Mobile technology – listening to the voice of Haitians

Haitian National Red Cross Society (HRC) and the International Federation of Red Cross and Red Crescent Societies (IFRC)

SECTION 1: PARTNERSHIP AND COOPERATION Haitian Red Cross (HRC): Active in since 1932 working in health, disaster preparedness and emergency response. To truly understand the needs of the most vulnerable in Haiti requires community level engagement. HRNCS has 13 regional branches across the country and a 10,000 person strong network of Haitian Red Cross volunteers working in their communities to empower them as partners in development. At the same time HRC uses this experience and community knowledge to work with public authorities on development plans and implementation.

The unprecedented 2010 earthquake seriously tested the capacity of the HRC to respond to a major disaster. However it also showed their ability to leverage its experience accumulated over the years to become one of the principal partners of the National Civil Protection Department (DPC) of the Haitian government thereby increasing the overall national disaster response capacity of the country.

International Federation of Red Cross and Red Crescent Societies (IFRC): The Red Cross Movement is the world’s largest humanitarian and development network with nearly 100 million members, volunteers and supporters. Globally,186 national Red Cross and Red Crescent Societies, are working to support the most vulnerable within their country and act as auxiliary to their Government in times of crisis. IFRC is responsible for coordinating humanitarian response during disasters and emergencies and works to increase the capacity of its members to address vulnerabilities in their countries.

The Haiti earthquake operation is the largest single country response in Red Cross history. Teams of specialists, including communications, were immediately put in place to support HRC in meeting the disaster needs. Whilst IFRC communications have overseen the development of tools, such as SMS and the Red Cross radio show, ‘Radyo Kwa Wouj’, the programme is a sustainable tool HRC will be able to use for many years to come.

Trilogy International Partners (Trilogy): invests in wireless telecommunication operations in international markets that exhibit strong opportunities for growth. Trilogy and its businesses own wireless communications systems in Haiti, Dominican Republic, Bolivia, and , holding licenses to provide wireless services to over 31 million people.

Trilogy has experience in creating effective communication systems at minimal cost. Immediately after the January 2010 earthquake in Haiti, Trilogy developed the Trilogy Emergency Relief Application (TERA) for its Haitian subsidiary, Voilà. This SMS system has transformed the HRC/IFRC’s ability to work with

communities coping with disaster. Now Trilogy has granted the IFRC a license to deploy TERA throughout the world.

Movement Networks: The Red Cross Movement (comprised of 186 member Societies, the IFRC and the International Committee of the Red Cross – ICRC) has strong internal and external communication networks enabling information to be disseminated, partnerships formed and learning shared. Within Haiti, 18 National Red Cross Societies have earthquake operations.

Digicel: A partnership will be sought with Haiti’s largest telecommunications provider Digicel, who have 70% of mobile users on their network.

Government, NGOs and civil society: Humanitarian actors and local institutions who are working in Haiti on areas of public information and education.

Beneficiaries and the general Haitian public will be the end users of the project.

HRC, with their legal status and local knowledge and expertise of Haiti, will lead the information collection and survey planning elements of the project. The tools developed within this project will remain in Haiti serving the population through HRC long after the international earthquake operation has ended.

IFRC, with its global history in coordination and managing funding and finance, will manage the budget and donor reporting of the project. IFRC and the HRC will collaborate on project management, particularly in the establishment of the IVR, with full project control moving to HRC as time progresses.

SECTION 2: BACKGROUND INFORMATION AND RATIONALE FOR INNOVATION/ PROJECT “People need information as much as water, food, medicine or shelter. Information can save lives, livelihoods and resources. Information bestows power” (The 2005 IFRC World Disasters Report)

Communication with beneficiaries is an essential service, not a secondary effort. Experience has shown that without information and a chance to voice their opinions, people lose perspective, hope and become frustrated and angry. The TEC evaluation on the Tsunami response reported that “poor information is undoubtedly the biggest source of dissatisfaction, anger and frustration among affected people”. As Haiti moves from emergency to recovery, it becomes even more critical to actively involve Haitians as their involvement in decisions about the country’s future will mean success or failure for operations.

Advancing technologies – such as SMS – now make beneficiary communications more feasible and indispensable than ever before. The success of beneficiary communications in Haiti to date lies in the appropriateness of the technology used. Research shows that 4% of Haitians access the internet daily whilst 93% of Haitians own a cell phone. Clearly mobile technology is the entry point.

