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.

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.

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.

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

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

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

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.

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.

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.

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

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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.

Mastering the art of hard problems (and avoiding the rush to easy solutions)

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Forward looking organisations take the need for innovation seriously, seeking original ideas that help avoid disruptive threats and pursue original opportunities. Unfortunately, these much needed initiatives often fail to deliver on their promise of impactful change.

There are a number of common stumbling blocks. Good ideas may fail to earn the required investment, while even those that are funded find that they are unable to muster on-the-ground support necessary to drive adoption. Unexpected barriers, tangled dependencies, and ongoing change in the surrounding environment can also derail the innovator’s plans. Perhaps the most disappointing projects, are those that succeed only by staking out a small vision, taking incremental steps that make little impact on future success.

Surprisingly, these varied failures are seldom driven by a team’s incompetence or lack of creative imagination. Instead, they are more often tied to a specific, but crucial, step that is missed in the creative process. In a team’s rush to embrace a solution, they fail to first immerse themselves in the full messiness of the problem that underlies an important challenges.

Rushing to Design

Innovation typically begins with lots of energy. Well trained innovators listen attentively to those who are immersed in the area where change is needed. They use these insights to identify a good idea and then quickly move forward with design decisions that are informed by user engagement (option #1 on the diagram). They fail fast and learn quickly.

This approach drives directly to a usable solution, yet a strong case must be made for inserting an additional step early in the process. Even a fast moving innovator can benefit from taking time to understand the root cause of the problem that is behind their User’s need (option #2 on the diagram). This insight helps inform good design decisions. Still, there are limits to this targeted look back. Focusing only on the specific problem behind a user’s need often leaves the original vision unchallenged. The innovator may do a slightly better job in design, but still rushes ahead with the same fundamental solution.

Innovation teams may justifiably feel that they are doing a good job when they use these first two strategies. Yet, these seemingly well tested practices still fall short.

The unrecognised challenge is that neither genuinely important problems nor truly impactful solutions are as simple as they appear in this rush to design. In real world systems, diverse individuals and organisations are tangled together, so that even simple activities are the result of dynamic collaborations involving varied skills, resources, and motivations.

Seeing Beyond the Keyhole

This fact requires a non-trivial addition to conventional fast moving innovation methodologies. Before rushing forward to solution design, there is a need to pause and intentionally look back at the messy systems that are at the heart of the problem. (#3 on the diagram)

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Understanding these systems demands a fundamentally different way of thinking. While a User’s specific challenge may be quite real, it is just a fraction of a much bigger picture. When an innovator focuses only on a specific need, it is as if they stare at the world through a keyhole. What they see is true, but it is hardly a complete view of what is inside the room.

This small actionable view comes at a cost. The unobserved complexity and challenges that lie outside the User’s and the innovator’s immediate view become stumbling blocks. Unrecognised complexity undermines business cases, casts doubt among potential stakeholders and leaves innovators surprised and unprepared for barriers and setbacks.

Innovators fail when they assume the world is simpler than it is. Of course this isn’t always the case. If an idea is small enough, or already thoroughly understood, it is possible to confidently make a small tweak or addition based on a narrow view of a problem and solution.

Yet, when innovators ambitiously seek to drive more substantive and sustainable change, it is no longer possible to assume that important problems can be addressed with simple ideas. To be truly impactful, the solution must embrace the true complexity of the problem and be suited to the scale of the challenge.

The embrace of the real world’s messiness begins by letting go of the original idea. Instead of supporting a preordained path to addressing a challenge, the user’s need can be treated as a symptom of the challenges found in complex real world systems. This broad-based, systems perspective looks at the diverse actors involved and seeks to understand how the world works. In real world systems, if something good or bad happens it is because of the way these tangled webs of actors, interactions and incentives connect. Understanding the rich complexity of these systems opens the door to a far more sophisticated view of the challenges and possible solutions.

