30 December 2011

2011: A Blog Year in Review

A real year in review is forthcoming, as are the ABBAs which I decided to hold in January given that everyone is traveling and on vacation right now.  Here is a quick run down of how the year went on AVFTC, what I hope for next year, and a request from all of you to let me know what you hope to see on AVFTC next year.

Top Post of 2011

  1. Ian Birrell vs Paul Kagame on Twitter 
  2. Volunteering Overseas: A Socially Conscious Action That Only Looks Like It Helps 
  3. Visualizing Kiva's Growth 
  4. Food Aid Sleight of Hand 
  5. 100K Discussions about World Vision 
  6. Aid's God Complex and Bloggers Groupthink 
  7. Stop the Pity: Now We are Getting Somewhere
  8. You Hate Innovation. Really, You Do.
  9. The Empire Strikes Back: Sachs Vs. The World
  10. Three Cups of Lies

The trend in the top 10 is that the stories are more towards the side of reporting than they are opinion and analysis.  It is something I have begun to explore further and expect to do in the coming year.

The Data

In 2011, AVFTC had 75,959 page views and 59,669 unique visitors.  I published a total of 456 posts (this puts the number to 436) placing my average just over a post per day.  The numbers felt a bit low until I compared them against 2010 when I had 28,322 page views and 19,761 unique visitors.  Comments also jumped by a significant margin thanks to the more popular posts like Birrell vs Kagame (79 comments).  In sum there were 880 comments on AVFTC in 2011.  A good portion are mine since I try to respond as frequently as possible. On average, this means that I had a comment and a response on nearly every post.  By all accounts 2011 has been a big year for AVFTC. Finally, RSS readers have grown from 127 to 619.

Looking to 2012

An outcome of this growth has been the opportunity to participate in more events that are traditionally covered by journalists.  I still have a tough time seeing myself as a part of the realm, but I would be remiss to avoid these reporting opportunities because of a discomfort with a title.  2012 should be a time to do more reporting.

I have criticized the reporting of people like Nick Kristof.  There is little I can do if I am not in the field, but that does not mean that I cannot use my available resources to provide an alternative.  I believe I am still a long way from what I envision, but having a strong community in this space means that I will be held to a high standard.

To My Readers

First off, thank you. Knowing that people read this space and hearing encouragement from you has kept me trying to make this as useful to both you and myself as possible.  I am very appreciative to all of you.

This started as a place to learn and it continues to be a space where I have grown in my understanding in international aid and development.  I have learned that it is also a place where people come to learn and stay informed.  Because of that, I want to do better by my readers.  What do you want to see on this blog?  How can this be a better resource for you? Please feel free to add some ideas in the comments section or shoot me an email at murph (at) aviewfromthecave.com.

Thanks again and see you all in 2012!

29 December 2011

The Challenge of Telling Global Stories

Sam Loewenberg, who has written for The New York Times, the Guardian, and Slate, among others, said he couldn’t garner interest in a story about the recent hunger crisis in the Horn of Africa, which this summer suffered the region’s most horrific drought in 60 years. Humanitarian alerts described it as the worst such disaster in the world with inadequate response efforts. Yet, Loewenberg said, “nobody cared.” 
“One news magazine said, ‘Oh, that could be interesting, but we’re going to have to meet with editors and see what the angle is and come up with an interesting approach to this.’” 
“Eight million people are going hungry and that hasn’t been reported anywhere,” Loewenberg replied. “What angle are you looking for, exactly?” 
Eventually, he sold the piece to The New York Times opinion page. But it was “a missed opportunity,” he said of the lack of media coverage. “Because there are a lot of things that can be done. But that’s the horrible result of the lack of press because it means the politicians don’t pay attention so the money doesn’t come.” 
Loewenberg pointed to the drastic downsizing of foreign bureaus over the past decade, saying, “now these stories aren’t getting covered. We can see how that directly affects funding … by putting stuff out there, we are affecting public policy.” 
Reading that makes me equally depressed and inspired. The article from the Global Post continues to describe how the challenge described by Lowenberg is particularly applicable to global health reporting.  Other journalists are quoted, but the core of the discussion is how hard it is to have stories like the HoA famine told.

