Digi-Health community empowerment

The DigiHealth proposal solves the problem of “infodemics”, being wrong information about COVID-19 and how to protect yourself. People not being part of the digital society do not receive trustful information about the pandemic.  We suggest “free access to information” as solution, thus contributing to capacity building and crisis response. We have introduced the novel concept Internet-Lite through information spots targeting community involvement and digital empowerment. Internet Lite fosters the freemium model for access, with free access to information and premium access to broadband services, presents the basis for a scalable solution for digital health, education for youth, innovation and job creation. 

If scaled up globally, our solution will change the life of people a) through the free access to trustful information, and b) through participation in the digital society. Our solution influences both knowledge uptake, increase digital literacy through digital health, and thus contribute to timely response to outbreaks. 

 DigiHealth addresses access, skills, and inclusion. Given that only 12% of people in rural areas in Africa South of Sahara (SSA) are participating in the digital society, information about the crisis, as e.g. the video on COVID-19 (here),do not reach out.

   By creating InfoSpots with digital health information, we can influence both knowledge uptake, increase digital literacy through digital health, and thus contribute to a timely response to an outbreak reaching every single person in the society. What will be executed through the following activities:

• Creating free digital public goods portal

• Establishing content in health, education and innovation, and adapting it to the specific requirements 

• Intervention: providing free access to digital information through local information spots at schools, dispensaries, and community centres.

• Measuring the knowledge uptake in selected areas before and after the innovation through in-depth interviews, as well as analysis of digital usage data

As part of the Digital Inclusion project, UiO has demonstrated an impressive knowledge uptake of 60% (from 15% to 75%), and an extremely high knowledge on HIV/Aids (94%) and Tuberculosis (91%) after the intervention using digital information for health messages. The knowledge increase is much higher than through other capacity building efforts.

Our solution is a combination of an open source knowledge portal and information spots in the edge of the network, based on the Internet Lite concept. The InfoSpots, established as mobile network end-points, carry bandwidth-demanding information like videos, and are the most cost-effective solution for constrained environments. With operational costs (OPEX) around 20 USD/month we provide free access to information on the Internet. 

Furthermore, we extend the reach of mobile networks to more than 20 km, as demonstrated in Selela at the Serengeti(LINK). Thus, we also build the base for connecting schools at low OPEX in areas with bad mobile coverage. 

Internet Lite(LINK) is the suggestion for a lightweight Internet protocols, basically being text and pictures(LINK). Internet Lite opens for the freemium model, with free access to information on the Internet and premium access to bandwidth demanding content such as video. We enable this freemium model through a local network control centre at the InfoSpot.  The InfoSpots will enable access for all to local content and information such as COVID-19 and other health-information(LINK) measures that are taken by the local and national authorities. The content includes prophylactic videos, access to other health and educational-websites.

We create the solution to connect the 3.5 Billion people who are not connected to the Internet. Being left-out from the Digital Society removes the capabilities for reaching higher levels of the Maslow-pyramid, e.g. meaningful work. DigiHealth  focuses on “connect the unconnected” from low income, rural, suburban within developing economies, though promote that “every single human should have free access to information on the Internet”. 

The implementation of free access to information enable people in the bottom of the pyramid to get part of the digital society, and can gain digital-skills. Through access and skills for everyone Internet Lite opens for knowledge uptake needed for decent work, gender equality, better health and education. 

Our research has demonstrated that digital health provided through InfoSpots is the enabler for digital skills. By adding information on education, agriculture, best praxis and other content of the knowledge portal we create the base for digital inclusion and societal empowerment. Through the freemium model we address “leave no one behind”, and through digital champions identified in each community, we create the local involvement needed for value creation in the society. Our roll-out is community driven, where local communities are the drivers for it and the involvement.