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The Power of Embracing Hard Problems

Investing time and effort in building a big picture view of a problem requires significant investment. This can be difficult to embrace. Just at the moment when everyone is excited to drive forward with realising the solution, the journey seems to take an about-face. Sponsors and participants in the creative effort may worry that the project is becoming mired in “analysis paralysis”. Fortunately, this thinking does not have to be bogged down in a never ending swamp of details. Rather, the effort should look down from above, doing just enough big picture work to see the important patterns of the system and its actors. This big picture systems view is broad but not necessarily deep.

With a top down view of the systems behind the problem, it possible to leverage four powerful creative capabilities:

  1. Claim Bigger Problems – A bigger picture of the challenge naturally encourages broader thinking about the nature of the challenge and the scope of the solution. A particular User may have identified a specific issue, but it is far more likely that making a substantial change that impacts the future will require addressing a more substantial version of the problem.

    Stretching the problem can help the innovator to strengthen their case for change. Smart organisational leaders naturally guide their investments to big urgent problems. Stepping back and understanding the full scope of the challenge allows the innovator to claim a bigger more compelling problem.

  2. Design More Sophisticated Solutions – It’s easy for an Innovator to look naive when they propose a simple solution to genuinely hard problems. Seasoned experts in the field quickly identify shortcomings, challenge the idea, and withdraw their support, often taking others with them.

    While an individual User may see a particular aspect of a challenge, working with system’s view makes it possible to see the many interconnected elements that are in play. Understanding the complexity of the problem makes it possible to recognise dependencies, trade-offs, and barriers that are only apparent when the entire system is considered. The innovator can then propose a sophisticated solution that rises to those challenges.

  3. Tap Complexity’s Bigger Toolkit – There are many moving parts and dynamic interactions in a real-world system. Understanding this complexity can be a challenge, but it also offers a creative gold mine of resources and capabilities that can be used to build solutions.

    Seeing a broad-systems view offers the use of a big toolkit that includes varied actors, capabilities, technologies, and existing resources. These resources can be reassembled in new and creative ways, building powerful solutions without starting from scratch. Shaping solutions with this holistic view also allows innovators to take advantage of synergies and emergent behaviours which are only visible at a systems level.

  4. Enable Creative Agility – The final advantage of beginning with a systems view of the problem is tied to the actual development of the idea. As innovations become bigger and more ambitious, the more they face unknowns and uncertainty. It’s simply not possible to plan a large creative change in advance.

    Powerful solutions are not just about coding a piece of technology and releasing it. High impact innovations require a wide variety of people, institutions, and technologies to evolve together, progressively transforming the current real-world systems.

    At any point on this journey an unexpected barrier may rise up to derail the effort. The best way for innovators to respond is to pivot and adjust as they go. Rooting an innovation in a broad understanding of the problem, rather than a specific solution, gives the innovator the flexibility to nimbly adjust their vision. When necessary, they can take a significantly different approach the solution, because they can see alternative ways to solve the underlying problem.

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A Worthwhile Creative Discipline

Because a systems understanding of the problem is so useful throughout the innovation lifecycle, it is important to begin thinking about it early in the creative effort. This is not a bit of busy work that delays the real job of the innovator. While rushing forward into detailed design and implementation may feel tangible and productive, it is in fact an indulgence that borders on creative negligence.

Taking the time to think deeply about the messiness and deeper challenges, when everyone is anxious to drive quickly forward, can be a hard sell. Nonetheless the creative payoff is substantial. Building an early understanding of the system behind the problem makes it far more likely that the idea will eventually be big enough to matter and will survive the winding journey to adoption.

About Dan and Outsight International

Dan McClure has spent over three decades working on the challenge of disruptive systems innovation. He has advised global commercial firms, public sector agencies, and international non-profits in support of their ambitious efforts to imagine and execute agile systems level innovation.

Outsight International is an organisation specialised in providing 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 Dan and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Why health needs to be at the centre of climate change discussions

I have worked in the environmental sector since graduating from university in 2011. In 2016, I transitioned over into health and climate change, bringing my expertise on climate change to health professionals. With climate records being continually broken, climate-related disasters on the rise, and limited action being taken to meaningfully reduce global greenhouse gas emissions, the need to understand the role of health in climate change discussions has never been more critical.

