How the Bangladesh government is repurposing assets for COVID-19

The Innovation Dividend explores how innovation in society and government are paying off. Over the coming weeks, we’ll be exploring how ‘policy frontliners’ are innovating in real time in the COVID-19 pandemic and asking which of these changes and “raw learnings” might become part of our new normal. You can see the backstory here.

In this episode, we interview Anir Chowdhury, policy advisor with UNDP and the Government of Bangladesh and Member of the Prime Minister’s National Digital Task Force, about the work that is happening to serve millions of people in Bangladesh in the first weeks of the COVID-19 outbreak. This interview was recorded on April 10, 2020.

Transcript

Anir Chowdhury: [00:00:00] Our livelihood is suffering and we’ve been looking at what this life versus livelihood equation really means in the context of developed countries. If you look at maybe poorer countries, developing countries, let’s say, India or Bangladesh, or Cambodia. How long can we continue the lockdown to save lives? Does the livelihood equation become another factor in actually causing deaths?

[00:00:27] Kal Joffres: Hi and welcome to the Innovation Dividend, the podcast that explores how innovation in society and government are paying off.

[00:00:36] I’m your host Kal Joffres and over the next few weeks, we’ll be exploring how the COVID-19 epidemic is unleashing some interesting and unexpected sources of innovation across Asia.

[00:00:46] Welcome. Today on the show we have with us Anir Chowdhury.

[00:00:50] He’s been, for the last 13 years, leading the formation of an innovation ecosystem in Bangladesh through massive capacity building, policy formulation, institutional reform, and a Service Innovation Fund. He’s also a member of the Prime Minister’s National Digital Task Force, and we’re speaking with him today because he’s been deeply involved in the COVID-19 response in Bangladesh. Anir, welcome!

[00:01:13] Anir Chowdhury: Thank you very much, Kal.

[00:01:14] Kal Joffres: Anir, could you tell us a little bit about your involvement with the COVID-19 response in Bangladesh and why did this opportunity come about?

[00:01:21] Anir Chowdhury: Well, about three and a half weeks ago when we we had our first death, I got a call from the Health Department — our Director General of Health Services — that the situation may look grim in future, and it was at the very beginning of COVID-19 infection Bangladesh.

[00:01:42] But the DG felt that the situation may look grim and there may be help, that the innovation ecosystem that we’ve been putting together for the last 13 years might be able to help: do contact tracing, to develop technologies for COVID-19 response, and we need to start preparing for that. So that’s sort of the beginning of that effort.

Bringing telcos together for public health

[00:02:05] The first thing we did was to get all the four mobile phone companies, the telcos, together to see how we could start with the immigration database and start tracing where these almost 500,000 people who came between the middle of February to middle of March into the country where they happen to move to different locations.

[00:02:33] So that was the beginning of the effort. And we realized very quickly, working with epidemiologists that they did not get proper, in many cases, they did not get the proper checking at the border entries, land ports, and airports so tracing them across the entire country might be a difficult thing.

[00:02:57] 20% of them had phone numbers that actually worked. The rest of them had phone number that we’re not Bangladeshi numbers. So we could not trace them. Some did not even register phone numbers. So it was very difficult to us. Then we started setting up an IVR system for self-reporting and started — massively promoting the concept of self reporting, even though the infection was that it’s very early stage, we were getting a lot of calls into the into the IBS system.

[00:03:29] Subsequently, we also set up a USSD technology because 60% of the population still carry feature phones and not smartphones, so the apps and web access would not be meaningful for them. So with the combination of IVR and USSD, both of which had a triage function.

[00:03:48] So essentially asking them specific questions about symptoms, about their travel history so that we could do some determination of the severity of their condition.

[00:04:00] So that sort of started the whole process in the last two and a half weeks since we’ve been doing this. We have about 2.2 million calls and USSD requests that have come in.

Multi-stakeholder coordination

[00:04:11] So that’s how we have been getting the telcos together the some of the security agencies because we wanted to ensure that data is anonymised and all this analysis is done in a secure environment so that there is no leak at all. And then the communication apparatus to promote the concept of self-reporting.

