Assessing Technology Platforms for Global Health Engagement to Support Integration of Efforts Across Geographic Combatant Commands

Global health engagement (GHE) is one of the strategic tools of the U.S. Department of Defense (DoD) for executing the U.S. National Defense Strategy (U.S. Southern Command, 2020). GHE is an integral part of the cooperation efforts of DoD with partner nations and provides support in training and preparing their military and civilian health systems. GHE helps build and sustain partner health capacity, as well as partner trust and stability. This helps create interoperability with partners to ensure the protection of deployed U.S. forces and provide medical readiness opportunities. Additionally, partner capacity-building helps create a joint effort, in collaboration with the U.S. interagency, in combating global health threats. GHE activities leverage DoD capabilities to execute a broad range of functions, including force health protection; foreign humanitarian assistance; foreign disaster relief; nuclear, chemical, and biological defense; infectious disease response; and other stability and security cooperation operations (Figure 1; Department of Defense Instruction 2000.30, 2017). These activities encompass a wide spectrum of engagements—military-to-military, military-to-civilian, and multilateral—and support joint missions of humanitarian aid and disaster response, deterrence, access and presence, counterterrorism, and homeland defense (Joint Publication 3-29, 2019). The importance of these activities has been particularly noticeable during the global response to the coronavirus disease 2019 (COVID-19) pandemic. GHE activities within the geographic combatant commands (GCCs) form a critical part of the U.S. government's global security cooperation apparatus and stability operations. GHE activities also enable the building of bilateral and multilateral relationships and interoperability that help support U.S. interests and security objectives.

Four circles are labeled Force Health Protection; Humanitarian Assistance (HA) and Foreign Disaster Relief (FDR); Nuclear, Chemical, and Biological Defense Programs; and Building Partner Capacity and Interoperability. The circles are positioned in a cloverleaf so that some parts of each circle overlap parts of each of the other circles, and GHE activities are positioned within areas of each circle to illustrate the overlap of activities.

For each item below, the initials following the colon indicate in which of the four areas the item resides; many items have overlap with multiple areas. Force Health Protection will be indicated by FHP; Humanitarian Assistance (HA) and Foreign Disaster Relief (FDR) will be indicated by HA/FDR; Nuclear, Chemical, and Biological Defense Programs will be indicated by NCBDP; and Building Partner Capacity and Interoperability will be indicated by BCPI.

GHE:

FHP, HA/FDR, NCBDP, BCPI

Security Cooperation:

FHP, HA/FDR, NCBDP, BCPI

Medical R&D:

FHP

Public health:

FHP

Preventive medicine:

FHP

Humanitarian and civic assistance (HCA):

FHP, HA/FDR

Medical support to stability operations:

FHP, HA/FDR

Infectious disease outbreak response:

FHP, HA/FDR, NCBDP

Humanitarian assistance and disaster relief (HA/DR):

HA/FDR

Disaster Risk Reduction (DRR) and other DoD HA Program sectors:

HA/FDR

Disaster preparedness (DP):

HA/FDR, NCBDP

Building partner-nation military medical capacity:

HA/FDR, NCBDP, BCPI

Cooperative threat reduction:

NCBDP

Cooperative Biological Engagement Program (CBEP):

NCBDP

R&D on select agents: detection, countermeasures, vaccines:

NCBDP

Capacity-building for partner-national civil-military emergency DP, response, and DRR:

NCBDP, BCPI

Global health security agenda (GHSA):

FHP, NCBDP, BCPI

Biosurveillance:

FHP, NCBDP, BCPI

Building coalition and partner-nation military medical interoperability:

FHP, BCPI

Department of Defense HIV/AIDS Prevention Program (DHAPP):

FHP, BCPI

Subject-matter expert exchanges (SMEEs):

BCPI

International Military Education and Training (IMET):

BCPI

Exercises for operational and contingency plans:

BCPI

SOURCES: Adapted from Uniformed Services University, undated; and Department of Defense Instruction 2000.30, 2017, p. 4.

NOTE: R&D = research and development.

Global health engagements and activities require extensive planning, funding, and resource allocation within the GCCs and component commands. For a continuously growing breadth of GHE and the need to support joint exercises with partner military and civilian medical professionals for partner capacity-building, GHE also requires the support of a robust information technology (IT) infrastructure. The IT infrastructure should be able to support various functions, both at the operational and tactical levels—military services, GCCs, and component commands—and at the policy development, planning, and program evaluation levels—including multiple Offices of the Secretary of Defense and the Joint Chiefs of Staff. GHE IT infrastructure consists of, and requires, platforms to broadly support (1) funding and activity tracking, (2) education and training of personnel and partner resources, (3) measurement, monitoring, and assessment of GHE activities for sustainment and medical readiness, (4) future planning and synchronization (Theater Campaign Plan [TCP] and resource allocation), (5) data analytics and reporting capabilities, and (6) collaboration and knowledge-sharing.

