The Center for Health Market Innovations – Using Data to Improve Health Market Performance

Chloe Feinberg — Mon, 10 Jan 2011 16:07:15 +0000

The Center for Health Market Innovations, an initiative coordinated by Results for Development, is, in their own words, “a global network of partners that seeks to improve the functioning of health markets in developing countries with large numbers of private health care providers.” The activities of CHMI aim to bridge the existing information gaps about Health Market Innovations and to diffuse promising programs so that lessons can be learned, partnerships formed, and innovative initiatives scaled. They focus on information, analysis, and the linkages between different stakeholders.

One of their tools I find particularly fascinating is the mapping of the health innovations around the world. By clicking on the map you can see what programs are taking place where in the world. The different layers they have also enabled a user to plot different metrics on the map as they look for programs around the world. Not only is there a map, but each of the data points can accessible information behind it. Are you interested in the program type? the health focus? or the target population? It is all there. Including background information, how the program is implemented, secondary effects from the program, etc. It is all there in a very easy to use format.

Last week, CHMI announced the publication of the first case study published by a CHMI partner in India, ACCESS Health International. Dr. Mohan’s Diabetes Specialities Centre is the topic if the case study and you can read the reasoning behind choosing this case here, which includes links to the case itself.

In addition to the mapping and the case studies, a user can search for various health market innovations programs by health focus, geography, and program type, making the site very useful for practitioners, policy makers, entrepreneurs, specialists, researchers, etc. CHMI has documented 470 programs in 105 countries with an additional 193 programs in the pipeline. If you have a suggestion for programs that should be part of the CHMI database, you can suggest programs to be highlighted.

Many initiatives try to act as aggregators of data and information for a field. I think the CHMI approach of having partners on the ground, focusing on a specific niche, and using various user-friendly tools to make the information accessible to users makes the Center an extremely valuable resource. I look forward to seeing how it continues to grow.

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Bringing Medicine to the Masses of Africa (when they are swimming in it?)

Bright Simons — Tue, 19 Oct 2010 14:49:43 +0000

In many parts of the developed world, the practice of medicine by relying on such tools as herbs, meditation, trance, acupuncture, ionised water etc. is tolerated under the rubric of “complementary medicine”.

In the United Kingdom, for instance, many public hospitals, such as the famed St. Mary’s in London’s Paddington, even have dedicated complimentary medicine wings, even though there is never any confusion about orthodox, “science-based”, medicine being the reigning sovereign[i].

The joke is that we prefer to think in similar terms in Africa too.

It would have been funny were it not for the fact that in Africa more than 75% of the population are estimated to rely, at least partly, on traditional medicine for their primary and secondary healthcare needs[ii].

Yet, the observers, commentators and so-called policy experts holding sway over the continent’s health sector continue to pretend as if we can afford to treat traditional medicine as the poor cousin of the mainstream medical system.

Take Ghana’s “Standard Treatment Guidelines” and “Essential Medicines List” documents for example. The former is the summary of recommendations made by the Ministry of Health for the benefit of physicians managing the most common ailments afflicting Ghanaians. I spent a significant amount of time this week leafing through the 20 or so chapters of this bulky tome and found it very interesting reading. [iii]

The latter document is produced by the same policy specialists in the Ministry of Health. It lists some 150+ medicines by their generic names and commends them to physicians for prescription in response to the conditions constituting the bulk of Ghana’s disease burden. The National Health Insurance Scheme is required to subsidise these recommended medicinal items in order to enhance access by ordinary people.[iv]

As you might have guessed already, the documents have scant regard for herbal medicine.

I was extremely intrigued by the section in the Standard Treatment Guidelines (STG) dedicated to haemorrhoids (the common “piles”), a once rare ailment that now regularly torments many in West Africa as a consequence of the increasing popularity of low-fiber, refined carb-heavy, diets.

The medicaments prescribed in the STG in connection with the clinical management of piles had such names as: “gentamicin”, “metronidazole”, “diazepam”, “senna”, and “liquid paraffin”. There is no award for noticing the total absence of herbal medicines on this list. If you lived in Accra, or indeed any of the relatively better-endowed, cities of West Africa, your first instinct would be to burst into laughter.

So few of the general population avail themselves to the antibiotic and analgesic-centric treatment regimes suggested by the STG for piles that for the typical observer of the terrain the guidelines might as well not exist. The typical self-respecting Ghanaian city dweller opts for any one of the myriads of herbal concoctions and will stub their nose at any surgery-prescribing physician ambling about professing to be managing their piles! I will leave what pertains in the rural areas to your imagination, dear reader.

So on what basis are herbal medicines, produced locally here for centuries, and an inherent part of the productive heritage of our indigenous industrial systems, excluded by stroke of national policy?

Before I create the conditions for the mass lynching of government policy experts in Accra or elsewhere in the region, I should hasten to add that the designers of the STG couldn’t have added herbal medicines to the list even if they had wanted to.

To rationalise both the use of medicines and spending from the national kitty arising from government’s subsidisation of their use, the Essential Medicine List and the STG both employ the generic names of medicines rather than their brand names[v].