How can the point arrive where Lowenberg can tell the story of the Horn of Africa at the moment of crisis?  More importantly, when can people living in the region begin to tell their own stories?  How can consumers make it clear that we want more of these stories to be told?  The blame cannot rest with media companies and journalists alone.  As Lowenberg showed, he was more than willing to report, but the story was not deemed important enough to publish.

25 December 2011

Merry Wonky Christmas

The Atlantic does the research for Christmas.  Merry Christmas to all who are celebrating!

22 December 2011

Ed Carr on Globalization and Development

Ed Carr is interviewed by Keith Kloor for Yale environment 360.  Carr discusses his book Delivering Development: Globalization’s Shoreline, and the Road to a Sustainable Future in the context of development and environmental change.  I am about halfway through the book myself and have enjoyed the challenge Carr has set by focusing on a pair of rural communities in Ghana.

One part that stands out in the book is Carr's treatment of globalization.  This section from the e360 interview captures a very small section of the book's discussion:
e360: In your book, you write that, “the single greatest misconception shaping contemporary views of development and globalization is the idea that the problems of poverty in the developing world are the result of the absence of development.” Can you explain? 
Carr: When we look at the global poor, when we look at people living on a dollar a day, there’s this assumption that development does no harm. That is to say, we couldn’t make things worse for these people so we ought to be trying everything all the time. That’s sort of the Jeffrey Sachs logic, that we have to be doing something and not just sit here. But this fails to grasp the ways in which people are already doing great things to make a living and in fact a nonproductive intervention could undermine those things and do real damage.
The book itself reads as the anti-The World is Flat as Carr argues that people are not necessarily chasing globalization.  I will save further comments when writing a full review, but I do suggest giving the book a read and checking out the e360 interview.

21 December 2011

USAID: Building Resiliency in the Horn of Africa

Resiliency has become the word of choice and de facto mantra chanted by USAID Administrator Raj Shah.  This reflects an organizational shift of focus in its programming in response to the five month old famine in the Horn of Africa (HoA).

The word ‘resilient’ carries two definitions; both of which are applicable to the present efforts to alleviate the effects of the ongoing drought in the HoA and ensure systems that prevent future instances of food insecurity.   It embodies the aim to bring together short term assistance with long term development.

Programming in the HoA seeks to give people living in the region the ability to adjust to the cyclical droughts that return every few years.  Feed the Future is one USAID program that hopes to build the capacity to withstand weather challenges.

Borne out of the 2007-8 food crisis and ensuing G8 Summit in L’Aquila, Italy, Feed the Future leveraged $3.5 billion in financial backing to rally support around the Rome Principles for Sustainable Global Food Security.  The signatories agreed to:

1.       Invest in country-owned plans that support results-based programs and partnerships, so that assistance is tailored to the needs of individual countries through consultative processes and plans that are developed and led by country governments
2.       Strengthen strategic coordination to mobilize and align the resources of the diverse partners and stakeholders — including the private sector and civil society – that are needed to achieve our common objectives
3.       Ensure a comprehensive approach that accelerates inclusive agricultural-led growth and improves nutrition, while also bridging humanitarian relief and sustainable development efforts
4.       Leverage the benefits of multilateral institutions so that priorities and approaches are aligned, investments are coordinated, and financial and technical assistance gaps are filled
5.       Deliver on sustained and accountable commitments, phasing-in investments responsibly to ensure returns, using benchmarks and targets to measure progress toward shared goals, and holding ourselves and other stakeholders publicly accountable for achieving results.

