911 for Global Health

Congratulations! This Entry has been selected as a semifinalist.

911 for Global Health: Citizens Reporting Global Health Emergencies

Delhi, IndiaBoston, United States
Year Founded:
2013
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Idea
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

We are creating an easy way to report tuberculosis drug stockouts online or by text. This feedback loop will help address drug shortages two ways: 1. Provide officials with real time reports of stockouts, and 2. Provide people with a tool to hold officials accountable for taking action.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if a text message could stop the next global health crisis BEFORE it started?
About Project

Problem: What problem is this project trying to address?

India faces shortages of tuberculosis drugs, threatening to leave millions of people across the country without access to life-saving treatment. Some government officials have denied that these drug stockouts exist. There is no simple mechanism for gathering drug shortage data, making accountability and transparency impossible. We aim to change this by identifying shortages in real time in order to stop wide-scale health crises in their tracks.

Solution: What is the proposed solution? Please be specific!

This solution will enable anyone in Delhi to report tuberculosis drug shortages as they occur. The user will log a complaint through SMS or web form. This data will then be aggregated and shared with District TB Officers to alert them of impending drug stockouts. Civil society groups and the general public will also be alerted through emails, social media, and marketing. The accessibility of this knowledge will empower communities to come together and hold their government officials accountable to respond rapidly to health crises. The web form is being built using MySociety's FixMyStreet platform (fixmystreet.com), the SMS/text-based system is being built using Textizen (textizen.com). Please see the attached mockup.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

A boy visits a Delhi government hospital complaining of a cough, and a doctor diagnoses him with TB. She begins to write a prescription for Rifampicin, a common TB drug, but then remembers the hospital has stocked out. Frustrated, she tells the boy's parents to come back next week. On her way home that evening she sees a poster, "Report TB Drug Stockouts," with a phone number. She texts it and answers a few questions. The next morning the District TB Officer sees an email. He grumbles, but knows a copy has also gone to local TB activists. He calls the hospital for details, and completes some paperwork. A few days later, the doctor gets a follow up text. She happily responds that the drugs have arrived and the boy has started treatment.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

In June, our team launched its first campaign, building a drug stockouts petition site for Indian TB activists. While only live for 2 weeks, 335 people signed the petition. However, the impact lies not in the number of signatures, but the profile of those who signed - our aim was for Indian citizens who directly suffer these injustices to speak out and sign on. 90% of signatures from TB patients or survivors came from Indian citizens. Overall, 55% of our signatures were from Indian citizens. 911 for Global Health will launch in 5-7 districts in Delhi, India representing a population of approximately 5 million people. In 2012, these districts were reported to have the lowest "Drug & Logistics Management Scores" in Delhi by India's National TB Programme. Through our project we seek to help these districts improve their scores by next year's report.

Spread Strategies: Moving forward, what are the main strategies for scaling impact?

Our expansion strategy has three phases: 1) Pilot reporting of TB drug stockouts in Delhi districts; 2) Expand to enable reporting of other TB treatment issues in Delhi clinics. This could include enabling patients to report things like "professional fees" (bribery), unacceptably long wait times, and incorrect diagnoses; and 3) Expand to other areas of health and other geographic locations. Eventually, we hope that this approach can be used by anyone -- from a doctor in New York facing shortages of AIDS drugs to a cancer patient in Lima being denied proper access to pain medications.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

Once the web and mobile tools are built, the major associated costs with this project will be staff time to manage the project and conduct outreach as well as the ongoing costs of maintaining local phone numbers ($500-$1000/year). To help mitigate the staff costs we seek to integrate this project within a broader program of TB advocacy we are undertaking with our partners (see team section).