You may recall my mentioning “metronidazole” in an earlier discussion. You may have rolled your eyes a little bit and continued reading without the least hint of recognition. Same would probably not have been the case had I mentioned “flagyl”. You would most likely have recognised this as a well-known antibiotic, and connected the dots immediately. If you are the kind of person who dabbles in these things, you probably would have tied “flagyl” to “Sanofi-Aventis” and wryly wondered whether this wasn’t a veiled advertisement for the giant French pharmaceutical company.

Exactly. The policy in many African nowadays is to deemphasise brands and wherever possible to promote generics in order to rationalise costs and improve access (see an interesting take on the matter from Australia).

For herbal medicines to attain the status of admission into national treatment regimes will require an unprecedented effort at standardisation (see a common view from India).

Ghana, for instance, has developed a basic herbal “pharmacopoeia”[vi], which is in essence an inventory of plants and their well-tested medicinal properties. Such efforts would need to be intensified. Because until there is a clear record of carefully and systematically collated body of evidence tying some properly defined plant compound to medicinal outcomes, the integration of herbal medicines into the orthodox healthcare system would not be possible.

The problem is that tying these systematically defined plant compounds to medicinal outcomes require subjecting them to a testing regime, which at some point should involve human subject testing[vii]. In most parts of Africa, the practice has been for the orthodox pharmaceutical regulators to demand results showing that plant compounds do not exhibit “acute toxicity” (very crudely put: whether one would not be poisoned within 48 hours of taking such medicine). Once they have satisfied themselves that this sub-minimal requirement has been met, they register these medicines for public consumption.

Orthodox medical practitioners would, of course, not be so magnanimous. They also want the “chronic toxicity” data, that is to say: the long-term effects of such medicines on organs like the liver and kidney, before considering even the sub-minimal criteria met. This however is the realm of late phase clinical trials.[viii]

The herbalists and plant medicine entrepreneurs can, to be blunt, scarcely afford such indulgences. The local laboratories usually lack the means to provide the service to enough of the 100,000 or so practitioners anyway. In Ghana, for instance, the only laboratory believed to be genuinely close to this competence is the Noguchi Memorial, which is based in Accra and by some accounts beyond the reach (both financially and geographically) of most plant medicine entrepreneurs.

The interesting thing is that local entrepreneurs who decide to produce the less angst-ridden orthodox pharmaceuticals usually come up against similar challenges at a somewhat higher level. According to an official of the Ghana Food & Drugs Board (the equivalent of the MRHA in the UK and FDA in the USA), the reason why no Ghanaian pharmaceutical manufacturer has so far been pre-qualified by the WHO to be able to supply pharmaceutical products to such major global procurers as the Global Fund is primarily because the West African nation of 23.5 million lacks “bioequivalence centers”. Very crudely, what this means is that when a Ghanaian company produces commercial samples of a duly standardised molecule with established medicinal properties, the facilities rarely exist for said manufacturer to demonstrate that her products are indeed “equivalent” to the established formulation with regard to the expected curative properties (see how the Ethiopians are wrestling with this).

The good news is that various Ghanaian laboratories are improving their capacity to measure chronic toxicity at a level correspondent to advanced animal testing. That should satisfy the regulators. But it would not necessarily satisfy all the doctors. The more orthodox ones might insist that the registered plant medicines also demonstrate “efficacy” and be produced under “quality” conditions. The battery of tests required to establish these principles cannot be properly performed in non-certified labs, and there are concerns whether the regulators themselves are sufficiently equipped to handle these matters[ix].

Back to square one then, it would seem.

My good friend Dr. Kofi Busia[x] of the West African Health Organisation has no time for these longwinded, self-serving, distractions. He has studied these matters extensively, and is completely convinced that it is a lack of creative policymaking that is standing in the way of integrating herbal medicine into the mainstream health system.

Throughout my discussion, I have given so much weight to the concern of orthodox doctors that one could have been misled into believing that there is no such thing as herbal medicine practitioners. Oh but they exist. If only we could focus on properly certifying and titling them.

There are already degree programs in herbal medicine in some of Ghana’s top universities. As far as the graduates of these programs are concerned, there is little cause for alarm. The Traditional Medicine Practice Council, which has been around for over a decade in Ghana, can do all the licensing required.

The issue is that the vast majority of herbal medicine practitioners did not graduate from formal programs of study in this field. Many people still acquire their competences in herbal medicine through informal apprenticeships. How may such be accommodated?

It is especially at this juncture that Dr. Busia likes to stress creative policymaking. If as a policymaker you were minded to admit ethnographic evidence, a ton could be provided in support of a particular herbal remedy that has been in use for centuries within a community that has spent significant amounts of time to evaluate the long-term effects and curative potential of said remedy. There are many who would argue that such evidence is superior to that obtained from 3 or 5 years of lab-mimicking clinical testing.

Dr. Busia can surprise you for days on end with his knowledge of the colourful array of cures sourced from the world of plants.[xi]

At any rate, as my friend at the Food & Drugs Board is wont to say: people are using these medicines in large quantities every day. You better acknowledge that fact and find ways to adapt to it or you can wait till the mountains melt into the valleys waiting for it to adapt to you[xii].