The 20 countries covered by Feed the Future represent some of the world’s most food insecure.  Notably, the capture in Africa involves the countries currently dealing with the drought in the HoA as well as the Western African countries that make up the Sahel region.

While the present focus is on the HoA, it is the Sahel that is starting to draw concerns from the likes of the World Food Programme who warns that Niger, Chad, Mauritania, Burkina Faso and Mali are at significant danger of seeing widespread starvation due to poor rains and high food prices. “Like the Horn of Africa, the Sahel is an area where we need to work in a concerted way to provide resilience for families to avoid famine,” said Nancy Lindborg USAID’s Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance.

I had the opportunity to speak with Lindborg after USAID held the two-day “Enhancing Resilience in the Horn of Africa: An Evidence Workshopon Strategies for Success” workshop.  The aim of the vent was to bring together practitioners and look at ways to bridge relief aid with long term development goals.  Administrator Shah spoke at the event and stressed the importance of finding solutions to aligning aid and development. 

It was made clear that ‘resiliency’ was the way forward for USAID and that sentiment was echoed by Lindborg.  “We know that this is a region where droughts come regularly.  Our goal is to help communities withstand those shocks without going into a crisis.  We can do this by helping people provide for their families through nutrition, better agriculture and a better economy,” she said.

The ability of Kenya and Ethiopia to avoid famine during the drought is the result of programs implemented by the respective governments.  “Huge expanse of Kenya beyond the paved road, area where the drought takes place; those areas are where we have worked on these resiliency programs so those families have now avoided crisis,” explained Lindborg.

Having aid and development at the same table means that more long term solutions will be embedded into the present relief work. Unfortunately, the lack of governance and structure in Somalia has both contributed to the famine in the south in addition to preventing adequate relief and development solutions to take hold.

Looking west, the situation now in Sahel feels much like the Horn of Africa in early 2011.  This will be another test for the goal of promoting resiliency in agriculture-based relief.  There are plenty of lessons to learn from the HoA famine.  The most apparent is the stark difference between how Somalia was affected compared to its better prepared neighbors.  Bouncing back is an integral part of resiliency, but like a ball being bounced, the composition matters a lot. 

Lindborg stressed that the determinant for the resiliency is the countries themselves.  She explained USAID as more of a support structure.  Keeping with the ball metaphor, the newly constructed material will be determined and forged by the country, not USAID.  Doing so is important as it places accountability on national and local governments rather than foreign actors.  It is what ultimately builds the connection between aid and development.

The issues discussed are nothing new or even earth shattering, but it is still positive to see that big donors looking for solutions that rest within the nexus of aid and development.

20 December 2011

A Hard Look At Aid Blogs

Tobias Denskus has consistently written one of the most reflective blogs that really looks hard at the aid/development blogosphere.  His latest post is no different when he reviews the year and writes:
However, all these positive experiences should not gloss over key problems of development blogging. As much as I like to praise open, innovative and modern approaches and organisations I have also realised that you can live relatively happy in your silo. The idea of an evolutionary process where only the ‘smartest organisations’ attract the best people and will thrive funding- and impact-wise will be a myth for some time. Take German development cooperation for example: If the minister does not like open aid ideas or peaceful development concepts nothing will really happen. Germany continues to be a donor and whenever the ministry will recruit new young staff they will receive plenty of applications...This also true to some extent for DIY-aid, voluntourism or how mainstream media report on development issues. Despite continuous, detailed and numerous posts, many bad examples are likely to surface next year, too. 
Or take the summits in Durban and Busan: This was old-fashioned conference-bubble-diplomacy at its best with some pretty predictable resultsComplexity theory? Not necessary to understand this document! I am still not satisfied with the open aid data discourse and its focus on quantitative data and IT-solutions. And when we talk about the ‘pulse of the industry’ it also noteworthy to look at initiatives like DevEx’ 40 under 40’: Great people, no doubt, but many of them are also firmly embedded in the organisational and ideological mainstream. Whenever the name of a big accounting or consultancy firm pops up, I have a feeling that alternative views and methodsstill have a long march through the institutions ahead.
Overall, Tobias is optimistic, but there is good reason to be concerned that the space becomes an exclusive sort of echo chamber.  Reading this, and his final point, pushes my thinking towards how more people can actively participate on the fringes of the 'organizational and ideological mainstream.'  I remain unsure what the exactly looks like.  Beth Kanter talks about 'free agents,' but I am not sold on their use let alone if aid agencies or multilateral will allow individuals to operate with complete agency.

