Navigating the challenges of humanitarian-academic collaborations

Image credit: International Committee of the Red Cross/Jacob Zocherman.

In the quest for innovation and progress, partnerships between humanitarian and development organisations (HDOs) and academia have become increasingly common. However, a recent article published in the Proceedings of the National Academy of Sciences (PNAS) sheds light on the practical challenges faced by such collaborations. Authored by Louis Potter — Managing Partner at Outsight — and a group of seasoned innovation practitioners, the article critically analyses the dynamics of partnerships between HDOs and academia, emphasising the need for a more strategic and efficient approach.

Link to the Article: Read the Full Article

Understanding the Landscape

The article delves into the motivations behind collaborations between HDOs and academic institutions. Highlighting the involvement of prominent organizations such as the International Committee of the Red Cross (ICRC) and Doctors Without Borders (MSF), the authors acknowledge the noble intentions of these partnerships—to leverage academic research and scientific expertise to address real-world problems in challenging environments.

Identifying Pain Points

Through a critical analysis informed by workshops and interviews, the authors identify three main categories of pain points along the technology development timeline: resources, deployment strategies, and roles and responsibilities. Each category poses unique challenges that, if not addressed proactively, can hinder the success of collaborative efforts.

1. Funding and Human Resources:

   • The article emphasizes the importance of securing adequate funding throughout the project duration.

   • Challenges arise from differing expectations between HDOs and academia regarding funding sources and project scopes.

   • A lack of commitment of human resources from both sides hampers the initial stages of project development.

2. Deployment and Sustainability:

   • The success of a technology is measured by its deployment on a wide scale, yet this remains a rare outcome.

   • The article highlights the lack of profit motivation, leading to neglect in maintenance, improvement, and training for deployed technologies.

   • Questions of self-sustainability and market outreach are critical considerations often overlooked in early project stages.

3. Roles, Responsibilities, and Expectations:

   • Clear definition of roles and responsibilities is identified as crucial for successful partnerships.

   • The authors argue that the classic academic approach to technology development may not perfectly align with the requirements of HDOs.

   • Expectations play a significant role in determining the success of partnerships, emphasizing the need for transparent communication.

Moving Forward

The authors advocate for a more strategic and informed approach to collaborations between humanitarian and academic sectors. They stress the importance of comprehensive planning, clear communication, and a critical partner selection process. The article concludes by calling for a literacy in technology innovation and development processes within HDOs to ensure a more nuanced understanding of the challenges and opportunities presented by collaborative initiatives.

Conclusion

As we navigate the complex terrain of humanitarian-academic collaborations, the insights provided by this PNAS article serve as a valuable guide. Acknowledging the inherent challenges and proposing solutions, the authors encourage stakeholders to approach partnerships with a strategic mindset, fostering a more efficient and impactful collaboration that addresses real-world challenges in a holistic manner.

How to deal with Intellectual Property Rights in humanitarian innovation

Outsight International recently supported the International Committee of the Red Cross (ICRC) in developing an intellectual property (IP) framework to help staff navigate the complex — and sometimes scary — world of IP. In this post we discuss the common concerns that those unfamiliar with the topic face when understanding their options and choosing an IP strategy.

Why is intellectual property an issue in humanitarian innovation?

Humanitarian innovation refers to the creation, adaptation, and application of new solutions to address challenges faced by individuals and communities affected by crises. These crises can include natural disasters, conflicts, epidemics, and other emergencies.

Over the last decade, humanitarian innovation has led to many new products and services being designed and implemented. These might be hardware, software creations or processes. Unlike the private sector where the end goal is to create profit from these products/services, the the primary goal of humanitarian innovation is to improve the effectiveness, efficiency, and impact of humanitarian efforts in providing assistance, protection, and support to those in need.

Although different in their goal, humanitarian innovators usually have to work with IP tools created for the private sector, which can lead to fear and a lack of clarity as to what’s the best approach to reach their goal.

This is for a number of reasons: firstly, IP is seen as an incomprehensible legal topic; second, the perceived risk of getting anything ‘wrong’ in the legal space is greatly feared; and thirdly, many practitioners in the humanitarian/development space see intellectual property rights as a negative thing, usually employed by the private sector to protect profits over people. We now breakdown these fears and try to allay them.

FEAR #1: IP is too complicated to grasp

To say that IP is not complicated would be unfair — there are indeed a lot of component parts to think about: types of IP protection, extent of IP rights, enforcement in multiple jurisdictions, contract wording, registration processes, etc. Among unacquainted innovators, the questions we often hear are:

• ‘How do we file a patent?’

• ‘Should the organisation own patents at all or should we aim to share the innovation as widely as possible for public good?’

• ‘How can we prevent others from appropriating or misusing an innovation?’

• ‘Is it worth it to spend resources enforcing patent protection in a fragile context?’

• ‘Are open source licences always the best alternative for our software?’

• ‘What is a licence?

• ‘Would all of this be the same if the innovation has been developed in partnerships with the private sector?’

• ‘What if the partner is a university?’

Despite all this confusion, IP can be simplified by thinking about options in straightforward language. At a base level, intellectual property can refer to anything created by the mind. This asset could be incorporated in a tangible creation (such as a newly invented device or a piece of art), but not necessarily (it could also be a process, a design, a trademark, or software). Intellectual Property rights comprise a range of rights over a creation, including economic and moral (being recognised as author).

In simple terms IP rights determine who is entitled to use that creation and under what circumstances. To protect these rights, a wide range of mechanisms are available, which can be roughly grouped into three categories: legal, contractual and informal.

1. First, legal mechanisms (often referred to as formal IP protection) offer the most sophisticated safeguard, but require technical knowledge and are harder to enforce, especially in fragile jurisdictions. Among these legal mechanisms, some require a complicated registration process (e.g., patents or utility models), while others are automatic (e.g., copyright) or easy to use (e.g., copyleft or FOSS licences).

2. Second, contractual mechanisms are agreed rules embedded in partnerships, employment or consulting contracts. Some examples include confidentiality or recruitment freeze clauses.

3. Last, informal mechanisms comprise all other protection mechanisms not emerging from laws or contracts, such as secrecy, protective publication, documentation, division of duties, and many others.

Fear #2: Getting IP ‘wrong’ is high risk

One of the main reasons humanitarians are so fearful of IP is because they believe there is a right and wrong way to deal with it. This is not the case. IP clauses written in contracts are — at their base level — just a fancy-worded version of a decision of ‘who has the right to use a creation and how?’.

In some instances, this decision will be influenced by existing IP rights — for example, when adapting something existing you will be bound by the IP rights of that existing thing, or an employee contract might dictate who owns creations invented during work activities. In instances of ‘true’ invention, there is a decision to be made based on a spectrum from closed to open, which also involves an assessment of risks and trade-off.

To determine what IP approach makes the most sense, innovators should consider not only what goals they are aiming for and what resources they have, but also what risks are involved. A systematic risk assessment must be conducted considering risk for the users of the innovation, risks for the organisation and its members, risk for third parties and risks for the innovation and its sustainability.

For example, disclosed IP may be used by third parties for unintended purposes, negatively affecting vulnerable groups. Organisations should consider the diverse profile of people in terms of gender, age, location, legal status or any other personal circumstances that might put them at harm due to IP disclosure to other parties.