[00:04:33] So a multi-stakeholder communication team has been put together with the UN, with the private sector, large corporations, who have extreme reach into the rural areas, such as the FMCG companies, pharmaceuticals.

[00:04:49]We got the media involved, social media promoters. So that whole thing started, then we realized that there were a lot of calls, which came into the IVR actually needed medical advice, and we involved about 15 or so telemedicine companies. But the combined work for these telemedicine companies was not enough to handle all these calls that were coming in.

[00:05:15] So we then very quickly, almost overnight, developed an Uber Pool-like system with doctors who are available would just sign into the system at any given time of the day. So we certified about — again through e-learning — about 15,000 doctors and nurses and medical interns into the system. At any given time, there are few hundred doctors to take these calls.

[00:05:40] So in the morning at 4am you will still have maybe 100 doctors manning calls , from cold calls coming in from all over the country. So that’s sort of how things started in progress so far on the medical side of things.

Governance during a pandemic

[00:05:53] Kal Joffres: It sounds like you’re really working shoulder to shoulder with the government. Can you tell us a little bit about how you’re working with the government, what kinds of maybe teams you’re working or as a part of?

[00:06:05] Anir Chowdhury:Sure . This program, a2i, it ran in the Prime Minister’s Office for about 11 years, and the last couple of years, it’s been part of the ICT Ministry. And very recently, also the Cabinet Division, which is the “super ministry” within the government that has oversight function for all administration, including field administration. So the a2i program is really a program of the government supported by UNDP from the very beginning of its existence.

[00:06:33] And since it’s so embedded at the heart of the government — Prime Minister’s Office, Cabinet Division, and the ICT Ministry — it looks at the entire response from a governance angle. And technology is a tool to solve health governance and the overall governance of the country, so it’s — it’s embedded, as I said, at the heart of the government. So getting access to anybody within the government is a natural process.

[00:07:02] And also having help from the private sector, from the NGOs, from the media, from academia is something that we have established as part of our day-to-day function for many years now.

Enabling innovation through coordination

[00:07:14] Kal Joffres: It sounds like as part of the response, there are many things that are possible today that you know maybe would have been much harder a few months ago, possibly even impossible. Could you tell us about what are some of the things that you see are actually becoming possible as a result of all of this, especially in government?

[00:07:34] Anir Chowdhury: Governments in general, especially in developing countries work by rules. So rules are established to govern, to control — and the rules are established to audit. So that’s how governments function.

[00:07:48] Typically, it’s very difficult to have innovations take roots. Although there are many innovations within government that take place but innovation that take roots and become scalable or scaled up is a difficult thing. But what has happened here is that we are working primarily outside of these set of rules. So procurement is almost non-existent at the moment. In the last three and a half weeks or so since we’re doing this. There are a lot of private sector companies that have been developing apps and web-based technologies and data analysis engines.

[00:08:29] These companies have come together very spontaneously. There is no procurement, there is no money being discussed by now, although at one point, I’m sure that we would have to figure out how to procure the service of these companies. But so that the standard rules of procurements did not apply in the last three weeks. And that has greatly facilitated and accelerated the work. If we had to follow regular procurement rules, we would be waiting for about three to six months, till any of this work would be done.

Rapid transformation of people coming together

[00:09:02] Kal Joffres: What other kinds of innovations are you encountering as you’re doing this? Are you seeing maybe teams organized in new ways or innovations not just in the, what that’s happening, but also how people are getting things done?

[00:09:14] Anir Chowdhury: Sure. In terms of getting people, or coming together, I think I’ll give you two examples. One is there are pockets of poverty that are emerging in the vulnerable groups and also groups that dependent on a daily income. So rickshaw coolers, construction workers, street hawkers who sell vegetables and other necessities, because of the social distancing that’s happening. Obviously, they don’t have work. They don’t have the income that they depended on on a day-to-day basis.

