The mountain kingdom of Lesotho, a small landlocked country in Sub-Saharan Africa, is an unlikely place to look for healthcare innovation. Yet in 2016, it became the first country in Africa to deploy the test and treat strategy for treating people with HIV. Rather than waiting for white blood cell counts to drop, patients begin treatment as soon as they are diagnosed. This strategy is backed by the WHO as it has the potential to increase the number of people who are able to access treatment, consequently reducing transmisssion and keeping people with HIV healthy and alive for longer. 

While lots of good work is underway in Lesotho, and billions have been spent on HIV programmes in the country, the percentage of the population infected with HIV has remained steady and is now almost 23%. Challenges of this scale need new ideas and better ways to adopt them.

On a recent trip to Lesotho as part of a project with the United Nations Development Group, we met various UN agencies, the World Bank, government leaders, civil society actors and local businesses, to learn about the key development issues in Lesotho and to discuss the role that ‘collective intelligence’ might play in creating better country development plans. The key question Nesta and the UN are working on is: how can we increase the impact of the UN's work by tapping into the ideas, information and possible solutions which are distributed among many partners, the private sector, and the 2 million people of Lesotho?  

As a starting point, together with representatives from a number of UN agencies in Lesotho, we discussed what challenges could be addressed by translating high priority issues, such as a high rate of HIV infection, into a number of specific challenges and then using collective intelligence approaches to surface new solutions.

In our discussions with government and UN partners, we honed in on two issues where collective intelligence could be applied in Lesotho: Lack of HIV knowledge and awareness amongst youth and gaps in the drug supply chain.

We then presented our framework of collective intelligence, a set of iterative stages which can help organisations like the UN tap into the ideas, information and possible solutions of groups and individuals which are not normally involved included in the problem solving process. For each stage, we also presented a number of examples of how this works in practice. 

Collective intelligence framework - stages and examples

1. Better understanding the facts, data and experiences: New tools, from smartphones to online communities enable researchers, practitioners and policymakers to collect much larger amounts of data much more quickly. Organisations can use this data to target their resources at the most critical issues as well as feed into the development of products and services that more accurately meet the needs of citizens. Examples include mPower, a clinical study which used an app to collect data about people with Parkinsons disease via surveys and smartphone sensors. 

2. Better development of options and ideas: Beyond data collection, organisations can use digital tools to tap into the collective brainpower of citizens to come up with better ideas and options for action. Examples include participatory budgeting platforms like "Madame Mayor, I have an idea" and challenge prizes, such as USAID's Ebola grand challenge. 

3. Better, more inclusive decision making: Decision making and problem solving are usually left to experts, yet citizens are often best placed to make the decisions that will affect them. New digital tools make it easier than ever for governments to involve citizens in policymaking, planning and budgeting. Our D-CENT tools enable citizen involvement in decision making in a number of fields. Another example is the Open Medicine Project, which designs digital tools for healthcare in consultation with both practitioners and patients. 

4. Better oversight and improvement of what is done: From monitoring corruption to scrutinising budgets, a number of tools allow broad involvement in the oversight of public sector activity, potentially increasing accountability and transparency. The Family and Friends Test is a tool that allows NHS users in the UK to submit feedback on services they have experienced. So far, 25 million pieces of feedback have been submitted. This feedback can be used to stimulate local improvement and empower staff to carry out changes.

After presenting these stages and tools we then asked UN partners to discuss how each stage could be opened up to new participants. A number of insights emerged. Taking HIV awareness amongst youth as an example, the collective intelligence conversation revealed the need to amplify work with young people themselves as a source of knowledge on how to tackle HIV.  We also discussed which other organisations might participate in addressing the issue (religious organisations and youth groups) and the role that technology can play. Mobile phone use is high in the youth across the country. The team talked about how mobile phone surveys, already in use by the UN in Lesotho for food security could be used for HIV prevention targeting.

Next steps

Following this trip, we will be publishing a report later in the Autumn on the use of collective intelligence tools in government. Alongside this, we will be working with UN representatives in Lesotho to explore potential ideas for a practical program based on the insights of the research.