Our research on digital-health demonstrated that health knowledge uptake is best provided through health education at schools. Bringing digital health information(link) to through InfoSpots to schools builds the knowledge needed for the COVID-19 response(VIDEO).  With operational costs of around 20 USD/month, and the ability of the freemium model to provide premium-services, we build the base for sustainable operations of school connectivity. Furthermore, the local-InfoSpots, hosting bandwidth-intensive content, offer an excellent quality of service. By providing the pilot with connecting 10 schools, we build the blueprint for digital health education at schools in addition to school connectivity in rural-areas.

The innovative approach addressed by DigiHealth is Internet Lite(LINK) enabling the free

addresses capacity building for digital empowerment as the main objective, executed through the following activities:

• Creating the digital innovation spots

• Establishing content in health, education and innovation, and adapting it to the specific requirements 

• Intervention: providing free access to digital information through local information spots at at schools

• Measuring the knowledge uptake in selected areas before and after the innovation through in-depth interviews, as well as analysis of digital usage data

Through the digital innovative spots we address the need for capacity building on digital connectivity, Internet Lite and digital skills. The freemium model for access is seen as the main intervention counteracting the digital divide, as it provides free access to information for all. Thus, the InfoSpots contribute to innovation (here: digital skills courses, health and educational information). 

The info-spots and free portal are the focus for  innovation and creativity, allowing users to discuss and elaborate on new business opportunities arising from the inclusive access to information on the Internet. The community capabilities of the InfoSpots, allowing each school to be the moderator of the platform, will foster local engagement and empowerment. 

As part of the Digital Inclusion project, UiO has demonstrated an impressive knowledge uptake of 60% (from 15% to 75%), and an extremely high knowledge on HIV/Aids (94%) and Tuberculosis (91%) after the intervention using digital information for health messages. The knowledge increase is much higher than through other capacity building efforts.

Lite parts can easily be provided through a mobile network, even on thin 3G mobile links, as only basic information such as text and pictures are communicated. 

Heavy parts are provided through a local representation at information spots. 

The result of such a separation of lite and heavy content would result in an extreme cost-effective model for access to information. To our understanding, the architecture will allow end-users a free access to information, with minimum costs for public authorities. 

A typical infoSpot consists of

• Internet Link 3G/4G modem with directive antenna 

• LNCC a Dual-concurrent Access Point, that provides Wifi coverage for 2.4 GHz and 5 GHz frequencies at the same time 

• Sector Antenna directive transmitter for point to multipoint distribution

• Point reception outdoor wireless device with an integrated antenna. 

• Local Hot Spot 

Achievements

• Connected villages which were “impossible to connect” Izazi and Selela, where we extended the 3G network from typically 7-9 km to 22 km (Selela), or reached to a village behind a mountain ridge (Izazi).
• Established an infrastructure costing about € 1000 for the equipment and the configuration.
• Brought free information to schools, dispensaries in remote rural Tanzania
• Have already many communities such as African Child,BOACSE, UDESO who picked up the ideas for connectivity, and established spots
• The mobile operators (Tigo and Vodacom) were involved us in their plans.
• National institutions like UCSAF fully supported us with background information to perform the roll-out.
• Our input to the UN High Level Panel on Digital Cooperation is well reflected by the recommendations (especially 1A and 1B) and the mentioning of our work.
• Our claim on seeing recommendations 1A and 1B in conjunction, by providing "'free access to digital public goods, is reaching more and more attention".
• We started a discussion on "lightweight digital public goods" and the free access to this lightweight information with actors like ITU, UNICEF, and CISCO. 
• Capacity building is key of “Internet Lite for All”, with a village server with free access to information and apps to download.
• Through the "Digital Inclusion" (DigI) project we reached tremendous interest, resulting in both academic presentation, but also invitations to ITU, the African Innovation Week, and other international events. 
• Early results from the medical intervention using video and animations to inform the local communities show outstanding results in health knowledge uptake.