The value of outreach via mobile phones was demonstrated during the cholera outbreak. From October 2010 to January 2011, 10.5 million SMS were sent using TERA, reaching at least ½ a million Haitians. Messages covered how to recognize the symptoms of cholera, treatment options and simple steps for prevention. The information uploaded on the Red Cross information line, *733, was accessed 130,000 times showing people need information they can use. While SMS has proven its worth in getting useful information directly into the hands of those who need it, its capacity for 2-way communications is limited. An SMS survey sent to 2200 people in February 2011, received only 75 replies.

Developing TERA to improve its capacity for 2-way communication and introducing an interactive telephony system (IVR) will break down identified barriers to participation, namely low literacy, complicated systems and lack of familiarity with sending SMS. It will create a simple, timely and cost effective way for beneficiaries to share their views with Red Cross. This could be replicated in other countries by the Red Cross/Red Crescent. In countries vulnerable to disasters such as Haiti, implementation of these tools means when disaster strikes next, the mechanisms to listen and act on peoples needs, already exist.

The following engagement and involvement is expected from stakeholders:  Trilogy: will support the technical selection and configuration for the development of TERA and the introduction of an IVR.  Digicel: will apply TERA to their network and house an IVR within the Digicel building that will be free for their customers to call.  Partner Red Cross Societies: will use the system to maximize outreach to the communities they are working with.  Beneficiaries: will determine the development and adaptation of the system via focus groups and through their interaction with the system.  NGO Community/Civil Society/Government: will contribute to messaging on key public information campaigns.

The addition of an IVR to TERA was a result of discussions with Trilogy senior management about ways to improve the *733 and use of TERA for more 2-way communication. IVR can be used in a wide range of activities from collecting country-wide information on health issues to keeping in touch with beneficiaries.

The crucial factor in the partnership between Trilogy and Red Cross is that the system was designed to support Red Cross programmes. It is part of a focused, collaborative partnership to pinpoint the right solution to meet the needs of Red Cross and people affected by natural disasters. TERA has been in use for 9 months and whilst effective and innovative, the limitations as noted above will be addressed through investment and development.

Trilogy has proposed two solutions to these limitations: development of TERA to increase functionality and capacity for 2-way communications, and the introduction of an IVR to expand reach and simplify the process. The next step is to hire a Development Manager to create an IVR proposal to meet Red Cross and beneficiaries needs and start the tender process of IVR companies. Initial

discussions with Digicel on a potential partnership will require immediate follow up by the Development Manager to double the reach of both TERA and the IVR.

Testing TERAs capacity for surveys began in July 2010 with development of an SMS assessment, aimed at establishing which residents in a camp owned their own land. Planned for 900 respondents it was a series of questions with multiple choice follow up. The questions were tested on HRC staff and volunteers to assess understanding and ease of use. The technology worked well, however the response was mixed. The system could only accept a reply to an SMS if it contained a pre-set key word. For example ‘’ or ‘no’. Attempts to reply which did not fit these strict criteria, such as “yes I do”, resulted in the sender receiving a message saying ‘incorrect keyword’. They were charged for the SMS and the information was lost. Eventually this survey was carried out face to face.

Trilogy responded to the key word limitation by further developing TERA to ensure a reply would be accepted as long as the key word appeared in the message. Local staff and volunteers have played an active role in testing the system by participating and providing feedback. They will continue to be a vital source of information and feedback, alongside dedicated focus groups, during the implementation of the IVR.

SECTION 3: CONTEXT ANALYSIS AND LITERATURE REVIEW “Get the communication right. Communication with the affected population is a first crucial step towards more inclusive humanitarian assistance”1 While this statement is true, establishing two-way communication between beneficiaries and aid agencies can be a challenging process as highlighted in the BBC World Service Trust report ‘Left in the Dark’2.

Mobile technology is helping to address some of these challenges by providing a cost-effective and simple means of reaching large numbers of people in a short space of time3. Haiti has the fastest growing market in the Caribbean, with 3.4million users (2010)4 and last year, Red Cross used TERA to send out 33.1 million SMS to approximately 1.2 million Haitians.