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

A number of TB advocacy groups exist in India and around the world. Many are also focused on ending drug shortages. And many groups have also built similar accountability tools. In particular eSwaraj (an applicant in this competition we hope to work with more closely) has developed an application that enables Indian citizens to report problems. However, our project is unique in that we enable anyone affected by TB to easily report drug shortages and then tie that information to a broader advocacy strategy to ensure that action is taken.
Team

Founding Story

We had just completed our first campaign - building a petition site for activists in India who were fighting the TB drug shortages - when we heard about a confrontation had taken place on the main stage of an important international TB conference. As a head of India's TB program began giving a talk at the conference, activists rushed the stage accusing him of not taking action to end the drug shortages. He responded by refusing to admit that shortages still existed, saying everything was under control. We realized there needed to be a better way for ordinary people - doctors, patients, community members - to speak out about what they saw happening. There and then, we decided that a better way to capture and show the truth was crucial.

Team

Combined, our team of 10 people brings 5 decades of experience in leading global health programs and policy change. This includes: 1 part-time coordinator from the Article 25 Education Fund; 1 part-time coordinator from Partners In Health; 1 strategic advisor from Cambridge University; and 1 part-time staff, 1 strategic advisor, 2 senior advisors, and 3 research students at the Dept. of Global Health & Social Medicine at Harvard Medical School.
About You
Organization:
Article 25
About You
First Name

Ankur

Last Name

Asthana

About Your Organization
Organization Name

Article 25

Organization Country

, MA, Boston

Country where this project is creating social impact

, DL, Delhi

Impact
Full Impact Potential: What are the main spread strategies moving forward? (Please consider geographic spread, policy reform, and independent replication/adoption of the idea or other mechanisms.)

Our long term aim is to scale this approach to citizen-led accountability into other areas of global health. First to other communities across India affected by TB, then to other countries that face high rates of health inequality and global health crises such as TB. Our vision is a world in which anyone who suffers an infringement upon their right to health is empowered to easily and intuitively speak out. We hope to shift the power dynamic and maintain pressure on those who should be held accountable.

Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?

Currently, the solution requires that a user have access to a device that can either send texts or access the internet. Potential methods to manage this issue could be an offline strategy that would enable community members to submit reports via phones at community centers or having organizers that would go door to door to collect reports.

Also, the cost of SMS may be a deterrent for individuals to submit a report. We could address this by partnering with network providers to incentivize individuals to submit reports by providing free texts for people submitting a verified report.

Sustainability
Partnerships: Tell us about your partnerships.

Article 25 is working with Partners In Health and the Department of Global Health & Social Medicine at Harvard Medical School on a project to scale up treatment for tuberculosis and drug-resistant tuberculosis globally (i.e. 911 for Global Health is one component of a broader grassroots movement building strategy to end TB).

We are also working with Textizen and FixMyStreet to develop the mobile and web tools needed for this project.

Closing the Loop
How does your project primarily ensure that feedback delivers results?

Help funders, governments, and other organizations to listen to and act on feedback.

Please elaborate on your answer to the above question.

Fundamentally, this project power shifts power to ordinary people in affected communities so that they can hold their governments accountable for delivering on their promises. It gives voice to those shut out of the often fierce debate between big institutions and activists, providing a new starting point for citizen-led accountability, advocacy and activism in global health.

Languages: In what languages are you able to read and write fluently?

English.

2nd Round Questions
Thinking about your feedback loop; what information are you trying to get from whom, to whom, and to bring about what change?

We are seeking reports about whether TB drug stockouts exist at a government clinic from doctors, TB patients, and their families. This information will be sent to the government's district TB officers as well as activists, NGOs, and the media to ensure that the Indian government takes emergency action to purchase more supplies.

What is the purpose of your feedback loop?

Creating broader awareness of issue/movement building

If other, please specify

It also aims to improve the quality of programs through feedback.

What mediums or mechanisms do you use to collect feedback? (check all that apply)

SMS, Website.

If other, please specify
Could you briefly describe the way you collect the feedback?

The feedback provider is first asked to provide either a location name or the name of a clinic where they would like to report a stockout.

If they enter a name of a clinic that matches what is in the database, then they will simply be asked whether they have any additional comments, and to enter their email address before submitting.

