The TrueFootprint FieldApp

Mobile-app-powered solution for health workers and patients to crowdsource problem-solving of health issues and produce real-time data.

Fredrik Galtung, CEO

We protect vulnerable populations (doctors, nurses, other hospital staff, patients), particularly in low-income countries. This includes millions of people (Uganda alone had 800,000 healthworkers in 2015 - WHO). Health authorities care about these populations but typically 3 data challenges put their safety at risk:

1. Unreliable data: During the 2014-16 Ebola-outbreak there were thousands of ghost healthworkers. There are numerous examples of improprieties in the Covid-19 pandemic, including mis-procurement, price-gouging, fake patients. 

2. Reporting can be compromised through political interference, administrative incentives and safety concerns.
   

3. Many employee or citizen reporting systems exist, but they tend to fail: they start out well but then data flows dry up. If their data inputs do not result in change, if the loop doesn't get closed, people stop reporting problems.

These data challenges prevent health authorities from making the right decisions. Our solution gives them reliable, facility-level, real-time data.

At least 17,000 healthworkers have died worldwide from COVID-19 over the last year. (Amnesty International, 5/03/2021). This pandemic is far from over and our solution also supports other health topics. We aim to embed our method firmly in the processes and daily lives of health authorities, healthworkers, patients, so all are prepared for the next emergency.

1. Health authorities: Our approach yields real-time, reliable data that can be used by decision-makers to inform policy and resource allocation. The data provides assurance that health products have not only been distributed but are also accessible and in use. Problems with the application of policy can be corrected in real time, failures adjusted, and outcomes measured. We engage with local authorities to understand their needs and present options so they can decide what questions they should ask and whom they should address.

2. Health workers: Our method engages frontline health workers to improve working conditions through self-advocacy by the people who have the most at stake to ensure safe working conditions. Many country partners we have worked with to set up a pilot are health workers and community health volunteers themselves, allowing us to find out their needs in particular country contexts.

3. Patients: Our method engages vulnerable patients and community members as positive agents of change. Working with patient groups (e.g. people living with HIV, malaria, TB, people living with disabilities) directly in a country has allowed us to define questions and topics in the app of greatest concern to the beneficiaries of health services.

The main public good we provide are data services that lead to improved health outcomes.  We help service providers and beneficiaries with a clear picture of what’s going on so they can take measurable action in their own best interest. Success is achieved through community and health worker engagement.

We also see as public good the knowledge sharing happening between monitors of how to solve common issues in health service.

We will also be building a capacity within ministries of health and local health authorities, health workers and patient organisations to make use of the FieldApp and the dashboards to manage health development projects themselves.

The FieldApp is free to the end-users and will not be switched off once people have downloaded it. Users will continue to benefit from it and be able to use it even if project funding is not renewed.

We expect our solution to have an impact on the health of vulnerable populations: frontline health workers and patients with chronic diseases. We expect that armed with the data our service provides, health authorities will be able to better decide where protective personal equipment should be sent to, and investigate and correct if their shipments are not being used or fall prey to fraud or corruption. We expect that this will save lives and result in fewer people catching Covid-19. We also expect that health authorities will intervene when they have the facility-level data about mixing infected people with others. And we expect that health authorities will tell us to put in the app any new topics they themselves see as most urgent, be it in the current pandemic or a new health emergency. As an example of our flexibility, we are now working on a pilot involving vaccination rollout in
Kenya. In this pilot we aim to address issues such as vaccine hesitancy
and counterfeits.

For patients with chronic diseases we expect that
fewer will have their chronic conditions worsen because issues with interruptions to their normal health service will come to the surface and decision-makers will take corrective action.

We are aiming to affect millions of people. Our starting point is the series of pilots we have done in 26 countries since July. We work with a local partner in a country, who manages the relationships with local health authorities, local funders and local patient groups. We provide the technology and support.
We are currently working on funding for a national rollout in a small country (Guinea). We work with local authorities to customise the app to ask the most pertinent questions for their circumstances.