However SMS has its limitations. Messages can only be 140 characters. While this is a good thing for the 34.7% of adult Haitians with limited literacy5, it means other tools must be employed to ensure people have access to the information they need. To augment TERA Red Cross added a free recorded information line *733, which received 877,000 calls in 2010 from Haitians keen for more detailed information on hygiene, cholera, hurricane preparedness and shelter. While *733 tackles low literacy it is only one-way communication and while surveys can be conducted using TERA, they exclude those with low reading and

1 Inter agency real-time evaluation in Haiti, 3 months after the quake 2 BBC World Service Trust ‘Left in the Dark’ Imogen Wall, October 2008 3 Un foundation 4 Mobile figures 5 UNESCO Institute for Statistics (2010)

writing skills. A new solution is needed to provide people with the information they need in a format they can understand, that also gives them the opportunity to feed back their opinions and play an active role in decision-making. HRNCS wants to exploit Interactive Voice Response (IVR) technology to meet this need. IVR is well used in the west6 and there is a growing recognition of its benefit to humanitarian programmes in the developing world7 for several reasons. Using services such as an IVR overcomes low literacy8; mobile phones are by far the most widespread form of information and communication technologies (ICTs) in developing world; and telephone-based services have lower infrastructure and maintenance costs than PC-based solutions9.

While the studies above examine the use of IVR in health programmes in Africa, it is difficult to find examples of IVR as a means of fostering two-way communication. The use of IVR as a means of empowering people to genuinely influence decisions will be an innovative and new use of this technology.

Key recommendations from the ICT4Peace Foundation Report, “peace building in the information age”10 states that information and communications technology systems and responses must be kept simple, they should be developed locally or in cooperation with local communities and end users and, importantly, they should encourage the constructive engagement of the private sector. The development of the IVR for use in Haiti offers all of these things.

SECTION 4: TARGET BENEFICIARIES The innovation will allow Red Cross to engage with people Haiti-wide, or with specific recipients. Target groups could include the entire country for hurricane preparedness or be limited to a small group of shelter beneficiaries.

At $10 for a basic mobile phone and with SMS costing only 1HTG, owning a mobile phone in Haiti is affordable for most. Those without access to a cell phone can still access the IVR through one of the many street vendor ‘pay phones’. Red Cross will promote the IVR number through radio, posters, community liaison teams and SMS. The reach of TERA, particularly if Digicel join the partnership, means Red Cross will reach a broad cross-section of Haitian Society.

Through this wide-reach, TERA can also connect with the disenfranchised or those not comfortable interacting with aid agencies. Giving your opinion through an IVR is impersonal, non-threatening and anonymous and so removes many of the barriers that often stop people engaging or expressing their needs. This also allows Red Cross to address sensitive subjects such as gender-based violence.

Beneficiaries have been at the centre of TERA and development of the system is based on their response to campaigns. There is also evidence of a demand for

6 http://www.call-center-tech.com/emergency-management-ivr.htm 7 http://researchspace.csir.co.za/dspace/bitstream/10204/3882/1/Sharma_2009.pdf 8 http://www.cs.cmu.edu/~jsherwan/pubs/ictd09.pdf 9 http://researchspace.csir.co.za/dspace/bitstream/10204/4317/1/Sharma_2010.pdf 10 ICT4 Peace Foundation ‘Peace building in the information age’

practical useful information through the 877,000 calls to the *733 during 2010. Currently the *733 cannot cope with beneficiary demand for providing information so establishing a Red Cross IVR is the best solution to address this issue.

Importantly, the evolution of the HRCS/IFRC beneficiary communications is based on experience. A hygiene kit 5-question survey, undertaken in February 2010, was tested multiple times on groups of local staff and volunteers before being widely sent out. This highlighted issues including low literacy, unfamiliarity with replying to SMS messages and a lack of understanding of questions. What seemed a simple set of questions and responses was not a straight forward process for Haitians. The survey was adapted multiple times until a fresh group could navigate all five questions with relatively few issues. Despite this, and with the incentive of 10HTG phone credit for participation, only 75 of 2200 recipients completed the survey. When researching the issue with Trilogy, it emerged that a survey by phone call would be simpler and better suited to Haitian mobile use.

TERA and the IVR will be used to support a wide-range of humanitarian interventions, specifically around providing information and asking for feedback.

Shelter: The SMS and IVR will be used to promote shelter solutions to people living under tarpaulins in Internally Displaced Persons (IDP) camps. As of April 2011, more than 700,000 remain displaced in Haiti. In camps where the Red Cross is working on shelter an SMS will be sent to residents asking if they would like to move into permanent shelter. They will then be directed to the IVR to hear the options available and complete a short survey. All those who register interest in a particular option will be contacted by the community mobilization team.

The IVR can also play a key role in community development. As the Red Cross focus moves from camps to communities, the IVR will provide a valuable source of information for neighbourhoods and an efficient way of obtaining feedback. For example, what is most important to improve your neighbourhood? This will enable better assessment of all the services needed for a community to thrive and will involve residents as active participants in their neighbourhood renewal. Such technology will complement but not replace traditional community mobilization methods; the innovations offered by this grant will allow Red Cross and others to increase the scope, scale and reach of their recovery efforts.

