Sector Transgressions in Uganda: Tech dependencies in health and education

In 2021, the Global Data Justice project partnered with Data4Change and a team of researchers to explore sector transgressions during the COVID-19 pandemic in East Africa. This online series includes excerpts from case studies of Ethiopia, Kenya and Uganda, as well as a synthesis report. Extended country analyses will appear in a forthcoming edited volume alongside other international contributions. 

Data4Change is a UK-based non-profit working to hold power to account with data. The East Africa project was supported with funding from Omidyar Network

Introduction

By the time the first COVID-19 case was reported in March 2020, the government of Uganda had already begun instituting strong measures – sanctioned by public health and national security laws, often at the expense of privacy and other basic rights – to curtail the spread of the virus. To justify the full lockdown of the economy, the president – a former guerrilla leader and self-professed freedom fighter – invoked military speak to suggest that the country be still and wait [until the virus passes]! Although the people waited, the virus was recalcitrant. The economy took a hit and the warts from public health failures were laid bare – for all to see. 

Frustrated, some private sector players transitioned from typical brick and mortar operations into online spaces for business. For many, this was short-lived. The Ugandan economy is dominantly cash-based, informal, and lacks sufficient infrastructure to support e-commerce 1. However, privately-owned telecommunications companies (telcos) grew more powerful in the economy. On the one hand, they bridged support among disparate domains such as health, education, and business while, on the other, they formed a core part in the government’s disease surveillance mechanism. Likewise, aid agencies grew even more central, particularly because of their legacy roles in supporting core sectors of the economy such as health and education. 

Having foregrounded the heterogeneous dynamics of COVID-19 (mis)management and the (re)production of contentious spheres where exercise of power is fluid and highly situated, how might we study/reframe sector transgressions in places where infrastructure is limited, insufficient or missing altogether? To this extent, in what ways have probable transgressions played out in the past?

This online essay, which forms part of an extended analysis of sector transgressions during the pandemic in Uganda, briefly highlights cases from three domains and the roles played by international aid and development partners, international data processing corporations, and the government. 

Health

Uganda’s health budget is greatly supported by international aid agencies. Following Uganda’s earlier challenges in digitizing health information systems (HMIS), UKAid, Norwegian Agency for Development Cooperation (NORAD), and other aid agencies provided core technical and financial support. The agencies capitalised on the ubiquity of mobile technologies, even in remote areas, to support health data capture and analysis. In addition, they trained over 60,000 health workers and spearheaded the development of new software platforms such as mTrac (“mobile tracking”) and DHIS2 (District Health Information Software v.2), with the latter now the industry standard. However, COVID-19 was unlike any of the health crises the country had faced. It required new approaches, even new technologies. Although the government initially took a ‘boots-on-the-ground’ approach to coordinate contact tracing and enforce night curfews, most of the technology-driven interventions were supported by international aid agencies and data-processing corporations. In particular, the DHIS2 team primarily based in Norway developed new modules for COVID-19 testing, treatment, and traveller screening. Similarly, the WHO repurposed Go.Data, its early warning and response system formerly used in Ebola contact tracing, to COVID-19 operations. Therefore, could it be said that this technology support by international aid agencies constitutes a sphere transgression insofar as it largely covers – although does not entirely displace – the government’s role in public health responses? Yet, it is left to speculation what precarity awaits the government in the event of discontinuation of the aforementioned support. 

Surveillance and contact tracing

Although widely used health platforms such as DHIS2 provided core support for the disease management including traveller screening and tracking at a national scale, the government entered into partnerships that provided additional support. For example, the East African Community secretariat with support from international partners developed a contact tracing app for cargo truck drivers who, in the earlier waves of COVID-19, were spotlighted for spreading the virus across the region. It can be seen that in spite of DHIS2’s similar capabilities on tracing cargo truck drivers at common points of entry in East Africa, the government supported another effort to trace the truckers. This portrays a multi-pronged approach where the government is open to facilitating interventions, irrespective of duplication.

In April 2020, the Ministry of ICT and National Guidance through the National ICT Initiatives Support Programme invited emergency proposals for digital solutions to support the fight against the COVID-19 pandemic. Nearly a year later, 45 winners were announced including Cogniware, a company headquartered in the Czech Republic, “originally built to investigate counter-terrorism,” and now “fighting coronavirus”. However, prior to the call, an unknown Ugandan company, Defining Technologies Ltd, had donated a contact tracing app to the Ministry of Health, apparently adopted by up to 5,000 users. More recently, in March 2021, MTN – the country’s largest telco – partnered with the National Information Technology Authority to create an electronic pass app to monitor those under COVID-19 home care.

