How Bangladesh repurposed tools to tackle Covid-19

By Shirley Tay

Anir Chowdhury, the Bangladesh government’s advisor on digital innovation, discusses how its national hotline was used for telemedicine and self-reporting.

When the pandemic first hit Bangladesh - a country of 163 million people - it only had one lab with the necessary tools to process Covid-19 test samples.

“You can imagine the difficulty we faced,” says Anir Chowdhury, Policy Advisor to the Bangladesh government’s flagship digital transformation program, Aspire to Innovate (a2i). “We needed to know where the disease was moving and where it was progressing the fastest.”

The a2i team transformed Bangladesh’s national 333 hotline into a Covid-19 line to enable people without smart phones - two-thirds of the population - to self-report symptoms. GovInsider caught up with Chowdhury to find out how these innovations have helped the country tackle the pandemic.

Pooling doctors for telemedicine

The hotline was launched in 2018, and has been used by citizens to find out about public services, or provide notices of social problems like child marriage and sexual harassment.

When it was repurposed to allow citizens to self-report any Covid-19 symptoms, the data generated was in the hands of Bangladesh’s four telcos.

The a2i team had to quickly set the right frameworks for data sharing and anonymisation. “We did not have the time to develop long legal documents and take months, we needed to do it right away,” Chowdhury says.

Their weapon of choice? WhatsApp. “We were making major policy decisions over WhatsApp, without even having physical meetings.”

The a2i team then built a machine learning system to track disease progression seven to ten days ahead of lab testing. That gave Bangladesh “a lot of leeway to prioritise interventions” such as additional doctors and ICU units.

The hotline was also repurposed into Bangladesh’s largest telemedicine service, he says. Over 4000 doctors logged onto the system to provide round the clock teleconsultations on a voluntary basis. The service was initially only for Covid patients, but has expanded to include women’s health and noncommunicable diseases.

Repurposing the hotline was a “big challenge in terms of accessing data, computation, and capacity,” Chowdhury says. “But because the telcos came forward with open arms, saying they will do the computation and anonymisation of data, that’s how it was done.”

His team is now working to “legitimise the work” that was done and draft a law for data privacy.
Image by a2i

Many silos melted away during Covid-19 and everyone contributed to fight a “shared enemy”. Collaborations within the government started happening quickly “because we did not have to figure out who would sit at the head of the table, and who’s the more senior minister.”

Chowdhury shares his hope for such collaborations and agility to continue after the pandemic. “Some of the gains that we’ve had in terms of collaboration is dissipating. I hope that we will go back and sustain many of them.”

Going digital with justice and education

a2i had also been trying to digitalise Bangladesh’s judiciary for the past few years, but it was a “difficult process”.

The pandemic made this an urgent issue. During Covid-19, a lot of bail petitions could not be filed, and prisons were overcrowding. “It was a very dangerous situation because prisons are the last place you want an outbreak of the disease.”

Within 12 days, the a2i team put together a virtual court system that allowed tens of thousands of bail petitions to be filed and cleared, he says. That created the appetite for digitalisation in the Supreme Court, and the team is working to digitise legal services to reach remote populations.

Bangladesh also had “a potential education disaster in our hands”. Schools had been closed since mid-March last year, and the government was concerned that students won’t be able to remember what they learnt a year ago.

The country put a lot of educational content on the internet, but not all students had access. a2i repurposed a TV channel used for parliamentary sittings to broadcast hours of lectures.

Even so, it only reached 55 to 60 per cent of students, and the lectures lacked interactivity. “I am quite worried, when schools open, what is the situation we’ll have to handle,” Chowdhury shares.

This experience has underscored the need for Bangladesh’s education system to digitalise and incorporate blended learning. “We’re discussing that with the two ministries of education right now to explore exactly what education would look like, but it will definitely not look like what it did in 2019.”

Covid-19 vaccines: leaving no one behind

Image by Mohammad Tauheed – CC BY-NC 2.0

Bangladesh began its Covid-19 vaccine rollout on Feb 7, and aims to inoculate 3.5 million people in the first month.

To reach rural populations, the country plans to tap on its network of NGO and government health workers. They have been going door-to-door for the country’s child immunisation programme, and “know almost all households in the rural area”.

“The problem is with urban slum areas, where we don’t have as much coverage by the health workers,” Chowdhury says.

Bangladesh saw a slow uptake of registrations at the start, but “the number of people registering per day has increased manifold” after extensive campaigning and visits by health workers.

The government does not want to leave anyone behind, he adds, and will work particularly closely with NGOs to vaccinate the Rohingya refugees in Cox’s Bazar, a Bangladeshi district home to many refugee camps.

The Ministry of Health, Department of ICT and a2i are building a smart system to track the side effects of Covid-19 vaccines. Citizens are required to wait at the vaccine center for half an hour after receiving the vaccination. But if any symptoms appear after they’re home, citizens can phone the national 333 hotline to report them. Doctors will then log these effects against the vaccine batches.

The a2i team also plans to build smart vaccination certificates, he says. Bangladesh is currently using paper certificates with QR codes for border control and travel – but is awaiting WHO guidelines for an electronic version.

Creating a digital social safety net for the newly poor

Bangladesh started digitising its social safety net payments in 2017, and that has paid off tremendously during the pandemic. a2i had also worked with the Bangladesh Bank at the end of 2019 to develop eKYC – a digital procedure to verify a user’s identity.

When the government added 5 million new families into the social safety net during Covid-19, the government of Bangladesh could create millions of digital mobile wallets and distribute welfare payments securely “in a matter of weeks”.

That has also helped millions of garment workers receive subsidies from the government after factories shut down, he says.
Image by a2i

The a2i team is looking to study citizens’ phone usage to determine real-time poverty rankings. UC Berkeley professor Joshua Blumenstock carried out a similar study in Togo. He developed an algorithm that crunches data, like call duration, to come up with a relative poverty ranking.

That would help Bangladesh “tremendously”, as it spends about 14 per cent of its budget on safety net programmes, Chowdhury says. “We have a lot of inclusion and exclusion errors, and targeting is done through surveys which are expensive and time-consuming.” Such an algorithm would reduce the errors and prevent people from falling through the cracks.

The road to 2041

“When the concept of Digital Bangladesh was declared by our Hon’ble Prime Minister Sheikh Hasina at the end of 2008, we had nothing. Technology was considered a luxury when we were struggling with poverty, food security, illiteracy and power scarcity,” Chowdhury says. 12 years later, the country’s GDP per capita has tripled to about US$1,855.

The next big milestone for the a2i team is 2041, Bangladesh’s 70th birthday.

Chowdhury says, “We aspire to become a developed nation by then. This will require Bangladesh to use technology in novel ways, by leveraging the citizen-centred innovations we are institutionalizing in our public and private organizations.”

“The next 20 years will be very, very different. And we’re trying to figure out together what that difference really means.”