FEAR #3: IP protection serves profit maximisation, not humanitarian goals

Historically, intellectual property rights were developed to protect economic and moral rights of creators, with an understanding that this would also facilitate innovation and fair knowledge sharing. Patents, the most IP protection tools, were designed to control who can access innovations, which is very well suited for the patent owner to exploit the innovation and make profits out of it. However, ethical concerns may arise if access to an essential innovation is limited by economic or legal barriers. In recent years, COVID-19 vaccines reignited this debate, with many government and international organisations advocating for a waiver on patent protection to facilitate vaccine accessibility.

Within this context, it is understandable that IP raises suspicions among many humanitarian staff as a tool tailored for profit maximisation, not humanitarian goals. However, since IP rights can be highly customised, humanitarian actors can use them for their own goals as well.

Overall, humanitarian organisations aim to maximise positive impact for people affected by armed conflict and violence. The most logical assumption is that people would usually be better off benefiting from an innovation, and therefore, in principle humanitarian organisations are likely to lean towards more open access IP approaches than the private sector. Open IP approaches allow collaboration, reuse and a more efficient resource allocation in the sector as a whole.

However, even open approaches involve some kind of IP strategy and management to meet the goals of the humanitarian sector. For example, software creators may want to share their code for reuse in the sector, but they still need to make a thoughtful decision among multiple free or open licences, each with its own characteristics, as well as understand the risks, resources and trade-off associated with it.

There are IP options available to innovators which require little ongoing management. Protective/defensive publication is one such tool. This involves publicly disclosing detailed information about an invention to prevent others from patenting the same idea. While the disclosure may not result in obtaining a patent, it acts as a defensive measure to ensure that others cannot claim exclusive rights to the invention.

Developing an IP framework

To address these concerns and develop a common IP understanding within an organisation, it is recommended that organisations working in the humanitarian innovation space develop a comprehensive IP framework, tailored to the organisational context.

In close contact with internal stakeholders and informed by sectoral best practices, the IP framework serves as a clear guidance for decision making, informed by humanitarian principles, risks, and resources available.

Outsight International can help organisations to this end: having already worked on hundreds of innovation projects aiming to serve the public good and helping organisations create these frameworks. If you’d like to learn more or you think we can help, please get in touch.

About the authors

Louis Potter
Louis has a wide range of experience covering development, health, innovation, technology and research. He has worked on over 100 humanitarian initiatives and helps humanitarian organisations, universities and companies to improve innovation processes and outcomes. Recently, he has been helping actors navigate paths to scale in the humanitarian sector and strategise business models.

Pablo Busto Caviedes
Pablo is a researcher with a legal background, who specialises in monitoring and evaluation (M&E), policy research, qualitative and quantitative data analysis. His experience includes a diverse range of social and economic development topics such as rural development, agriculture, or social inclusion.

Landscaping AI-assisted diagnostics for respiratory illness

Outsight was recently contracted by FIND, the global alliance for diagnostics, to help them scope the existing landscape of AI-assisted diagnostics for respiratory illness. The aim of this work was to help FIND identify platforms that could be appropriate for use in the Global South. There are specific challenges in these contexts, different to those in Europe or North America, which is where most of the solutions are developed. For example, different racial backgrounds show up differently on X-rays, and the level of background noise in crowded health structures can be higher. It is essential to test the ability of AI algorithms to cope with these contextual differences. To do so, FIND used context-appropriate datasets from these regions — that might not normally form the foundation of the AI dataset testing — to evaluate performance of these solutions for use in these types of contexts.

The Outsight team identified a long list of 75 digital solutions of interest from around the world. These solutions included a range of signal-input methods, including thorax image capture (X-rays, CT, MRI), auscultation, cough sounds and pulmonary function tests, and captured data with traditional medical devices, as well as smartphones. Of the 75, 25 of these solutions were taken forward to a short list (based on discussions with the FIND team), where detailed information was requested from the companies developing these solutions. This information was assessed and a final list of 11 solutions of particular interest was drawn up.

Moving forward with this work, the hope is that FIND will be able to use the information gathered to help shape their diagnostic strategy in various disease and technology areas.

About Outsight International

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Worth the risk? Humanitarian innovation's risk challenge

Any meaningful change comes with new risks. The merit of the change depends on the balance of benefits and risks that the change offers. Ideas that deliver essential value that cannot be obtained elsewhere may well easily justify the risks that are incurred. Deducting the risk against potential benefit can offer a way of visualising if an intervention can be justified or not. 

Humanitarian innovators have become increasingly aware of the risks associated with new creative processes, services and products. These risks are of concern when they are borne by already vulnerable people. In particular, technology change has the unintended potential to create widely distributed ripple effects that are often not immediately visible. Understanding these consequences can be daunting in their scope, as illustrated by the 2018 ICRC report “Doing No Harm in the Digital Era”, which catalogued over 100 pages of digital risks in the humanitarian context. The current humanitarian discourse is to do no harm. But is doing no harm possible when also innovating?

The Dilemma - Risk as a Barrier to Beneficial Change

The range of innovation risks is not limited to digital technologies. Drones, robotics, and even construction projects all inevitably create new risks when they change the status quo. Considering risks is an essential step in any proposed innovation, particularly one that affects people with limited resources or resilience. However, a too narrow focus on risk can bring even valuable change to a standstill.  

Whilst it is clearly wrong to needlessly expose people to risks and harm, it is also unreasonable to deny communities of potentially beneficial innovations that could substantially improve overall wellbeing.

The risks and benefits of an innovation should be assessed and measured using the same scale and common indicators as status quo programming, helping the innovators to compare, contrast and make an informed decision on whether this idea is taking acceptable risk. This is especially important as there can be a tendency to veto innovation proposals based on small risks due to perception biases. For example, risks are perceived as irrationally high when:

1. The risk taken is involuntary.

2. Prevalence and reach of the innovation increase to affect more people.

3. An innovation is particularly novel.

Overall, this inherently tips the scale in favor of the status quo when dealing with innovations even though more good may be achieved through the means of innovation at equal or lesser risk as the status quo.

And what type of risk? Usually, we don’t go further in depth during risk assessments. Any sort of ‘harm’ closes the door and the idea is put ‘on hold’ indefinitely. ‘Risk’ as a general term is vague and abstract: harm needs to be considered on relative levels if it is life-threatening, financial, legal or if it is compromising the future plan of a specific person. This needs to be entered into the calculation before pausing a new idea. 

Within the humanitarian and development space also there is an added imperative to include financial risk within this calculation: money spent on an innovation that fails, could have been spent on proven methods such as vaccinations or supplies instead. This seems a legitimate points, but this is not the whole picture. As a new report from Elrha will detail, there are financial resources available to humanitarians, outside of an organisation’s operational budget i.e. through organisations like Grand Challenge Canada, foundations and impact investment grants. Through this, the level of financial risk can be mitigated. 

Finally, on how risk is assessed, we reach the problem of individual prestige. Identifying such risks in projects is a profession. Ensuring that there are people there to raise risks where they have been missed is undoubtedly important. However, such assessments often have a clear leaning towards detail, rather than the bigger picture and, as such, can lead to excessive scrutiny and stop a project in its tracks.

Comparing risk and benefit on the same scale

The relative weighing of benefit — or utility from a philosophical standpoint — is something that harks back to political philosophers of the past. John Stuart Mill – an ardent support of individual liberty — famously described the correct use of weighing utility as: 

"that actions are right in the proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness."