Our theory of change is based on “digital inclusion for all”. As starting point we take the statement of Kate Gilmore, director for human rights at UNO in Geneva (UNOG), who pointed out:  “Internet had the ability to dismantle the divide. Internet failed completely, the divide is bigger than ever”. We see that business models of mobile operators focus on profitable services, and that non-profit services such as health information do not reach those who are in need for information. “If you have 1 $, will you spend it for premier league or for a health video?”. 

Furthermore, mobile broadband is rolled out only in areas with suitable revenue for the operators. According to Vodacom, the connections using 3G/4G phones are just 20-25% of the total traffic in Tanzania, meaning that more than 75% of connections are just 2G, thus voice connections.  

The short term output is free access to information, the longer-term outcome is digital empowerment through the content being provided through the InfoSpot, leading again to digital literacy and participation. 

Though Facebook is providing FreeBasics(LINK), UNICEF provides the Internet of Good Things(LINK), and lot’s of initiatives promote affordable Internet(LINK alliance for an affordable Internet) and Broadband for all(LINK broadband for all), they don’t address the core-issue: The costs of roll-out and last mile connectivity. Through our InfoSpots and the freemium model we address: - access: building InfoSpots, and through Internet Lite getting a sustainable business model

• Skills: Information from the Knowledge Portal are available locally, free of charge

• Regulations: the freemium model with free access to the knowledge portal

Our evidence is Ethiopia, where the government changed the regulations and brought free access to the National Digital Library (NDL), as well as to health sites.

Ghana has introduced a national portal focussing on digital inclusion, Rwanda is in the process of setting up the national knowledge portal. Thus, our message is heard, but needs to reach out to more societies.

Each InfoSpot in rural areas serves typically 1500-2500 people. As of now, we have established about 20 pilots, thus addressing roughly 40.000 people. In 2020 we target another 120 InfoSpots in 5 countries in Africa(LINK), as well as 10-15 schools. Thus, through our InfoSpots we target directly roughly 300.000 people. 

Indirectly, our suggested “change of regulations” affects far more people. Only in Ethiopia, the free access (“zero rated”) to the National Digital Library and health information addresses directly 109 million inhabitants. We work actively with partners to establish the “free access to information” in other countries like Zimbabwe, Rwanda, Ghana and Kenya. Though, we often need the demonstration of InfoSpots with free access prior to changes in regulations.

We expect that our demand for “free access to information”, as demonstrated in Ethiopia for the 109 million inhabitants, can be repeated in other countries in Africa and worldwide. Our immediate impact goal is to convince 2-3 countries within 2020, thus affecting about 200-300 million people.  

By creating the showcase for adopting Internet Lite and the freemium model in these countries, we create the base for almost all the 54 countries in Africa within the next 5 years, thus addressing potentially 1.4 billion people. 

However, given that the mobile network broadband roll-out lacks behind, there will be the need to create InfoSpots in rural areas. Thus, we target community involvement on large, being able to deploy the InfoSpots(LINK) in their respective communities.

The barriers we face in adoption of Internet Lite are as follows: 

• Financial: Though our OPEX costs are below 20 USD/month, our CAPEX is in the order of 1400 USD per info spot, including shipment, tax and local installation. Thus, we are looking for grants to establish the roll-out.

• Technical: Internet Lite is not an approved Internet Standard. As as starting point, we use the AMP, former known as accelerated mobile pages, standard, available as e.g. an plug-in to Wordpress (see BasicInternet.org/Mission/?amp as example)

• Legal: Governments are reluctant to change existing regulations, thus it may time to get “free access to information” as part of the mobile regulations in place. Exceptions like Ethiopia show that novel regulatory frameworks are possible. New licenses, e.g. using TV white space or 5G, give an opportunity to bundle requirements, e.g. demanding “5G for all”

• Cultural: Good governance, and the need for digital inclusion, is not standard. As “information is power”, the free access to information will move power to the people on the ground.

• Market: Operators see the need for digital inclusion, and thus are positive to measures enhancing digital skills and contributing to digital inclusion. Though, being private companies, they have a clear focus on “return-on-investment first”. 