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No one is immune to the health impacts of climate change

Every impact of climate change will affect human health to some degree and no one - no matter where in the world they live - is immune. Yet capturing the health impacts of climate change can be very complicated. Direct health impacts are simpler to identify: for example, death and injury following a storm; heat stroke during a heatwave; or spread of infectious diseases as vectors’ ranges alter in a warming world. However, the indirect health impacts of climate change are much harder to capture and understand. Indeed, there can be seemingly endless trickle-down effects of climate change, which can affect human health and wellbeing to greater or lesser degrees all around the world. Just one example - forced migration. While forced migration in itself can be a direct impact of climate change (for example, from sea level rise), the consequences of this forced migration are numerous and complex, from post-traumatic stress disorder and anxiety to economic insecurity and low access to health care. These in turn can have further trickle-down effects for health and wellbeing. Capturing all of these nuances is an almighty challenge, but one that needs to be met. Only by understanding the full scale of the direct and indirect health impacts of climate change can we incentivise action and also put in place measures to increase resilience to these impacts.

 

Health systems are not prepared for climate change

Essential to reducing the health impacts of climate change are robust and well-functioning healthcare systems. To be resilient to climate change, a health system must have early-warning systems, disaster-response systems, disease-specific responses, and nutrition-focussed responses in place. The ability of health systems to do this will be significantly undermined — or indeed made impossible — if they are unable to deliver basic healthcare; use meteorological information to project climate-related health risks; or continue functioning if hit by a natural disaster. Many healthcare systems are not able to meet these criteria, particularly in low- and middle-income countries, which are often the most vulnerable to climate change. The 2019 WHO Health and Climate Change Survey Report tracks global progress of actions by national governments to address health and climate risks. It found that only half of countries (50 out of 101 surveyed) have a national health and climate change strategy or plan. Furthermore, early-warning systems and health sector response plans were not in place for the majority of climate related disasters. Specifically, for flooding 60 out of 99 countries had an early-warning systems and health sector response plan in place; for storms this was 50 out of 90 countries; for heatwaves it was 42 out of 98 countries; for drought it was 38 out of 97 countries; and finally for air quality it was 31 out of 98 countries.

 

Climate change is a human rights issue

Under the Universal Declaration of Human Rights (1948) health is a human right for all. The health impacts of climate change are in direct violation of this human right, in governments continuing to allow unmitigated climate change, which is already having, and will have increasingly severe and widespread, health impacts. Thus, the health impacts of climate change make it a human rights issue. The formal global recognition of climate change as a human rights violation is an essential step in protecting human health. In January 2020, the UN Human Rights Committee issued its first ruling supporting asylum for climate change refugees from Kiribati, forced to move as a result of rising sea levels. This is a promising step, but more needs to be done: more ambitious mitigation targets are needed; the UNFCCC needs to formally recognise the links between climate change and human rights; climate financing mechanisms must be equitable; greater financial and technical support is needed for low income countries; and loss and damage must be addressed to understand the scale of impacts in affected countries.

 

Co-benefits in the health and climate space are enormous

The scale of actions needed to tackle climate change can seem rather overwhelming. Indeed, a fundamental shift in the way society functions and is powered is needed to mitigate and adapt to climate change. We know how to do this - we just need the will. Furthermore, we need to recognise that many of these actions have huge health co-benefits, which can make plans much for economically efficient and broadly beneficial. Air pollution is a great example of this. Many of the sources of local air pollution are also emitting greenhouse gases (and so contributing to climate change) — such as petrol and diesel cars and coal-fired power plants. By taking petrol and diesel cars off our roads and shutting down coal power plants, not only do we reduce the significant contribution of these greenhouse gas emitters, but we also quickly improve local air quality. This is a big win-win. Ambient air pollution is estimated to cause 4.2 million deaths every year due to stroke, heart disease, lung cancer and chronic respiratory diseases. By identifying and maximising these win-wins and reaping the health and climate co-benefits available, we can make significant and relatively immediate improvements in people’s health and wellbeing.