Mill is one of the founders of modern liberalism, widely regarded as underpinning many of the foundational principles of the current world governance. Therefore, why would we choose not to apply this principle in the case of humanitarian innovation when it’s good enough for the operation of modern democracy? 

Ultimately, the benefit and risk of two whole systems need to be compared. For example, the mortality rates for women undergoing childbirth in remote areas can be dramatically reduced through the use of drone deliveries of blood supplies.  The first system - unassisted childbirth - is the status quo, which has substantial unmitigated risks of death. The second system leverages the delivery of blood supplies by drone. This system offers strong medical benefits that are amplified by the lack of other effective alternatives. Yet, drones also come with concerns associated with safe operation in a shared airspace.  These whole systems need to be compared and contrasted with each other. 

If, as often happens, the questions around privacy or the risk of crashing a drone are seen in isolation, it’s easy to understand why permissions are difficult to obtain. Yet, if you’re to consider the possible gains of an overall system in terms of lives or disability-adjusted life year’s (DALYs), then the situation can look significantly different. 

When deciding on whether the risks of a clinical trial are acceptable, an Ethical Review Board will consider the possible improved patient outcomes in a relative manner. It seems odd this luxury is rarely extended to innovation projects, often dealing less directly with patients. Indeed, many innovation projects are deemed unacceptable because of a perceived risk to privacy or data management. Whilst this is a significantly less serious risk than the risk of side-effects in a clinical trial, it is given a disproportionately high prescience. 

Finally, when considering potential harms, it’s important to consider how we each operate within the social norms of our societies. Engaging with beneficiaries’ points of view is commonly accepted as best practice. Yet, there lies significant contradictions when considering the normative nature of humanitarian and development work. One classic example is identity and privacy. For those operating from Europe and North America, there is a tendency to see the right to privacy as fundamentally essential. Take the UK public’s resistance to identity cards, or the French law prohibiting the collection of ethnographic data for example. However, for many other regions, especially where having a recognised official identity can lead to greater access to social service provision, there is less concern for hiding personal details. Whilst this may be based on the levels of trust in government, the debate is far from definitive. Given the decolonisation of aid narrative in the humanitarian and development space, these cultural differences seem to rarely be accounted for. 

Using Systems to Support Responsible Innovation Tradeoffs

Discussions surrounding risk and harm need to be based on a broader view of the opportunity for change. This does not imply there is a blank check for change: a rigorous review of the benefits and harms alongside a consideration of alternative systems should be done for any proposed innovative change. 

A well-reasoned discussion can only be had with a big picture of both the current situation and an open mind to the proposed new combination of benefit and risk. The work that has already been done to identify potential sources of risk has laid a solid foundation on which to take this next step in analysis.  

It is now time to routinely embrace taking a more holistic view of status quo challenges and the alternative systems that are proposed to replace them. This whole systems view would not only allow a more balanced view of the value of change, it would also offer a broader range of alternatives for mitigating potential risks, or at the very least make them better understood to those involved.

About the authors and Outsight International

Dan McClure, Lucie Gueuning, Denise Soesilo, Monique Duggan, Louis Potter for Outsight International
Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Decrypting human-centred design: Why it is important for the third sector

What role can human-centred design practically play in development and humanitarian work? As a researcher and designer, Gunes Kocabag — an Outsight Associate — is often asked this question. Sometimes with scepticism — but more often with genuine interest.

Human-centred design has become a respected practice in certain parts of the humanitarian and development sectors (aka the third sector). However, while many people may have seen references to its techniques, it may not be obvious how it is applied in practice. In this article, she outlines: what is human-centred design; why it is necessary; and how to apply it in humanitarian and development contexts.

FROM DESIGN AS A CRAFT TO DESIGN AS A MINDSET, and FROM USER-CENTERED TO HUMAN-CENTERED

Design has historically been categorised as an art, a craft, or as a way to improve the look and functionality of products. However, from the 80s onwards a new perspective on design has progressively taken hold – an approach that defines design as a process and a mindset that can be applied to solve diverse problems. The term ‘Design Thinking’ was popularised by the design firm IDEO in the early 90s and today has gained increasing popularity in the business world as a methodology to approach complex problems.

A key principle of the design mindset is its emphasis on placing user needs and expectations at the centre of the process. As users (aka customers) in the commercial context are more and more empowered with their decision making, companies are racing to understand their users and identify their innermost unmet needs to create the next winning product in the market. That is why user-centred design is increasingly popular in corporate innovation circles.

Global development work often happens within complex systems made up of multiple partners, people on the ground, multiple end beneficiaries and various contextual factors. So it is not only about creating solutions that work for the end-user but also for all key stakeholders within the system. It requires an approach that is not only user-centred, but human-centred, which takes into account the complexity of all stakeholders. Thus, in humanitarian and development innovation, the term that is predominantly adopted is human-centred design (HCD).

WHY HUMAN-CENTRED DESIGN?

Although human centred-design is becoming increasingly recognised and embraced by leading third sector actors such as the Bill & Melinda Gates Foundation, UNICEF and WHO working regularly with innovation, there remains lack of clarity on how human-centred design can be properly harnessed to ensure better interventions for a greater range of projects.

Here are three key reasons why human-centred design can greatly improve the success of humanitarian and development projects.

Reason 1: HCD complements system thinking to reveal differences between how the system works in theory and how people actually engage with it

Systems thinking is often referred to as a go-to approach to solve complex problems — and rightfully so — as it provides a great way to break down and make sense of the parts of a system and the relationships between them.

The systems thinking pioneer Donella Meadows defines social systems as “the external manifestations of cultural thinking patterns and of profound human needs, emotions, strengths and weaknesses.” Human-centred design can help dig deeper into those external manifestations to get to the core of human behaviours, needs and expectations behind them.

By placing the focus on the human actors within the system, HCD helps bring abstract concepts such as beneficiaries, government officials or private sector initiatives to life.

By placing the focus on the human actors within the system, HCD helps bring abstract concepts such as ‘beneficiaries’, ‘government officials’ or ‘private sector initiatives’ to life: identifying the human stories behind each, with their unique needs, motivations and goals. HCD’s emphasis on qualitative data helps us move beyond an understanding of what people do to an understanding of the social, cultural, and psychological patterns that reveal why people behave the way they do.

Understanding not only how the system theoretically works, but also how people live and breathe within the system, we can create effective solutions that meet needs and expectations at both functional and emotional levels.

Case study: Improving the adoption of home-based immunisation records (HBRs) in Africa

Home-based records are medical documents issued by a health authority, and provide a record of an individual’s history of primary healthcare services (e.g. vaccinations) received. They are maintained in the household by an individual or their caregiver. Since the beginning of the Expanded Programme on Immunization (EPI) in 1974, home-based records have served an important role in increasing the effectiveness and efficiency of immunisation programs around the world. However, retention rates in many countries remain significantly low, which is particularly worrying in countries with a high birth cohort.

To tackle this problem, we first need to understand the system and the actors within the system. A systems-thinking approach focuses on understanding the key parts of the system and how they interact with each other. Adding human-centred design to that, we glean a better understanding of the human actors behind the institutions and the human actors that affect and get affected by the system.