Year 1:

• We aim to roll out our solution nationwide in 3 countries, helping health authorities protect the lives of 1000s of health workers and patients in the Covid-19 pandemic. Adapting the app to include challenges with vaccination, and expanding into other chronic disease areas (TB, malaria, HIV). Enhancing the app's knowledge sharing capabilities and expanding the platforms on which it can run.
  

Years 2-3:

• Further rollout to at least a dozen countries. In the medium-term, we aim to embed our method as a normal way of life for all actors in health. This ensures that when the next health crisis strikes, actors know what to do, reducing fatality numbers and improving health outcomes.

To get robust proof of the impact of our method we are working with 3 academics (Professors Nancy Qian and  Erika Deserranno from the Kellogg School at Northwestern; Dr Tali Regev from the IDC in Israel). Using randomised controlled tests they will test their hypothesis that TrueFootprint's method provides better outcomes for key stakeholders.

Independently, we look at our internal metrics. One metric we use is the issue resolution rate: how many of the issues monitors flagged up were solved by them? Although one could argue that any issue resolved is already a success, we set our standards higher and aim for an overall 25% resolution rate in healthcare. The target is dependent on how centralised processes being monitored are; the more localised they are, the higher target we set.

We also work upfront with local ministries of health to define what success looks like for them. We anticipate they define success in terms of:

• Reduced fatality rates among health workers.

• Better health outcomes for patients and health workers, particularly in vulnerable populations where data is a scarce commodity.

• Reduced fraud and corruption, e.g. stolen materials, ghost workers, ghost materials.

We work with the ministries to get the metrics needed.

Financial barrier: for a national rollout in a country we need funding for our local partners and funding for TrueFootprint to evolve the technology and provide countries with support. We are pursuing funding from The Global Fund to fund the effort by our local partners. We are pursuing funding for our own startup to grow the development team to enhance our platform.

Social barrier: our aim is to be inclusive but smartphone use is not widespread in the rural areas of the countries we target. Fortunately it appears coverage is sufficient to make it work: not every health worker's voice is needed, not every patient's voice is needed, but we are aware that women for instance may be under-represented. We aim to adapt our platform so that it works with feature phones.

Legal barrier: we are not the first to encounter some legal issues in some countries with respect to cloud computing. Sometimes data is not allowed to leave the country. The cloud service providers do not offer ways to restrict data to one particular African country. Our argument so far is that no personal health data is leaving the country, only answers to our questions.

We are a founding member of Catalyst 2030.

We have partnerships with HumanCapitalNetwork and Hogan Lovells.

We are still a very small start-up of 7 people. We are not in a position where we can build our vision without a financial injection and we can not build it quickly without the expertise and manpower we ask for. We believe winning the Trinity Challenge will act as a catalyst for other prospects to fully embrace the concept of grassroots agency.

Technology partner: Microsoft.

Why: their vast experience and capability in areas we seek:

Consulting services

• Tech Architecture

While we believe we have a decent foundation for our Android app, we would like to have experts advise us on the way forward.

• Data Security

Before we set out to design and build our admin portal and clients other than Android-based, we would like data security advice.

Developers and UX designers

• USSD developers and UX designers. How do we adapt the FieldApp to feature phone users?
  

• iOS developers. We are using React Native for the front-end. Experienced iOS developers can help us build an iPhone version of the FieldApp.

• API developers. We envision that in some countries there are already dashboards and they require a data feed to integrate with those, so they don’t have to go to yet another dashboard.

Cloud computing and storage

• The more successful the app, the higher our cloud services bills. 

How we like to partner: No preference.

Policy support: introduce our solution to more health authorities or private sector. Any member.

Research support: Conducting Randomised Controlled Trials that test the effectiveness of our interventions as they scale up. Any academic member.