Notes:

[1] See a comparative account of different traditional medicine regimes around the world:

http://apps.who.int/medicinedocs/en/d/Jh2943e/7.21.html

2 The WHO is careful to clarify that the oft-quoted “80%” figure may prevail in some countries but not in all. My sources in the plant medicine community are however adamant that most surveys consistently come up with more than three-fourths being reliant on herbal medicines. I note from a paper that I reference below, however, that one such survey turned up 51% for maternal mothers in a West African community.

http://www.who.int/mediacentre/factsheets/fs134/en/

3 The latest edition of these documents can soon be accessed online here:

http://ghndp.org/index.php?option=com_content&task=view&id=47&Itemid=1

The more observant readers will note that it took more than 6 years for Ghana to update the previous one.

4 You may read more about the interplay of insurance systems and access to essential medicines here:

www.popcouncil.org/pdfs/GEMI_FinalReport_Winter2010.pdf

The focus is on Ghana, but as in many healthcare issues in Africa, you will soon find that issues tend to cut across geographical boundaries.

5 A good overview of the subject can be accessed here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486664/

6Please see:

http://openlibrary.org/books/OL1197131M/Ghana_herbal_pharmacopoeia.

7 Efforts are rife to better understand the dynamics of clinical testing in the African terrain.

http://www.edctp.org/Current-Call.410+M5e12c078de5.0.html

www.who.int/entity/ictrp/network/pactr2/en/index.html

8 A useful technical brief re pre-clinical acute toxicity studies:

www.crcnetbase.com/doi/pdf/10.1201/EBK1420045604-c4

9 The WHO is trying to spearhead the drafting of “current Good Manufacturing Practices” (cGMP) frameworks for developing countries. See:

apps.who.int/medicinedocs/en/m/abstract/Js14215e/

10 See this seminal piece: http://findarticles.com/p/articles/mi_m0FDN/is_2_10/ai_n14731873/?tag=content;col1

11 Check out this database for an interesting collection: http://www.metafro.be/prelude. Last accessed on 15 October 2010.

[1]2 You have probably noticed that I very quickly deplaned to “herbal medicine” even though I began my submissions with the all-encompassing term, “traditional medicine”. This was entirely deliberate. The piece of Ghanaian legislation that deals with traditional medicine begins the definition with these surreal words: “the beliefs and ideas...”. Any attempt to deal with the horrors of trying to systematise traditional medicine would have led to a treatise several pages long and many times more incoherent. Especially also, when there is a dry hint that perhaps systematisation and standardisation aren’t always the gems of wisdom they are usually held up to be.

[i] See a comparative account of different traditional medicine regimes around the world:

http://apps.who.int/medicinedocs/en/d/Jh2943e/7.21.html

[ii] The WHO is careful to clarify that the oft-quoted “80%” figure may prevail in some countries but not in all. My sources in the plant medicine community are however adamant that most surveys consistently come up with more than three-fourths being reliant on herbal medicines. I note from a paper that I reference below, however, that one such survey turned up 51% for maternal mothers in a West African community.

http://www.who.int/mediacentre/factsheets/fs134/en/

[iii] The latest edition of these documents can soon be accessed online here:

http://ghndp.org/index.php?option=com_content&task=view&id=47&Itemid=1

The more observant readers will note that it took more than 6 years for Ghana to update the previous one.

[iv] You may read more about the interplay of insurance systems and access to essential medicines here:

www.popcouncil.org/pdfs/GEMI_FinalReport_Winter2010.pdf

The focus is on Ghana, but as in many healthcare issues in Africa, you will soon find that issues tend to cut across geographical boundaries.

[v] A good overview of the subject can be accessed here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486664/

[vi] Please see:

http://openlibrary.org/books/OL1197131M/Ghana_herbal_pharmacopoeia.

[vii] Efforts are rife to better understand the dynamics of clinical testing in the African terrain.

http://www.edctp.org/Current-Call.410+M5e12c078de5.0.html

www.who.int/entity/ictrp/network/pactr2/en/index.html

[viii] A useful technical brief re pre-clinical acute toxicity studies:

www.crcnetbase.com/doi/pdf/10.1201/EBK1420045604-c4

[ix] The WHO is trying to spearhead the drafting of “current Good Manufacturing Practices” (cGMP) frameworks for developing countries. See:

apps.who.int/medicinedocs/en/m/abstract/Js14215e/

[x] See this seminal piece: http://findarticles.com/p/articles/mi_m0FDN/is_2_10/ai_n14731873/?tag=content;col1

[xi] Check out this database for an interesting collection: http://www.metafro.be/prelude. Last accessed on 15 October 2010.

[xii] You have probably noticed that I very quickly deplaned to “herbal medicine” even though I began my submissions with the all-encompassing term, “traditional medicine”. This was entirely deliberate. The piece of Ghanaian legislation that deals with traditional medicine begins the definition with these surreal words: “the beliefs and ideas...”. Any attempt to deal with the horrors of trying to systematise traditional medicine would have led to a treatise several pages long and many times more incoherent. Especially also, when there is a dry hint that perhaps systematisation and standardisation aren’t always the gems of wisdom they are usually held up to be.

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E-nabling Citizen Participation in Planning

Sandesh R. S. — Thu, 23 Sep 2010 19:13:51 +0000

The apex planning body of India, Planning Commission, is entrusted with developing, executing and monitoring the five year plans, which are plans formulated for the effective use of the nation’s material, capital and human resources. The commission was set up in 1950 in order to improve the standard of living of the people by efficient use of resources, increasing production and creating employment opportunities. The commission has so far formulated 11 five year plans.

