Mekong Collaboration Program

Mekong Collaboration Program

The primary aim of the Mekong Collaboration Program (MCP) is to strengthen regional surveillance and response systems in Southeast Asia through the development and adoption of collaboration software that makes it easier to work together, identify threats and respond quickly.  InSTEDD is working throughout the Mekong region, recognizing that diseases know no national boundaries. We work closely with the Mekong Basin Disease Surveillance (MBDS) Network, an innovative regional collaboration between national governments to support cross-border disease information sharing.

2008: Laying the Foundation

Before InSTEDD introduced any software to Southeast Asia, we spent substantial time understanding the workflow gaps, understanding how the current disease reporting systems work, and discerning the political, social and cultural constraints and opportunities. We wanted to support all of the countries in the region immediately, but we knew, with our limited resources and the numerous and unique disease surveillance systems in the region, it would be necessary to narrow our focus in this first year.

We decided to emphasize Cambodia as our country model in Year 1 out of respect for Cambodia’s role in the MBDS network as the ICT lead. We also laid the groundwork to expand activities to the bordering countries of Thailand, Lao PDR and Vietnam beginning in 2009.

Surveillance and response assessment: InSTEDD engaged in an in depth assessment process of the needs, opportunities and constraints to supporting better disease surveillance and response with an initial emphasis on national system strengthening. We met with the key stakeholders (Ministry of Health staff, World Health Organization, US Centers for Disease Control, NGOs working specifically on surveillance and response such as CARE, Wildlife Conservation Society, AED and others) and evaluated how we could support the already strong work underway. Cambodia had already planned to implement SMARTPHONES in all of their districts, and had developed innovative methods of transmitting weekly reports of key symptoms and diseases from the district level to provincial level. We did on-site visits to the places involved in disease surveillance, from non-profit hospitals (Sihanouk Center of Hope) to provincial hospitals to health centers only reachable by boat. Because we have a regional and cross-border emphasis, we also visited the Lao-Cambodia border region and learned about which clinics get regular cross-border traffic because of proximity.  Our entire assessment was focused on understanding what the national CDC needed and wanted to strengthen their system.  This several month process culminated in an extensive set of recommendations for where InSTEDD could start our work in Cambodia, with plans in Years 2 and 3 to work in other Mekong countries.

Through this requirements gathering process, and through experience in developing prototype tools for response to public health emergencies in 2007, we identified 3 essential capabilities required for effective detection and response:

• Deep-field discovery and reporting of events;
• Sharing that information within and between organizations and their data management systems;
• Enabling groups to analyze and act on that information.

To support these capabilities, InSTEDD has begun development of a suite of open source platforms, tools and modules. These modular, but interlocking, technologies can form a low-cost, flexible and interoperable backbone for local, national, regional and global surveillance and response systems.

Innovation lab in Phnom Penh: By August of 2008, we had set up a field-based innovation laboratory (iLab) in Phnom Penh.  At the heart of our sustainability strategy for the region, the iLab is founded on the belief that the best ideas and innovation will come from those closest to the issues who understand the context. We co-design and develop the software tools with a team of Cambodian developers on contract from other technology NGOs (Yejj and Digital Divide Data) in a shared, neutral space in the heart of Phnom Penh. Rather than bring in our expertise alone and leave training and support to local staff, we want to ensure the Ministries of Health and others have a large network of software innovators upon whom to draw for new applications.  We also hope new businesses will be spun off the developing local expertise. We have enlarged our innovation hub in the region with the addition of Grameen Solutions (February 2009) as an engineering partner.  A team of engineers from Grameen can provide deeper technical expertise to our Southeast Asian team as well as explore new and useful applications in their own context in Bangladesh. Grameen Solutions is only an elevator away from other Grameen businesses working to enhance the lives of many who have been excluded from global economic success.

Open Source Emergency Response Prototype: In addition to establishing the structures necessary for long-term success, InSTEDD worked closely with Cambodia CDC to identify their core needs around disease surveillance and response.  After extensive assessment, 2008 culminated in the successful test of an open source emergency response prototype by 65 Cambodian participants October 13-15 in Stung Treng, a small border village in northern Cambodia. This SMS based system received over 2300 messages between seven different response teams during the simulation. That led to a stated readiness by Cambodia CDC to begin implementing technologies that InSTEDD has been developing with them throughout the latter half of 2008. 

2009:  Innovating for Better Surveillance and Response

Now that we have a strong team in the region, we are building, testing and iterating applications that will strengthen collaboration around disease detection and response.  Here are a few of our efforts underway:

• Mekong Basin Disease Surveillance Network: we are working with the Mekong Basin Disease Surveillance (MBDS) network to enhance the ability of their international leadership to collaborate and communicate in real time. MBDS recognizes that diseases know no boundaries, and has set up innovative cross-border monitoring sites throughout the region. Our GeoChat tool was designed specifically with cross-border collaboration in mind. We are starting to test out new methods of conversation and engagement across the region that will hope will enhance and strengthen cross-border communication, including the use of GeoChat.  They have also requested an SMS version of ProMed, one of the most important sources of information about potential outbreaks. In close collaboration with ProMed, we are developing a way to modify ProMed feeds for SMS use for MBDS and as a general application.

• Mukdahan, Thailand – Savannakhet, Laos: Mukdahan health office has already been recognized by MBDS for doing innovative mapping of cross-border disease information. InSTEDD embarked on an in depth field visit in November 2008 (see picture), and partnered with Bangkok-based social entrepreneurs ChangeFusion and OpenDream to support the technology needs Mukdahan had identified.  Mukdahan will be setting up a pilot to have local hospitals use GeoChat (30 users) on a trial basis.  They are also planning be doing a pilot (with 30 users) testing out sharing information from local hospitals in 2009.  They also plan to develop standards for SMS message communication to monitor dengue at the cross-border area with Savannakhet, Laos PDR.

• Cambodia CDC: we are working with the Cambodian Communicable Disease Control (CDC) Department to develop a set of software tools that will enhance their reporting and response capacities from the village level to the national level, including:
  
  
  • Hotline: we are working with Cambodian CDC to be able to track and monitor calls to their public hotline that until now were only captured in general terms. What is so important about this hotline is that it is the most significant way disease outbreaks are detected, and right now that data is not tracked.
  • Outbreak response and investigation: as in many countries, Cambodia’s CDC is stretched extremely thin.  We are working with the leadership to simplify and automate their outbreak investigation form so data can be gathered and analyzed in real time over SMARTPHONES.
  • Emergency response system: in 2008 we tested a prototype of an emergency response system the Cambodian CDC could use in the event of a large-scale outbreak. This system is being refined for implementation.

• National Veterinary Research Institute (NAVRI): inspired by our work with Cambodia CDC, InSTEDD is working with NAVRI on their animal surveillance system, starting with a prototype of their national animal surveillance hotline.  Our interoperability tools such as Mesh4X will ultimately be able to connect the NAVRI and Cambodia CDC systems even though, out of necessity, they are being designed in different software languages.