 

People inherently care about health

We’ve known for decades that greenhouse gases are causing our planet to warm. I will not go into the unforgivable reasons for this being buried, ignored and denied, but it is important to recognise and then to understand why the health angle could be a game changer. People care about health. They care about their own health, they care about the health of their loved ones, and they generally care about the health of strangers around the world. The same sadly cannot be said for the environment, which has traditionally been the lens through which climate change has been discussed. Furthermore, climate change has historically been presented as a long-term problem - this can make it difficult to engage with it as it seemingly doesn’t affect people’s day to day lives. However, it is becoming increasingly clear to the public that this is not the case. It is also becoming increasingly clear that not only is climate change having impacts now, but that these impacts are affecting people’s health and wellbeing. Talking about climate change through the lens of human health can be a powerfully persuasive tool for action.

 

There is a long way to go

Sadly, we’re not on the right path. We’re currently heading towards 2.8°C - 3.2°C global temperature rise. A conservative safe limit is 2°C, as set under the Paris Agreement. Incentivising further action is essential and health might just be the angle through which to achieve increased action. It must be understood and recognised that no one is immune to the health impacts of climate change and that health systems are generally not prepared for climate change. Then it can be formally accepted that climate change is a human rights issue. To further incentivise action and make climate action more broadly beneficial for all, health co-benefits must be captured for these are enormous. Beyond this, the fact that people inherently care about health makes for a more compelling and easier “sell”. So the time has come to stop treating issues associated with climate change and those with health as separate entities. They are intricately and inherently linked. Only by mainstreaming health in climate policies, and vice versa, can we truly begin to make tackling the enormousness of the climate crisis a viable possibility.


About Nicola Outsight International

Nicola is an environmental health specialist, with expertise in climate change and health and environmental determinants of health. Previous projects she has worked on include health impacts of climate change, population vulnerability to climate change, health co-benefits of climate mitigation, health adaptation and resilience, ecosystem services and air quality. Nicola works with both health professionals and environmental professionals (across governments, UN agencies, NGOs and academia) to help them better understand the links between climate change, the environment and human health, and also works with professionals to enable them to better account for and address the human health effects of climate change and other environmental changes through targeted policies and plans.

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

Should NGOs be more empathetic in partnerships with the private sector?

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Over the past few years, I have focused a lot on improving partnerships between the private and nonprofit sectors. This has involved work for Medecins Sans Froniteres (MSF) and the International Committee of the Red Cross (ICRC) among others, assessing what’s worked and what hasn’t from previous collaborations between sectors.

For MSF, this culminated in the Innovation Partnership project report, offering an improved step by step towards scaling innovation and leveraging MSF’s respected brand favourably in the private sector. The report can be found here.

During this work, I also authored a blog piece after facilitating a workshop for the MSF Scientific Days in London entitled ‘Does MSF need a more intelligent/empathetic approach to partnerships?’. Please check in out and get in touch if you have any comments.

I am also currently working with the EPFL EssentialTech centre to improve collaborations between academia and the nonprofit sector, following a workshop that was held earlier this year. We hope to have an article on the key pitfalls to avoid in such collaborations published in the coming months.

If partnerships between the development/humanitarian world and other sectors if of interest to you, please get in touch!

About Louis and Outsight International

Louis is one of the Co-founders of Outsight. He has a wide range of experience covering development, health, innovation, technology and research. Having worked in in the field with Medecins Sans Frontières as well as with other NGOs, he is well acquainted with the practical realities of delivering impact in the field. In recent years, has been helping organisations to improve innovation processes and outcomes. In particular, this has included managing projects focused on improving healthcare provision in hard-to-reach contexts through new technologies. He is an experienced facilitator and has been closely involved in efforts to improve collaborations between the nonprofit, academic and commercial sectors in recent years. He is based in Lausanne, Switzerland, and received his MSc in Global Health from the Karolinska Institute, Sweden.

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

How can we use drones in the humanitarian and health sector?

