Technology Salon

Vodafone's Efforts to Expand ICT in the Developing World

2010-02-19T13:15:26Z

In what has become an annual tradition, we're honored to have Terry Kramer, now Regional President - Vodafone Americas, return to the Technology Salon and update us on Vodafone's continued efforts to bring mobile technology to the developing world.

Note: This is a San Francisco event, at mission*social, the Inveneo offices on Mission Street in SoMa

Terry Kramer of Vodafone

Vodafone in the Developing World
March SF Technology Salon
Thursday, March 25, 8:30-10am
mission*social Conference Room
972 Mission Street, 5th Floor
San Franscisco, CA 94103 (map)

We'll have espresso and donuts for a morning rush, but seating is limited. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

And while Terry organizes his thoughts for this year's discussion, be sure to review his talk last year where he issued a m-Development Challenge from Vodafone.

eLearning's Promise: Will New Models Scale to Educate Youth?

2010-02-19T12:15:39Z

Young people make up 18 percent of the world's population today, or 1.2 billion in absolute terms. Of these 15-24 year-olds, 87% live in developing countries. At the same time, their basic educational needs are not being met. More than one-third of all youth around the world are not in the classroom - 73% of youth in sub-Saharan Africa and 51% in South and West Asia.

Yet developing world governments cannot expand traditional educational facilitates to these youth or the even larger cohort behind them. Demand for higher education in Asia and Africa will grow from 48 million enrollments in 1990 to 159 million enrollments in 2025, but India spent only 3.2% of GDP in 2005 on education, ranking it 140th of 180 countries tracked by the CIA World Factbook.

Look at that eLearning idea

The inability of developing countries to meet the demand for quality secondary and higher education has a direct impact on economic growth. Researchers at Harvard University estimate that:

"a one-year increase in tertiary education stock would raise the long-run steady-state level of GDP of Africa GDP per capita due to factor inputs by 12.2%."

So improving access to higher education is one of the best investments that donor agencies, foundations, and governments can make. Now what if it were possible to nearly double the number of secondary and university seats in a developing country overnight and with relatively little investment from the public sector?

Steve Schmida, founder of SSG Advisors, believes that eLearning - the provision of educational opportunities via information and communication technologies - could have that kind of scale with recent advances in electronic content creation and the proliferation of technology devices. He's developed ideas around the three main questions eLearning models bring forth:

What do these new eLearning pedagogical models look like?
How can new business models make eLearning services affordable?
Who will validate or accredit eLearning programs?

Join us in a Technology Salon lead by Steve, that will discuss these three questions with the hope to answer a forth: What effect would scaled eLearning in higher education have on economic growth in Africa and Asia?

eLearning's Promise: Will New Models Educate Youth?
March DC Technology Salon
Thursday, March 4, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

We'll have hot coffee and Krispe Kreme donuts for a morning rush, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Girls and ICTs: Salon Thoughts and Conclusions

2010-02-04T13:00:06Z

The Girls and ICT Technology Salon was a great opportunity to get an amazing group of thinkers and do-ers in the same room to debate around a particular topic. I'm Linda Raftree, Plan International West Africa Regional Office, Advisor for New Technology and Social Media. I was honored to lead 20+ people in a conversation revolving around 5 aspects I mentioned in my blog post on Girls and ICTs:

Tension between participation and protection
Online behavior is an extension of, and a potential amplifier of offline behavior
Qualifying the digital divide
Girls' involvement in developing and designing ICT solutions for their own needs
Research on Girls and ICTs

My impressions from the Salon on the topics are below. These points and others raised in the Salon were fed into a high level consultation for Plan's upcoming 2010 Because I am a Girl Report (in process).

Does ICT education help girls?

Tension between participation and protection.

The main point here is that ICTs offer girls (and people in general) huge opportunities for increased participation and connection. However, due to the very real problems of on-line child pornography, child trafficking, child harassment, and cyber bullying, there is a strong push by some for more control and more restricted on-line use by children and youth in the name of protecting them.

Girls, however, can participate actively in self-protection if given the opportunity to learn and practice. Teachers and adults can play a role as guides, coaches and support systems for girls to feel comfortable with ICTs and also to help them navigate and protect themselves on-line. Globally, there are differing levels of openness to girls (and children in general) going on-line. In US schools, there seems to be a stronger focus on the dangers of the internet and a bigger resistance to ICT's in education as opposed to many 'developing' countries. Adults in these particular 'developing' countries seem to be less focused on the dangers of the internet and much more aware of the opportunities for connection, advancement, broadened educational opportunities and employment that ICTs represent.

Online behavior is an extension of, and a potential amplifier of offline behavior.

ICTs are not the problem in and of themselves - they reflect existing social issues, existing human behaviors. ICTs become a concern because they can exacerbate negative behaviors, such as bullying, pornography, early sexualization of girls, trafficking, sugar daddies, sexting, etc. Girls, boys, youth shouldn't be banned from using ICT's; they should be supported to learn to navigate these spaces and use them positively. There are examples of safe platforms where children can talk to each other ( eg., a 'sand box' to learn and be safe).