The commission has decided to seek suggestions from public for the 12th five year plan, which begins in the year 2012. The commission has decided to launch “a web portal for general public to share their views about achieving more inclusive and robust economic growth of over 10 per cent during 12th Five-Year Plan”. The web portal to be launched next month will have specific objective type questions and a suggestion box. The responses received on the portal will be sifted and suggestions will be used to prepare the approach paper of the plan, which will be out in 2011. The Planning Commission is also setting up a facebook group to engage youth in the process. This is welcome move in a country where 50 per cent of the population is under 26 and the average age of the cabinet ministers is 64.

The commission should consider allowing citizens to participate via mobile phones as India has 600 million mobile phone connections and also because rural India is not well connected to the Internet. Though widespread participation might complicate the sifting process and reduce this exercise to pretence, it is a move in the right direction.

Image Source: Planning Commission, Government of India

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MILLEE: Education and Mobile Phone Games

Sandesh R. S. — Thu, 02 Sep 2010 08:17:29 +0000

Mobile and Immersive Learning for Literacy in Emerging Economies (MILLEE), a non-profit organization uses mobile phone games to improve literacy skills in emerging countries. Founded in 2004, MILLEE develops human-centred, immersive and enjoyable language learning mobile games which are modelled after the traditional games children play in the community. In India, MILLEE is using mobile games to impart English literacy skills to the poor children attending public schools. Mobile phones have also facilitated out-of-school learning. The organization has confirmed the effectiveness of mobile phones in learning through field projects in India.

Mobile phones provide a cost-effective, easy to use and fun medium for learning. Issues with mobile phones such as small screen, small keyboard and limited amount of storage have not proved to be hindrances for MILLEE. MILLEE is scaling up its English literacy program in India and also expanding to China, Kenya and other emerging countries. The rapid proliferation of mobile phones provides an excellent opportunity for expanding into many countries. India, for example, has more than 600 million mobile phone connections.

Mobile phone as a medium of learning has attracted considerable interest. Last year Nokia introduced Nokia Life Tools, a set of application for Agriculture, Education and Entertainment services for customers in emerging economies. Recently, a mobile service operator in India has also started offering language learning feature.

Photo Credit - unreasonableinstitute

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The ‘nano’ Computer

Sandesh R. S. — Fri, 30 Jul 2010 08:55:28 +0000

The Indian Minister of Human Resource and Development, Mr. Kapil Sibal, released a $35 (Rs. 1500) tablet computer last week. The touch screen device has been designed and developed by experts from Indian Institute of Technology Kanpur (IITK) and Indian Institute of Science (IISc), Bangalore. The device was conceived 5 years ago as a response to XO, One Laptop Per Child (OLPC) Foundation’s laptop, which is currently priced at $199. Is it another feather in the cap of the Indian innovators, who earlier produced a $2,200 car and $16 water purifier?

The device based on the Linux platform comes with a number of applications such as video conferencing application, a multimedia content viewer, Open Office suite and media player. It also sports a USB drive. Keeping in mind the infrastructure challenges of developing countries, a solar panel has been included in the device. The price of $35 includes the cost of manufacturing the device abroad. The cost of the solar panel has, however, not been factored. The government has already decided to provide a discount of 50% to educational institutes, which will make the device as affordable as a basic mobile handset at $18.

"The aim is to reach such devices to the students of colleges and universities, and to provide these institutions a host of choices of low-cost access devices around Rs 1,500 or less in near future," said the minister at the unveiling ceremony. The device is expected to be available to students in 2011. The specifications of the device have not yet been disclosed. The utility of the device and its developmental benefits will ultimately depend on how well this device is integrated into the education system.

The OLPC program which championed a similar cause has been criticised on many grounds – no sharing policy, no seamless integration with the existing education system, creating resource imbalances and also for its top-down design. The people behind the Indian initiative can learn many lessons from OLPC. Opening up the platform and encouraging the technology community in India to improvise and build better devices and applications will help the cause in a big way.

Image Source: AP Images

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“Call them not your children, call them your builders”

Chloe Feinberg — Mon, 26 Jul 2010 19:01:39 +0000

This post first appeared on the Global Health Ideas blog. It has been cross-posted with their permission.

***

This is a guest post by Preethi Sundararaman, summer associate working with the FEC Healthcare for All team at Ashoka.

It is a known fact that childhood obesity is on the rise, affecting one third of American children today. Alarmingly, researchers are predicting that for the first time in U.S. history, children may have a shorter life expectancy than their parents.

On July 13th, I attended the “Innovation, Information and Technology for Better Health Outcomes” conversation event held at World Bank. Todd Park, the Chief Technology Officer of the U.S. Department of Health and Human Services (HHS) and co-founder of Athenahealth Inc., was one of three panelists at the event.

A key theme Park brought up was the impact technology and social media could have on healthcare for younger generations. “What if FarmVille were HealthVille?” Park asked. FarmVille, a real-time farm simulation game, has acquired 75 million Facebook users just within a year of being available. If games with the potential to reach this many were designed around health data, generations to come could grow up being more health conscious.

Park highlighted the 2010 Health 2.0 Developer Challenge, which is run by the company Health 2.0, and supported by HHS and its Community Health Data Initiative (CHDI), the new open government effort encouraging innovators to use health data made publicly available by HHS. “Community Clash” is one of several new apps created to engage users in the health data available through CHDI.