[00:09:51] So pockets of poverty are emerging in those areas. And a lot of people could not sustain themselves in the capital city in Dhaka where large migration happens because of the availability of livelihood opportunities in Dhaka, as opposed to other parts of the country.

[00:10:09] So they need food. They need essentials. They need relief items on a daily basis or a weekly basis. And the government has been proactive in terms of mobilizing its own internal resources, meager in many cases. But it has still done that, but the community has come forward. So there are thousands of voluntary groups across the entire country which are mobilizing local resources from wealthy individuals, from communities, and we’re tracking all this activity or coordinating a lot of this activity through social media, through Facebook, and through WhatsApp.

[00:10:49] So that’s sort of a natural thing that has emerged in an unprecedented accelerated fashion and these existed before. So we saw blood drives, we saw relief work being done during the times of flood. But this is such a massive scale right now.

[00:11:07] And this is such a rapid transformation that’s happening across the country that many people need to come together, and electronic forms of communication, social media, really is the only way to communicate with each other to find where the needs are. So to address many calls from these far flung areas where pockets of poverty are emerging. We repurposed our national helpline, Triple Three, which we repurposed for medical calls first connected to the Uber Doctor Pool that I mentioned, but we repurposed it again four or five days ago to get calls from the underserved far-flung areas where people were not able to communicate directly.

[00:11:56] So they would call into this number, and we have a set of operators who then forward these calls by taking the information to the local authorities in those areas and then food and relief arrived. So it’s a combination of social media, communication from different communities, crowdsourcing of information, and a national helpline that is working in tandem to address many of these local needs. So that’s one community development that’s happening.

Education system adapting to the pandemic

[00:12:26] The second one that I’m seeing emerged again almost overnight is the transformation in our education system. So the schools and colleges were closed for quite a while. I think over a month now because of the fear of transmission of this infection in the education institutions are among the young people.

[00:12:48] So all these young people are sitting at home right now, and not able to access education. So we have a Parliament TV that is primarily used for Parliament broadcasts. So this happens every few months, for a few days and few hours every day, and it largely sits idle for the rest of the time. So we have been talking about whether we could repurpose this as an education TV platform and the honorable Prime Minister has endorsed this five, six years ago. But we were not able to mobilize this for various reasons.

[00:13:25] Almost overnight, we saw Parliament TV being repurposed as an education TV and we’re working with the two Ministries of Education — the primary education and the secondary education and then just a few days ago, that the Technical and Vocational Education Department also joined in. So now we have TV broadcasts on primary, secondary, and vocational education happening many hours a day from morning to night every day. So this was another example of what happened, where content producers, television producers, teachers, teacher trainers came together in a spontaneous fashion and we facilitated the process because we’ve been working with the education ecosystem for over 10 years now.

[00:14:14] It was kind of natural for us to get all these different people together to produce content broadcasted, develop a web-based system where which would do quizzes and assessments, and the students in their homes are now having a semblance of education. They’re not going to classrooms, but they are being, they are actually in classrooms through TV, and the internet, and through phones. So that’s a very interesting, I would say, aggregation of technology that we put together along with human beings to continue the education process in the country.

Ensuring an inclusive digital COVID-19 response

[00:14:52] Kal Joffres: And in the context of Bangladesh, what else do you think needs to be done to ensure that the most marginalized aren’t excluded in the COVID-19 response?

[00:15:01] Anir Chowdhury: One important thing is subsidies, basically because it’s a poor country still. We are still below $2,000 dollars per capita income. We have grown rapidly in the last 10, 11 years — almost tripled our per capita income — but still we are under $2,000 a day, which basically means there are a lot of pockets of poverty that still exists. 10% of the people are considered what we call hardcore poor.

[00:15:30] Just over 20% are considered poor, and because of lack of income on a daily basis and potentially going to be weeks and months, potentially, there’ll be many, many people who were poor will be pushed into the hardcore poor category. Who were lower middle class will push into the lower class or poor category. So they need help and they need help in the form of financial subsidy, and also in- kind subsidy.

