As the second wave of COVID-19 pandemic hit Nepal, the number of confirmed cases rose exponentially. The transmission of the virus was faster as compared to the first wave which resulted in a shortage of essentials like Oxygen cylinders, ICU, ventilators, ambulances, and more. These shortages, limited infrastructure, and a lack of a standard technical framework to follow up and track the infected patient’s health status resulted in slower response and delays in curbing the spread of this second wave of infections.

In Tulsipur, authorities reported a severe lack of ability to take stock of the health status of individuals who have tested positive. As such the health system and the municipality were unable to provide timely services to people in need. In response, D4D Nepal proposed to develop the information system to trace the patients who tested positive and are currently in home isolation and provide sub-metropolitan cities with technical and human resource support. Open Knowledge Nepal was selected for the implementation.

The work officially started on 6th Jestha, 2078 with the mobilization of 10 volunteers in 5 groups after identifying the number of patients in each of 19 wards. The volunteers not only inquired about the health conditions of the patients but also about their needs for food, medicine, and counseling. All these issues were addressed with the coordination of local health officials, psychosocial counseling groups, donor agencies, and individuals from society. The Tole Level Organization (TLO) also got involved in the operation to provide information about infections and testing in their community. We penetrated up to the smallest part of society to gain information about infected patients and address their problems with the help of the Tulsipur Sub Metropolitan City and its subordinate bodies.

Based on the traced data and information, the team monitored the situation and identified the cases where emergency actions were required, and reported the municipal COVID response team with the recommended actions on a timely basis. In total, 8178 phone calls were made and on average each patient got 5 to 6 follow-up calls until their recovery. The team identified 33 patients in need of oxygen, 5 in need of an ambulance, 59 in need of health facilities, 161 in need of medical counseling, and 81 in need of food. The timely identification, reporting, and response made the public feel like the Tulsipur Youth COVID Response team was with them at the time of the global crisis.

Project Activities

The project conceptualization phase finalized the project structure, teams, and communication channels that were required for implementation. The expected outcome was described as the four main deliverables of the project as:

• Development of Information System: The information system was developed to trace home isolated COVID patients. This information system was developed using easy, accessible tools like Google Sheets and Drive for data storage, retrieval, and update. Volunteers were mobilized to collect and store data in the sheets, they used phone calls to collect data on patients. The sheets were designed to collect data on the fields that can be used for the identification of emergency cases needing immediate actions as well as for future records. The creation of the fields in the sheets like the condition of mild or critical patients can help identify the case which may need immediate actions like ambulance service, oxygen services. Furthermore, the collected data can be subjected to analysis to help make effective responses.
• Mobilization and training of the volunteers: Mobilization and training of volunteers are yet another main aspects of the project. Enthusiastic individuals from Tulsipur worked for the projects whose role was to make follow-up calls to the patients, provide them with counseling, information and collect the status of the patients. This meant that the volunteers had to be adept in the technical skills of data collection, communication skills as well known and informed about the health counseling and information they had to provide the patients. The training and mobilization of the volunteers were done on those matters that helped in smooth operation and teamwork.
• Daily analysis of the collected datasets: The collected data were analyzed with the main objective of providing immediate actions to the identified requirements like ambulance service, health counseling, oxygen supplies, health facilities, and foods. Besides, the collected data are used to generate insights on the condition of the Tulsipur COVID cases trends and scenarios and the responses’ effectiveness. Daily insights are generated from the collection which are total cases of positives, recovery, and deaths.
• Coordination with COVID response team of Tulsipur: The knowledge acquired from the collected data is used to coordinate the actions with COVID response teams. These response teams were responsible to manage resources for the affected patients. When the cases requiring needs of oxygen, health facility, foods, and counseling are identified daily the immediate actions can be performed of allocating the resources more effectively. Furthermore, a more comprehensive analysis of the COVID data can help coordinate teams to decide on more strategic actions to efficiently control the COVID situation.

Project Timeline

The project began with the planned project timeline that divided the project in three phases: Project Conceptualization, Project Implementation, and Project Reporting & Presentation. Overview of the project timeline can be understood with the project timeline image:

• Project conceptualization: The initial phase of the project started after the identification of the need for an information system for COVID tracking and follow-up. After the assessment, an information system model was designed quickly using pre-existing knowledge and easy-to-use technologies. The solution was created using a volunteer-based paradigm of manual data gathering and entry into the information system. Other tasks included examining existing databases, identifying volunteers, establishing the team, identifying emergency responses, and sketching out the implementation strategy.