Ever since I watched the exceptional 2013 TED talk by Raffaello D’Andrea on the athletic power of quadcopters (above) I have been fascinated by the possibilities of unmanned arial vehicles (UAVs) or, as they’re more commonly called, drones. Finally, it felt like the film-like future dreamed of for 20 years, was arriving. Since that video, there has been no end to proposals for which they might be used. No sooner had I been discussing with a friend that what I really wanted was an autonomous drone to take holiday photos without going through the usual stop, say ‘cheese’ routine, than I stumbled across an advert for Lily, a drone which does just that. In a few weeks, if the claims of the Indigogo project ONAGOfly are to be believed, this type of drone will soon be small enough to fit in your pocket and cost under $200. Oh, you want a Back to the Future style hoverboard? No problem, thanks to drones. 

Photography and sports aside, what serious applications might drones have in the imminent future? We already know they are used with devastating effect militarily, but how can they be used for good and what implications can such a versatile machine have in the humanitarian or health sector? For me, they have potential to revolutionise; and here’s why. 

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Search and rescue

The advantage for drones to be used in search and rescue operations is self evident: using simple commercially available drones with cameras, you immediately have an extremely manoeuvrable eye-in-the-sky (watch the Drone Racing League to see just how manoeuvrable) that can access places previously only accessible by aircraft at a fraction of the cost. Further development of UAVs with the search and rescue brief in mind include the Kwago drone (video below) that incorporates commercial flight awareness and night-time manoeuvrability being a prime example. Whilst running their search and rescue operations in the Mediterranean during 2015, the Migrant Offshore Aid Station were using eye-in-the-sky drones as a means of expanding the radius of their operation

Surveying

Closely linked to this, the use of autonomous drones in surveying provides a genuinely futuristic option to aid organisations. Using geo-referenced photography (or photogrammetry), UAVs are already being used to quickly survey and produce large 2D and 3D maps of astounding accuracy — particularly within the agriculture and construction industry. However, it is easy to envisage how such tools could be used by humanitarian actors within emergency or refugee situations — for example, a detailed survey of a refugee a camp could be conducted by a single person and UAV in a matter of hours, and in addition, this could be updated at regular intervals with minimum additional work. The non-profit Drone Adventures is doing just this; having worked in Haiti with the International Organisation on Migration on 3D mapping for flood prevention (video below); and with MEDAIR in the Philippines onsurveying areas affected by Typhoon Haiyan.

HumanITas Solutions is another organisation that has foreseen the potential or UAV surveys in humanitarian work and is about to release a virtual environment to utilise this. Using UAVs that carry commercial smartphones and tablets instead of specialist equipment, their software works as an operating system specifically focused for humanitarian teams. With their android or OS app turned on, the phone can be fixed to the drone and sent to autonomously map areas — working alone or in tandem with other drones — using GPS and photography, by stitching these images together, complete maps and 3D models can be quickly collected. The software then allows for annotation, collaboration and import/export with other teams. The beauty of this system is the use of conventional equipment — understanding that often getting experts quickly to disaster zone can be difficult. Check out the video below. 

As with all innovation, technology is the deciding factor on feasibility. The Swiss Foundation for Mine Action (FSA) has been using drone observation in mine detection for many years, for obvious reasons. Though not there yet, there are projects which aim to mount instruments — such as thermal imaging — on the drones they fly over suspected minefields, providing and invaluable resource in the fight against civilian deaths. This doesn't seem like an unreasonable goal: drones that can map radiation already exist, whilst there is a renewed interest in using drones for gas detection after a recent leak in California. 

As surveying becomes more widespread, so too the technology is improving. A new startup, Nomoko, claims to have built a 1,000 mega pixel camera that, if mounted on a UAV, could map huge areas to 1cm accuracy in a fraction of the time it currently takes — the company claims that 10,000 drones mounted with its camera could map the world at this accuracy in just 60 days at a cost of around $100 million. Currently, a single satellite will set you back at least this amount and would take two years to achieve the task at a much lower resolution. Beyond just being a nice sales pitch, such accuracy could allow the data to be used in the search for survivors after a natural disaster by comparing photos taken of the same scene at short, regular intervals.

