Mobile Data Collection Platform for Ebola Response

1. Robert Peter Ndugwa, PhD Chief Global Urban Observatory Research and Capacity Development Branch United Nations Human Settlements Programme UN Avenue Gigiri, UN Complex, Block 4, South Wing, 2nd level P.O.Box 30030, GPO Nairobi 00100, Kenya Tel +254 20 762 23342 | Mob + 254 720 492021 Email: robert.ndugwa@unhabitat.org | ndug2000@gmail.com Technologies for Disease Epidemics: Experiences from Roll-out of a Mobile Data Collection Platform for Ebola in West Africa.

2. Overview • UNMEER background • Assessment findings • Design • Results of pilot • Lessons and challenges • Way forward • Questions

3. Background • UNMEER: The first ever United Nations Mission for Emergency Ebola Response. • Ebola timelines were pointing to increasing deaths and worse humanitarian situation

4. UNMEER-BackgroundAs per Accra planning conference (October 19, 2014), UNMEER responsibilities was based on 4 lines of action and 5 enabling activities:

5. Problem at hand • Time stamping • Location stamping • Relational links and structures • Connection trees on individuals • Multi-country • Mapping and GIS • Photographic evidence • Real-time reporting and decision making • Back/forth communication devices • Race against time

6. Findings from quick assessment on data collection methods

7. Findings from Nethope-led quick assessment

8. Findings from Nethope-led survey

9. Findings from Nethope-led survey

10. Overall data flow plan Region Country Global

11. Flow Diagram of Cases and Contacts -- Processes Epidemiology Team Case Management Team Identification of contact Clinical assessment Disinfection of Home Suspect taken to isolation facility Visit contact (21d) Meets susp case def? No Yes Transfer to confirmed ward (+) LAB results 24h No Fever+Symp? Isolate? Yes (-) Yes No Discharge per protocol Inform case management team Continue follow-up until 21d Additional contacts identified Continue to follow-up for 21d Contact listing & follow-up forms Case Investigation form LAB form

12. Requirements and gaps: e.g surveillance Contacts per month needed Contact tracing teams needed • At an estimated capacity of 800 contacts per contact tracing team this translated into ~215 teams needed by December 2014

13. EPINFO limitations • EPINFO is a desktop package that has always worked well on epi-surveillance in small epidemics

14. Can mobile solutions contribute to the response effort….. Client Records & Tracking Data collection Client Counselling Checklists & Protocols SMS for Performance Improvement* Program Monitoring & Evaluation

15. Mobile-phone Data collection Opportunities • Real-time data collection (on and off mobile grid) • Patient record tracking over time • Point of care decision making algorithms • Visit reminder alerts • Alerts for new cases in specific geographic areas • Multimedia for strengthened counseling (video, audio, image) • Videos for refresher trainings • Mapping of cases with GPS points

16. Tools • 13800 phones (Samsung, LG, Motorolla, Amazon, HTC) • 500 IPADs • Solar chargers • Extra batteries • BGANs In addition online forms were developed for use on laptops and computers

17. Supply versus demand balancing…

18. Advantages of the mobile app CDC safety checklist built into application GPS Capture Identifying level of risk depending on case profile

19. Advantages of app cont’d Audio aids for Counseling Quality Controlprofile Visual aids for Counseling Quality Control Built in workflow alerts to improve communication

20. Combination of tools • Online forms used to transmit data more easily • Phones used to map key facilities and geolocations e.g hospitals, ETU, airfields, logistics bases, etc • Field based Ebola crisis managers used phones to take photos for decision making. Photos have automatic GPS codings. • Field teams able to collect the WWW

21. Quick mobile survey results

22. Example Of Complex Field Deployment Of Contact Tracing • Identify a case • Identify x contacts to case • Follow contacts for 21 days • Exit them after 21 days follow up if no disease • Active contacts can be contacts for many cases • Report contacts who develop disease • Follow cases from contacts until outcome (death or recovery)

23. Three linked applications CONTACT MONITORING (CT) CASE AND CONTACT REGISTRATION (ETU) CONTACT ASSIGNMENT (DPS)

24. Case registration • Index Case Registration • Conducted during interview with case at the ETU • Assigns outbreak ID • Registers case details (name, age, location) • Registers health facility • Identifies symptom onset data • Identifies admission date • Identifies number of contacts *Note: These images are samples taken from the application and do not reflect the full questionnaire

25. Contact registration: at ETU • Contact Registration • Identified by index case • Registers case details (name, age, location) • Registers relationship to index case • Identifies last contact date with index case • Identifies DPS office that will need to assign the contact • This data gets pushed to the DPS office to then conduct assignment *Note: These images are samples taken from the application and do not reflect the full questionnaire

26. Contact assignment: at district level • Contact Assignment • Data pushed from the ETU case/contact registration application • One questionnaire that requests the district lead user to assign each contact to a contact tracer • Assignments made based on existing protocols (that balance contact tracer workload, location, etc)

27. Contact monitoring: at household • Contact Monitoring • Data pushed from the district head and can be opened by a contact tracer • Edit registration option • Collects GPS (optional) • Asks about fever and other symptoms • Logic flow based on previous answers – i.e. presence of symptoms lead to prompt to contact supervisor • No symptoms leads to sensitization content *Note: These images are samples taken from the application and do not reflect the full questionnaire

28. HQ: Performance Snapshots

29. HQ: Index Case-Contact Linking

30. Our Surveillance Dashboard

31. Data Analytics: Registration Data

32. Data Analytics: Contact Monitoring Data

33. Data Analytics: CT Closures

34. Data Analytics: CT Performance

35. Lessonlearnt • Quick assessments are valuable for benchmarking on what works. • Value of partners and support. • Pilot prior to scale up. • Buy-in is never automatic until you demonstrate value addition. • Connectivity remains a challenge in some parts of Africa. • Many apps exist and sometime expert opinions help to select the best for the situation at hand. • A combination of tools is sometimes valuable • BENEFITS • Reduces delays in reporting of possible Ebola cases • Vetted real-time data from contact tracers was available at all management levels • Streamlined communications and information relevance across governing authorities • Allowed for use of health and location data for rapid response deployment

36. Partnerships • UNHABITAT • UNMEER • National Governments • WHO • Samsung • LG • Motorolla • Vulcan Corp Inc. • Dimagi • Tableau • Ericsson • The Earth Institute: Columbia University • CDC

37. Questions? For more Q&A please email Robert.ndugwa@unhabitat.org or ndug2000@gmail.com