Health: In the run up to World First Aid Day in September first aid tips will be sent country-wide by SMS. The last message will direct people to the IVR where they can hear a more detailed description of how to deal with particular injuries. People will be asked to take part in a short survey to measure knowledge across the country and can be connected through to a local Red Cross office if they are interested in taking part in a first aid course.

Water and sanitation: The Red Cross emergency water trucking programme will end this year and the IVR will be a key tool in getting feedback from camps on their preferences for alternative solutions. As water and sanitation services are rehabilitated in surrounding communities and camp services ended, camp residents would be informed of where to get these new services. An option for

callers to be connected through to the Red Cross manned questions and complaints line would also be made available.

Livelihoods: The IVR will play a key role in monitoring how beneficiaries use livelihoods grants and what additional support they need. After receiving a grant a beneficiary will be asked by SMS to call the IVR to answer questions. The information gathered will be used to decide on the next steps of the project.

Disaster preparedness and response: SMS will be sent before and after storms and hurricanes to warn people of the danger and how to prepare and respond. The SMS will direct people to the IVR for more detailed information and if available, specific details on safe areas and health centres. After a storm, affected communities could be encouraged to feed back via a survey on the IVR.

SECTION 5: PROJECT DESCRIPTION This project will combine the success of TERA with the two-way information- sharing capacity of IVR to create one innovative solution that not only broadcasts life-saving practical information, but also gives Haitians an easy way to get their voice heard to become real partners in the recovery process.

The project objectives are to build on the success of TERA by: 1. Establishing an independent, neutral and low cost Interactive Voice Response (IVR) hub in Haiti. 2. Increasing beneficiary feedback to Red Cross through a communications modality that is better suited to Haitian mobile phone culture. 3. Creating a system that can be used globally.

Upgrade TERA System: Following nine months of TERA use since July 2010, IFRC will provide Trilogy with the requirements to upgrade the system, based on analysis of responses/uptake of information and key stakeholder feedback from programme managers and beneficiaries.

Recruit supporting staff: IFRC will recruit a Development Manager to lead the set up of the IVR for 3 months. The Development Manager will recruit a local Project Manager. In collaboration with HRC, the Project Manager will be responsible for the daily running and ongoing development of the project and ensuring institutional knowledge and sustainability of TERA and the IVR.

Confirm Digicel involvement: HRC and IFRC have held discussions with Digicel to discuss potential partnership. A decision is expected by the end of May 2011. Once confirmed, Digicel will begin the process of incorporating TERA onto the Digicel system. This will take between 4-6 weeks. The combined partnership of Trilogy and Digicel will substantially expand the reach of the system, tripling the number of people reached and increasing beneficiary feedback to Red Cross. If the Digicel partnership doesn’t go forward at this time, the currently partnership with Voila will still give HRCS significant reach.

Develop IVR Proposal: The Project Manager will work with programme managers (health, shelter, livelihoods, water and sanitation, disaster preparedness and relief) to identify the information their beneficiaries need and the information programmes require. The Development Manager will create an IVR proposal to determine the software required to bridge this information gap based on focus group results.

Appoint IVR Company: HRC and IFRC will begin a tender process for the IVR contract, with Trilogy advising on the technical selection and configuration best suited to increasing beneficiary feedback and engagement with the IVR.

Gather Information: Based on the information gaps identified, the Project Manager, with HRC, will decide upon the menu of recorded information needed for the IVR. A series of overarching themes and issues will be further broken down into specific information sections. The Project Manager will gather the information needed, in Creole, and record for upload to the IVR.

Confirm SMS/IVR Campaign Timeline: Working with each of the programmes, the Project Manager will create a timeline of campaigns and gather referral information from external organisations as necessary. Referral information will be used to direct callers to onward services such as helplines or health clinics.

Data Analysis: The Project Manager will recruit a data analyst to advise on survey structure, monitor data and analyse survey results to ensure the IVR’s two-way capacity is being maximized.

Testing: The Project Manager will work with Digicel to test the TERA system on the Digicel network. The IVR will be tested with beneficiaries to review responses to the recorded information line and a short voice survey. This information will be used to fine tune the final version of the IVR.

Training: Training sessions will be organised by the Project Manager so Red Cross staff understand how to use the system to its full potential.

Launch IVR: One SMS and IVR campaign, linked to Digicel and Voila customers, will launch the system. This will be followed by the roll out of planned campaigns. The Project Manager will also develop a promotional plan, utilising other beneficiary communications tools such as the weekly radio show, posters and SMS to ensure feedback and involvement with the system is maximised.