Girls (and boys) who are vulnerable online are usually also vulnerable offline, and this is where any intervention should begin. Life skills and self-confidence are critical, and these need to begin at an early age, before girls and boys even go on-line. There is a need to be aware of the law enforcement agenda which, to stop pedophilia, advises children not to go online, as opposed to preparing them for a lifetime use of ICTs. This can backfire when children go around these controls and don't know how to self-protect. It can subsume the positive aspects of cyberspace and ICTs and create unnecessary fear in parents and other adults. Adult-child communication and cooperation in protection/learning to navigate is critical here and preferable to outright prohibition of Internet access.

Qualifying the digital divide.

We often think about the digital divide in terms of economics, 'developing' vs 'developed' countries, but we need to also consider the gender divide, urban-rural divide, age divide, disability divide. These divides all need to be taken into consideration when working with girls and ICTs, and ICT related programs in general and we need to be quite specific when talking about 'access.' For example, girls working as maids in urban areas vs. girls living in wealthy homes in those same areas may have quite different access levels, though they are both 'urban girls.' We need to talk about the gender divide in terms of males as partners, not just as obstacles to girls' ICT access. ICTs can also be used to positively influence the behavior of men, and men and boys can be participants and partners in programs to support girls' access to ICTs.

Young people tend to be better than their parents and teachers at learning and manipulating new technology. This can be disempowering and threatening for adults. It also means that parents and other adults may be less able to provide support to children who are using ICTs and navigating cyberspace. Institutions that provide different services may need to be retrained to deliver their services for a younger population using mobile phones and internet as their usage grows, to go where young people, where girls are. For example, in Sweden, psychologists are offering services in authorized chat rooms. Children profess to feeling safer there as it gives them anonymity.

There is a perceived divide between the tech sector and the NGO/development sector, and also between the tech sector and the gender sector. It's important to bridge these disconnects for better work in all these sectors.

Girls involvement in developing and designing ICT solutions for their own needs.

It's important to think about whether girls are involved and engaged in voicing their needs and whether those who are designing ICT processes and solutions are listening and involving girls in them. A study in the EU found a difference in how boys and girls use technology by the level of middle school. Girls tend to then use ICTs for social purposes whereas boys think of them in terms of employment. It's suggested that girls need female mentors and role models that use technology and that work in the technology field.

Putting tech in the hands of women, for example, primary school teachers, can increase their status and strength as role models and enable them to carry out different and important roles in the community. To help girls feel more empowered, one program trains exclusively girls as ICT facilitators. The girls then train boys and the rest of the community at a big public community festival. This breaks down barriers and allows girls to take a leading role. A broad and representative range of girls should have a seat at the table to give ideas and input into research and design of technology solutions for their protection and their empowerment. This will make ICT initiatives more successful, relevant and realistic.

Specific research on girls and ICTs.

There is quite a bit of research on girls education. However, there is not a lot of specific research on girls and ICTs in "developing" countries or on the specific impact of a particular ICT or ICT-related process in reaching development objectives. Most of what is there is anecdotal. Funding for Girls and ICTs will likely be dependent on evidence gathered through monitoring and evaluation to prove certain approaches work and to discover the differentiated impact and role of ICTs in the process. It's quite difficult to unpack the impact of a particular technology given the variety of other conditions and elements in an initiative. How can ICT impact or influence be measured as something separate from reaching the broader goals in an initiative? And should it be?

There may be ways that skilled monitoring and evaluation experts can pinpoint whether a particular methodology that involves ICTs did have a greater impact on reaching goals; however, there are many other content variables eg., quality of training provided in the project, location, interest of participants, methodology, etc. that may be more important than the ICTs themselves in terms of impact.

If you'd like to lead a session of the Technology Salon, please email me today!.

Improving Girls Education and Development with ICT

2010-01-13T17:26:28Z

In the developing world, girls need new skills and capacities for the 21st Century. They need to have the ability to be flexible, adaptive, and innovative to grow into positions of influence in their communities and countries.

Does ICT education help girls?

Yet - as we learned in the Gender Equality in ICT Education discussion - just getting girls to secondary school is a challenge, and once there, girls often shun ICT's unless they have strong mentors and female role models.

Please join us Thursday, January 28th, as Linda Raftree, Social Media and New Technology Advisor for Plan International's West Africa Regional Office, leads us in a discussion of three pertinent questions:

How can the technology and international development communities support the development of girls?
What role does ICT play in facilitating girls' growth?
And where are the concrete examples that prove ICT is a net positive for female progress?

We'll also try to identify case studies, partners, and further research around girls development and ICT for inclusion in Plan's Girls at the Cutting Edge of Change Report, now underway.