• Project implementation: This phase of the project deals with the actual realization of the information system using tools like google spreadsheets. These tools were selected for their universal accessibility, quicker learning curve, and also keeping in mind the criticality of time. Furthermore, volunteers were selected, trained, and mobilized to identify patients, reach out, follow up, collect and enter the data onto the system. Since the project worked at a rapid cycle, the nuances and details of implementation were optimized as the project went on by addressing the issues that arose along with the integration of learnings. After the data was collected by the volunteers, it was analyzed to identify the patients in need of emergency support and response. Different thresholds and parameters were set before assisting the process of identifying critical patients.  These activities of identity, reach out, collect, analyze and respond were performed daily. Finally, information about the identified patients in need of immediate help was reported to the COVID response team of the Tulsipur Sub Metropolitan City Office.
• Reporting and presentation: The final phase of the project involved creating a report of the entire operation. The report outlines the activities performed, challenges, lessons learned, and suggestions on dealing with a similar crisis in the future. A presentation was also given to report on the entire project to the concerned authorities depicting the role of youths on COVID response in Tulsipur.

What Went Well

During the period of project implementation, some notable areas where our project went well are project implementation, team coordination, and effective responses.

• Smooth project implementation: The project implementation phase went smoothly. The implementation phase included the development and use of information systems for the data collection and updates. Based on the acquired data, emergency actions were identified which required quick responses. The use of simple tools like Google Sheets, Viber, and Zoom helped in smooth adaptations for the volunteers and stakeholders so that the operations were efficient and fast. Along with this, the cooperative behavior of the infected people helped in the project’s smooth operation.
• Proactive team coordination: All team members acted responsibly and helped in effective collaboration within groups to help/reach a maximum number of people. The team members had their roles to achieve the common goal of providing effective responses to the infected people. Volunteers were responsible for data collection required for the assessment of the situation and program coordinators were responsible to take action based on the assessment. The establishment of effective communication channels and discussions helped in proactive team coordination during the project implementation period. Frequent discussion sessions were carried out to share experiences and suggestions on how to solve upcoming problems.

• Effective responses to emergency cases: Out of 86 identified emergency cases; almost all of the cases were reached out with needed responses. This signifies the completion of the intended response from the project. One of the main objectives of the project was to work on a system to identify and address the needs of emergency cases.

What Went Wrong

• Little late start of the project: Based on the patients’ feedback they were satisfied with the service and response they were receiving. The feedback was positive for results like the counseling for the patients in matters of psychological or information support, responses to the critical requirements like oxygen, healthcare, and ambulance services. Along with such positive responses they suggested that it would have been better if they got these services from the beginning of the crisis. Thus, the late start time of the project was identified to have caused some inconveniences.
• Quick response and information flow: Many volunteers received complaints from the patients regarding the response to the emergency actions. According to the complaints, the immediate actions required by the patients though were identified, the response/actions to these issues were lacking promptness resulting in inconvenience to the affected. Also, it would have been easier to disseminate information to the community if the volunteers had been given information regarding the notice of vaccines, testing, available from health facilities, etc.

Follow Up Actions

• Data standardization: Data standardization is very important, as with the time new data is accumulated, and maintaining a standard data format aids in collaborative research, large-scale data analytics. With these things in mind for the follow-up actions, Tulsipur Sub Metropolitan City can maintain various datasets in a proper management system or data portal so that data can be easily accessed and used for all kinds of data-driven decision-making or response.
• In-depth sensitization/training: Sensitization or training ensures that the involved team understands the goal, value, and work ethics. In our project, a basic training session was conducted to sensitize the team regarding how to update the data at the system, maintain data quality, and how to deal with people during the phone call. The team did the best but the in-depth training would have been more effective and efficient if they were trained regarding data analysis, data collection, and more.

Acknowledgment

We would like to express our gratitude to Mr. Ghanshyam Pandey, Mayor of Tulsipur Sub Metropolitan City, and the Municipal COVID response team for their coordination support. We would also like to acknowledge the generous support provided by the Data For Development (D4D) Nepal team in the conceptualization, coordination, and implementation of the project.

In addition, we thank our partner organizations Green Foundation Nepal – Dang Chapter and National Youth Council for their help in team mobilization. The young enthusiastic team who worked in the field for the data collection are; Suresh Rawot, Deepak Kafle, Jhaggu Bhandari, Oda Bahadur Bhandari, Asmita Bhandari, Khum Prasad Bhandari, Himal Oli, Madan Bhushal, Ganga Kandel, and Tez Raj Oli.

This project is supported by the Data for Development Programme phase II, implemented by the Asia Foundation in partnership with Development Initiatives, with funding from the UK Department for International Development to strengthen data and information ecosystems at the provincial and local spheres in Nepal.