Civitas

Long before the pandemic, governments in emerging markets are facing the problems surrounding personal health data tracking, integrity and privacy. In the face of the COVID pandemic, these problems have been exacerbated, with direct effects on how and when economies can reopen.

Civitas enables governments to coordinate more effective transmission tracking and to connect that information to other economic activities. One example of this is using test results to issue travel documents and screen passengers at airports and other ports of entry.  The Civitas digital passport is similar to the Certificates of Immunization that many currently use as part of their travel documents. Rather than a paper record, Civitas uses blockchain technology to create a digital record of COVID-19 testing and transmission tracking. As COVID-19 continues to spread in lower-income parts of the world, a fully scaled Civitas solution can help manage and coordinate response efforts among these stakeholders. 

All over the world, countries are dealing with overburdened, resource-constrained, and highly fragmented public healthcare systems. The huge number of COVID-19 cases seen over the past few months has highlighted gaps in these systems, and raised questions about how to coordinate more effective responses. Inequalities in healthcare systems that predated the global pandemic have been exacerbated, leaving vulnerable populations in danger of suffering greater morbidity and mortality rates. This is especially true in emerging market countries, which are beginning to see a significant increase in COVID-19 cases.

A lack of reliable data on real-time community transmission rates, coupled with capacity shortfalls in testing equipment, personal protective equipment (PPE), ventilators, and medical staffing have hampered government responses. Such challenges make ongoing discussions about reopening economies extremely problematic. If we don’t know who’s been infected and who hasn’t, who’s immune to COVID-19 and who isn’t, how can government and healthcare officials make informed decisions?

This means that the worlds most vulnerable are going to be the hardest hit by both COVID-19 and economic lockdowns. According to the International Labour Organization, 1.6 billion informal economy workers are impacted, with the first month of lockdown already decreasing global earnings among the group by 60%. 

Civitas tracks COVID-19 test results and case transmission, and improves data transparency between testing facilities and government agencies.Civitas creates a digital ID system, built for the blockchain with AI elements.  

Civitas' digital profile system allows residents to access medical care through approved COVID-19 testing and treatment facilities. Users first connect with telemedicine professionals who evaluate the symptoms of a patient from home. Patients who require in-person medical attention for COVID-19 symptoms are immediately referred to hospitals, where a scan of their Civitas profile UID supplies their profile history to the attending physician. Civitas’s telemedicine software also offers health systems the opportunity to remotely support patients with mild presentations of the virus, without having those cases overwhelm public health clinics. This frees up resources that are desperately needed for more urgent cases. 

Civitas’s approach emphasizes privacy, security, and inclusion. It uses existing Internet and cellular network systems to transmit information, with citizens able to interact with the system by SMS, or through a Progressive Web App, so there's no need to download anything onto your device. It also means that Civitas can be deployed in emerging-economy countries with populations that do not have smartphones or lack reliable Internet access.

Civitas is for any health system or government that wants to get a better grasp on what their constituents are facing. We are currently piloting Civitas with the Government of Honduras. In order to better understand their needs and engage with them, we are constantly updating and tweaking our solution to create what will best fit what they need. This is a fast paced process, but we want to make sure that each of our solutions is customized for the stakeholders, in order to ensure that it fits their needs seamlessly. 

Indirectly, Civitas is also for helping the most vulnerable people get the proper care. As mentioned above, Civitas is built with inclusivity in mind. You don't need to have a smartphone or access to the internet to be able to access the solution. This means that in places where there is extreme poverty or lack of mature telecommunication infrastructure, Civitas can still thrive. We want to reach the ones who need help the most, and that means building solutions for those that have the least access possible.

The problem is that legacy healthcare systems in emerging markets have long been overlooked and underfunded. Now, with COVID grinding economies to a halt and governments facing a need to reopen, the only solution is to make these healthcare systems work more effectively. Civitas, is a robust software application to effectively track and manage community transmission of COVID-19. Civitas can help increase the capacity for the rapid response to COVID-19 cases, and can prevent further community transmissions. The solution is built with the world's most vulnerable in mind, and operates on a light framework to ensure that accessibility anywhere, anytime. 