One of the strategic requirements of GHE and DoD decisionmakers is to have the ability to create a common operating picture (COP) for GHE within the combatant commands and DoD. To support this requirement and other more-operational needs, the IT infrastructure should include:

• platforms that provide processes and capabilities to seamlessly integrate engagement data across GCCs
• access to current and historical data
• tools for planning, funding, recording, and tracking GHE activities across the GCCs
• tools for reporting and analytics, and collaboration.¹

A GHE capabilities-based assessment (CBA) was funded by the Deputy Assistant Secretary of Defense for Health Readiness Policy and Oversight and conducted using the DOTmLPF-P² framework (Chairman of the Joint Chiefs of Staff Instruction 5123.01H, 2018). Completed in July 2018, the CBA affirmed the importance of GHE capabilities in contributing to GCC TCP objectives and in “adding significant value to civilian-led global health efforts” (Department of Defense, 2018). The CBA also identified numerous GHE capability gaps, including (1) the lack of availability of technology platforms and related policies that support the planning, capturing, tracking, monitoring, reporting, analyzing, and evaluation of the funding and execution of GHE activities and (2) insufficient understanding of how to engage the intelligence community and other relevant communities in support of GHE, along with a lack of information integration and knowledge exchange of DoD global health activities with civilian agencies and nongovernmental organizations. The CBA resulted in 15 recommendations to increase the effectiveness and efficiency of GHE activities in supporting GCC TCP objectives. The recommendations were compiled in a DCR and endorsed in a Joint Requirements Oversight Council Memorandum (Selva, 2019, Attachment A).

The RAND National Defense Research Institute was tasked by the Office of the Assistant Secretary of Defense for Health Affairs (OASD[HA]) to conduct research for the DCR actions related to (1) GHE funding mechanisms and authorities, (2) education and training, and (3) technology and process requirements to enhance GHE capabilities, from the planning phase to the evaluation of activities, and to support information- and knowledge-sharing needs. The research was conducted as three parallel studies for the DCR actions related to the three categories mentioned above.³ This study focuses on technology platforms and solutions to support GHE activities and training (Actions 7 and 9 of the DCR). Action 7, under the Training category, states the need to “[c]onduct a feasibility study on the development of a Joint GHE ‘Intellipedia’⁴ site … for the GHE community. The site should include … best practices, templates, frameworks, and links to the training modules on GHE activities.” Action 9, under the Materiel category, states the need to “[c]onduct a technology survey to identify potential government off-the-shelf (e.g., Joint Civil Information Management System) and commercial off-the-shelf solutions that satisfy the requirement to systematically identify, collect, synthesize, analyze, and report data relating to the environment to enable accurate problem articulation and planning. Solutions should work towards being compatible and aligning with current online information management systems used for GHE” (Selva, 2019, Attachment A, p. 3).

Study Objectives and Approach

Our team conducted research related to these actions as two separate tasks to identify the stakeholders, program offices, and relevant supporting technologies and platforms for each action. We then sought to understand the requirements (the information needs) and the capabilities of the technology platforms that would support the planning and execution of activities, as well as assessment, monitoring, and evaluation (AM&E) approaches. We also sought to understand the gaps related to policy and processes, platform capabilities, and access of information for collaboration, decisionmaking, and analytics.

We addressed two main research questions (and several subquestions) based on the two technology-related DCR actions, as follows.

Assessment of Technology Platforms

What are the technology infrastructure requirements of GHE planners and practitioners, both at the GCCs and component commands and within the Office of the Secretary of Defense (OSD), to support the planning, execution, and AM&E of GHE activities? To address this question, we sought to answer the following:

• How are the current systems used? How do these systems align with the funding authorities and activities related to GHE?
• What requirements are being met by the current systems?
• What are the gaps in capability needs, bottlenecks, policy and process gaps, and interoperability and collaboration issues?
• What types of platforms, interfaces, processes, and policies would help alleviate these issues and provide a better picture to the decisionmakers?

Feasibility Study on the Development of a Joint GHE Intellipedia

How would the development of a joint GHE Intellipedia-like site improve collaboration and information-sharing among the GHE community? To address this question, we sought to answer the following:

• How would the GHE community benefit from the information shared on this site (in addition to the IT platforms already in place)?
• What features or tools could be offered by GHE Intellipedia that would be different from any other collaboration tools, such as dashboards, data visualization interfaces, and chatrooms?

One of the issues that the GHE community sought to address is the lack of integrated and comprehensive data and a COP of all the GHE activities in various GCCs and their components. Hence, we could not base this research on any significant existing data on global health engagements. Therefore, our team carried out the research using multiple qualitative methods. Our research approach consisted of three overlapping steps. First, we conducted a literature review of documentation, articles, and previous RAND research related to GHE activities, funding sources, and stakeholders; the DoD directives, instructions, and guidance on GHE and software systems; the evolution of technology solutions to support GHE; systems in use by GHE practitioners; and technology solutions in the market, focusing particularly on cloud infrastructure and services and cloud service providers. Concurrently, we identified and had discussions with subject-matter experts—at the GCCs and component commands, OSD, and the Center for Global Health Engagement, as well as technology platform product owners, program managers, and technical leads—to document and analyze GHE technology platform requirements.⁵ Finally, we assessed available and planned platforms based on their features, enhancements, support and maintenance, data integration, interoperability, and future road maps. Table 1 provides a brief overview of the findings and recommendations to improve the support for GHE activities, practitioners, and planners by enhancing GHE IT infrastructure and the access to and capabilities of IT platforms. Additionally, we provide recommendations for future studies for deeper analysis into specific GHE capabilities, requirements, and GHE platform user insights.