Improving Girls Development with ICT
January Technology Salon
Thursday, January 28, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts for a morning rush, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Addition January Technology Salon Events

I'm pleased to announce two other events supported by the Technology Salon in January. Each event is organized independently, so contact the respective event sponsors for details:

NYC Mobile Tech Salon - January 20th
MobileActive is organizing a conversation in New York City around how mobile phones can empower grassroots NGO's to effect change:

Mobile Campaigning and Tools on a Shoestring
Wednesday, January 20th, 6-8pm
Digital Democracy
109 W 27th Street, 6th floor,
New York, NY 10001 map)

USAID Daybreak Discovery - January 27th
The Business Growth Initiative project of USAID is examining the impact of public-private partnerships in Asian & the Middle East:

Economic Growth Alliances in Asian & the Middle East
Wednesday, January 27th, 9-11am
Smith School Business Suite
Concourse Level, Room C-3
International Trade Center
1300 Pennsylvania Avenue, NW
Washington, DC 20004 (map)

Can Donors Improve Enterprise Competitiveness with ICT?

2009-11-06T14:54:05Z

Competitive private companies know that just adopting the tools of ICT will not magically lead to productivity gains - it takes much change and investments in business processes to really reap the rewards that ICT can bring. But this basic tenant can be lost in the hype around specific devices or technologies.

So how can donor-funded projects that aim to increase enterprise competitiveness using ICT, make sure companies can take advantage of technological advances to create a sustainable advantage? Or even a strategic advantage.

In the November Technology Salon, we'll get an exclusive sneak peak at "How Information and Communication Technology (ICT) can Catalyze Enterprise Competitiveness", a brief from the Business Growth Initiative (BGI), that's not yet released.

In our forum, we'll be able to review and give our opinion on the brief's ability to inform those who design and implement donor-led ICT projects through its four sections:

A framework for supporting ICT as a tool to improve enterprise competitiveness for donor projects
Examples of framework operation in agriculture/agribusiness, tourism, and manufacturing sectors.
Lessons from donor-initiated ICT projects with greater impacts, more sustainability, and larger scale
Recommendations to donors on creating better ICT-enabled business and competitive environments.

Please join us Thursday, November 19, for what will be a lively discussion around enterprise competitiveness and donor funding at the intersection of technology and development. We'll be led by Michael Ducker, an ICT development specialist focused on supporting ICT, entrepreneurs and innovation.

Can Donors Improve Enterprise Competitiveness with ICT?
November Technology Salon
Thursday, November 19, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

ICT4D Sustainability: Relative to Observer, Absolute for Scale

2009-10-23T01:07:17Z

Whew, I think this was one of the most intense and contentious Technology Salons yet! After an hour of lively discussion around what "sustainability" and "scale" means to information and communication technology programs, we were just starting to pull back the layers around the topics.

(Want to attend the next Technology Salon? Then subscribe to our meeting announcements to be invited.)

Sustainability Means Many Things

We quickly found that there were many definitions of sustainability and scale. Maybe too many, as these terms differed wildly across implementers and donors. It was even suggested that in the realm of ICT, development has an unbroken string of failures since none of the projects have scaled to the extent of mobile phones.

Before we cast out the entire body of work to date, much of ICT4D is done as experimentation - there is an expectation of failure while we figure out models that would work. At least we have mobile phones to show that there are ICT models that can scale, sustainably.

Government supported project sustainability

Donor Funding is a Sustainable Model

Mobile phones also show that beneficiaries must pay for at least a portion of ICT services. This both validates the service and makes it responsive to the beneficiaries. But they do not need to pay for all of it. In many cases, long-term external funding from donors, government, foundations, etc, can be the cornerstone of a sustainable program.

Great examples of this are in the education and health field. Universal primary education is a public good in many countries - paid in full by government entities which themselves can be funded indirectly by beneficiaries (taxes) or external funders (multi-lateral donors).

In the health field, health information is often created and supplied via free-to-beneficiary models supported by donors. And before anyone thinks donor funding isn't sustainable, there are multiple countries that are in their third or fourth decade of multi-billion dollar multi-lateral donor agreements.

Different Time Horizons for Sustainability

Which brings us to time horizons. In development, we are often looking at projects with a three-year funding commitment, while in domestic private industry, three years is considered the initial start-up phase, with five years the usual time horizon for profitability. In the developing world, even successful organizations like Kick Start, consider 10 years a more reasonable break even benchmark.

So there is a gap between this pilot/start up phase, and a self-sustaining business model, that isn't bridged by current financing. Donors are reluctant to fund "on-going operating costs", yet venture capitol sees development investments as too risky, and development financing organizations rarely see above microfinance or below multi-million dollar financing.

Add to that gap, the reality that donor project requests don't give much guidance around what they consider sustainability to be in their given time horizon, nor do many donor staff have the training to evaluate what models would be sustainable anyway, and implementers are often left to create fantasy sustainability plans and financing.

Are 400,000 Uruguyan XO's sustainable?