What makes our solution so innovative is twofold; Civitas is built for privacy, and Civitas is built for those who need it the most. Many other tracing solutions rely on collecting data on everyone, no matter their risk level, and then sharing the with government authorities and/or the public. The real world implications of this are that people excluded from civic life, and can face government surveillance. Civitas keeps personal data with the patient, having it only be accessible by a health professionals. Automatically generated insights tied to location and health outcomes such as how many other patients have tested positive for COVID-19 in their area are what is available on tiered access. We implement Civitas in places where citizens may be rightfully fearful of government mismanagement of their data, which is why we make sure that the only person who holds personal information is yourself. 

The second thing that makes Civitas stand out from the crowd is that it is built with inclusivity in mind. We have not created a solution that requires bluetooth, a downloadable app, or even internet service. instead of building for technologically advanced places, Civitas is for the most vulnerable. We use SMS messages and a PWA to capture initial data and phone calls with health care professionals for further assessments. This enables us to deploy the solution in low tech-capacity environments, such as in rural areas or in unplanned settlements. Civitas is cutting edge technology that can run on last century infrastructure.

Civitas uses blockchain and AI in order to help governments better allocate much needed resources. More specifically Civitas uses permissioned, tokenless, Distributed Ledger Technology (DLT) in order to secure patient records and provide full chain of custody and accountability for them. The DLT is the back-end of the system, and is part of why we can guarantee confidentiality of records. By using blockchain, we can also provide a history of use, with changes never erasing but instead building on top of one another. This allows health professional to get a better picture of a patient's care over time. 

Civitas also uses AI in order to help predict health outcomes. Based on a patient age, any declared underlying conditions, and what the the rate of other COVID-19 cases are in the declared area,Civitas is able to ensure that high risk individuals are able to access the care they need. Civitas can do this by either giving the patient priority in the queue to talk with a health care professional, or by making the risks clear to the Health Care professional who accesses their records. 

To complement this, we use legacy systems already in place, Progressive Web Apps (PWAs), SMS and cellular infrastructure, and advanced analytics. We also use GDRP/CCPA/HIPPA compliant cloud storage solutions.

Blockchain in the form of DLT is already widely used. Blockchain technology has been proven to work since 2012. In terms of using DLT to secure medical records, DLT Resolutions operates a health information exchange and secures records using blockchain technology.  We should also note that we are currently piloting this technology in Honduras, which in and of itself proves the feasibility of the technology. 

We can provide a demo upon request, as we currently build integrations into current governance systems in place rather than generic systems. Also, please find below articles on our pilot in Honduras.

https://www.coindesk.com/as-governments-rush-to-track-coronavirus-honduras-may-offer-a-privacy-first-model

https://medium.com/@EmergeDev/emerge-and-penta-network-support-public-covid-19-response-with-civitas-515ae2b1cb72

https://ca.finance.yahoo.com/news/governments-rush-track-coronavirus-honduras-213102996.html

Our project management methodology follows the approach of a logical framework matrix. On the minor scale, metrics and milestones are tracked. These metrics are labelled as outputs and flow into objectives. Each objective is made in service of a goal, with a goal being complete when the objectives are fulfilled. Completed goals lead to positive outcomes, such as a better operating environment. Future goals can build upon the positive outcomes in order to ensure continued growth. This is a highly scalable process of project management, and is used on both the individual scale and project wide scale.  

The project management system can also be rationally mapped backwards. The final outcome of a successfully implemented project is predicated on the completion of goals, which are further  predicated on the implementation and fulfillment of objectives, which can only be fulfilled by metrics or outputs.  This methodological system ensures two main needs. First, it ensures that the project stays on course and has a strategy for near and long term implementation. Secondly, it ensures that the project implementation is always in line with the end result that the client needs. By fulfilling these parameters, Emerge projects are able to have a positive change for their clients and the operating environment as a whole. 