“Community Clash” creatively incorporates HHS data in what Park calls “Healthcare Blackjack.” The online card game, launched by MeYouHealth, involves a comparison between your city and a “Rival City” on a number of health indicators from obesity rates to unemployment rates. Todd Park claimed he learned things he didn’t know by playing the game, adding “it’s incredibly addictive.” After trying the game myself, I would have to agree! I was surprised to learn that 68.1% of adults in Washington, DC eat on average less than the minimum daily recommendation of 5 servings of fruit and vegetables.

Charged by the excitement and new knowledge I had gained, I proceeded to search for initiatives on apps specifically for kids and found that earlier this year, First Lady Michelle Obama had announced the Apps for Healthy Kids Challenge in conjunction with the USDA as part of the Let’s Move! campaign, asking innovators around the nation to develop video games and mobile applications to incite physical activity and promote healthy lifestyles.

One of the 95 final entries was developed by Alaka Sarangdhar, a Portland-based software engineer. Her application, called iNutri8, is an iPhone app designed to make nutritional information available at your finger-tips and show users how their daily eating compares to the food pyramid guidelines. This allows kids to be aware of the portions and food groups they are lacking or exceeding in, and how their eating habits can be improved. I was able to ask Mrs. Sarangdhar how she sees the tool affecting kids in the future, and she stated “I hope iNutri8 teaches the younger generation to be aware of what they are eating and its nutrition value. With this on-the-go tool, they can even try to evaluate their options before they eat to see what will give them an overall healthy diet…” You can vote online for iNutri8 and your other favorite entries in the Apps for Healthy Kids Challenge until August 14th.

After browsing through the entries in the Apps for Healthy Kids Challenge, it became apparent that Todd Park was on to something. What if apps were created to engage kids in HHS health data? With something like “Community Clash” that is fun, appealing and adds a competitive element to useful information, kids could not only improve their own lives but be more aware of healthcare issues in the communities around them.

Enter: the “Why-Health?!?!” challenge. In this challenge - one of five on the Health 2.0 Developer Challenge platform - Whyville.net, a virtual gaming site with 6.3 million users aged 9 to 15, asks developers to design games and other interactive resources that cater to their young users and make health data “accessible, understandable and actionable.” You can submit your applications to the Whyville health challenge until September 15th of this year.

Provided with the right tools to be more aware of health issues, today’s younger generations could build a better future for all of us.

*The quote used in the title is from the Talmud, and is displayed at the American Visionary Art Museum in Baltimore.

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How Much Gas Do You Emit?

Chloe Feinberg — Mon, 12 Jul 2010 19:10:16 +0000

This post was submitted by Preethi Sundararaman, an Ashoka Summer Associate working with the FEC Healthcare for All team.

Most people underestimate the effect of household energy consumption on CO2 pollution, though statistics show that households and small consumers account for nearly 25 percent of all CO2 emissions.
I know that I would like to reduce my own energy consumption, but sometimes it is difficult to know how or where to start. Now, imagine if we could check our household energy consumption rates as easily and as often as some of us check our Facebook newsfeed. Our world could be infinitely more energy-conscious.

It turns out that Ashoka fellow Johannes Hengstenberg is a step ahead of us, having created a website back in 2004 that can be used to calculate household energy consumption numbers.

Through his “Climate Seeks Protection” Campaign, Johannes Hengstenberg aims to reduce CO2 emissions from private households and small consumers due to heating, electricity and transportation. Johannes believes that by saving fossil fuel energy, we can stop the increase of greenhouse gases in the atmosphere.
Part of this campaign’s media outreach includes Germany’s oldest polar research ship, the “Grönland”, sailing the North Sea to inform visitors along the ports about sustainable energy use.

More notably, with the help of some software engineers, Johannes developed online tools that allow consumers to analyze energy bills, track their energy consumption and take action to reduce it. Johannes has designed the tools to emphasize the economic benefits of a more sustainable lifestyle, offering personal comparisons to the national average and identifying a household’s saving potential, both monetarily and in terms of CO2.
Consumers may find that by upgrading home appliances and heating systems, modernizing water boilers or changing the materials used to build their houses, they could save up to 70 percent of energy costs.

The tools are available (in German) online at www.co2online.de free of charge. The website also offers email services, FAQ sections, and relevant how-to information on subjects ranging from modernizing heating systems and basements to insulating roofs, walls, and windows.

As of 2008, Johannes’ online tools had reached more than 2 million people in Germany. Currently, it is estimated that users have been motivated to reduce a total of 4.5 million tons in CO2 emissions. Having replicated his approach in Austria, Johannes is now working towards expanding his efforts across the rest of Europe. He hopes to ultimately take the technology and the approach worldwide.

Since Johannes’ election as an Ashoka fellow in 2007, several related websites and applications have appeared. The U.S. Environmental Protection Agency includes a Household Emissions Calculator on their website. Microsoft takes this to another level through Hohm, its online home energy management application where users can also compare their energy efficiency scores with neighbors. Utilities in some major metropolitan areas such as Chicago and Seattle have also started using the neighborly competition approach to motivate customers to reduce energy consumption, offering neighborhood comparisons along with the monthly bills. This June, Cisco announced its new Home Energy Management Solution technology which utilities can provide to their customers, featuring a countertop LCD touchscreen display that allows monitoring and control of energy use and costs in real time.