When I worked on this challenge in collaboration with WHO and multiple other development partners, focusing on six African countries, our first task was to understand the system map and identify the key stakeholders. Then we applied HCD to dig deeper. Through ethnographic, immersive research on the ground with health workers and caregivers as well as officials in the Ministries of Health, we were able to challenge the big picture.

During pilot research, we brought together Ministry of Health officials, caregivers and health workers to compare their knowledge of how the system should be working, with an understanding of how it is actually working. Being able to observe what was actually happening, the physical and emotional burdens on the ground, what unofficial, makeshift solutions were put in place by those who had to solve problems on the ground helped us all view the system under a different light and helped shift priorities at the institutional level. Through this nuanced understanding, we were able to align key stakeholders on prioritising the needs of the end beneficiaries and health workers on the ground, as well as creating a roadmap for successful implementation that balanced the different priorities of the stakeholders involved.

Reason 2: HCD goes beyond creating solutions to creating end-to-end experiences that drive adoption

For successful adoption of a developed solution, a functional framework focusing on efficient delivery is not enough. To deliver a solution that is efficient and effective, we need to ensure it fits into the lives of those who will be using it. The main premise of HCD is to frame the whole challenge from the perspectives of the human actors, be this the end beneficiary, a specific actor in the value chain, or a key decision maker. We then design interactions and experiences tailored for the specific context and expectations of those who will be interacting with the particular product or service.

When designing services, HCD addresses these interactions not only at one point in time but through the whole journey of service delivery: before, during and after. This helps us understand the functional and emotional highs and lows of the experience, developing fixes to mitigate the lows and catalysers to enhance the highs. Through this methodological approach we can identify potential pitfalls early on and design solutions that work end-to-end.

A service journey maps out the user’s experience step by step, as well as the people, processes, policies, and systems behind the service delivery.

Case study: Improving the quality of data in humanitarian emergencies

Access to high quality and timely data can be a life and death-defining factor when monitoring humanitarian emergencies. The MSF REACH project, coordinated by my colleague, Lucie Gueuning, is an initiative addressing exactly this problem through creating a web-based platform to support MSF staff on the ground. The platform combines institutional data with crowd-sourced information from various sources.

While all are working towards a common goal, the platform needs to be used by different types of users with different levels of familiarity with the technology, different environments of use, culture and legal context, different skill sets and mental models. The quality of the data, which is key to the platform’s success, depends on providing an inclusive experience to all its different users.

A human-centred approach to solution development in such a context, can ensure that the user experience of the platform is designed to maximise its effective use by different users, taking into account all steps of the experience from accessing the service to data entry to making sense of the data. To give one specific example, the design of the user interface can have a significant impact on the quality of the data as well as how users perceive and prioritise data.

By putting users at the centre, human-centred design ensures that the interactions fit the users’ different mental models and drives the adoption and successful use of the platform. For MSF REACH this means high quality data, which is critical for saving lives.

Reason 3: Through divergent thinking, HCD catalyses new perspectives and out-of-the-box solutions

HCD is a process that can be applied to different problem spaces. It is made up of iterative cycles of divergent and convergent thinking, following a pattern of exploring possibilities before narrowing down on one solution. This emphasis on divergent thinking allows its practitioners to ask ‘what if…’, think out of the box and imagine possibilities beyond established patterns of thinking. Divergence is then followed by a structured and criteria based process of convergence that defines what is possible.

HCD follows an iterative process where divergent thinking is followed by structural convergence, both for problem definition and for solution development.

Bringing together different mindsets and skills sets is essential for divergent thinking. This helps explore the problem space from different perspectives and create richer solutions. Thus, HCD projects rely on a combination of different topic expertise combined with the perspectives of stakeholders on the ground. Participatory design, co-creation with communities, design sprints are common methodologies that are used to catalyse divergent thinking in a structured way.

Case study: Developing a strategy for 10 years from now

Developing strategies and roadmaps in the humanitarian and development context is a complex task. It involves multitudes of stakeholder (often with very specific areas of expertise) who need to understand one another, if not reach a common understanding. Building empathy between stakeholders is key to having a meaningful conversation around priorities. HCD, with its emphasis on divergent thinking, can create a space for building empathy among stakeholders, a safe space to step into someone else’s shoes and think creatively. It is here that HCD practitioners can thrive in a facilitating role, helping structure discussions, outcomes and strategic roadmaps.

When I worked with a global foundation as a consultant on HCD, our challenge was to bring together employees to co-create a future strategy while introducing the HCD methodology. Using a HCD approach, we were able to get participants from different groups within the foundation to work together and collectively discuss how the foundation should evolve to support its global network of partners. In a workshop setting, participants stepped into the shoes of policy makers, advocates, scientists, end beneficiaries and other actors they interact with day to day. With this new perspective, they articulated how the future could impact those actors and what this could mean for the foundation’s strategy. This approach enabled participants to leave behind their roles and titles and explore the problem space from a new angle, providing a strong foundation for the definition of a new strategy.

To sum up, human-centred design can greatly improve the success of humanitarian or development projects by:

• Revealing the nuances between how the system works in theory and how people actually engage with it.

• Creating end-to-end experiences that drive adoption.

• Catalysing new perspectives and out of the box solutions.

HOW CAN WE APPLY HUMAN-CENTRED DESIGN IN THE THIRD SECTOR?

Going back to my initial question, ‘What role can human-centred design practically play in development and humanitarian work?’, I would like to finish this post by providing some concrete pointers on when and how you can incorporate HCD into your work:

• During scoping and need identification - to ensure we’re accounting for the experiences, needs, mindsets and context of the all human actors involved and not just making assumptions about what is needed.

• During solution development - to develop solutions that fit into the lives of the target group and provide an end-to-end experience that drives adoption.

• During implementation - to prototype and test solutions with users and stakeholders, to learn and iterate to improve the solutions.

• During monitoring and evaluation - to complement quantitative data on what is happening with qualitative exploration of why it is happening.

• Throughout our work - to catalyse collaboration, out of the box thinking, iterative solution development and experimentation through design sprints, co-creation workshops or methodological training.

Human-centred design is not just a high-level theory, but a practical tool that can add value over different project phases. For those who use it, it quickly becomes indispensable for achieving efficient and effective implementation. It is exciting to see its increased adoption in the global development field, yet there are still many more situations in which humanitarian or development practitioners are not taking in the whole picture, and thus missing opportunities to implement much more efficient projects and systems.

ABOUT Gunes AND OUTSIGHT INTERNATIONAL

Gunes is a researcher and service designer specialising in the development of human-centred solutions in complex stakeholder environments. She has worked as a consultant for public and private sector entities as well as global development organisations in areas including global health and financial inclusion.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Gunes and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Making development self-sustaining: Seven essential principles

The Kit Yamoyo diarrhoea treatment kit under local production in Zambia for the local Zambian market. The kit was designed, and the local market developed, using one-off donor funding.

What is self-sustaining development and why is it important? Simon Berry — Outsight Associate — explains…

The term ‘sustainable development’ appears often in international development discussions. But what does it mean? The phrase can be used interchangeably to mean one of two things which are, in fact, very different. In the environmental sense it means ‘living within our environmental limits’ — development that ‘meets the needs of the present, without compromising the ability of future generations to meet their own needs. The term, however, also describes development that carries on once the resources used to create it are removed. Here, I refer to the latter form of sustainable development as ‘self-sustaining development’, to distinguish it from what one might call ‘environmentally sustainable development’.