Sustainability Changes Over Time

In sustainability plans, there is also often the expectation that sustainable business models do not change, or if they do, they should always go from a donor or publicly supported program to one privately funded. In education, its often the opposite.

Educational innovations, like computers in classrooms, start with private schools which are funded through parental school fees. Then, once the benefit of that innovation is considered a basic necessity for a quality education, the government is expected to scale it up to all public schools.

It was suggested that while education and healthcare could be public goods, industries like finance or telecoms didn't need public support. Then we were reminded of the recent troubles in the financial sector, and its billions in bailout funds handled by Central Banks around the world. In addition, Universal Service Funds helped spur innovation in rural telecoms that have come back to benefit all users.

How Do We Scale, Sustainably?

While we didn't answer this question today, we did agree that the market works in the developing world. Mobile phones prove that if there is beer money, there is money for information and communication technologies. People will find a way to pay for what they consider necessities. Our challenge is to keep innovating, and nurturing that innovation, until we find another model that scales - lest ICT become a one-hit mobile wonder.

At least we can celebrate one small step towards scale - the Technology Salon is now replicated with Mobile Active's the NYC Mobile Tech Salon. And like any good model, we've adapted to the local conditions - they're meeting in the evenings, over beer, instead of the morning over donuts. Next, a San Franciscan conversation.

"Sustainability" and "Scale": What's that really mean for ICT4D?

2009-10-09T19:18:20Z

What do you think is the single most important issue at the intersection of technology and development? Recently, the twin issues of sustainability and scale have come to the forefront in many conversations, with both peaking in October in several forums:

Sustainability: Besides being the buzz word de jour, this month's Educational Technology Debate is focusing on ICT4E sustainability and at an IADB meeting, one discussant suggested that virtually everything that USAID does was unsustainable.
Scale: Both Joel Selanikio of Data Dyne and incoming mHealth Alliance Executive Director David Aylward recently reminded us that while there is an incredibly vibrant mobile phone industry, after 15 years of PDA and mobile phone pilots there are few, if any, scaled mobile technology development projects - most are small, non-sustainable proofs of concept.

But what do we mean by "sustainability" and "scale" in ICT4D?

Is it only about private income streams?

Now here's the real issue. What might be our shared definition of both "sustainability" and "scale" with information and communication technology programs in international development?

Is sustainability when projects are self-funding, like a for-profit business, and is scale reaching an entire country? Or can sustainability be reached by a dedicated funder, like government, and can scale be just a community large enough to support sustainability?

Also, is sustainability and scale different for different sectors in the developing world? Could donor support be a valid business model in education or health - two sectors dominated by government support in developed countries - while finance and agriculture are required to source private sector income streams?

Please join us Thursday, October 22, for what will be a lively discussion around sustainability and scale at the intersection of technology and development, lead by Kerry McNamara, a Scholar-in-Residence at American University and a noted expert on technology and development.

"Sustainability" and "Scale": What's that really mean for ICT4D?
October Technology Salon
Thursday, October 22, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

mHealth Means Mobility, Information, Connectivity & Feedback

2009-09-17T14:14:29Z

In our September Technology Salon, we took on James BonTempo's pertinent question of What Does the "m" in mHealth Really Mean? in a spirited debate with technology and development practitioners.

We were seeking a better definition of mHealth than the current focus on devices, and specifically the hype around mobile phones. As one participant bemoaned, it seems that every health project with a mobile phone or PDA, no matter their usage, is now an mHealth project.

(Want to attend the next Technology Salon? Then subscribe to our meeting announcements.)

Is this mHealthcare? (photo: Data Dyne)

So we sought to put parameters on what could be called an mHealth project, and through that, come up with a new definition for mHealth. After an hour of vibrant debate, we developed these four aspects for mHealth projects:

1. Field Mobility

First we all agreed that the "m" stood for mobility - health workers empowered with tools that allowed them to actually leave the clinic and visit with patients in the field. This concept of mobility could be as simple as a mobile community worker visiting clients with the original mobile data collection device: a clipboard. Yet, we felt that that was too basic - mHealth was more than just mobility, it had to include the collection of electronic health data.

2. Electronic Information

As much as mobility, we felt that the "m" in mHealth could just as easily stand for modernization - the digitization of health records systems. Its the storage and analysis of massive amounts of health data which is fostering a revolution in healthcare with Ministry and community worker alike. But more than just data, which implies numbers, we are really talking about health information - new treatments, activities, and practices shared with the community so they can improve health outcomes.

3. Timely Connectivity

Moving information means connectivity, but not necessarily constant connectivity. Asynchronous, store and forward or even sneakernet connectivity can be quite effective in remote locations. This led us to think of community health worker movement as more nomadic - many site visits between stints as a central health clinic - than always mobile all the time.

With nomadic movement, timeliness is relevant to location. In the health clinic, connectivity would be synchronous and aggregate information could be shared between clinician and Ministry, while in the community, connectivity could be asynchronous, with personal information shared between clinician and community.