[00:16:05] So let me talk about the in-kind subsidy first. I’ve already mentioned that communities, volunteers are mobilizing themselves across the country communicating through digital means, and trying to get food and necessary items to these underserved and the poor communities.

[00:16:25] Let me also then talk about the financial stability that is necessary. So obviously, cash will not be an option. It’s slow, it’s unsafe during COVID. It’s also prone to leakage. Half of the cash may disappear on the way, or at least a fraction, a large fraction of it may disappear on the way.

[00:16:47] So digital financial services really is the only option. In the last three years. With the support from Gates Foundation, we have developed the country’s first and largest social safety net payment that’s done online. That’s done through mobile phones. That’s done to internet payments, that’s done through what is called agent banking where banks can set up overnight banking agents by just licensing them in rural areas without establishing a bank branch.

[00:17:17] So all these different technologies are now being utilized, explored right now. We have not used it yet, but these will be used for delivering financial subsidies to remote areas. So we may have a very large unemployment that is created in the manufacturing sector. Our largest manufacturing sector is ready-made garments which employs anywhere from 3.5 million to 4 million people, mostly women, and lot of them are actually losing jobs or will lose jobs in the coming months, potentially because orders are getting cancelled.

[00:17:55] Many other manufacturing sectors will also see huge unemployment again financial subsidies will be necessary. They’re the same system will be used. We’re just exploring the possibility that many people will want to provide financial assistance to the poorer segments of the country.

[00:18:16] So the Prime Minister already has a Relief Fund. We are exploring the possibility of connecting the digital payment system to that Relief Fund.

[00:18:25] Relief Fund was completely analog before so large corporations wealthy individuals would come in and hand over checks to the Prime Minister. For this fund, but now we’re exploring what about crowdfunding this entire ecosystem. So the Prime Minister’s relief fund can actually receive $1, $5, $10 payments from whoever who can afford it from all over the country. So the digital means will help crowdfund possibly the largest relief fund that has been in operation in Bangladesh ever.

Life versus livelihood dilemmas for policymakers

[00:18:58] Kal Joffres: What kind of new dilemmas do you think that the pandemic poses for policymakers in Bangladesh? Are there trade-offs that you’re seeing policymakers thinking about or taking already in real time?

[00:19:13] Anir Chowdhury: Absolutely, absolutely. The first trade-off is life versus livelihood. So we’re trying to save lives by locking down everything: by locking down our trade, by locking down our transportation, schooling system. Pretty much everything that generates income, that generates revenue for the government, that generates what will contribute to GDP.

[00:19:40] So all of that is virtually at a standstill. Which basically means that our livelihood is suffering and we’ve been looking at what this life versus livelihood equation really means in the context of developed countries. So if you look at the US from what some of the numbers that I have seen, it’s a massive part of GDP if you cannot save lives. Germany, very similar things; and many other countries in Europe.

[00:20:11] But if you look at maybe poorer countries developing countries, let’s say, India or Bangladesh or Cambodia. How long can we continue the lockdown to save lives? Does the livelihood equation become another factor in actually causing deaths? we don’t know that. I mean that’s a very difficult trade-off choice for policymakers.

[00:20:35] Do we save lives now or do we actually cause more deaths by stopping lives? So that’s a very, very important debate that we’re facing right now. I’m sure many developing countries are facing this debate. Developed countries are also talking about this. So we don’t have an answer to this, I’m sure.

[00:20:54] We will have to make an answer, or develop an answer with the information that we have at hand pretty soon. Then the issue of who delivers services? Does the government deliver services? Does the private sector deliver services in a in a time of such national crisis? So government versus non-government. That’s also a debate that we’re having.

[00:21:18] Kal Joffres: Anir, how do you think that the people of Bangladesh are reacting to the lives versus livelihood trade-offs?

[00:21:25] Anir Chowdhury: A difficult question. I don’t know right now.