In 2010, my partner and I started discussions with stakeholders in Zambia around transforming access to oral rehydration salts (ORS), the globally recommended treatment for childhood diarrhoea. Having established that there was local interest, we set-up a UK-based charity, ColaLife, to take the idea further. We started with a trial of the idea and went on to a national scale-up. By 2016 a locally designed and tested diarrhoea treatment kit was available nationwide in supermarkets and in hundreds of small shops. Additionally, the government were showing interest in a government-branded version for distribution through its clinics.

Donor funding finished two years ago (March 2018) and ColaLife formally completed its role in September 2018. It is early days, but all indications are that the transformation we achieved while we were involved and donor funds were flowing will continue to be self-sustaining. In fact, things have developed further with the government adopting the diarrhoea treatment kit as the standard in the public sector. The change that was created with the help of donor funding and external support from ColaLife has survived following the withdrawal of both. It has proved to be self-sustaining.

How does one achieve development that is self-sustaining?

Here are some key principles I have developed over the years while working with others on development projects that I think are crucial if you are to achieve self-sustaining development.

1. Plan for self-sustainability from the outset - You don’t achieve self-sustaining development while being forced to come up with ‘an exit strategy’ two years before donor funding comes to an end.

2. Don’t do anything that makes you or your organisation a permanent part of the solution - This is crucial and is the foundation for the other principles. If you allow yourself to become a part of the solution, then, by definition, when you leave, part of the solution will leave too! It is alarming how many ‘development’ initiatives fall into this trap, always with at least two negative consequences: firstly, the change they created while operational is not sustained; secondly, while operational they are likely to have undermined and weakened the capacity of local organisations who have the long-term responsibility for creating and sustaining the desired change.

3. Do everything through local systems and structures - If you are not to become a permanent part of the solution, then you will have to work through local systems and structures. Where these lack capacity or direction, help build the capacity, help refine or improve the direction. Above all, avoid setting-up parallel systems or structures.

4. Build a ‘smart partnership’ to guide planning, testing and scale-up - It follows that you will need to work in partnership with local stakeholders. However, it is important how these partnerships are formed and operate. It is important that partnerships are formed around a shared vision not around an organisation or an individual. When this is done successfully, it promotes engagement, ensures shared ownership of the vision and helps ensure that the partnership will survive the departure of any single member. We call partnerships formed around a vision ‘smart partnerships’. From the outset, be open and inclusive: invite everyone in, as part of a process where a broad membership can self-select their level of engagement. Some may go on to become implementation partners, while others may continue as a broader consultative group.

5. Self-sustaining development should fit with government policy - If it doesn’t, seek to better align plans or work with government to influence or advocate for policy change. It is unlikely that any initiative that doesn’t fit with local policy will be self-sustaining.

6. Engage your intended beneficiaries from the very outset - This sounds obvious but it often overlooked. It is essential to operate on the basis of what you know people want, rather than on what you think they need.

7. Be invisible - The urge, on the part of donors and development agencies, to brand everything they fund or support is overwhelming. However, this must resisted as it completely changes how the intervention is perceived. For example:

This was the original artwork for the billboard for the promotion of the diarrhoea treatment kit - Kit Yamoyo – at the start of the scale-up in Zambia.

In a second phase of marketing a USAID project, run by JSI, agreed to fund additional billboards but insisted on having their logos on the billboards and these ended up looking like this.

This was a mistake. Inherent in ColaLife’s self-sustainability approach is that any donor assistance should not be permanent. This approach is not compatible with donor branding being on any customer-facing aspect of the intervention.

Integrating these principles into your project

Undoubtedly, many of these principles may require a more extensive level of planning and analysis than was originally thought necessary, yet there is no such thing as too much preparation. As explained by Dan McClure (another Outsight Associate) in his blog post on ‘Mastering the art of hard problems (and avoiding the rush to easy solutions)’ — mapping the complex systems and stakeholders involved with a problem or possible solution is essential in order to ensure that these principles can be integrated efficiently into development initiatives. Do not be scared to think big and think ahead early on in order to ensure you’re not putting out fires or having to re-orientate the project at significant extra cost further down the line.

Investing in the right things at an early stage — system design thinking, researching the existing structures, analysing the problem, and stakeholder engagement — will ensure a project stands a much better chance at becoming self-sustaining and, thus, create a greater positive impact for beneficiaries.

ABOUT Simon AND OUTSIGHT INTERNATIONAL

Over a 40-year career Simon has been a leader in the voluntary, private and public sectors. He has lived and worked in South America, the Caribbean, North Africa, sub-Saharan Africa and the UK. He is an expert on self-sustaining development – development that out-lives the resources that were used to achieve it.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Simon and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

How can AI be used in the humanitarian sector? Lessons from the frontline

The MSF REACH platform on a phone in Jakarta 2018

Artificial Intelligence (AI) has become a buzzword within the humanitarian sector in recent years. Much like ‘blockchain’ or ‘drones’, it’s an area where new technology is developing quickly and operators are keen to test its possible applications. From an economic perspective, it’s big business too: from a total of $1.3B raised in 2010 to over $40.4B in 2018, funding has increased at an average annual growth rate of over 48%.

Understanding how exactly AI can positively impact humanitarian field work remains a work in progress. Lack of actionable knowledge about impact, potential, and infrastructure needed for a long-term strategy are slowing the adoption of the technology. Yet, AI-based interventions could: automate time-consuming tasks; aid in data collection and management; enhance user capacities and capabilities; and ensure emergency specialists focus on complex analysis and decision-making. But where and how should these applications be utilised to achieve this potential?

My experience working with AI

For the past three years I have managed REaction Assessment Collaboration Hub (REACH): an emergency support program to enable Médecins Sans Frontières (MSF) act faster in emergencies. REACH combines institutional data with crowd-sourced information (including social media, early alert websites, and relevant RSS feeds) in real-time to provide the organisation with virtual eyes on the ground.

Humanitarian organisations have disaster teams who specifically focus on monitoring emergencies — ensuring that collected data is timely, reliable, and shared with relevant stakeholders. The ability to deliver critical information is currently highly person-dependent, often taking significant time for the relevant information to reach decision-makers during disasters.

REACH’s platform addresses these challenges by providing a quick and more accurate insight into the evolving situation on the ground, which in turn allows for rapidly rolled-out interventions, adapted to the specific needs of an affected area.

The MSF REACH platform

In the initial phases of the REACH project, we wanted to integrate AI components into the system. However, it was through extensive research, scoping, interviews and testing that we made a strategic decision to leave these components out of the platform. The following explains why we made that decision based first on three main misconceptions we identified, followed by possible areas of added value.

Three common misconceptions about AI

• Misconception 1: AI is the same as other types of automation
  There is a general skepticism within the humanitarian sector about ‘automation’ — humanitarian work has traditionally been a sector that relies on human relationships and diplomacy in volatile contexts. To hand such delicate and high-stakes interactions to machines is understandably seen as too risky. However, to extrapolate this to all possible uses of AI in the sector is naive. There are clear situations in which AI can help inform stakeholders, but we require a new understanding of how to design and interact with AI.

