necessary tools – like U-Report and mHero – did not yet exist to take advantage of this.
“I think if we had had both of those [systems]in place earlier, then we would have been able to respond more quickly and probably more accurately in many cases,” Mr Fabian says.
U-Report, another UNICEF mHealth tool, is a free, open-source text message based program designed by UNICEF Innovation Labs to empower people in developing countries to share information on the issues they care about in their communities.
It can be used on even the most basic mobile phone. Information is instantly mapped and analysed, yielding real-time insights. UNICEF has received more than 86,000 messages about Ebola to date via the service.
In countries such as Nigeria and Uganda where U-Report already has an established user base, it was used to quickly spread accurate information about signs, symptoms, prevention and treatment of Ebola when the virus started spreading in early 2014. The countries each have 565,000 and 290,000 registered users, respectively.
While U-Report is now being mobilised for health purposes, it has also been used to track information about job skills, safe water, female genital mutilation, early marriage, and a host of other development issues. It has also launched in Mali and Sierra Leone, with plans underway for a launch in Guinea.
U-Report was eventually launched in Liberia in November 2014. Today, more than 50,000 Liberian youth are registered to use the service. They engage daily in Ebola-related discussions about proper hand washing techniques, safe burial practices and stigma faced by survivors.
Unlike Nigeria, which has a fairly sophisticated web over mobile network, less than 1 percent of Liberia’s population is connected to the internet. U-Report’s SMS based service dovetailed with Liberia’s text-centric mobile users, and helped with rapid uptake.
Risks at play
The rapid spread of mHealth apps across many countries in the region points to a wider trend of increased dependence on mobile as a portal for public services.
“Mobile phones are quickly becoming the primary tool for access to health services,” says Ivan Thomas, ICT Coordinator for the West Africa Ebola Response at the World Food Programme (WFP).
However, this dependence comes with risks – especially in countries where resources, and therefore contingency plans, are minimal.
“If mobile networks are damaged in an emergency and go offline, it is essential that services are immediately restored,” Mr Thomas points out.
The Emergency Telecommunications Cluster (ETC) and the likes of GSMA – a telecoms industry association – and UN Office for the Coordination of Humanitarian Affairs are now addressing this through the Humanitarian Connectivity Charter.
The charter offers a common, predictable operational framework to ensure that mobile network operators respond to people’s needs more quickly and efficiently in the wake of a disaster.
The WFP played a critical role in using technology to help contain the virus by serving as the leader of the cluster during the Ebola epidemic. ETCs provide communications services and voice and Internet connectivity to humanitarian workers within 48 hours of a disaster.
Since April 2014, the ETCs have provided internet and radio connectivity in 115 locations across the three worst affected countries Sierra Leone, Guinea and Liberia. The clusters also ensured reliable internet access for more than 2,100 humanitarian staff.
But while strides have been made in how technology can been used to fight Ebola, the epidemic has also exposed notable weaknesses.
“The main weakness was the human factor,” says Mr Tom-Abba.
Consequently, his team is now working to incorporate the new technological innovations into their existing disease surveillance system. Along with their partners, they hope that by training public health professionals to use these technologies so they can be more ready to respond to future disease outbreaks.