[00:21:30] It’s a complex issue. So I’ll give you some of my own perspective. And this is, this is absolutely personal. So we have seen people not only in Bangladesh, recently there was a huge exodus from Delhi, that we have all seen.

[00:21:49] On the fourth day of the lockdown, people were forced to go back to their village, because they could not afford to be in the city and similar things are happening in Bangladesh. Not as large droves because just two days before lockdown people moved back. So that was possibly a good thing at that time. So before the lockdown happened, they had access to public transportation and they moved back to the village.

[00:22:16] But having loss of livelihood for an extended period of time is dangerous. Poor families will sell their last asset, a small piece of land to save a life. A pregnant woman who needs an emergency surgery and the husband and the in laws will actually sell their last asset to save that life.

Increasing privatisation of healthcare

[00:22:41] There is a growing privatization of the healthcare sector. More and more people are going to private sector service providers for many reasons. So now, how does the government work together with the private sector to fight this disease to fight the progression of the disease to do treatments?

[00:22:58] Are we are already seeing the private sector has the largest share of ICUs. So how do we make sure that these ICUs are used to treat patients when we need them perhaps at the same cost? Private sector cost is much, much higher than the public sector cost of the health sector. So how do we make sure that people don’t die because they can afford an ICU? So how do we merge the public and private sector in this common fight. So those are very important policy decisions that we’re looking at. And then the digital versus analog — we have been forced into digitization almost overnight.

[00:23:40] In Bangladesh and in many other countries that we are forced into digitization things that we have been discussing things that we’ve been doing. But now we’re doing them not discussing anymore. Now we’re doing them in such an unprecedentedly accelerated fashion it’s just unbelievable.

Shifting toward new normals: repurposing and collaborating

[00:23:57] Kal Joffres:And right now, what you’re doing to address this as you’re in fact developing new public services in real time. What do you think are the implications of that?

[00:24:07] Anir Chowdhury: I would say probably two or three things. One is I would hope that the collaboration, the unprecedented collaboration that we have seen in the last month or so that we see in pockets during a national crisis like flood. So we have a common enemy that we’re trying to defeat and we have to work together. So that’s one thing that will happen. So all these technologies, all the efforts that are going towards bringing people together, people coming together spontaneously. I hope that that will continue. I think that is necessarily even in the post-COVID situation. So collaboration is absolutely essential and technologies could potentially catalyse that.

[00:24:52] The second thing that is important is that now that we are forced to work from home that practice is thrust upon us. So that will also be helpful in many cases because the issue of social distancing may prevail, even after lockdown is lifted.

[00:25:13] Because we may have to be careful about letting our children go back to schools. We have to be careful about letting our colleagues, go back to offices, we have to be careful about letting our workers go back to the manufacturing plants.

[00:25:26] So if we have to figure out how to maintain some sort of social distancing in in those situations so we have a we have a unit called ilab, Innovation Lab, that has been busy since the first case of outbreak to develop PPEs, the protective equipments, face shields.

[00:25:47] Now they’re working with Medtronic to develop a ventilators locally. So we’ll see a lot of “Made in Bangladesh” products coming to this where we always dependent on other countries China for protective equipment. So we are now trying to develop our own knowing that nobody’s coming. Nobody has the time or the resources.

[00:26:12] Kal Joffres: With all the changes that are happening, what are the changes that you see as having the potential to become longer term changes ? The so-called “new normals” and which ones would you like to see preserved after this COVID-19 crisis?

[00:26:27] Anir Chowdhury: I think that one of the things is the healthcare service delivery. So right now, the telemedicine service that we created by connecting our 333 hotline to the thousands of Uber pool of doctors is a good example of how things can be radically shifted overnight.

[00:26:50] The 15 or so telemedicine companies that we’re working with day and night right now is a recent collaboration that happened just to two and a half weeks ago. So these companies, I would hope will grow very quickly.