  More specifically, what is needed is a hybrid solution that combines the experts with the machine. Such a methodology can help us develop this approach and ensure that any solutions are appropriate for the context and address the users’ specific needs. In each and every context, we need to define a goal for the technology to solve. An algorithm should produce reliable data that will support people running operations, not replace them. With this in mind, solutions should not simply be a concept, but real tools enabling end-users to focus on tasks that require human intelligence (i.e. analysis, choices, etc).

• Misconception 2: AI will replace human labour
  AI interventions are intended to minimise human effort on tasks that can be streamlined, allowing for human skills and interactions to be more meaningfully focused. For example, when we look at the applications of AI in healthcare to date, such as clinical decision support, this is intended to reduce the clinician’s administrative burden and allow for increased face time with patients.

  There is an increasing understanding in many sectors that humans will not be replaced by AI but rather supplemented by it. However, it may also be speculated that those who choose to explore and leverage AI applications within this frame may just replace those who refuse to consider AI optimisations. To work effectively, AI requires proficient data managers and data scientists to feed data into the algorithm and maintain it in addition to various other roles to validate and translate AI insights into tangible practices.

  To this end, AI works best when:

  1. A. Common-sense is not a requirement, and the answers are unambiguous. AI can outperform humans on some complex tasks, but it performs poorly on some others that humans take for granted (e.g. AI cannot answer questions such as ‘How can you tell if my carton of milk is full?’); AI works best in ‘black or white’ binary scenarios. Such as ‘Is my carton of milk is full?’

  2. B. Detailed explanations of results are not needed. It can be extremely hard to offer a satisfactory answer to the question ‘Why did the machine give this answer?’ When dealing in unstable contexts or with vulnerable populations, this lack of accountability can have serious implications.

• Misconception 3: AI can solve any problem
  The success of AI depends on the quality of the dataset. Before an algorithm can operate on a dataset, the data needs to be processed and cleaned so that the results produced by the algorithm are not skewed or imprecise.

  Cleaning data is laborious. Given the value of clean and structured data, an important design choice for a socio-technical system is how many resources to use up-front to ensure that the inflow of data is structured and stored appropriately. To build a high-quality database, the platform should incentivise users to input data abundantly and in the correct formats. It should have data managers to monitor the process and clean the database. With a pre-existing high-quality database, solutions can be adapted to harness the power of AI, but this option involves costs and design choices at the very beginning of the project/program.

How AI can add value the humanitarian sector

In the humanitarian sector, there are some specific areas already where AI may be harnessed for specific tasks to add value. These are:

• Predictive Analytics - Predictive models of humanitarian crisis (such as: migration patterns during conflicts, famines, epidemics, or natural disasters) allow for early preparation. These predictive analyses may also be leveraged for the improvement of workflows and the optimisation of supply chains. The Forced Migration Forecast developed by a team of scientist at the university of Brunel in London is an example of this.

The Forced Migration Podcast

• Image recognition - Used to identify disaster zones from satellite or drone data. Something currently being used by the Humanitarian OpenStreetMap Team.

• Natural language processing - Semantic models allow for complex searches for navigating information. This may be performed through: chatbot style interactions, speech recognition, transcription, and translation for various communication tasks. These tools can be rolled out to help people adapt to new contexts (i.e. due to forced migration) and better understand how to navigate their new surroundings and services.

• Adaptive web design - Sites that offer personalised interactions based on users’ behaviour. Allowing, for instance, prioritisation of the most relevant information for that user.

Smoothing the implementation of ai in humanitarian contexts

Humanitarian organisations need to invest in educating their personnel on relevant points of progress in other sectors. In any organisation, one of the major limiting factors of adopting AI is identifying expertise that can determine if AI is actually the right answer to a specific challenge. Education and knowledge transfer should happen frequently and bring the basic expertise to the workforce; enabling all staff members to understand how to, for instance, input data and set up data structures etc. With this in place it is possible to get the most return of investment from the technology application to a certain context or problem.

Also, it is very important to educate staff to engage with what has been tested — successfully or not — in order to learn from the others. It is very important to share lessons learned and new reports and publications should to be digested in order to stay up to date. For example the essay published by UNHCR and this publication written by IFC, a member of World Bank Group.

Given how resource-intensive creating AI solutions is — from data sourcing and cleaning, to validating the output — obtaining organisational buy-in with proper consideration of its risks and benefits is currently rare in the humanitarian sector. We must acknowledge that AI is still at a relatively nascent stage and a plethora of potential applications are still being tested and validated; mostly in high-income or private sector contexts. However, it is expanding in the humanitarian sector and low income contexts… albeit a little slowly.

One key final consideration for digital humanitarian projects and actors today is to focus on building large datasets that are clean and structured so that AI models could be trained on the data in the future. Mobile phones and other devices for data collection are already key components in humanitarian response and international development programs — offering a potential ready-to-use goldmine of insights, if structured correctly. Adding algorithms and automation to this well-structured data, allows for the fast identification of patterns in the data that can inform decisions and real-time analysis for a greater impact for your operations in the field.

ABOUT lucie AND OUTSIGHT INTERNATIONAL

Lucie studied at the Université Catholique de Louvain in Belgium. For the past three years, she has managed the MSF REACH project — researching AI and machine learning in the humanitarian context. More widely, she focuses on digital implementation for the development and humanitarian sector. She believes that digital solutions can be harnessed in order to increase the efficiency of the humanitarian sector and the service provisions for the most vulnerable.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Lucie and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Implementing cargo drones in Africa: Some lessons from the field

Denise (in the yellow vest) with the pilots during the Lake Kivu Challenge in February 2020.

My experience working in the cargo drone field

My journey with drones began in 2015, working with FSD on a dream project funded by the European Union Humanitarian Aid. The objective was to find out how we can use drones for anything anywhere in humanitarian settings. Given a blank slate and the task to find the most effective and promising applications, there was no better way to find out than to try.

Within the two years we implemented mapping projects in the Tadjik Pamir Mountains, Switzerland and Malawi, and deployed drones as part of an emergency simulation in France. During those years I also began first discussions with large medical humanitarian organisations to develop pilot implementation for cargo drone transport of diagnostic samples in hard-to-reach places. After having spoken to many tech providers, carefully weighing the pros and cons we decided that at that stage in 2016, the technology was still too early in its development to responsibly take into a real-world setting.

In 2017, I began a deep dive into cargo drone operations, working on the Lake Victoria Challenge in Tanzania, which was followed by the African Drone Forum Lake Kivu Challenge in Rwanda in early 2020. During those years, I worked closely with nine cargo drone companies to enable their flying operations. Seeing the industry evolve over the years, I am confident that we are ready to take this to the field in 2020 and 2021.

Where are we now?

Zipline is the only company so far that has been able to provide cargo drone services at scale – operating on the continent with some impressive successes to date. The initial business model is based on delivering transfusion blood. Today, four years after Zipline’s first delivery flight in Rwanda, the nation is on track to shift its entire transfusion blood supply to drone logistics reaching every part of the country in less than an hour upon receipt of the order. 

Medical deliveries and other development objectives remain at the core of the drive towards enabling a thriving drone industry in Africa, and the recent African Drone Forum has confirmed the appetite and commitment towards these objectives. Following the success of Zipline, the industry has been busy rising to the challenge.