4. Feedback Loop

Note the multiple mentions of information movement between Ministry and community. A real mHealth project must have bi-directional information sharing. No matter how important health data may be for Ministry-level decision makers, its even more important to have health data flowing back down to the very community health workers who are collecting it - for direct usage with patients.

As we looked at the four requirements listed above, we realized there needed to be one more change to the concept of mHealth, and that's the limitation of the word "health". We're really talking about a holistic approach to improving health outcomes, with an end-to-end communications infrastructure, so we're really talking about mHealthcare, not mHealth.

Yet even mHelathcare is still a subset of the more holistic eHealthcare, where these field-focused solutions tie into national electronic healthcare systems that can empower changes in people and policy at the country level.

Back down at the Technology Salon level, we concluded with a simple hope for our discussion. That this exercise would help each of us better discuss and explain what the "m" in mHealth means in our respective professions and promote a more inclusive and pragmatic concept of mHealthcare to the larger development and technology communities.

What Does the "m" in mHealth Really Mean?

2009-09-02T16:36:09Z

In a recent Twitter exchange, James BonTempo asked a very pertinent question about the current mHealth buzz:

The only mHealth definition? (Img: DataDyne)

Should definition of #mHealth include devices (wondering specifically about netbooks) or simply the concept of mobility?

He followed up his initial query with a simple poll that asked if mHealth should include a list of specific platforms or just the concept of mobility. So far, Twitterers agree, the "m" in mHealth should represent mobility, regardless of form factor.

But that's different from the general notion of mHelth, represented by the mHealth Wikipedia entry, which focuses on equipment "mHealth is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices"

In our next Technology Salon, we'll explore what the "m" in mHealth means for those who actually practice mHelath, with these field-experienced experts:

James BonTempo who says, "Ask someone about #mHealth they'll mention (smart)phones and PDAs. But who's counting users with laptops? After all, they are "mobile" devices."
Josh Nesbit who says, "I tend to frame everything in reference to end users, so the "m" describes the mobility of healthcare workers, facilitated by devices."
David Isaak who says, "I am definitely in the "m" in mHealth being everything mobile. I usually use the acronym "mICT" for a broader view."
Wayan Vota who says, "Ask those in #mHealth hype and they say (smart)phones. Ask those who DO #mHealth and they talk about holistic ICT ecosystems."

But enough about what the four of us think. Come out Thursday morning to give your own voice to the conversation. Our goal: a shared definition of mHealth from an implementer's perspective, and a better understanding of mHealth for everyone involved.

What Does the "m" in mHealth Really Mean?
September Technology Salon
Thursday, September 10 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts to wake you up, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Four Key Themes in Improving Patient Care with ICT

2009-07-29T18:10:16Z

As I listened to Mike McKay, former country director of the Baobab Health Partnership, speak about how his organization is improving patient care with ICT in Malawi, I was struck by four key themes in Baobab's solution:

Mike McKay of Baobab Health

Start with Patient Data
Keep Technology Easy to Use & Modify
Always Build Local Capacity
Project Poverty is an Advantage

Now neither Mike, nor Baobab's founder, Gerry Douglas, made all these points explicitly, but they are the takeaways we can learn the most from.

Start with Patient Data

Knowing a patient's past medical history is critical to continuity of care, particularly for patients with chronic illness. Do you know if the patient in front of you has tuberculosis? Or HIV? Or both plus malaria? Or is on any other medications or has any peculiarities you should know about them before you diagnose or treat their current ailment? If you had their medical records, you may.

And if you could track vital signs like body weight and Mid-Upper Arm Circumference (MUAC) over time, you could map its fluctuations against the patient's ails. Aggregate that data from all patients, and you could track disease and malnutrition across entire populations.

This is the promise of starting with patient data. And capturing the data electronically, at the point where its taken - from initial registration to actual patient-clinician interaction - makes the input process more streamlined and the data more accurate and timely; the approach Baobab took to great success.

Even though Baobab initially started in the pediatric ward of Kamuzu Central Hospital in Lilongwe, by focusing on creating an easy way to record patient data, they've been able to expand into other medical wards, and other clinics, across the country. At the same time, they are able to deliver accurate and timely aggregate data to the Ministry of Health. Baobab has now issued nationally unique patient ID numbers to over 800,000 Malawians, and tracks more than 20,000 HIV patients using their point-of-care approach.

Keep Technology Easy to Use & Modify

Even in Lilongwe, the capital of Malawi, electrical power is intermittent. Yet, if you are using an electronic patient records system, you have to commit to 100% uptime during clinic hours. Technology solution needs to be very energy-efficient so it can be run off backup power as needed. Baobab has introduced a 48VDC approach taken from the telecommunications industry to provide multi-day power backup using locally available solar batteries. You are also working with a user population that is not usually familiar with computers, so your solution needs to be dead simple. In general, the technology used has to be both cheap to buy and cheap to ship to your clinical sites, and also cheap to maintain and customize.