[00:27:05] We’d provide services to millions of people, not just potentially hundreds that they do today, or thousands today. So that would be scaled up 10 times, 100 times in the next few months. We’re seeing a lot of doctors providing telemedicine services that were never considered before because it was probably not cost-effective, or would cut into the revenue stream in the case of private sector hospitals, but now they’re all offering this. So that’s a shift that I think is happening because of pressure, because of the current situation, because of social distancing. And I think that should last, that should be sustained.

[00:27:41] Working from home has become super productive for some people. Obviously not for factory workers, obviously not for educators and students. But for many people who would spend endless hours in traffic going from one location to another, they become very productive because they can make quick decisions over video conferencing without leaving the location that they’re in.

[00:28:10] So I think that’s another thing that should sustain. We’ve been trying to develop that approach within the government for many years. The push towards electronic service delivery of the necessary or the vital common services will be expedited through this process.

[00:28:27] We’ve been talking about government as a platform where the services become interoperable. So even digitization does not always enable interoperability, because people digitize in silos. One thing that I’m worried about is the economic recovery. So much of the digitization may require upfront investment in many cases. So whether we’ll have the money to make those investments upfront, we’ll have to see. But that’s where we have to be very creative about repurposing and collaborating. So if we can repurpose many of the tools and technologies that were used for something else. So the case in point is the 333 helpline that was used for just getting national information about how to get passports, where to go for national ID, what does it cost to do certain things, land records, and so on and so forth was repurposed for medical service delivery. And then again repurposed for food and essential relief delivery and then again we are thinking of repurposing it for e-commerce next week.

Post-COVID preparations and the Fourth Industrial Revolution

[00:29:35] Kal Joffres: What do you think practically that governments and UNDP could do to prepare to take advantage of the opportunities of what may happen sort of after the immediate crisis?

[00:29:49] Anir Chowdhury: I think that the most important thing will be economic recovery. Bangladesh was on a fairly aggressive trajectory to graduate from LDC status. So we had our first evaluation which we passed with flying colors in 2018. The next one was going to be ’21. And the final one in ’24, so the LDC graduation was one of the highest priority of the government, and that will be in peril because we’ll be losing tax from the private sector. We’ll be providing subsidy to the private sector and to a large number of the poor population and the growing, growing population.

[00:30:29] So that’s going to be one of the most important focus areas right after the COVID lockdown is lifted. Then skills — so in the new world , we may require completely different skills. We’ve been talking about the Fourth Industrial Revolution, and what kind of reskilling and upskilling that will force or encourage perhaps.

[00:30:52] This just swept us of our feet completely so the Fourth Industrial Revolution is something that we discussed for the last two, three years and have been planning for the next five to ten years. Now, COVID has happened in the last few weeks, and we have to plan for the next few months about what kind of new skills that we need to turn around and continue growing. We have a national target of becoming a developed country in terms of national income by 2041 which is the 70th year of our country’s anniversary.

[00:31:28] Kal Joffres: Thanks, Anir.

[00:31:29] Right now, you know, working on developing these new services connecting different stakeholders and making some really tough decisions. I really appreciate you taking part in this conversation.

[00:31:40] Anir Chowdhury: Thank you, Kal, for taking the time. I know you’re busy with many different things, but thank you for having this conversation. I really appreciate it.

[00:31:47] Kal Joffres: Pleasure is mine.

[00:31:47] That was Anir Chowdhury. He’s a policy advisor with UNDP Bangladesh and the government of Bangladesh as well as a member of the Prime Minister’s National Digital Task Force. We’ll be following Anir over the next couple of weeks to understand what the situation is, how government services are evolving, and what are some of the different challenges and opportunities around that.

[00:32:10] So stay tuned and we’ll be releasing podcasts regularly on this topic.

The Innovation Dividend explores how innovation in society and government are paying off. Over the coming weeks, we’ll be exploring how ‘policy frontliners’ are innovating in real time in the COVID-19 pandemic and asking which of these changes and “raw learnings” might become part of our new normal. You can subscribe to the podcast here or listen on Spotify here.

In the Asia-Pacific region, we are interpreting the renewed mandate for innovation as an opportunity to reframe: follow us and contribute as we explore