The global drone logistics and transportation market is forecast to reach 11.2 billion USD globally by 2022, yet only a fraction of this market growth is forecast to take place in Africa. This is due to a combination of factors, but particularly that implementing high-tech solutions in remote settings has many risks and challenges. And there is not much experience or guidance out there in how to navigate these.

The following are some key lessons I’ve learnt over the past five years working in the sector, coordinating between industry, donors and governments.

What to look for in a cargo drone delivery company

Four key considerations I advise clients to consider seriously before working with any technology are the following:

• A demonstrated commitment to safety. This cannot be over-emphasised and should be one of the first considerations. Technical documentation, operations manuals, flight and maintenance reports are crucial to build a track record. To be absolutely sure, it can be beneficial to solicit the advice of one or several subject matters experts. This procurement guide provides a helpful checklist of documentation to request when looking to hire a cargo drone company.

• Technical specifications and business model appropriateness. Do the technology specs and business model align with what is required for the use case being addressed? Is the company committed to building technology for cargo delivery? Can the application accommodate African business models? I still encounter companies that have a primary focus in data collection (mapping and monitoring) but say they can easily also deliver cargo. That is a red flag for me. There are significant (technical) differences implementing these two applications and cargo drone work deserves full attention to its specific challenges.

• Range. Bigger is not always better but when flying drones in the expanses of the African continent, range can make the difference. Studies recently published in the Lancet show that drone logistics work in the African context can only compete with alternatives — namely motorcycles and other ground vehicles — in terms of cost effectiveness starting from a minimum range of 60-65 km both in routine and emergency scenarios. All the companies on our list can cover at least this minimum range. Many pure copter designs have a range limit of 20km and are not suitable for typical African use cases beyond urban deliveries. 

• Willingness and ability to adapt. When implementing projects, delays and setbacks are to be expected. We are charting very new territory. Building relationships based on trust and openness will help companies better understand their customers while implementing organisations can get the most out of their investments through valuable lessons-learned. 

Volansi getting ready for take-off.

Who’s doing what?

Here are some of the most promising drone tech providers I have been keeping an eye on — besides Zipline of course: 

• Avy - This Dutch company adheres fiercely to its “drones for good” slogan, keeping to a strict civilian focus. Avy’s Aera aircraft is being prepared to deliver medicines in the Netherlands within a year — circumventing traffic for essential and high priority deliveries. The aircraft is small and light with a payload capacity of around 1 kilogram — just enough for these high-value products. However, like many of their competitors it is likely that a larger model is in the making. Avy is no stranger to the African continent, having provided surveillance support for anti-poaching and park management activities.

• Phoenix Wings - Their Manta Ray aircraft is a heavy lifter among the small electric cargo drones. The aircraft was designed around the cargo and that thinking has paid off beautifully: the Manta Ray SR easily carries 7 kilograms in a 30 litre cargo compartment with a range extending more than 60 kilometers. Its signature turn into the wind upon take off is reminiscent of a spaceship in flight. Upon landing at the delivery location, the cargo compartment is released automatically.

• RigiTech - This Swiss company has an impressive track record within their management. Two of its founders were part of Sensefly’s early start-up team before moving into the cargo drone business. The third co-founder is an MSF veteran having conducted medical delivery operations in Papua New Guinea as early as 2015. RigiTech’s business model centers around developing a complete hardware and software platform for cargo logistics.

• Swoop Aero – This fast-rising Australian start-up has been flying vaccines for UNICEF and is about to start major operations in the DRC. From the outside, the aircraft looks less shiny than some of the competition, but the fundamentals are designed for safety, reliability and durability, which has proven to be a winning strategy. Swoop Aero is committed to expanding healthcare access through their logistics services and they are quickly establishing themselves as a market leader.

• Vayu – Vayu has settled on a long-range design that is capable of several hundred kilometers (up to 800 kilometers to be precise) of flight. Vayu provide the only gasoline-powered aircraft in this list, and have been involved with the development sector projects for years, striving to make solutions that work. In some environments the use of fuel can be justified as it greatly extends range compared to battery powered systems.  

• Volansi – Volansi is another Silicon Valley backed start-up with an impressive line-up, having logged experience in both North America and Africa. The company participated at the African Drone Forum Lake Kivu Challenge — and demonstrated solid tech and a highly professional team. A new aircraft has been in development, and will be launched shortly, so expect to hear a lot more from Volansi in the near future. 

• Wingcopter – Known for their fine German engineering and for having produced the fastest civilian drone (fast = stable flight in the cargo drone world), Wingcopter has made recent headlines with a strategic partnership with UPS. Wingcopter are also veterans when it comes to operating in Africa and other rural settings, among others delivering vaccines with UNICEF in Vanuatu and delivering health supplies in Tanzania. Wingcopter have adapted quickly to their customers’ needs by developing the winch system that lowers their cargo without the need of landing the drone.

A Wingcopter aircraft winching down a cargo box.

Implementing cargo drones in development

Implementing the use of cargo drones for logistics is a complex matter that requires careful choreographing. Safety (and security) management will take much attention and time. This includes: risk assessments; implementing risk mitigations; route planning; applying for activity permits and potential certification; air traffic management; and coordination. In addition, other aspects need to be managed: procurement; use case analysis; perceptions; waste and other environmental concerns; insurance; import and export; operations; skills development; regulations; perceptions; (data) protection; cost-benefit analyses; and media — among others. Since in many environments the cost-benefit is not yet fully established, future implementations should also be designed around collecting quality data. Cost-benefit analyses will require data on major cost drivers of drone operations such as failure rates under various operational conditions, down-time due to weather conditions and fixed costs for maintenance and running the operation.

To pull so many aspects together, whilst also dealing with multiple stakeholders with different interests, requires significant expertise, diplomacy and technical knowledge. Although, complex, I have seen that it is possible to bring all the pieces together efficiently and effectively. Any new implementations must build on the — so far — established best practices and lessens learned. This will help elevate cargo drones to their full potential in Africa.

ABOUT denise soesilo AND OUTSIGHT INTERNATIONAL

Denise is one of the Co-founders of Outsight. She is a world-renowned expert in unmanned aerial system (UAS) use in humanitarian and development settings, and in operationalising clean technologies. She has worked with the World Bank and other development, humanitarian and UN agencies — advising on the application and implementation of space-based systems and UAS technologies in humanitarian operations. Denise was directing the flying operations of the African Drone Forum. Denise has led the European Union Humanitarian Aid innovation grant for the implementation of drones in humanitarian action globally and has authored several leading publications on UAS in development and humanitarian action.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Denise and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Covid-19 and mental health: An exploding global burden

An increase in the already substantial burden of disease related to mental health will put a strain on healthcare systems at risk of collapsing under the pressure of the Covid-19 outbreak.

As the world grapples with the Covid-19 outbreak, rushing to “flatten the curve” and mitigate the risks of collapsing health systems, it is imperative we turn our attention to the mental health implications of this pandemic. Many proactive measures put in place around the world have underestimated the importance of incorporating MHPSS (mental health and psychosocial support) as an essential component of any emergency response. In a recently released report, the Inter-Agency Standing Committee (IASC) for Mental Health and Psychosocial Support in Emergency Settings advise that Mental Health and Psychosocial Support (MHPSS) “should be a core component of any public health response.” The fear of being infected can not only lead to severe anxiety, but also cause individuals to avoid seeking healthcare to prevent being exposed to the virus – or, paradoxically – to present too readily at emergency centres without medical cause. As noted in an article recently published in the British Medical journal, 

“Surges of such low risk patients are often precipitated by high levels of anxiety, leading patients to identify, catastrophise, and seek help for symptoms that might otherwise have prompted little concern, and leading clinicians to refer patients to hospital at the first sign of a mild symptom developing.”