Back in 2001in the hunt for a solution that could be robust yet easy to use and cheap, Baobab stumbled on the Netpliance I-Opener, a low-cost, low power solution for Internet access. This device, with some customization, seemed perfect for running electronic patient records software as a web-based application with a touchscreen interface.

The real innovation came with that touchscreen interface. By eliminating the keyboard and mouse, Baobab was able to make its patient record system easy to use by everyone - from doctor to janitor - eliminating the need for users to have advanced ICT skills. And by using Open Source software, they were able to develop their own solutions, and modify them as needed with local programmers making the changes.

The only drawback is the limited supply of their original touchscreen hardware - its not longer produced and current touchscreen hardware is over $700 per device, relatively expensive for Baobab's saturation model, but still considered to be a viable solution by Baobab.

Always Build Local Capacity

Let's be honest. Expatriates are expensive, often temperamental, and almost always temporary. So for any project to have real staying power, it needs to be designed for handover to local staff from the beginning. But at the same time, its usually hard to find local staff that have a Western work culture. Which means that projects also need to be constantly training local staff, grooming internal candidates for advancement.

Gerry and Mike were both committed to transferring their knowledge and skills to their local staff, often hiring fresh graduates to train them in Western methodologies - especially software development. In fact, once trained, their local programmers were able to get more and better feedback when Gerry and Mark were not involved in requirements definition (so called "mzungu free meetings"), as local clinical staff were more honest and open about software issues with their countrymen than the expatriates.

Baobab Health is now almost entirely locally staffed, only the Country Director is an expatriate, and that's more a function of her skills and leadership than a specific need for an expat.

Project Poverty is an Advantage

It may seem counter-intuitive, but being resource constrained can actually be beneficial to a project's long term success. When there is little money to be spent on extravagance, the organization is very focused on delivering quality on time and on budget. And when low budgets are expected to continue, the project can be designed to have low maintenance costs, making sustainability easier to achieve.

For Baobab Health, its tiny budget kept it lean and focused. It only recently reached $200,000 a year, so everything - salaries to software - was cost-efficient. Baobab was able to reject opportunities for mission creep and helped it achieve acceptance by the Ministry of Health. Its seen as a real Malawian solution, not a donor-driven external organization.

Now that Baobab is looking at scaling up, and has a significantly increased budget, the challenge will be for it to keep that lean, focused organization.

Improving Patient Care with ICT: A Malawian Example

2009-07-16T14:06:53Z

In last month's Technology Salon, we looked at Health Information Systems that improved reporting systems for governments. But what about improving patient care? Giving clinicians support and feedback at the point of care can bring about immediate changes in diagnosis and treatment, and start the reporting process with high-quality data.

Baobab Health Partnership is using innovations like touchscreen clinical workstations and unique power systems to guide low-skilled healthcare workers through the diagnosis and treatment of patients according to national protocols. They've even developed a HIV eVCT System - a locally designed and implemented solution to advance medical care in real time for Malawians in resource-poor settings.

Here is a video of their electronic records system in action registering new patients:

We'll have Mike McKay, former country director, lead us through their technology choices and into a larger discussion around improving feedback loops inside the clinic, not just above it. We'll also have a hardware show and tell to get acquainted with the technology.

Improving Patient Care with ICT: A Malawian Example
July Technology Salon
Thursday, July 23 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Key National HIS Success Technology: Change Management

2009-07-01T00:00:14Z

In this month's Technology Salon, National Health Information Systems: Who Uses What, Where?, we discussed a recently-completed study by Vital Wave Consulting that surveyed the global landscape of national HIS ecosystems in the developing world. The overall outcome may surprise some development practitioners, but its well known to IT experts: basic change management matters more than fancy technology.

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Brendan Smith started the Salon with a great overview of the challenges faced by contemporary paper-based national Health Information Systems (HIS), from delayed initial reporting, to transcription errors, to the massive time commitment required to analyze the data. In fact, Jamaica clinicians have over 500 forms to record their activities, and Indian clinicians typically spend every Saturday recording the events of their week.

Health information system in practice

With the obvious drawbacks to paper systems and the allure of massive efficiencies expected with automated ICT-based systems, many countries are looking at or actively moving to electronic national Health Information Systems. Vital Wave Consulting identified 5 levels of sophistication that countries go through in their HIS automation progress:

District Routine Health System Data Reporting
Manual tallies from activity registers using redundant paper forms reviewed only at higher Ministerial levels
Optimized District Health Data
Still paper-based, but indicators rationalized and simplified to reduce collection burden and increase data quality
Electronic Storage & Reporting of District Health Data
Manual data entry from log books to electronic forms for stronger analytics, requires basic computer literacy and continuous tech support
Incorporation of Operational IT Systems
Automatic data capture in routine transactions where indicators are automatically generated with access to information from all levels
Fully Integrated National Health Information Systems
Data from all key sources (public & private), governed by explicit national policies, creating a strong data-driven culture with sense of ownership at all levels

They also categorized the studied countries into each level, with one notable exception. Not a single country made it to Category 5 - Fully Integrated HIS. In discussions with Technology Salon attendees, it was our opinion that no country - developing or developed - is in that category either. And skipping ahead to Vital Wave's report conclusions, shows us why.