With last year’s “Cash-for-Clunkers” rebate program resulting in the purchase of almost 700,000 fuel efficient cars in the U.S., and Johanne’s success through co2online in Germany, there is reason to believe that financial incentives and easier access to information can encourage more energy saving behavior worldwide.

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Empowering Chilean Farmers via SMS

Sandesh R. S. — Tue, 29 Jun 2010 20:56:30 +0000

COOPEUMO, a grassroots farmer’s cooperative with more than 350 small scale farmers as members provides a number of services to farmers such as technical assistance, credit and training. Last year COOPEUMO started a pilot project called DatAgro to provide SMS based information to farmers. The service started in April, 2009 has been supported by DataDyne, Federation of Agrarian Innovation, UNESCO, Entel PCS and two Chilean newspapers- El Mostrador and El Mercurio.

By providing information related to supply and product prices, climate conditions, and international markets; the initiative allows small scale farmers to align with the market needs. Thanks to the proliferation of mobile phones, farmers today have access to such information. ‘Last week I received one (message) about the weather so I didn’t plant anything because of the information I received and I planted yesterday, after the rain had stopped’ says Hugo Tobar, a farmer. Ninety percent of adults in rural areas of Chile have mobile phones. Farmers today consider mobile phones as a necessity and not a luxury.

At the heart of this initiative is the Mobile Information Platform (MIP), a technology developed by DataDyne. MIP is a platform to broadcast SMS based information to mobile phones. MIP works on the most basic mobile phones and on less-than-GPRS networks. The added advantage of MIP is that farmers can also subscribe to RSS feeds from interesting and useful internet sources by sending simple SMS text commands.

Mobile phone based services are not only easy to set up and easy to use, but also less expensive. Farmers in Chile required little training in using DatAgro. With mobile subscriptions projected to reach 5 billion this year, initiatives like DatAgro can create a positive impact on the farming community worldwide.

Image Source: DataDyne

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Episode 14 of the AshokaTECH Podcast: Marc Maxson of Global Giving

Alex Budak — Thu, 27 May 2010 03:14:02 +0000

On this week's episode of the AshokaTECH Podcast host Alex Budak interviews Marc Maxson, the Manager of Performance Analytics, for Global Giving.

The two of them discuss the work Marc has been doing with encouraging storytelling in Kenya and the latest in the field of analytics and measurement for non-profits. They discuss an innovative project in Afghanistan called "Beer for Data" as well as leading scholarship in the area.

Visit the podcast's page in iTunes to subscribe, or listen to and download the episode directly on the official AshokaTECH Podcast page. To download the .mp3 of this week's episode, click here.

Movirtu and frog design team up to create "telecom cloud"

Dave Foster — Fri, 21 May 2010 19:21:58 +0000

From a press release dated March 31, 2010:

MOVIRTU COLLABORATES WITH FROG DESIGN ON USER INTERFACE INNOVATION

Global innovation firm frog design will assist Movirtu to ensure quick navigation and ease of use of their MX series of products for a population in need

Movirtu, a supplier of innovative network infrastructure solutions for mobile operators servicing rural poor communities in Africa and South Asia, will collaborate with global innovation firm frog design on user interface design for Movirtu’s MX series of products.

...

frog will help bring a critical resource–communication–to a population in need, in an easy to use and easy to understand format. frog will focus on navigation, ease of use, and lifestyle appropriateness of Movirtu’s products. As part of the effort, frog will jointly work with Movirtu on field studies including one in the Kibera slum in Nairobi, Kenya.

“One of our primary goals is to ensure that people living at the ‘Base of the Pyramid’ find our products simple to use and easy to connect with,” said Nigel Waller, Founder and CEO of Movirtu. “We are proud to work with such a talented firm as frog, and it gives me great pleasure to see how committed they are to helping those living below $2 a day.”

Movirtu’s Product Series

Movirtu’s MX series of patent pending products enables shared access to basic mobile phone services for people earning less than $2 a day. The series includes MXShare, which when installed in the core of a mobile network establishes a virtual mobile phone system enabling people who cannot afford to buy a handset to make and receive calls, SMS's and messages using other people's phones or street-side payphones; MXPay which allows people who do not own a mobile phone or SIM to send or receive remittances using existing mobile payment systems; and MXInfo which enables personalized information access and exchange for healthcare, agriculture and education. All the products require no special handsets, SIM cards, or additional client software; they work instantly on all mobile handsets available today using protocols already existing in today’s GSM Association standards.

The MXShare process is illustrated below. Customers pay for an initial account with ID number and PIN. They can then buy additional “Top-Up” cards to add minutes as needed.

Movirtu Meets frog

I had the opportunity to talk with frog designers Ashley Menger and Michael Cetaruk and marketing coordinator Kristina Loring to ask them about their experience designing the customer interface, their research with residents of Nairobi’s neighboring slum, Kibera, insights from the process, and frog design’s commitment to social innovation.

frog design (spelled lower-case) is a global innovation firm based in San Francisco with multiple studios across the U.S., Europe and Asia. They work “with the world’s leading companies, helping them create and bring to market meaningful products, services and experiences…across a broad spectrum of industries, including consumer electronics, telecommunications, healthcare, media, education, finance, retail and fashion.” frog's team includes designers, technologists, strategists and analysts, and like many design firms with roots in product and industrial design, has expanded its scope and services since its founding in 1969 to provide their clients with design and innovation in a broad spectrum of formats.