Drones as delivery tools

UAVs are evidently well-equipped to access difficult terrain, and this is something that Médecins Sans Frontières (MSF) exploited when conducting a trial of a UAV delivery system for lab samples. Traditional microscopy tuberculosis (TB) testing requires sputum samples to be tested within three hours to be valid, (newer GeneXpertsampling allows 3 days) but such a time-constraint was inhibiting in remote and inaccessible locations such as Gulf Province; a swampy region in Papua New Guinea, to which ‘normal’ access by car took four hours. With the UAVs, delivery times were slashed to just one hour. The trial was successful — as was acceptance by the local population — and such a system could provide an excellent means to improve infectious disease surveillance when time is of the essence. Could such a system improve the emergency response to viruses such as Lassa or Ebola, where quarantine is necessary? Could a suspected case be quarantined in their home whilst an UAV carrying samples is dispatched to see if bringing them to a health facility is really necessary? 

Drones could also facilitate speedy delivery in the opposite direction. Again, UAVs almost always offer a cheaper alternative to conventional aircraft. Capitalising on this for cold-chain products seems like an obvious move. Of course, the tech is the limiting factor: battery life and payload are preventing goods of reasonable size being delivered any meaningful distance. However, future developments could change this: solar-powered drones are one option or drones with combustion engines another. What about UAVs that can automatically dock with charging stations (possibly solar powered) along a set route? Effectively hopping from one station to the next as far as required...

The SaveME smartphone UAV, uses a quadcopter frame to transport a smartphone and can be used to find help in the event of being trapped. However, it is also proposed as a tool for prescription collection. In the future, could sending your drone to the local pharmacy to collect your prescription become the norm when you are too ill to leave your house? All interesting proposals and one specifically targeting the delivery of medical supplies in the humanitarian sector was recently proposed by Norman Foster. The notion of delivery is starting to be explored with a more specialised health focus in two areas: organ harvest and cardiac arrest. 

Drones in emergency response

There are few medical situations where time is more imperative than organ transplant — a heart can only survive for 4-6 hours outside the body so, in order to be matched to a recipient with the same blood type, body size and geographic location, the process must occur very quickly. Research has shown that, though for the victim there is no clear medical advantage to air ambulance over ground ambulance for arrival on the scene, the air evacuation did provide more organs than traditional ground units. Could drones offer the paramedics on the scene the tool to harvestand send organs on a par with the system of getting the organs to the hospital by air within the urgent time window?

Cardiac arrest is another situation where time is of the essence. In cases where defibrillation is the only thing that can revive someone, drones might again provide the answer. Alec Momont, a Dutch engineering student, has proposedmounting a defibrillator on a UAV which can lock on to the GPS of the smartphone making the emergency call and arrive on the scene on minutes. The idea is particularly bright because modern defibrillators operate automatically and just require correct attachment to the victim’s body — something that the caller could easily do with guidance. Though they are appearing much more frequently around cities in Europe, a rapidly deployable defibrillator could provide an invaluable service in suburban areas on the outskirts of places with many public buildings. The project created a prototype, and the video, but it has yet to be developed further. 

Vector control

A key process in health development remains vector control. Prevention of malaria, dengue or Zika, relies on limiting mosquitos; be it through sterilisation, environmental measures or fumigation — as Bill Gates famously wrote, the mosquito is the deadliest creature in the world, being ultimately responsible for 725,000 deaths per year. One drone project — MosquitoCopter — is targeting this problem through the sterilisation route. By releasing sterilised male mosquitos, who will mate with the blood-sucking females and prevent propagation, the mosquito population can be significantly reduced. As with most such projects, the problem becomes accessing the affected areas — MosquitoCopter, does this with a manoeuvrable quadcopter that can be programmed to follow a set route, automatically releasing the sterilised mosquitos at set intervals. A similar concept is also being used to support the Southern Tsetse Eradication Project in Ethiopia — though in this case, the drones are larger and can cover an area of 100km2 per flight. Even at a more basic level, UAVs can help by identifying mosquito breeding sites for direct action and are already being put to good use in Brazil to combat Zika.