The above can be interpreted in two ways. First, the government facilitated the transition of any entity, be it established or otherwise, to support contact tracing and disease surveillance irrespective of safeguards and guarantees to privacy and data protection. Secondly, the government’s approach through widely publicised schemes and partnerships could be understood as a public performance, a format of technology theatre, where the government creates the impression of deferring to budding technologists and advanced technology to combat a virus that has imperiled everyday life. Yet this performance, besides possibly allaying public fears (and strengthening the government’s image) might pose negative implications emerging from data misuse and abuse. 

Education

Following the national uptake of DHIS2, the platform operators recently forayed into serving education, an allied sector – ironically most affected by government’s restrictions on movement and opening of public spaces. Accordingly, Uganda has so far had the longest closure of schools in the world, and the president promised that schools would reopen in January 2022 2. Based upon this, DHIS2 for education will build off the education management information system (EMIS) but importantly will replicate its initial successes on decentralizing data capture, especially for those in remote areas. The platform is built to cater for COVID-19 testing and tracing among students. Perhaps it is too early to tell; however, this intervention could be an attempt to support the government’s efforts to safely open public schools. To date, the government has not acted on its promises to support e-learning through distribution of FM radios to families. To this effect, it is only a handful of students in elite private schools that are able to study remotely, leaving most of the population at the losing end. Accordingly, this demonstrates a transition of an effort by an international aid agency into a sphere that masks the government’s inadequate response. Relatedly, in April 2021, Makerere University in partnership with the Ministry of Health and Child and Family Foundation Uganda, developed a COVID-19 app to enable case investigation and contact tracing while supporting timely reporting and decision making including in schools that have been disproportionately affected by the pandemic. There is no substantive evidence on neither the app’s uptake nor its impact.

Bridge International Academies (BIA) roll-out in Uganda in 2015 perhaps best captures what might have been a sector transgression nipped in the bud. Under the auspices of an IFC and Gates Foundation bankrolled international educational technology and data company – NewGlobal – BIA were rolled out in Africa and Asia to democratise access to education to low income families through ‘lean’ educational and pedagogical models. The schools’ roll-out in Uganda pitted the upstart against poorly facilitated public schools and expensive private schools. BIA undercut the market through staff rationalisation (one administrator per school, for example), remote monitoring to curb teacher and student absenteeism, and centrally developed lesson plans – and minimally constructed classrooms that apparently did not meet safety and public health standards. Nimble as they might have been, they shook the primary education establishment – a source of political power for the government (through its ‘universal primary education’ programme) and large sections of the private sector. Although BIA marketed their services as low-cost and inclusive, maybe that was not the case. Rallies of trade unions, activist groups, and government bureaucrats drove the corporation out of Uganda, though it still has operations in countries such as Kenya. The articulation of this example serves to show that there have been likely cases of transgressions by corporations that imbricate people in webs of ‘inclusion’. Yet, the story also shows that the government and other stakeholders are not just recipients of appropriations or merely sites of impact, but rather actors with agencies. However, in many cases, especially where transitions have helped the state perform or render its mandate, there has not been substantive pushback let alone protection of people’s rights and privacy in the wake of COVID-19.

Addendum: Where’s Big Tech?

Apple and Samsung [and Google] were reported to have activated contact tracing capabilities in their devices globally including in Uganda. Additionally, similar activations were seen in many devices running the Android operating system but their efficacy cannot be independently assessed. Nonetheless, they tell only part of the story of sector transgressions by large and established technology companies.

Footnotes

1. ^ In fact, e-commerce leaders such as Jumia (online marketplace) and SafeBoda (motorcycle ride hailing) have footprints that are often limited to elite sections of society. Upstarts such as Rocket Health, part of a telemedicine concierge group, did see massive uptake. It is reported that the government re-worked its telemedicine policy having witnessed the need and uptake of such services. Nonetheless, it is yet to be seen how this works out beyond a tiny middle class.

2. ^ Uganda’s president finally reopened schools on January 10, 2022. However, from the look of things, we cannot tell whether there’s been massive deployment of DHIS2 for education let alone any sort of techno-mediated adherence to disease tracing and surveillance in schools in Uganda.

About the project

Places and populations that were previously digitally invisible are now part of a ‘data revolution’ that is being hailed as a transformative tool for human and economic development. Yet this unprecedented expansion of the power to digitally monitor, sort, and intervene is not well connected to the idea of social justice, nor is there a clear concept of how broader access to the benefits of data technologies can be achieved without amplifying misrepresentation, discrimination, and power asymmetries.

We therefore need a new framework for data justice integrating data privacy, non-discrimination, and non-use of data technologies into the same framework as positive freedoms such as representation and access to data. This project will research the lived experience of data technologies in high- and low-income countries worldwide, seeking to understand people’s basic needs with regard to these technologies. We will also seek the perspectives of civil society organisations, technology companies, and policymakers.