It was frog’s depth of expertise in mobile design that brought the collaboration about after VP of Creative, Robert Fabricant, met Moviru’s founder and CEO, Nigel Waller, at the annual PopTech event this past October, 2009. PopTech is a network and event series dedicated to changing the world through innovation and technology that has grown in prominence and impact over the last few years especially.

As Michael put it, “Nigel had this idea of making mobile communications available to the B.O.P.—the ‘bottom of the pyramid’—which can be anywhere from 2-4 billion people around the world, sometimes called ‘the last billion.’”

Borrowing phones and swapping SIM cards (the removable chip in the phone that holds your personal contacts and mobile phone information) can be problematic, so Movirtu involves logging in using codes. Customers' contacts and all usage data are stored in the “telecom cloud,” not on the mobile device, which maintains privacy, reduces personal data security risks and frees customers from using SIM cards or any specific device. The business model also includes incentives for phone lenders, addressing the other half of the transaction equation.

frog’s design team set out to create deliverables for Movirtu in two parts: 1) a synthesis of data collected and what they had learned from their research, and 2) the technical architecture, after the research and refinement, that Movirtu’s MXShare would use. This project required what Michael called “some left brain, some right brain, and some business brain.” As a for-profit business, Movirtu’s intent is to create a beneficial and accessible product for some of the poorest people in Africa, effectively solving a problem while serving a market that has so far been underserved.

frog Goes to Africa

Ashley and Michael, both based in frog’s studio in Austin, TX, traveled to Kenya earlier this year to spend about 10 days in Kibera with its residents, testing their initial proposed designs, getting reactions and collecting feedback to refine the user interface. As Ashley said, “It’s hard to imagine the situation (for Movirtu’s targeted customers in Africa) from an office in Texas. Part of the goal in going to Kibera was to identify their basic needs—practical and emotional—and to ensure that this product was going to do that."

(photos from Flickr by: Mothers Fighting For Others and khym54)

frog's team toured Kibera for the first few days, talking with people, gathering observations and getting to know how its residents lived. After that overview, they focused on 12 different individuals for their opinions and input, running through their script and demonstrating their application, testing their initial concept. They wanted to find out if customers could easily grasp it, and if so, what did they think of it? All 12 interviewees were residents of Kibera. None owned a mobile phone but all relied entirely on mobile phones for communication.

“People said ‘This is great!’” says Ashley. Though feedback was mostly positive, there were some issues to refine. One of which was the nomenclature to be used. Ashley says that surprisingly, most of the snags they ran into with wording had more to do with language differences between MXShare's tech developers and its end-users than with any differences between native or non-native English speakers. Commands like “back” or “answer” didn’t quite jive with the functions they performed in operation. One word choice that didn’t quite work was “Call log”—maybe because a literal translation of “log” could understandably lead to some head-scratching—but “call list” or “call register” were more familiar terms and could be used instead. The team also looked at Swahili to get a sense of how they could use it, but in the end, Michael said they “ended up going largely with established nomenclature,” reflecting a larger trend of increasingly universal design, including language.

What They Learned

“In the case of Kibera residents, a product that satisfies these needs, isn’t only a successful product—it ultimately provides empowerment to the disempowered.”

The designers identified six basic needs of the people they’d be designing for: pride, privacy & security, identity, education and enablement. With every aspect they would design, they would hold it against this list, asking “does this meet a need?”

Pride – Of the individual and of the lender. The individual has the pride of ownership of an account while not having to ask as much from a lender because the phone no longer needs to be taken apart to swap SIM cards. In fact, because of the incentives provided to lenders, the borrower is helping the lender by borrowing their phone.

Privacy & Security – There is no lingering data left on the lender’s phone. The mobile account is protected by a secure PIN (personal identification number) and all calls and text messages are sent to the subscriber’s individual mobile account.

Identity – Each user has their own phone number with the ability to send and receive messages. Friends recognize who is calling and can save them as a contact.

Education – A consistent navigation model among MXshare products supports educational materials from MXShare and incentivized lenders can teach borrowers how to use the service.

Enablement – No longer dependent on a particular device or SIM card, MXShare is as simple as logging in. Contacts are stored in the account and the incentivized system for phone lenders is creating a broader network that will ensure all borrowers can access mobile phones.

Connection – Users’ contacts are stored and accessible in their account only, along with waiting messages, incoming calls, missed calls and received calls, and a community of lenders welcomes their business.

Those six elements were distilled from information, observations and stories gathered. “The most basic elements people really need in Kibera are the ability to store contacts, and ability to text,” Ashley said. “People ran home to get contact lists (phone numbers) often. They spend so much of the day commuting and working, there’s no real time to spend time with people. Here, contacts are even more important than the ability to text.”

In further discussion about connection, Ashley says, “The internet is hardly available—when it’s used, it’s for Facebook.” (Facebook, really?!) “I was talking with one of my guides when I was doing my basic design research. He said he used the internet about every 2 or 3 weeks, on a dial-up modem and has to pay per minute. The time lag is horrible and cost-prohibitive. As we were parting, he asked me ‘are you on Facebook?’ I said yeah, and by the time I got back to the hotel 3 or 4 hours later, I had 4 or 5 new friend requests, from him and a few of his friends. It was touching for amount of effort it took.”