Since our goals operate as the nucleus of the project methodology, it is vital that they are done with strict thinking surrounding them. This is the reason that the creation of our project goals follows a modular approach. Each goal is created with the stakeholders and problem owners benefit in mind, ensuring that each minor goal and objective that is achieved not just builds towards the overall goal of the project, but ensures that positive change occurs at each step of the process. This gives us multiple benefits, including allowing us to track change throughout the project. Fulfilling goals creates better outcomes for stakeholders and creates stronger goals in the future. Furthermore, it also mitigates risk since even in partial implementation, there is still a worthwhile investment and a positive change that is of direct benefit to the problem owner. 

The solution is being piloted on a national level for a 1 month period before scaling to a permanent solution. Assuming a completely successful pilot, the government plans on a full integration into the general health sector, non-COVID-19 related, over the next year, which would service roughly nine million Hondurans. Over the next five years, we hope to be able to partner with more governments, both national, regional, and local to implement Civitas in their respective communities. 

Our goals over the next five years are to threefold: increase use cases for Civitas, increase possible features for stakeholders, and increase our geographic scope of operations. 

In terms of increasing use cases, Civitas is a solution that at its core is about creating a better system around the management of personal health care records. This obviously has uses outside of a pandemic as well. We would like to increase the use cases of Civitas to make sure that people in emerging markets can have better access to healthcare, regardless of the global context.

In line with that goal is to also increase possible features of Civitas. Future implementations of Civitas can have increased complexity or slight changes to the operating function. One example could be the creation of disposable digital certification for providing a clean bill of health, or the use of the Civitas health record to provide binary options for the movement of people. We want Civitas to be able to fit future stakeholders needs, and that means being able to deliver more than its core functionality. 

We would also like to increase our scope of operations. Civitas has the possibility to affect billions who live in places where health records are inaccessible, fragmented across stakeholders, or effectively useless because of the sheer amount of them in a database. We believe that our solution is of the best service when more people can have access, and that means expanding outside of Honduras, and bringing Civitas to the world. 

One of the problems financially is that Civitas can have too high of a price point to operate for some stakeholders. Initial costs estimates can be up to $150,000 USD. While this is not a lot for a national or regional government to provide, it can be too much for a local clinic or small municipality, especially in emerging markets. Furthermore, while we are committed to making Civitas accessible to as many as possible, it is still not accessible to all. The technical component relies on a cellphone. This leaves out those who may only have a landline or no phone at all. Civitas is also completely text based initially, meaning that those who are illiterate cannot participate. Culturally, people may distrust technology, such as among certain indigenous communities in Central America. People may also distrust having records seen by a government who they feel is corrupt and oppressive. Finally, in terms of market barriers we need to ensure we are in line with all patient confidentiality laws and certifications of the stakeholders country. This can be an expensive and time consuming process that increases costs for us to engage new markets. 

In terms of increasing costing inclusivity, we are working on embedding a crowd-funding platform into our website. In situations where a stakeholder cannot afford the solution but the outcome is of public good, we would be able to use this platform to raise funds from the global community that can offset the price. What incentives there are, whether a micro-loan system, equity in the project, or other ideas to solicit funds is still being explored. We are currently engaged with Kiva to set up the infrastructure for this initiative.

To increase our technical accessibility, we are exploring using voice to text software to increase our inclusivity. Ideally, this would allow both those who are illiterate as well as those with landlines to be able to input their data, with the identity public wallet existing as a printed QR code. Access to partners with complementary technology would be invaluable.

Culturally, we need to make it clear that the patients would have agency over the records. This can be done through sensitisation campaigns, enlisting the help of advertising and radio broadcasting to increase knowledge of what Civitas is. We benefit from international networks on this front.

Finally, certification should be a one time cost. by working with partners and contractors to ensure we are within different regulation, this should only be an initial barrier and not a long term chronic cost. 

We currently have a decentralized team, with 2 full time staff and one part time staff on the operational side, as well as one contractor who's mandate is implementation within the EU. Our technical team is made up of 3 full time staff and 1 part time staff via a merged strategy with our primary blockchain partner. Additionally, we currently have 9 interns in place.

