Fredrik Galtung is a man who knows all too well the three-headed beast that haunts the world of international development, otherwise known as fraud, corruption and mismanagement. Having spent ten years at the anti-corruption advocacy group, Transparency International, he saw firsthand the pros and cons of trying to address these issues from the top down.

Despite Transparency International producing such useful tools as the Corruptions Perception Index,¹ and working successfully with the United Nations and other intergovernmental bodies to enact binding anti-corruption legislation; the efforts of such organizations are generally limited to policy-level actions that miss the primary source of fraud, corruption and mismanagement, namely bad actors operating at the grass-roots level. “How?” Galtung thought, “can we empower people working on the front lines of development projects, to audit their own activities in a way that would both root out fraud, corruption and mismanagement, and improve the efficiency of their projects in the process?”²

This question led to the creation of a very different kind of advocacy group, one that successfully addresses the problems of fraud, corruption and mismanagement, not from the top down, but from the bottom up, as Galtung had envisioned. Integrity Action, formerly known as Tiri, is a non-profit organization that has successfully monitored over $1 billion worth of development projects in dozens of countries, by training local monitors to identify and fix problems in real time. Using smartphone technology, and an app known as DevelopmentCheck™ they not only identify problems in the field, they share their findings with local contractors, NGOs, government authorities and other stakeholders, in order to develop cost-effective and timely solutions to those problems.³ To date they have fixed four thousand problems out of seven thousand identified by local monitors (a 57% “fix-rate”),⁴ and are currently working on over five hundred projects across Africa, Asia and the Middle East.

Seeing the effectiveness of this approach, Galtung turned his attention to the more complex problem of sustainability reporting in the corporate world. It is well known among environmental advocacy groups that a company’s actual environmental footprint can only be measured if the impact of its entire supply chain and product life cycles are taken into account. By using the bottom-up approach that he and his partners had developed at Integrity Action, and by redesigning the user-friendly, hand-held technology that had empowered local monitors to audit development projects, Galtung believed that multinational companies could, in fact, capture environmental impact data at their various sources, and TrueFootprint was born. Then came the COVID-19 pandemic.

Despite countless warnings from epidemiologists that such an event was virtually inevitable, the world was caught flat-footed, especially as it related to personal protective equipment (PPE).⁵ In the United States, the first concern was for health-care workers working on the front lines, in hospitals and clinics around the country, who were in desperate need of masks, gloves and shields. Dr Patrice A. Harris, president of the American Medical Association, famously implored the Trump Administration to make PPE a national priority, noting that, “Physicians and front-line health-care workers across the country are pleading for more personal protective equipment, doing everything they can to raise awareness of this crisis. Those on the front lines of the COVID-19 pandemic are concerned that the lack of adequate PPE endangers not only themselves, but their patients and families as well.”⁶

The pleas would generally go unheeded however, as the Administration refused to invoke the Defense Production Act to increase PPE supplies;⁷ and individual States competed with each other, and with the Federal Government itself, to procure whatever PPE they could. The situation became even more critical as private citizens themselves began to purchase medical-grade masks, and many users resorted to reusing disposable products, and making non-medical-grade products on their own. This was happening in the richest country in the world, and as is often the case, the situation was potentially more dire in the countries of the Majority World, and especially in Sub-Saharan Africa, Southeast Asia and parts of the Middle East.

In a report published in July 2020, titled Strategies for Managing Acute Shortages of Personal Protective Equipment During COVID-19 Pandemic,⁸ Africa Centers for Disease Control and Prevention gave specific guidance on the preservation and rationing of PPE, including the decontamination and reuse of masks, the use of face shields when masks aren’t available, the use of gloves for direct patient care, and the reuse of disposable gowns. However, little guidance was given on the procurement and effective inventory management of PPE. Shortages, it would seem, were merely assumed and pilferage, no doubt, highly anticipated.

Enter TrueFootprint, Ltd. and the COVID-19 Care Monitoring Coalition (CCMC).