Review: The Project Manager will secure the services of an internal evaluator to review the impact of the IVR and document learning and recommendations for improvement in relation to increasing beneficiary involvement.

Outreach and Dissemination: HRC and IFRC will carry out internal and external dissemination on impact from the initiative to share learning globally. Key stakeholders will include Red Cross Movement partners, international humanitarian organisations and media development agencies.

End Evaluation: The Project Manager will appoint an evaluation specialist to carry out a final evaluation. This will support the dissemination of the project and provide a model for global roll out.

The establishment of an IVR will have the following impact:

Increased two-way communication: The IVR will conduct automated voice surveys, giving beneficiaries the chance to influence Red Cross decision making. SMS will be sent encouraging people to call the free Red Cross line and answer questions by pressing numbers on their phone. This bypasses literacy issues and is easier than SMS surveys.

Reaching more people: As the IVR will be managed by Red Cross it will be commercially neutral and opened up to all networks, including Digicel who has around 70 percent of the market. Red Cross will also aim to expand TERA to Digicel allowing many more Haitians to receive life-saving information.

Faster dissemination of life-saving information: The current Red Cross information line, managed by a Voila subsidiary, can take 2-3 weeks to upload information, depending on other commercial demands. A Red Cross managed IVR will mean information can be uploaded immediately and advertised by SMS that day. Additionally the system allows for direct connection to other services.

Provide more specialised information from different organisations: Once the IVR is in place Red Cross can offer an information service to other humanitarian organisations, such as Handicap International, to deliver important messaging to vulnerable communities.

In-depth information and analysis: The advanced technology of an IVR means that in-depth information can be retrieved from the system allowing Red Cross to analyse data quickly. For example, how many people ask to be patched through to a clinic or how many know the location of their nearest hurricane shelter.

The development of TERA SMS system will have the following impact:

Better 2-way communication: TERA will be developed to allow for three different reply options to be set before an SMS is issued. For example, no reply for information only messages, keyword reply for simple surveys of large numbers of people, and an open reply response for collecting richer data from smaller numbers of people.

Faster response to emergencies: A new emergency response function will be built into TERA to allow fast grouping of mobile cell towers. For example if high tides are expected along the coast, every cell tower within 2km of the coast could be grouped and SMS despatched quickly.

Easier to use: Additional development will increase system functionality, making it easier to navigate based on the experiences of users.

The IVR will have a positive impact on the humanitarian sector, both in Haiti and globally. Through the Red Cross, civil society, NGOs and the Government of Haiti will be able to get critical information to those who need it most. In turn, Red Cross will share important information collected through the IVR with other agencies, helping to improve their approach and the content of their programs e.g. level of awareness of HIV transmission can help inform mass media campaigns.

Focus groups will be held with beneficiaries at two key stages of the IVR development. Once launched the IVR itself can be used to monitor beneficiary involvement. For example, monitoring response rates to surveys or asking callers to rate the usefulness of information they received. Beneficiary interaction and feedback will affect how the IVR is used and developed on a regular basis.

Trilogy will use their expertise to help Red Cross design the most effective IVR for the Haitian telecommunications market.

As with all Red Cross National Societies, HRC is an auxiliary to the government. The Red Cross approves all health and disaster preparedness public messages with relevant national departments such as the Ministry of Health or the Department for Civil Protection. The establishment of a Red Cross IVR will allow HRC to provide a key public information service for the Haiti Government in times of crisis. For example, in the event of a hurricane the IVR could be the public information service for lists of hurricane centres.

Red Cross has completed a successful four-month pilot with Haitian software company, Solutions. Through their crowd-sourcing website Noula and local call centre, Solutions addresses questions and complaints on behalf of the Red Cross shelter project. The Shelter team then follows up issues Solutions staff cannot resolve. A key onward referral will link the IVR to the Noula service, where beneficiaries can ask direct questions on issues they need investigated.

Red Cross operational teams recognise the importance of communicating with beneficiaries. The difficulty is often how to practically manage this in a time- efficient manner. TERA and IVR will address this gap by providing Haitians with an affordable and easy means of voicing their needs. Additionally, traditional community mobilization methods sometimes only give a voice to the most outspoken and those with power. This initiative will increase equity among beneficiaries by giving the hard to reach a chance to be heard.

Red Cross is an active member of the Accountability Learning and Working Group and the Communicating with Disaster Affected Communities (CDAC) network. These forums share information between organisations and facilitate collaborative working to ensure projects complement one another. Additionally by working closely with Haiti’s two major telecommunications providers, Red Cross can ensure no similar initiatives are being established simultaneously.