“Facebook is different there," Ashley continued. "People put up one or two photos but don’t use status updates. Their usage is sort of a stripped-down version because of bandwidth restrictions.” Another Facebook story: asking a girl if she was familiar with the meanings of “account” and “login,” she said no. “But wait!” she said, “My friend does. She has Facebook.”

“To spin off of that,” said Michael, “I think that part of the attraction for Facebook is that it allows people to build communities. Communities are fragile over there, and shifting. Connections with community are not as firm as we have here and without steady communications, they become more vague. Facebook helps provide some of that permanence.”

Ashley stressed the importance of identity in conditions like in Kibera, “You have no address, no phone number, no way for people to find you. Facebook and phone numbers are like an address. And if you have communication, now you have access beyond where you walk each day—to news, mPesa (a mobile-phone based money transfer service), education. There is a sense of connection with world around you, and ultimately empowerment.”

On connectivity and income, Michael pointed to the benefits of having access to a mobile phone. “In Kenya, there’s a pretty advanced way of sending money – mPesa. That’s one of the huge uses of communications, as well as just trying to find a job. One man who’s a day laborer, earning $3-4 per day has to walk to a placement center 5 to10 miles away just to get a day’s work. What if there’s no job when he gets there? He can’t afford a phone, but he could afford $0.20 to call and see if there’s work available.”

Until now, the use of SIM cards have allowed multiple users to share mobile devices, but as the frog designers (and many others) have discovered, SIM cards are problematic. SIM cards are often shared by families, friends and so on. When a person carries their SIM card with them, there’s a fear that it will get lost or stolen. If you lose your SIM card, it can be nearly impossible to find—the terrain is hilly and streets are hard to navigate, nothing is paved, there is a lot of scattered trash and people often walk very long distances in a day, meaning there are a lot of steps to retrace if you have to search for your tiny lost SIM card. If a person doesn’t have their SIM card with them—whether they left it at home or someone else they share it with has it at the moment—they could spend hours just going to get it before being able to make a call or send a text. Another problem is that to use a SIM card in someone else’s phone, you have to physically take pieces of the phone apart, which can understandably make a phone lender nervous or unwilling to lend their phone.

The Future of Movirtu’s MXShare

The research portion is done and the development is underway. Movirtu will then look to take it live, most likely partnering with an existing telecom company. “Will launching it be difficult?" I asked. I wondered if there would be difficulties involved with infrastructure or the politics of business in the region or if telecom companies have that mostly wired by now so that MXShare could be launched smoothly and easily. Michael said I’d be better off asking Nigel about that, so maybe there’s a follow-up blog post on the horizon. In either case, Nigel’s past successes and experience give pretty good hope that he and Movirtu will be able to make it work.

VIDEO: Nigel Waller presenting the MXShare concept at PopTech 2009:

What’s Next for frog’s Designers?

I asked Michael, Ashley and Kristen if they saw or learned about anything in their research and work on this project that they can’t wait to work on next.

Michael was impressed with a number of the people he met, including Eric Hersman (well-known blogger and technologist also known as White African - blog / twitter) who they met at the newly established iHub in Nairobi. He said he’d love to help people like Hersman and the communities they're helping with communication, mobile payments and micro-credit like Kiva to make their lives easier. “Information flows like water, and if money can too, we could do great things,” Michael said. He said that he and Ashley are working on some of that stuff in their private lives.

Ashley was most interested in stitching together existing communication solutions, helping people put them together and use them. She was struck by the basic technologies people relied on in Africa in comparison to those most prevalent in the U.S. “I think what was unique about this (working with Movirtu) is that we’re usually involved in the biggest and baddest technologies but what was exciting about this was using basic, rudimentary technology to solve a problem. Not from a tech view but from an enablement perspective.” Ashley suggests people design more for basic mobile technologies like the Nokia 1100—"the cheapest, most baseline, most accessible phone—the base currency phone in Africa," as she discribes it.

Kristen and other frog designers are currently working with a group called Vittana to help students and micro-credit institutions with peer-to-peer loans to finish their educations, contributing UI and web design services in-kind. Kristen is also a frequent writer and involved in frog’s monthly publication, design mind.

frog design and Social Innovation

frog has been increasingly involved in social innovation and impact, most notably working on Project Masiluleke (or "Project M") with the South African government on a program of advocacy, awareness, prevention and treatment of HIV and Tuberculosis based in mobile technology. The program has achieved much acclaim and is continuing to expand. As mentioned, frog design is also lending their services to Vittana to help students receive loans through micro-credit. frog has worked on educational issues within the United States with MTV and the Gates Foundation, and frog designer Jon Kolko has recently established the Austin Center for Design, a school dedicated to design and social entrepreneurship.

When I asked about the future of frog's commitment to social impact, Michael said there's a commitment to more. "We’re in that mix and the community continues to grow. We find that new frogs (as the firm's employees are known) that we hire, when they hear about this, they say things like 'this is why I came to frog, to do this kind of work, changing the world.'"

Here's to much more from frog and the growing list of designers working to create better solutions for real social impact around the world.

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