This document summarizes how open source software and mobile payment systems were used to help coordinate the Ebola response in Sierra Leone. It describes how second hand laptops and open source software like Open ERP were used to build management information systems and digital payment systems that helped overcome challenges like lack of infrastructure, corruption, and ensuring workers were paid reliably. Over 3,000 duplicate worker records were removed, while over 200 fraudulent or double dipping workers were reported. The systems helped digitally pay over 21,000 Ebola response workers in Sierra Leone, demonstrating how open source solutions can be effectively deployed in limited resource environments.
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How to stop and apocalypse with second hand laptops and Open Source Software.
1. How to stop an apocalypse with
second hand laptops and Open
Source Software
32C3 Hamburg
By: Emerson Tan (NetHope Emergency Response),
Salton Massally (iDT Labs, Sierra Leone)
December 30, 2015
2. Private and Confidential
Content
Introduction and outline
Background: Ebola and Sierra Leone
The principles of successful intervention
Development and implementation of MIS and Payment systems
Questions?
3. Private and Confidential
Content
Introduction and outline
Background: Ebola and Sierra Leone
The principles of successful intervention
Development and implementation of MIS and Payment systems
Questions?
4. Licensed under Creative Commons
Introduction
Sierra Leone:
• Roughly the size of Ireland; population ~6 Million
• 6th Poorest country on earth
• Civil war 1991-2002
• Rich in resources (diamonds, gold, minerals)
7. Licensed under Creative Commons
Health System Scale Up:
• 18 Ebola Treatment Centers
• 50 Community Care Centers
• Contact Tracers
• Safe Burial Teams
• Ambulance Drivers
• Disinfection teams
• Labs
We’re going to need an army…
Coordination System:
• 13 Command Centers
• 2 Rapid response teams
• 117 Ebola Emergency Line*
• Labs result reporting system
• VSAT based internet to all key
facilities
• Mobile Phones, Sat Phones,
BGAN…
8. Private and Confidential
Content
Introduction and outline
Background: Ebola and Sierra Leone
The principles of successful intervention
Development and implementation of MIS and Payment systems
Questions?
9. Licensed under Creative Commons
Principles of effective technology intervention in developing world contexts
Be on the Ground, Not remote
• Being on the ground means developers are immediately exposed to problems and failures. Changes can be implemented quickly as problems are
identified
• Tighten the development loop
Make use of Local resources and people
• Local people understand the local environment and way of doing business, including all the local scams
• Those that have taught themselves and innovated locally are highly invested in project success and will not leave
Take chances and fight inertia
• Giving the right people a chance to prove themselves can have excellent results over more established complacent providers
• Fresh eyes see problems differently
Use open source software, reuse and leverage what exists
• Reuse and repurpose everything!
• Make source code available for next time
Plan how you are going to leave
• Bake in handover to local ownership and make provisions for system longevity
10. Private and Confidential
Content
Introduction and outline
Background: Ebola and Sierra Leone
The principles of successful intervention
Development and implementation of MIS and Payment systems
Questions?
11. Licensed under Creative Commons
The Nightmare
- Challenges
- Solutions
- How to work a miracle
12. Licensed under Creative Commons
Challenge: Pressure
There was some pressure…
• Problems with pay led to strikes and civil disorder
• Strikes and civil disorder lead to bodies and patients in the streets
• “You guys have six weeks to come up with a working solution this problem set or the country
is fucked.” – Senior UN official in private conversation, October 2014.
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Challenge: Welcome to the nightmare of trying to pay for everything
“The sinews of war are endless money’
Paying people is harder than it looks:
• 8 ATMs in the entire country
• Banks shut down due to epidemic
• One of worlds most corrupt countries
• Banking system circulation shutdown
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The Nightmare
- Challenges
- Solutions
- How to work a miracle
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Approach
Ubiquity of mobile phones among the
Ebola Response Workers, Extension of
mobile money wallet schemes
A local ICT social enterprise with technical capability in
open source ERP, Internet infrastructure implemented
as part of the response
A comparatively advanced
mobile phone based digital
payment ecosystem
18. Licensed under Creative Commons
The Nightmare
- Challenges
- Solutions
- How to work a miracle
19. Licensed under Creative Commons
Open Source had solutions for most of our key technical problems
Complications Open Source SolutionProblem
Can’t use finger print based biometrics
(cross contamination risk)
ODK makes developing enrollment
applications very fast
Open source facial recognition
framework
No Worker ID scheme
Must store profiles, payment histories,
generate pay lists, manage issues
OpenERP/OdooData Repository
Very limited variation in names
nationwide
Lots of missing and inconsistent data
Dedupe, a python library that uses
machine learning to quickly perform de-
duplication and entity resolution on
structured data
1000’s of duplicate
and ghost entries
from Gov lists
(corruption)
Must be SMS based, and scale to 30K
users flawlessly. Must allow interaction
Kannel SMS and WAP gatewayCommunications
Corruption is a way of life
Audit module included and code is
available for audit! Transparency win!
Leakages, system
gaming and
patronage
20. Licensed under Creative Commons
Deployment
Complications SolutionProblem
No power grid, No data centers, No
good sysadmins, No infrastructure.
Emerson ‘persuades’ GoSL into letting
the system be hosted at Amazon.Government demand
s data hosted in SL
Had to be instantly available
99.999 reliability
OpsWorks
Amazon EC2
Amazon RDS
Amazon Route 53
Amazon SQS
Amazon SES
Infrastructure
Must be robust Berkshelf/Chef
Deployment
management
Constant scope change
Coffee, Energy Drinks, Camp beds in
office, no showers, not enough sleep
DevOps
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Open Source Software restored faith in ability of systems to be run honestly
22. Licensed under Creative Commons
The real challenge is never technical
Business process
development and
implementation is
much harder than
tech in these
contexts.