In their analysis of national HIS efforts, Vital Wave found five key metrics to success, which should look familiar to anyone involved in change management for large organizations:

Integrate an HIS in conjunction with broader health system reforms
Streamline data collection and reporting as a first step
Plan for hidden costs and staff resistance
Cultivate a data-driven management culture
Create change management and incentive structures

To bring home the point about change management vs. technology, let's walk through the India HIS example Vital Wave gave from their own field research.

India's National Rural Health Mission is rolling out a health information system to gather data from the block level - an administration point, usually a hospital-type community health center, that has local and rural clinics beneath it. These clinics will still use a paper system, but 3,000 data points have been reduced to 200. These paper forms will be entered by dedicated data entry staff at the block level, and eventually block level clinicians and higher will enter their own data directly.

Category 3 advance

While this system will greatly increase accuracy, timelines, and efficiency overall, Ministry staff were the most proud of the data point reduction. It was seen as the greatest challenge and accomplishment of the HIS - more than even the computerization of the process. In fact, that single act alone took the personal intervention by India's Health Secretary as there was huge resistance to giving up indicators.

Each indicator was seen by the person tracking it as integral to their work, maybe even to their continued employment, so reducing the number of indicators, while creating benefit for the whole, also created intense fear and uncertainty in the Ministry rank and file. In addition, the reduction of errors also posed its own problems. With more accurate information, long-held assumptions, some of which careers were tied to, were revealed to be false. Salon participants reported instances of Ministry staff, even Ministers themselves being fired when the new HIS data reflected a different reality than previous systems.

So deploying a national health information system successfully does not require the high-end technology resources available to richer countries. The major hurtles to successful national health information systems are human, not high-tech. Having a clear goal of improving data quality, and a solid change management approach to achieve is the critical success factor. And this can be accomplished in countries as varied in resources as Belize, India, and Sierra Leone.

National Health Information Systems: Who Uses What, Where?

2009-06-18T14:11:06Z

It often seems that there are as many health information systems (HIS) as there are governments - from custom legacy systems to new web-based applications. But which governments are using a HIS, what system do they employ, how has it helped them, and and what can we all learn from their experiences?

Health information system in practice

For the next Technology Salon, we'll focus on a recently-completed study by Vital Wave Consulting that surveyed the global landscape of national HIS ecosystems in the developing world. This study was sponsored by the Bill & Melinda Gates Foundation to:

analyze the landscape of national HIS ecosystems
review prominent examples of HIS implementations
identify critical success factors to strengthen health outcomes

We'll have Brendan Smith of Vital Wave Consulting lead us through the report highlights, India case study, and an accompanying online HIS forum with an engaged discussion around the various health information systems, fueled by a hot coffee and Krispe Kreme donuts sugar rush.

National Health Information Systems: Who Uses What, Where?
June Technology Salon
Friday, June 26, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that this Salon is on Friday morning, instead of Thursday, seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Engaging Electrical Engineers in International Development

2009-06-11T02:43:39Z

Last week I had the privilege to participate in the Humanitarian Technology Challenge - a call to action for the IEEE membership to get engaged with the multiple issues facing development that could be overcome with technology. The HTC is a partnership between IEEE and the United Nations Foundation Technology Partnership with the Vodafone Foundation. (more on the HTC partnership)

Mark Summer of Inveneo

Over two days, IEEE members were encouraged to develop and implement technological responses to three humanitarian challenges in developing countries:

Reliable Electricity: Availability of power for electronic devices
Data Connectivity of Rural District Health Offices: Capability of exchanging data among remote field offices and central health facilities
Patient ID Tied to Health Records: Maintain consistent patient records, including when patients visit different clinics and when they relocate

Working with them were representatives of 10 humanitarian organizations, and the brainstorming sessions where technology and development experts came together to devise solutions made the conference feel like a large-scale Technology Salon.

We did not achieve any immediate solutions, but we did practice a number of key skills in deploying development solutions. My favorite was using elevator pitches to increase excitement and buy-in by local leaders around solutions to the three challenges. We started with the challenge to sell a power system to generate electricity for a school, for a day, where I came up with the following pitch:

You want power. You want cheap power. You want cheap power through people power! And people power from those with the most energy: kids. Better yet, naughty kids. Put the youth on bicycles that recharge batteries. And while this idea is not new, my plan has a bonus: electroshock therapy. That's right, electrodes to shock the kids if they don't pedal fast enough. Which gives you a reward that every parent will find even more impressive that electrical power, exhausted, calmed children.

While my pitch was greeted with laughter, it was also meant as a lesson. Think outside the box for your solution, use cheap, available materials that are easy to maintain and expand on locally, and be flexible to respond to unforeseen needs.

