Digital Innovations and Universal Health Coverage:
Reinventing development work

13.04.2022, Hanna Olbrich

 

The global crisis created from the COVID-19 pandemic has laid bare gaps in health systems, social protection schemes and emergency preparedness. The Sustainable Development Goal (SDG) of achieving Universal Health Coverage(UHC) becomes more pressing and with it the need increases for coordinated efforts across multiple sectors in order to develop reliable and innovative programmes to improve health outcomes. Carolin from German Leprosy and Tuberculosis Relief Association (DAHW), Ajuluchukwu from RedAid Nigeria, a sister organisation of DAHW, and Marcel, co-founder of the German non-profit organisation URIDU, convened with one mission: improve digital health education for women in the most remote areas through the established project Audiopedia. I met the three of them on a Thursday afternoon online with the challenging question: How is their work contributing to enhance the Universal Health Coverage Agenda 2030!

 

Hanna:
Marcel, Audiopedia is a digital community outreach tool, particularly for women, that provides audio health education. Digital interventions make it possible to reach out to areas that were previously unimaginable in development work, especially in rural areas. What criteria are used to evaluate the ecosystem and to assess whether digital tools are helpful for women?

 

Marcel:
Audiopedia enables local organisations to extend their community outreach. It is often difficult for non-governmental organisations (NGOs) to reach remote areas, so there is a clear need for tools that enable digital community outreach. This does not mean that we make local organisations redundant, but that we equip them with capacity building, content and digital tools. On the question of how we can measure this: It depends on the scenario and the technology which is used. In Nicaragua, for example, Audiopedia is used together with WhatsApp to give women audio information about COVID-19. When the women were interviewed, 99% said the information about COVID was valuable and 96% expressed a desire to continue using WhatsApp as an educational tool. WhatsApp is a very popular tool and we have to rely on the same communication channels that local communities use.

 

Hanna:
What are the potentials of digital tools to advance the UHC 2030 agenda? Do you also see threats and if so, how could they look like?

 

Marcel:
This is an important aspect that is often neglected in health promotion and health education. Infrastructure and access as well as support are important for UHC, but health education empowers the population to use what UHC offers. Take case detection, for instance. Tuberculosis for example is one of the leading causes of death in children under five. This huge risk can be minimized by offering health education to mothers so that they recognise the symptoms when their child coughs. The risks of using digital tools enable to spread fake information more easily. WhatsApp is known for spreading fake information, but this underlines even more the importance of Audiopedia as a source of reliable information to counteract fake information.

 

Hanna:
Founded in 1957, DAHW devotes its work against leprosy and other neglected tropical diseases (NTDs). You dedicate your work above all to the poorest and most vulnerable and are careful to take a gender-sensitive and culture sensitive approach. How do you do this and what criteria do you apply?

 

Carolin:
Community outreach and awareness raising have always been a mission of our work. Leprosy is such a stigmatized disease. Often it is not possible to reach people with content, so digital tools are one way to raise awareness and destigmatize certain diseases. If we now look at the countries where Audiopedia is used, namely Brazil, Nigeria, Uganda and India, the settings are quite different in terms of infrastructure, smartphone accessibility and energy access – in refugee camps there is in some cases no electricity. To ensure gender-sensitive and culture-sensitive approaches, local partners are crucial: Only locally adapted health education material can lead to the behavioural change we are aiming for within a society. I am convinced that an important means to achieving Universal Health Coverage is in promoting preventive measures but also in changing perspectives on certain (stigmatized) diseases.

 

Hanna:
How do you implement your work to ensure a de-stigmatization of diseases?

 

Ajuluchukwu:
We started with Social Economic Rehabilitation (SER) for persons affected by leprosy or living with disabilities through the provision of livelihood support to enable them to provide for themselves and family. Then we transitioned to Community-based rehabilitation with the aim of bridging the stigma suffered by persons affected by leprosy (other diseases such as Buruli Ulcer) or living with disabilities through reintegration and provision of rehabilitation services within the community. These approaches were not all-inclusiveness and stigma still persist. So currently, we are implementing a community-based inclusive development (CBID) approach, which promotes the involvement of all relevant stakeholders within the development sector for the promotion of disability as a development issue not just a health issue, focusing on the sustainable development goals (SDG). With this approach, persons affected by leprosy or living with disabilities are involved in community decision-making, have a voice in the community and development issues. We have carried out community sensitization and awareness programs in partnership with Disabled People Organisation (DPO i.e., JONAWP and IDEA) in these communities to re-educate them on the need for stigma reduction using Information, Education and Communication (IEC) materials (posters), now we have widened the scope with the introduction of audio messages (Audiopedia) on health and development issues considering those who cannot read nor write, making these information easily accessible in their local languages.

 

Hanna:
What strategies have you developed in this regard?

 

Ajuluchukwu:
With Community-based inclusive development (CBID) strategy, we can now easily set up self-help groups in the communities: “Help yourself to solve your own problems”. So, it is a community approach, they are not treated in isolation but as part of the general community issues. In Nigeria, there are different ethnic groups and language becomes a barrier in replicating this strategy but with using audio messaging tools (Audiopedia) we are working on voicing in many languages to be able to accommodate everyone, and since it is open-source, other Community-based organizations can replicate.

 

Hanna:
Are there any special moments that showed you that you are on the right track with the project?

 

Carolin:
We are already working together with some partners for years. The biggest challenge in development cooperation and in this project is to create ownership and change business-as-usual, especially with a new digitalisation approach. There was a highlight with a colleague in Uganda when she said she wants a second phase with Audiopedia because it gives community health workers a safe tool to convince people in the face of the pandemic and a reliable tool that they can share and disseminate in the communities when it comes to vaccine hesitancy. Also, listening to information from a solar player, out of 392 beneficiaries from Moyo (Uganda), 212 beneficiaries got vaccinated even though fake news was all over the place.

 

Hanna:
Your work is very much community-based and therefore people-centred. How can community engagement shape the delivery of UHC?

 

Ajuluchukwu:
Ownership, that is the key thing, especially using community volunteers and health workers who are part of the community to create a safe environment for one-on-one engagement. People are more susceptible to familiar faces, so we must make engagement and sensitization community based with as much local content as possible.

 

Hanna:
The scholar Robert Chambers published his work “Rural Development – putting the last first” in 1983 where he talks about the threat of Western hegemonies in knowledge production in development interventions. How do you ensure that educational content is decolonised and separates itself from a Western narrative?

 

Marcel:
We need to involve the beneficiaries and stakeholders on the ground. I can give you an example of a project that was led by an anthropologist who worked with the Aka Pygmies, an indigenous community in the Congo. Here, a song was developed that included indigenous knowledge that could be used to remedy diarrhoea. Local knowledge was incorporated into the production process from the beginning and adapted to the cultural environment.

 

Carolin:
We also implemented a research project in Sierra Leone, where the inclusion of traditional healers in health care was analysed. People seek advice from them and their involvement in the health system is crucial.

 

Ajuluchukwu:
Local content! Community should be involved in developing content that they aregoing to consume. We have implemented it and it works like magic.

 

 

This interview was conducted by Hanna Olbrich who works for the Indo-German Programme on Universal Health Coverage at GIZ India. The project is supported by the #SmartDevelopmentFund, implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ GmbH) and launched by the German Ministry for Economic Cooperation and Development (BMZ) and the European Commission (EC) in spring 2020. As part of an innovative competition, digital approaches were sought out to cope with the challenges caused by the coronavirus pandemic.