Calling upon his twenty years of experience in the development sector, Fredrik Galtung knew that a huge influx of both governmental and philanthropic money would create an environment too tempting for the previously described bad actors to ignore. He also knew that the distribution challenges of a multinational effort, conducted in places where infrastructure and other public services are limited, would undoubtedly result in an uneven distribution of resources and unnecessary PPE shortages at the local level. He believed however, that the technology the company possessed could be redesigned once again, and if used properly by health-care workers themselves, help to ensure that those shortages were both minimized, and short-lived.

In order to bring their solution to market as quickly as possible, the company focused on “one key data point,” i.e., “are the health facilities safe: safe for the people who work there … [and] safe for patients, especially those in high-risk categories?” This one metric drove the entire Care Monitoring Coalition project, with the ultimate aim being to “improve health outcomes … [and] reduce infection and mortality rates for health workers.”⁹

While the technicians concentrated on the redesign of the TrueFootprint FieldApp (more on that below), Galtung and his team began assembling the networks necessary to establish an effective “coalition” of partners. Drawing on their own vast database of contacts, the company was able to team up with a remarkably diverse group of partners, including several Ministries of Health, well-known NGOs such as the Global Fund,¹⁰ Members of Catalyst 2030¹¹ (an expansive network of social entrepreneurs dedicated to achieving the United Nations’ Sustainable Development Goals by the year 2030) and countless other local partners and health-care providers, who constituted over 90 percent of the CCMC network.

Finding, training and supervising local monitors, however, is no small task and is replete with technical and ethical challenges. To ensure their monitors were neither tempted to operate outside the bounds of both law and ethical custom, nor ill-equipped to do their jobs effectively, the company has established a robust protocol for both digital inclusion and data protection.

Local partners for instance, were required to provide monitors with the telephony and connectivity necessary to carry out their assigned tasks and, in extreme cases, provide manual (i.e., pen and paper) formularies as an alternative. The data protection policy met or exceeded the EU’s General Data Protection Regulation; monitors were eligible for a “certification” process that included advancement to “Advanced Monitor” and “Supermonitor” status, and all monitors were asked to sign a detailed code of conduct. The firm’s commitment to the development of local monitors was so central to the ethos of the programme that local partners were asked to commit 7.5 percent of their operating budgets to “Monitoring, Evaluation and Learning.”¹²

In order to roll out the programme as quickly as possible, the company concentrated on the delivery of a minimally viable product that could be tested in the field among a handful of partners, establishing “proof of concept” at very little cost. This meant developing a basic Android-use version of the FieldApp, that may be easily adapted for iPhones at a later date if required.¹³ Other attributes of the app and the process connected to it are that it only requires ten minutes of training, can generate reports in a matter of minutes, and may be used offline for audits and online for data sharing.

As demonstrated during a two-week pilot of the programme, users were able to simply tick a few boxes on their hand-held devices, and the information on the ground was captured in “real time,” allowing local monitors to react quickly to local shortages. As the data from various locations was automatically collated, patterns across regions and even countries could be identified so that authorities in those jurisdictions could respond accordingly and quickly.

Unfortunately, a lack of private funding prohibited the company from operating at the scale it originally intended, but it demonstrated both the power of innovation and the potential of small businesses to solve big problems in creative ways. They have shown how small companies with good ideas can have a positive impact, far beyond what either the state or the market might assume. They have proven, once again, that people at the grass-roots level, if properly equipped and empowered, are the ones best suited to identify and find solutions to problems, not to mention rooting out fraud, corruption and mismanagement before they happen.

TrueFootprint is the epitome of how small, privately held companies can positively impact society. It is now up to socially conscious private investors and associated stakeholders to invest in their continued success.

Dr Kenneth J. Barnes is the Mockler-Phillips Professor of Workplace Theology and Business Ethics at Gordon-Conwell Theological Seminary, USA.¹⁴