23. Licensed under Creative Commons
Results
Duplicate Records Removed through Information Management
System 3,054
Number of Fraudulent Ebola Response Workers Reported to the
Anti-Corruption Commission
150
Number of Double Dipping Ebola Response Workers Reported to
Anti-Corruption Commission
78
Medical Centers reported to Anti-Corruption Commission 3
# ERWs
Paid
Total # ERWs
in Country
% of Total ERWs
managed IMS
Direct
Cash
Digital
Money
Guinea 1,400 23,174 N/A 78% 22%
Liberia 1,393 11,000 N/A 43% 58%
Sierra Leone 21,058 27,000 100% 0% 100%
25. Questions?
WHEN A PLAN COMES TOGTHER
Salton: smassally@idtlabs.sl
Emerson: emerson.tan@nethope.org
Editor's Notes
Sierra Leone: Key facts
Famous for all the wrong reasons, civil war, blood diamonds, leonardo di caprio movies
Roughly size of Ireland for European reference
Very poor
Life expectancy is only 48 yrs
Civil war wrecked the education system: literacy rate is less than 25%
Lots of minerals, place should be rich
I could spend hours banging on about how Ebola nearly brought the countries it affected to their knees. The disease is terrifying, and the images that played across your TVs are nothing on actually watching it in front of you (from a safe distance of 2 meters).
However, these documentary makers showed up and this trailer for their documentary does a pretty good job of summing up some of the impacts to society and individuals that the epidemic had.
The strategy to get the outbreak under control was at first glance pretty simple.
70% of dead ebola patients buried safely, as recently dead people are the most infectious
70% of live cases in treatment in isolation units so they be cared for safely
This gets the curve to flatten out and the situation stabilises, as the system improves to 100% in all categories the epidemic should be ended.
But this is a race against the clock, how to build the systems needed and get them to national scale in a very hard environment starting from a very low base.
Of course the previous slide is a gross oversimplification, because achieving those simple goals means building a huge amount of infrastructure and employing a huge number of people, in new organizations, who all then have to be coordinated together.
In a country with 30% phone coverage, only 2 paved highways outside the capital, no power grid, economy shutdown, movement restrictions
Ok, this is now sounding much more complicated. I had to do a bunch of infrastructure work to get all this to work, but this was simple compared to the ultimate nightmare
Paying people.
By October, strikes and other disruptions due to failure to pay healthcare workers were becoming a critical danger to the effort to contain the epidemic
Hazard pay introduced to bypass the mess at the ministry of health, some workers hadn’t been paid for months as the Ministry of health manual systems collapsed
The policy was great in theory, only the system needed to run it all simply didn’t exist at the time the policy was announced
I got dragged into a session where finally how the system was to be built, almost casually. I’d been working on getting Satellite internet service to all the treatment centers and disctict command and coordination centers. In the course of the meeting I remember saying ‘what you guys need is an ERP system’. I got some very blank looks, finally, someone said ‘what’s one of those’. After about 10 minutes this turned into ‘you seem to know something, you advise us who to hire and how to do this’
Oh shit.
Paying people should in principle be really simple. In the developed world more or less everyone has a bank account and paying people is as simple as
Only it isn’t.
No ATMs outside the capital, No Accurate staff lists, There are only 12 surnames in the entire country, Most people can’t read and write and many don’t even know their own birthdays.
This makes for an administrative and organizational NIGHTMARE.
Lorissa had known about iDT labs for some time
Sierra Leone’s only real software development startup since 2013
Everyone was very young, but they has already had some OpenERP experience having built the HR system for Africell, a local cell phone company with about a thousand employees.
So, take the existing HR system, tweak it a bit and scale it to ~30K people.
That’s easy isn’t it?
Deduplicating without enough details was a nightmare
Twenty thousand records supplied with no unique ID or adherence to convention and unique characteristics missing
Important fields like Identification, telephone numbers, address etc that we could use to deduplicate were mostly missing
Extensive spelling mistakes added several feathers to our hats of frustration
Devops and an appreciation/patience for major scope changes and feature creeps was Key
Ability to respond to how users interacts with the system and the deficiencies in processes that the system was meant to support and data supplied was paramount
Almost daily deployment to opswork for the first two months…
…longest streak 29 days
…328 commit in the first month alone after the system was already in production
…longest stay in office 3 days without sleep or shower
...The gods named Cheap Coffee and yet still Cheaper Energy Drinks kept us going
Devops and an appreciation/patience for major scope changes and feature creeps was Key
Ability to respond to how users interacts with the system and the deficiencies in processes that the system was meant to support and data supplied was paramount
Almost daily deployment to opswork for the first two months…
…longest streak 29 days
…328 commit in the first month alone after the system was already in production
…longest stay in office 3 days without sleep or shower
...The gods named Cheap Coffee and yet still Cheaper Energy Drinks kept us going
After a few weeks of operation and once people were confident they were being paid on time and with no deductions, strikes stopped completely
We hacked together biometric registration kits from voter registration kits, replacing secure tamper proof parts which wouldn’t run our software with laptops ‘borrowed’ in a hurry from World Vision (an NGO) after some hasty phone calls.
Seeing the team and seeing the technology built faith in the system in the health workers