Considering the mental health impact is essential: 

• The baseline prevalence rates of mental health disorders – before the outbreak – already constitute a significant portion of the global burden of disease. 

• Under the current climate of fear, enforced social isolation, and economic devastation, mental health difficulties may be expected to increase sharply.

• This burden will have a substantial impact on already over-stretched health systems.

Baseline prevalence: the substantial global burden of mental health diseases 

The Institute for Health Metrics and Evaluation and reported in their flagship Global Burden of Disease study estimates that 970 million people lived with a mental health or substance abuse disorder in 2017. This represents a staggering 1 in 7 people (15%) globally. The ‘disease burden‘ – measured in Disability-Adjusted Life Years (DALYs) — considers not only the mortality associated with a disorder —, but also years lived with disability or health burden. Of this, mental health disorders accounted for around 5% of the global disease burden when measured in 2017 (up to 10% in several countries). We may consider these to be conservative estimates. Many difficulties go under-reported and undetected, particularly in the developing world where there is typically less awareness and more stigma around mental health issues, and fewer resources at hand to identify and treat those in need.

Mental health from a socio-ecological perspective 

Mental health disorders are complex. They take many forms. Difficulties may range from depression, anxiety, PTSD, and schizophrenia — through to substance abuse disorders. They are not only located at the level of the individual. They are increasingly understood as unfolding within the context of systems of relationships which constitute our socio-cultural environment. They are exacerbated by harsh living conditions, the erosion of mutual social support mechanisms, limited access to basic needs and services and lack of opportunities for maintaining livelihoods and education. In recent years, there has indeed been a burgeoning of theoretical models for understanding mental health disorders that situates individuals’ mental health sequelae and recovery within interpersonal, political, and social context. This ecological perspective similarly incorporates a “resource perspective”, which assumes that human communities evolve adaptively. We are deeply embedded in complex and dynamic social contexts. Equally, symptom severity is not static but fluid and changes according to a continuum of pathological reactions. 

Simply put, the social and economic environment has a fundamental role to play in mental health. We need to pay attention to the various, context-dependent, long-term, and complex social, political, and economic measures affecting the mental health of populations. Given the importance of the socio-cultural and economic environment on mental health, the anxiety, economic impact, and social isolation brought about by the Covid-19 pandemic can only exacerbate the burden. 

The mental health impact of Covid-19

Some of the key factors related to the Covid-19 outbreak and its influence on mental health include:

• Boredom linked to quarantine: risks exacerbating most mental health difficulties, including substance use disorders, anxiety, and depression.

• Frustration, anger, and powerlessness linked to quarantine: risks exacerbating domestic violence, sexual abuse and violence and childhood abuse – further linked to the increased risk of substance use disorders as a maladaptive coping mechanism. In China and Italy, cases of domestic violence have increased. Several organisations preventing violence against women and feminist collectives are sounding the alarm.   

• Social isolation and loneliness: risks exacerbating most mental health conditions, notably depression, anxiety, and substance use.

• Fear: risks exacerbating anxiety disorders, including Obsessive Compulsive Disorder and PTSD. Feeling overwhelmed by anxiety can make it difficult to cope with the new lifestyle changes that are required, or may lead to people using unhealthy ways of coping, such as substance use. Another risk related to fear is an increase in psychosomatic reactions, in other words, physical manifestations of psychological suffering (sometimes understood as conversion disorder). This again could result in an increased number of patients attending emergency centres. 

• Financial loss: risks exacerbating most mental health difficulties, including substance use disorders, anxiety, and depression. 

We have little evidence on the mental health impact of quarantine on individuals. We have even less on the impact of a global enforced quarantine on entire communities. However, this rapid review recently published in the Lancet “suggests that the psychological impact of quarantine is wide-ranging, substantial, and can be long-lasting.” Most of the studies examined in this meta-review reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors highlighted across studies included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. 

We need to be concerned for the individuals affected and for their families and communities. Importantly, we also need to be concerned for the healthcare systems at risk of collapse globally in the face of increased mental health difficulties. 

The impact on frontline workers 

A recent article published in the Lancet, exploring the lessons learnt on MHPSS in China, stated that:

“Under strict infection measures, non-essential personnel such as clinical psychiatrists, psychologists, and mental health social workers, are strongly discouraged from entering isolation wards for patients with COVID-19. Therefore, frontline health-care workers become the main personnel providing psychological interventions to patients in hospitals.”

This is a triple burden, with negatively reinforcing feedback mechanisms: 

• Healthcare workers “on the frontline” of the outbreak are particularly at risk of experiencing mental health difficulties themselves. The large body of literature on medical emergency workers in general attests to the high prevalence rates of mental health difficulties related to the stress of the job. This refers both to the nature and the amount of work, as well as the exposure to human tragedy, increasing the risk of secondary or vicarious trauma. A recently published article in Brain, Behaviour and Immunity confirms the significantly high levels of vicarious trauma among frontline workers facing the Covid-19 outbreak in China.   

• Healthcare workers are also asked to take on the double task of acting as both medical AND mental health care workers. Not necessarily within their scope of practice, they may not be equipped with the necessary tools and resources, both professional and psychological, to handle this extra load.

• Healthcare workers may see an increase in the number of people presenting with mental health difficulties. There is a significant risk of the global burden of disease related to mental health difficulties increasing. This is not only necessary in relation to the virus itself (for example, anxieties and fears around contracting the illness), but more generally related to mental health conditions globally being exacerbated by current conditions.

Physical distancing, social solidarity: moving forward together 

The crisis has catalysed countless creative examples of social solidarity, mutual aid, encouragement, and support. As global mental health experts have noted in a recent report:

“We need to encourage physical distancing along with social solidarity. And any MHPSS intervention during this time needs to include key psychosocial principles, including hope, safety, calm, social connectedness and self- and community efficacy.”

• Healthcare workers need to be armed with adequate MHPSS strategy integrated into their response activities and the systems in which they work

• Patients in quarantine should have access to mental healthcare 

• Mental health professionals should be resourced and equipped to offer support online/via tele-therapy – and paraprofessionals (such as community healthcare workers) should be trained and equipped to join them in picking up this load. Online mental health services have been successfully implemented in response to the outbreak in China, as confirmed in this report in the Lancet. 

By mapping existing MHPSS service providers and institutions, efforts can be pooled to address the global burden of mental health disorders: a substantial burden projected only to increase.

About Gail Womersley and Outsight International

Gail Womersley is based at the University of Neuchâtel, where she lectures BA and MA students in sociocultural psychology. She has worked for over ten years as a clinical psychologist and researcher with displaced communities in the Central African Republic, the Democratic Republic of Congo, Greece, Iraq, Israel, the Philippines, South Africa, South Sudan, the Ukraine, and Zimbabwe. Her recent publications include the book: “Trauma Without Borders: Working with Adversity and Resilience Among Displaced Populations” (to be published by Springer in 2021).

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Gail and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.