Building A More Resilient West Africa

How Open Innovation Can Help

Ann Mei Chang
U.S. Agency for International Development


Improving local health workers’ access to real-time health information will enable a faster and better response to global health threats. / Neil Brandvold, USAID

Imagine a world where a health worker in rural Liberia has real-time access to the information she needs to save lives.

When a patient shows signs of a deadly disease, she can input his symptoms into her phone and an alert goes off in the Ministry of Health in the capital, hundreds of miles away. When her local clinic does not have enough supplies, the regional supply store is alerted and automatically sends new stocks. When she does not have the capacity to take care of a sick patient, she has a digital, up-to-date list of all nearby clinics and hospitals where she can refer her patient.

Unfortunately, real-time health communications is out of reach for most of the world.

Local health workers often have very limited access to digital data systems, and the systems they do have do not link with regional or national health information infrastructure.

The data that does get collected and communicated is usually low quality and unable to be used across different systems because of inconsistent standards and identifiers. The consequence is that crucial information, such as a disease outbreak, cannot be communicated in a timely or reliable manner.

As the international community continues to work towards a sustained Ebola-free West Africa, communities and economies across Guinea, Liberia and Sierra Leone remain devastated by the virus.

More than 11,000 people were killed by Ebola, with tens of thousands more infected. In the wake of this crisis, USAID, West African governments and our partners around the world are working together to help communities and economies recover.

As part of USAID’s multi-pronged approach to recovery and resilience, I am excited about using open innovation to source new, collaborative approaches to making those real-time health information systems a reality.

Currently, much of West Africa’s health information is paper-based. / Neil Brandvold, USAID

We now know that thousands of deaths could have been prevented at the peak of the Ebola epidemic with better and more actionable health data, including transmission rates, case notification, infection control options, geographic spread, health service availability, and related animal health data. The inability to use this type of information — because it was incomplete, inaccurate, or simply not available — significantly hampered the national and international response to the epidemic.

At the heart of this challenge were insufficient health information systems.

These systems are a foundational piece of health infrastructure, providing governments, development partners, service providers, health workers and communities with critical information so the public health community can better target health solutions, allocate resources and effectively respond to disease outbreaks.

This challenge is not exclusive to West Africa. The difficulty of coordinating local, regional and national health systems expands far beyond one region or one health crisis. A recent Harvard study notes that after the Severe Acute Respiratory Syndrome (SARS) outbreak in China, the World Health Organization revised its International Health Regulations to ensure that each country met a basic level of ability in detecting, reporting and responding to health emergencies. However, as of 2014, two-thirds of countries had still not met these requirements.

The crisis in West Africa and the public health threats we face around the world make it clear that improving health information systems must be a real priority for the international community. The Ebola outbreak has proven that the stakes have never been higher.

One key to our success is interoperability.

The next generation of health information systems have to not only quickly and accurately deliver the necessary information to healthcare workers, but they need to be able to communicate with each other. The wide range of people involved in combating epidemics such as Ebola need to be able to efficiently and seamlessly share information to ensure coordinated responses and better resource distribution.

Armed with real-time health information, ministry officials can better make decisions and allocate resources during a disease outbreak. / Leah McManus, courtesy of IntraHealth International

USAID recognized this challenge early on, but we recognized that we weren’t going to find ways to better coordinate on our own. We knew any solution would require consensus and coordination among the many people working on health information systems integration and on the ground. We also knew it would require a diversity of skills, ideas and expertise.

And we imagined that one answer might not cut it. We would probably need a set of solutions.

To get the conversation started, USAID put out a call for innovative concepts for improving interoperability within health information systems in the developing world. We gathered over 40 organizations for a three-day co-creation workshop in Washington, D.C. in November. Almost 100 experts — including donors, engineers, software developers and implementers in the field — arrived to co-design a solution.

We wanted concrete answers to questions of technical interoperability between individual health information systems, and also to create an enabling environment for continuing interoperability — recognizing that political dynamics, incentives, funding, management and coordinated programming are also crucial elements for success.

At the workshop, participants broke into groups to begin mapping out technical responses to the challenge. Among the proposed solutions was a platform to clean “dirty” health data — data that is unclear, inaccurate or incomplete.

Workshop participants co-design potential solutions to strengthen health information systems in the wake of the Ebola outbreak. / U.S. Global Development Lab

Another team proposed building a tool to digitize health records in real time. During the workshop, they even built an architectural framework for integrating real-time surveillance data systems. A third concept focused on crowdsourcing data into a national registry system to help detect outbreaks and communicate data back to the health worker.

Over the next few weeks, workshop teams will continue to collaborate to refine these ideas and put them into practice. We are on track to have projects integrated into our existing work on the ground within several months, with continuous learning and evaluation to adapt and modify them as we go.

I’m excited by the progress that this co-creation process has already made. I hope that we can continue to work together to not only respond to devastating crises such as Ebola, but to develop systems to reduce the frequency, scale and impact of global health threats — from other outbreaks, such as the Zika virus, to chronic issues such as maternal and child health.

It will be critical to continue to engage a wide range of experts to find new ideas and approaches. I hope you will join us in these efforts in the future.

Learn more about opportunities to co-create and innovate with the Lab, including the Broad Agency Announcement for Science, Technology, Innovation, and Partnership and Development Innovation Ventures.

While we know we don’t have all of the answers, there’s one thing we are sure of — we won’t solve our greatest challenges alone.

About the Author

Ann Mei Chang is USAID’s Chief Innovation Officer and Executive Director of the U.S. Global Development Lab. Follow her @annmei.



Ann Mei Chang
U.S. Agency for International Development

Author @LeanImpact . Former Chief Innovation Officer @PeteForAmerica @USAID @MercyCorps . Innovation/data for good.