Report: Fighting Ebola with Information

Originally published on January 20, 2017.

Most of us have probably heard stories about how the Ebola response was helped (or not) by different technologies — be it through better maps, donated hardware, text messages or big data analysis.

USAID has just published a very interesting report that looks at the Ebola response and the role of technology as whole: “ Fighting Ebola with Information: Learning from the Use of Data, Information, and Digital Technologies in the West Africa Ebola Outbreak Response “. In my opinion it should be required reading for anyone who is involved in implementing tech projects in emergencies.

Here are some things that I took away from reading the report:

This is a bit of a pet peeve of mine, since I have been telling critics of the humanitarian coordination structure for years that not having this structure would be much worse than trying to make what we have work. Obviously, the system can and should be improved, but it is this system that people know and in which they know how to operate. In the Ebola response, OCHA was not coordinating the response and the cluster system was not rolled out. Instead WHO and UNMEER were supposed to fulfil these functions but were not up to the task:

“On the humanitarian side, many interviewees highlighted the absence of the Office for the Coordination of Humanitarian Affairs (OCHA) and the humanitarian cluster coordination system as contributing to confusion surrounding coordination and information sharing, and forcing a reinvention of the wheel when established practices already existed. (…) With many of the normal coordination channels absent, particularly in early phases, the collection and management of response-wide information suffered.”

Whether you consider data to be a common good, a potential risk or the means to exert control is partly a question of organizational culture. This cannot be changed quickly. The decision to staff UNMEER with people from the UN Department of Peacekeeping Operation (DPKO) led to an almost inevitable culture clash with many humanitarian organizations.

“Multiple interviewees highlighted the diverging data cultures between a humanitarian operation, in which information-sharing is an essential part of the mandate, and a peacekeeping mission, in which information is largely regarded in the context of privacy and security. As one humanitarian official said, ‘DPKO does record keeping for the mission. They are not focused on public information … or on making products for public consumption.’”

I total understand why people publish PDFs. As a matter of fact, I wish the Ebola report itself was available as a PDF, and not just as a website. However, there is an important difference between, on the one hand, documents that serve as records and which you want to be immutable and, on the other hand, data that other people need to be able to reuse for their work. As a system we really need to do better than this.

“The publication of critical outbreak data in non-machine readable format slowed and narrowed the use of these data by actors who could have helped to contextualize the data and provide insight that could inform the response. This included epidemiologists and researchers who needed access to case data for predictive modelling.”

There are a couple of examples in the report where technology champions were surprised by the amount of resources that were necessary to implement a change in procedure or a technology.

“Effectively using data and digital technologies require more, not fewer, staff to coordinate and manage collection of information across multiple partners, to support use and adaptation of digital platforms, and — most importantly — to analyze the data in order to inform decision-making.” (…)”For example, we discovered 100 people who had the same unique ID and realized [one health center] had a form with a unique ID and then they photocopied the form. So you had 100 people with the same unique identifier. We only realized later the need to provide clear guidance on how this should be implemented.”

The reason that I’m likely to trust a printed document released by the German Ministry of Health is that I have been socialised in a society where we consider institutions trustworthy. That is not the case in many of the countries we are working in, where formal structures are weak or might even be perceived as hostile. In an environment like this establishing trust can only happen through face to face encounters and with the help of the people whom a community already trusts. This requires resources. Only once trust has been established, can digital and analogue communications tools support the provision of information to the community.

“We developed messages about avoiding physical contact and used aired broadcasts carried over national TV as a way to suggest a new form of greeting, with arms crossed over chest and bowing. This was a major cultural shift as people were used to touching. But when the bishop went on TV with other religious leaders doing it, it became more accepted.”

Last but not least I’d like to share a quote that we all know at heart to be true, but which we often ignore when we are fascinated by a shiny, new toy:

“The value proposition for integrating digital technologies lies in enabling richer, more diverse, and more rapid data and information exchange, the benefits of which can accrue to health and humanitarian programs, particularly in crises (…) The use of digital technologies will not, as this research demonstrates, automatically confer these benefits.”