We believe in the need for governments to become digital, and thus use the “free access to the National Knowledge Portal” as the core of our argumentation. Bringing the message across, we can overcome the barriers:

• Financial: The CAPEX costs 1400 USD per info spot can be covered through regional development funds, as obligation in new mobile licences, or as grants from international donors. In our discussions with mobile operators we have seen willingness “if the same license conditions are applied to all”. 

• Technical: We have addressed lightweight protocols such as AMP as suggestions for standards, both in IEEE through the “connect the unconnected (CTU), and in the 6G research initiatives in Europe, see invited talk to 6G Summit: http://content.6gsummit.com/Josef%20Noll.mp4 

• Legal: As pointed out, examples from Ethiopia show that novel regulatory frameworks are possible. Furthermore, the national portals in Ghana and Rwanda are promising ways ahead.

• Cultural: Free access to information is a demand from the population, as well as a demand by donors. As an example, the government of Norway has expressed that “access, skills, regulation and inclusion” are the topics forming the development policy. 

• Market: We have reached agreements with operators like Orange and Vodacom to look into novel business models for free access to information and digital inclusion. These discussions, addressing both wholesale as well as reduced mobile license fees, are ongoing.  

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The Basic Internet Foundation is formed by experts, driven by the vision that everyone deserves to be part of the digital society. Excluding the Foundation partners, the foundation has three full-time staff, six part-time staff of expert leading the different fields of work.

Prof. Josef Secretary General at the Basic Internet Foundation and professor at the University of Oslo. He is specialist for Wireless Networks and Security. He is project leader of the “Digital Inclusion” (DigI) and “Security in IoT” (IoTSec.no) projects, and was involved in several international projects, including nSHIELD for measurable security in IoT systems, Citi-Sense-MOB for mobile air quality measurements, GravidPluss for mobile diabetes advise, and Ka-band propagation for polar regions.

Wisam Mansour is Chief Operating Officer at the Basic Internet Foundation.  Her field of research focusing on entrepreneurship in developing economies with special focus on women entrepreneurship empowering.

Sudhir Dixit is a Senior Fellow and Evangelist at the Basic Internet Foundation in Oslo, Norway, and heads its US operations. He is also associated with the Academy of Finland Flagship Programme called 6G Flagship. He is in the editor boards of IEEE.

Dr. Danica Radovanovic is a digital media specialist and senior researcher at the Basic Internet Foundation in Oslo, Norway. She is  PhD Chevening Scholar, Oxford Internet Institute, University of Oxford.

 Brenda Jimris-Rekve is a Partnership and Community Engagement Advisor at Basic Internet Foundation in Oslo Norway. She has a Master Degree in International Relations from the Norwegian University of Life Sciences (NMBU).

Iñaki Garitano is a Professor Titular in Electronics and Computer Engineering department and Data Analysis and Cybersecurity group of Mondragon Univertsitatea, Mondragon University.

Hamed Arshad, Developer, PhD Researcher at UiO

Gerdi Stoppel, Senior Advisor, international relations, Vienna, Austria.

Kathe Arnesen, Partner Network manager.

AHERI has  implemented information spots at the Community Initiative Support Services Community Centre at Akala, Ng’iya Community Centre in Siaya County and Omuga Vocational Training Centre at Kabondo in Homabay County. AHERI is working in partnership with the County Government of Kisumu city  to provide information centres in all Social Halls and informal settlements in the County.

CISS has been in operation for more than 30 years. The Organisation supports women and youth groups by encouraging  them to use energy saving stoves, practice apiculture, rear dairy goats as well as Community Financing. Community Initiative Support Services also manages projects focused on sustainable individual development through economic empowerment, food security, environment management as well as preventive health management particularly in HIV/AIDS. 

Siaya Library has contributed to empower the Siaya County, and is joining to enhance the conversion of traditional knowledge through books into online knowledge through the local InfoSpots.