We and our partners are truly global. Our technical team is mostly based in Australia. Our CEO is Honduran and currently in Tegucigalpa, and the company is based in Toronto. We have a staff member in LA and one in Europe. This allows us to be able to respond 24/7. if there are technical issues, We can address them in a timely and quick manner. Our team's geographic diversity also lends itself to more diverse thinking. We try to build our solutions holistically and taking into account all stakeholders. Our team also has experience working with governments and public sector actors as well as with the private sector, ensuring that we can manage the needs of a diverse set of stakeholders. 

Currently we partner with Penta Solutions, a private company that supports our technical builds for all of our blockchain based solutions. We have a close working relationship with them, and our CEO, Lucia Gallardo, sits on their Board of Directors and serves as the Director of Social Impact. 

We also partner with Gimly, which sources our IoT technology; IG Liaison for cybersecurity support, Smartifice for AI work, and more. The Civitas pilot in Honduras has engaged with the Ministry of Digital Government, 911 Response, The National Emergencies System, and the InterAmerican Development Bank. 

At Emerge, we work in two B2B/B2G ways:

1. On-demand and client-focused: When a public- or private-sector organization approaches us with a problem, we commit to solving that problem as impactfully as possible. Instead of approaching challenges with preconceived notions and one-size-fits-all solutions, we strive to understand how existing ecosystems work. This enables us to respect and improve our clients’ processes, instead of tearing them down. If our solution is approved, we develop it, pilot it, improve it, and scale it.

2. In-house and passion-driven: When someone from our team is motivated by a pressing global issue, we brainstorm and road-test ideas to address it. We will then research, design, develop, and pilot our solution, refining it until it becomes best-in-class. We then commercialize it, scale it, and bring it to as many affected populations as possible.

Ultimately, Emerge is looking to scale deep and influence technological systems change at a policy level and behavioural level to shift certain paradigms that society holds true for equitability, inclusion, and sustainability.

In order to fund our work, we look to bring in revenue through selling our products and services. 

A major reason we are applying to Solve is because we would like all the help we can get. We truly believe in our solution and want to make sure that it is implemented as deeply as possible into a society, and as widely as possible in the world. This is part of what will help lead to us making the biggest impact that we can with Civitas. Being part of a network of brilliant and likeminded individuals who are part the Solve network. Being able to grow and having mentorship from the MIT network would prove invaluable for helping make Emerge and Civitas as strong as possible. Furthermore, the prize money would help make sure that we can make Civitas available to as many people as possible, as well as ensure the continued financial stability of Emerge.

We would like the partnerships to focus on go to market and on monitoring and evaluation so we can build the strong case for scale and growth through commercialization.

MIT Media Lab, partners from within the consulting world for efficient go-to-market deals, from INGOs, and potential technology providers such as from within the Alphabet ecosystem. This would allow us to strengthen the technology in anticipation of strengthening our access to new markets.

As an MIT Innovator Under 35, our CEO, Lucia Gallardo is qualified for the Elevate prize. Emerge is also an award winning social enterprise startup, having been nominated for the 2018 Global SDG Awards and Newsweek’s 2019 Blockchain Impact Awards and was named one of Hatch's 20 Most Impactful Startups in the World. 

Winning the Elevate Prize would be incredibly helpful for Emerge and Civitas. Often times, emerging technology can be met with resistance or that it carries high risk. By having MIT behind us, it would add a massive amount of credibility to our solution.

The ongoing financial support would also mean that we can work on deploying Civitas where it is most needed, but maybe not most profitable. The money can help financially sustain pilots in rural areas or in unplanned settlements, where the need might be the greatest but the means might be the least available. 

We currently leverage tools such as self-diagnostic evaluations, a medical practitioner intelligent chatbot, and layers of intelligence to spot tendencies and predict potential outcomes and risk zones. We would improve the quality and depth of these tools in order to improve the overall quality of our solution.

This Prize is directly in line with what we want to achieve - which is to raise funds to help stakeholders access pilots and then work with them to design viable models to leverage the technology in the long-term.