Future hurdles

As with all new technology, UAVs are undergoing a delicate phase right now: simply put, governments and regulators don’t yet know how to deal with them in terms of safety (i.e. plane collisions etc.) or security (someone recentlymounted a hand gun on a UAV). The regulation of drones therefore, will change drastically in the coming few years and determine their prevalence in our everyday lives. It's worth noting that UAVs pose a challenge to the control of governments over our skies — an area that has, until this point, has maintained a miraculous safety record through very strict controls — so new challengers to that can be seen as a threat. The Federal Aviation Authority's legal pursuit of Raphael Pirker, a Swiss drone pilot who was fined $10,000 for making a promotional video using a drone, is a prime example of the confusion and delicate politics surround this emerging area. 

In the US and Europe, much of the regulation is in the testing phase, largely pushed by the development of delivery drones in the commercial sector. Last year, testing licenses were issued to a number of projects including a small startup delivering medical supplies to rural communities in Virginia. These small projects will mainly serve to inform regulatory legislation, which will then likely be the foundation in other countries. Amazon is one of the most vocal advocates for the use of commercial drones and the company's influence will play a huge part in deciding the future of commercial drones. This influence isn't going unnoticed: in 2015, the internet giant spent $10 million on lobbying in Washington and one suspects that its Prime Air service had a lot to do with this sharp increase. In fairness to the regulators, the proposals by Amazon will (if the video below is to be believed) fundamentally alter the skies over the US and Europe, so proceeding with caution does not seem unreasonable. Once permission is granted, the chances of it being revoked are much smaller. 

It's difficult to envisage exactly how this regulation will play out in developing countries and thus affect the humanitarian possibilities of drones. In the wake of natural disasters, their implementation will almost definitely become a necessity in coordinating the humanitarian response, but particularly in conflict zones, flying UAVs could have negative consequences for aid agencies who wish to avoid association with warring parties. Just the term 'drone' itself can conjure images of the US military's Predator drones, which do look rather similar to some UAVs already being used in vector control. Such associations have already led MSF to reject their use in conflict zones. There have also been cases of the data being collected for humanitarian purposes also being used for law enforcement: a point that could in the future severely damage aid organisations' reputation for neutrality if similar events occur in conflict zones. It seems probable however, that as the use of UAVs become far more widespread, their possible military connotations will be lessened. In terms of acceptance by the local population, existing humanitarian UAV projects have all seemed to show that, as long as they are well informed about the project and how the drones work, this is not a problem. 

2014 report by OCHA did try to consider some of the wider issues and possible applications for UAVs in the humanitarian sector, but the technology is moving so fast, this is already largely outdated. The FSA is currently trying to update and consolidating the existing knowledge on drone projects in the humanitarian sector as a means to increase awareness of the UAV tools available to aid workers and to propose guidelines for UAV use in the field. 

The final hurdle for the adoption of such useful technologies is cost. Professional UAVs are not cheap, and the hardware and software for a project like those run by Drone Adventures would cost around $20,000 and there are maintenance and repair costs to factor in to that, plus training. Other issues such as drone malfunction or hijack could also prove costly for organisations using drones for humanitarian purposes.

Conclusions

Having explored a range of possibilities for UAVs in the health and humanitarian sector, it seems clear that the coming decade will bring with it an extraordinary amount of change — in no small part due to drones. Their obvious benefit as search and survey tools will probably be their first point of mass use. With improvements to battery life and payload weight, delivery will quickly become important too and projects such as the TB sample delivery should be capitalised upon. The use of more autonomous drones will no doubt go in directions currently impossible to imagine, and this is exactly why UAVs are so exciting: they offer a blank canvas on three axes upon which anyone can imprint their ideas. 

This article was first published by Louis Potter on the Innovating Health blog. 

About Louis and Outsight International

Louis is one of the Co-founders of Outsight. He has a wide range of experience covering development, health, innovation, technology and research. Having worked in the field with Medecins Sans Frontières as well as with other NGOs, he is well acquainted with the practical realities of delivering impact. In recent years, has been helping organisations to improve innovation processes and outcomes. In particular, this has included managing projects focused on improving healthcare provision in hard-to-reach contexts through new technologies. He is an experienced facilitator and has been closely involved in efforts to improve collaborations between the nonprofit, academic and commercial sectors. He is based in Lausanne, Switzerland, and received his MSc in Global Health from the Karolinska Institute, Sweden.

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