University of Oslo (UiO) is represented by the Centre for Global Health with Prof. Dr. Andrea Winkler, and the Department of Technology Systems with Social Scientist Dr. Danica Radovanovic and Prof. Dr. Josef Noll. The health related competency is with the Centre for Global Health, while the technological aspects of connectivity and the digital platforms and courses are with the Department of Technology Systems. UiO will be responsible to follow-up with a scientific study on the uptake of health information, digital inclusion and community involvement.

Furthermore, we work together with partners from 9 countries as part of the DigI-project (LINK)

Through the digital innovative spots we address the need for capacity building on digital connectivity, Internet Lite for all.

The established infrastructure is cost effective, with a local info spot costing not more than a mid-size mobile phone (~400 USD), and provides free access to information. The remote management system, established solely through OpenSource software, supports the freemium model.

With operational costs of as little as 20 USD/month, and the ability of the freemium model to provide premium services.

The freemium model for access is seen as the main intervention counteracting the digital divide, as it provides free access to information for all.

Local civil communities or individuals can easy adopt this solution and implemented it in their societies with our support. Many organisation such like African Child,BOACSE, UDESO have picked up the ideas for connectivity, and established their own local information spots

As of now, the main focus has been on development and demonstration of Internet Lite, as well as convincing governments and international organisations on the need for “free-access to information for all”. 

Regarding sustainability, we need CAPEX grants or regulations for establishing the InfoSpots. An example of regulations are the regional development funds (in TZ: universal communication service access funds - UCSAF), being established for connectivity in rural areas. Through UCSAF support in our school connectivity, we are able to cover the local costs of installation, and thus reduce the CAPEX from 1200 USD to 500 USD per school connectivity. 

Another opportunity is to establish a package solution, selling the InfoSpot as a bundle. Such a solution is under development for NGOs working in Africa. 

Regarding OPEX, we see a potential ROI of 1-3 USD per month, given our target of a maximum of 20 USD/month for operating the info-spots. Now, the business models for wholesale are discussed with operators, but not signed. License conditions for acting as ISP often are too costly for our type of operation, thus we have worked under license-exempt operations in connection with the authorities. However, such license-exempt operations prohibited revenue creation by selling e.g. vouchers for premium services. 

Our path to financial sustainability consists of three parts:

• Creating projects together with partners to roll-out solutions

• Receiving donations for the CAPEX costs of installations

• Becoming wholesale service providers in mobile operator networks

• Operating the freemium model with income from sales of vouchers for premium access.

We are looking for scalability and implementation of the remaining technical issues during the 9 months of personalized support from Solve's community of peers, funders, and experts in advancing our innovative solution for Internet Lite and InfoSpots. 

Given the footprint of “solve through MIT”, we see that our initial pilots get visible for the whole world. Together with MIT and your network, we will make the “free access to information on the Internet” the solution to connect the remaining 3.5 billion people. 

We are based at Kjeller in Norway, the place where the Internet reached Europe back in June 1973. About 20 year later, Jon S. von Tetzchner and Geir Ivarsøy established Opera Software, the first browser dedicated for mobile Internet. Another 20 years later, we believe it’s time for digital inclusion of every single human on Earth. And that is where we invite MIT to join. 

Our goal is that the MIT network will help us to reach out and establish Internet Lite as the free part of the freemium model for access. “Digital Inclusion does not create return on investment, but it pays of for the society”.

We would like to spread our message “Free access to information”, and like to ask for your help in getting the across.

As part of the Digital Inclusion project, UiO has demonstrated an impressive knowledge uptake of 60% (from 15% to 75%), and an extremely high knowledge on HIV/Aids (94%) and Tuberculosis (91%) after the intervention using digital information for health messages. The knowledge increase is much higher than through other capacity building efforts (see full presentation here ).

Thus, providing information spots with free access to health information is one of the key solvers for better health knowledge and community involvement, two of the main topics requested by the East African Council (EAC) during the 2019 Health and Scientific Conference.