If they enter a name of a clinic that doesn't match, or they just enter a geographic location, then on the web platform they will then be taken to a map of the general area specified with a number of clinics displayed to choose from. If they are reporting over SMS they will be asked follow up questions via SMS until a clinic matching what is in the database is identified or enough information is collected that the report can be matched to a clinic manually by one of our team members.

Once a stockout report is submitted, it will then be anonymized and sent to the district TB officer over email. Additionally, a full (non-anonymized) report will be sent to our project staff. We can then aggregate and repackage this information and will then send it via email to media, activists, and civil society (while protecting the privacy of the individuals reporting, of course) to ensure that pressure is put on the government to take action. We will also post the aggregate, anonymized data on our website for the public to see.

What mechanisms are in place to protect people from retribution?

Option to provide feedback anonymously

If other, please specify
What are the immediate benefits or incentives for people to provide feedback?

Confirmation of use of feedback

If other, please specify

Both the website and mobile SMS option will provide immediate confirmation to the user that their feedback is being used.

How do you ensure new and marginalized voices are heard?

Specific targeted outreach efforts

If other, please specify

Partnerships with local advocacy groups and local organizers.

What are the incentives for the intended recipient to act on the feedback?

Pressure through media outlets

If other, please specify

In addition to pressure through media outlets, we also plan to partner with health activists to organize advocacy actions.

How does the feedback mechanism close the loop with those who provided feedback in the first place?

Other

If other, please specify

Follow up emails or SMS messages will ask the original reporting individual whether the problem has been solved.

How is feedback published/transparent?

On a website

If other, please specify

The feedback will also be reported in media stories.

Give two concrete examples of how feedback loops have brought a program or policy more in line with citizens’ desires.

In Delhi, one of the new political parties (the Aam Aadmi Party "every man party") launched an anti-corruption hotline. Though it ended up getting flooded with tens of thousands of calls, and not all were focused on corruption, it did get many citizens involved in the process of accountability.

In global health groups like World Vision have implemented programs such as "Citizen Voice and Action" which have enabled citizens in Indonesia to understand their right to health, demand those services from governments, and then ensure they are delivered properly. Though this approach relies heavily on trained staff leading exercises with the community, it has led to marked improvements in access to health care (see: http://bit.ly/1gMcVuB).

While we are not a political party or large community organizing group ourselves, we do think these are important examples of what is possible in global health through feedback loops that empower citizens to demand change.

If there was one thing you could change to increase the impact of your feedback loop, what would it be?

While we are focused on web and SMS technology for now, with additional funding we'd like to expand the system to integrate with approaches that may be more accessible to more people in Delhi such as phone hotlines and even in-person organizers at community centers. The two latter approaches are more labor intensive but would help ensure that even the most marginalized populations could have their voices heard (which may not be possible with a web platform or SMS-based model).

What are your biggest challenges or barriers in “closing the feedback loop”?

An “expert paradigm” where the perspectives on “non-experts” is not valued

If other, please specify
Are you aware of The Feedback Store?

No, but I would like to be on it

What are the main uses you can envision for the Feedback Store?

Over time we could see it as a way to integrate our work within other platforms (and vice versa).

What is the one thing you would most like to see changed to improve the competition process?

It was terrific - especially the peer feedback part! It was nice to have some choice in who to evaluate, but we would appreciate if the organizations we were evaluating were more closely tied to our focus area to catalyze connections and partnerships. (Our team ended up going through the profiles of all the applicants and made a list of which ones were aligned with our work, but it would be great if the competition organizers could help facilitate that too!)

What are you doing to make sure that feedback providers know that they are empowered by the information they can give and that they know exactly what the information they are providing?

Initially, we are mainly limiting the information someone can provide to the location (clinic) where the stockout happened. This way there is little ambiguity about the purpose of the tool.

Over time, we hope to engage feedback providers in the process of actually participating in advocacy and the movement to address TB. This will require more than a feedback platform, however, which is why we are working to develop partnerships with local NGOs, doctors, and civil society groups to ensure that our feedback tool is part of a broader movement building strategy.

randomness