From here, the IEEE membership will do deep dives into these three areas and we should see interesting outcomes in a few months around possible technology solutions to these vexing development challenges.

m-Development Challenge from Vodafone

2009-05-05T13:52:03Z

At the Future of Mobile-Empowered Development Technology Salon, an audience of development practitioners and technologists had the unique opportunity to host Terry Kramer, Board Member of the Vodafone Americas Foundation, as well as Vodafone's Group Strategy and Business Improvement Director, and hear about Vodafone's vision, strategy, and engagement in emerging markets and the base of the pyramid (BoP).

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We focused on the desire by mobile network operators (MNO) to increase revenues and market share by expanding into rural areas, where it becomes more difficult and costly to provide service. We also recognized that the development community wants to capitalize on the success and reach of the mobile network to assist the poor, but these two actors are still wrestling with how to make that happen.

So how would the development community partner with an MNO like Vodafone? The Salon identified two issues that are key to developing partnership opportunities:

MNOs have specific business objectives and drivers. The development community needs to understand these requirements to design projects that will engage MNOs.
MNOs want to partner with the development community. They are looking for key applications that solve a common need for many in developing countries. MNOs want to satisfy those needs for better business results.

In essence, both parties need to understand each other's business better. Let's begin with briefly outlining Vodafone's strategy and then what they are looking for and how development initiatives can partner with them. We'll conclude with a mDevelopment challenge from Terry.

Who is the next mobile owner?

Vodafone's Emerging Market Activity

Vodafone has been successful in the higher end of the developing world market - urban areas, more affluent populations - and are now reaching into the mass market at the base of the pyramid because this is where an MNO can achieve scale. India will be a major market for Vodafone - they're forecasting it will account for one-quarter of all their revenue growth in the next four years.

The challenges Vodafone and others face in serving the BoP are that return on investment is low. On average the monthly revenue per user in emerging markets is only $4-5, so it is not usually economical for an MNO to go into remote areas. In most markets today there are four competitors and in general there are low-priced players, igniting price wars.

Business Drivers for Mobile Applications

Vodafone applies the "80/20" rule - they want to find the key applications most commonly needed by many ("80%"), the programs with the greatest impact. Vodafone is interested in mobile applications that:

Generate a high volume of transactions and therefore more revenue
Protect market share or retain subscribers
Increases market penetration and adds new customers
Has mass market appeal, works on a large scale

Key Applications Needed by Many

Vodafone is particularly interested in developing projects from corporate social responsibility (CSR) activities that can then be scaled to commercial activities. M-PESA was originally a joint project with DfID that is now a commercial success and Vodafone believes some m-health applications will eventually become mass market commercial products. They are now looking to the development community for the next key application.

In the Salon, thought centered around agriculture apps that scale and satisfy business drivers, as there was consensus in need but not services - NGOs are saying "wouldn't it be nice if" but don't see solutions that can help with:

Agriculture market price information systems that scale and are sustainable
Supply chain finance between farmers, suppliers, buyers, and banks, possibly leveraging M-PESA type systems
Farmer education on crop rotation, fertilizers, or weather information
Farmer market linkages between associations & co-ops and commercial actors
Food traceability for food security & export quality requirements

Yet agriculture is a hard nut to crack because at first glance, one does not see a high volume of transactions being generated out of this system, nor an inherent path to achieving scale and sustainability, which creates difficulties in getting the interest of the MNOs.

On a larger scale, there are many silo systems (m-banking, health, agriculture, etc) that could be an opportunity for the development of common platforms which could scale across industries and countries. The Ministry of Health in Senegal is asking their software development industry to create a single m-services platform.

Looking for the next M-Pesa

Ways to Engage with Vodafone Foundations

Vodafone has the Vodafone Group Foundation headquartered in the UK that focuses on global programs, and foundations in 23 markets, each with their own programs. The Vodafone Americas Foundation can also fund US organizations that do international work.

Social investing is the Foundations biggest focus. The Wireless Innovation Project is a great example. Its a new initiative that identifies and funds unique innovations grounded in local needs and yet can scale to solve critical social issues around the world.

Generally Vodafone keeps foundation and commercial work separate, but there is commercial value in CSR projects. Vodafone is able to do more when they can present themselves to a new market as a firm that helps build the economy. It allows them easier access to licenses and facilitates a more effective rollout.

A Concluding Call for Engagement

Mobile network operators (MNO) want increase revenues and market share by expanding into rural areas, and see partnerships with the development community as a key market entry strategy. Specifically, Vodafone is looking to the development community for key applications that solve a common need for many and can be scaled into commercial activities.

Terry Kramer emphasized that he wants to hear of new ideas and new approaches directly from us, and spur a vibrant dialogue on possible solutions and their ability to scale and meet Vodafone objectives. Vodafone is willing to put great effort into application with great social benefit, as doing well while doing good has direct benefit for Vodafone.

Let the comment section below be that feedback forum - submit your ideas today!