There is plenty to think about as the year winds down. Do read the full post.

19 December 2011

Revisiting the Birth of a Great Leader

To commemorate the death of Kim Jong-il, I am reposting the birth story of my cat while living in Kenya in 2009.  Having learned of the great birth story of KJI, I thought it was appropriate to have one for the cat.

On January 20, 2009, a new great leader was ushered into this earth.  A meteor from sent directly form heaven, which had been traveling for over eight million years, crashed into the Rift Valley, home of the revered Masai warriors.  From the fiery pits of  the mile diameter creator the wisest, most brave, strongest, and greatest leader was borne.  

In the tail of the meteor flew 10,000 angels to herald the greatest leader in a song so perfect that it is both unplayable and inaudible to any person or animal save the greatest leader.  Born in and of fire, the greatest leader makes his bed within a fire pit each night and turns into pure fire when he sleeps. So he may commune with the Gods.  He can make the rain stop with one look at a cloud and change the direction of the wind with a gentle purr.  The day he was born a unicorn was seen flying across a rainbow that included the additional colors of purple and black.  

Set against a red sky to signify the blood of those who will be spilt if disobedient. People stopped working and fell to their knees at the sight and rejoiced.  The greatest leader had finally arrived.

To all commoners, you may refer him as either "The Greatest Leader" or "Meowmar al-Catdafi."

16 December 2011

Impact of HIV/AIDS on Women and Girls in Asia

I wrote this post for the PSI Healthy Lives Blog.

A comprehensive study on the socio-economic impact of HIV at the household level in Asia was carried out by UNDP. The findings found that the "the region has been the inadequate efforts to mitigate the social and economic impact of the epidemic on people living with HIV, and their households." Most notable of the findings were the impact that HIV had on women and girls. The study found:

  • Female-headed (non-widowed) HIV-affected households (HIV-HHs) in Cambodia and Indonesia were less likely to own their home than maleheaded (non-widowed) HIV-HHs. They were also less likely to own a motor-vehicle, and in Indonesia, less likely to own a non-motor vehicle.
  • Female-headed HIV-HHs in Indonesia were more likely to be in debt than male-headed HIV-HHs.
  • The majority of female widows in HIV-HHs in Indonesia and Viet Nam reported being denied a share in their deceased husband’s property and assets. In India, the overwhelming majority (79%) of widows living with HIV were denied such rights.
  • Across the region, girls in HIV-HHs were the least likely to be attending school, and the most likely to have dropped-out.
  • In India, female PLHIV were more likely than male PLHIV to report having been sick, but not having sought care. They were also more likely than males to state the reason for not having sought care was due to financial reasons.
  • Female PLHIV in Cambodia and Viet Nam were more likely to report having low self-esteem and more likely to have had suicidal thoughts than male PLHIV.
  • In most countries, female PLHIV were more likely to have immediately disclosed their status to their spouse or intimate partner than male PLHIV. However, this may be partially reflective of the high male to female intimate partner transmission rate.
  • Responses from NA-HHs in China and India showed high levels of discriminatory attitudes towards PLHIV and their families. In India, more women held discriminatory attitudes than males, while the reverse was true in China.
  • In general, female PLHIV were more likely than male PLHIV to have been discriminated against: in Viet Nam they were more likely to have reported discrimination in health facilities and rights abuses; in Indonesia and Viet Nam they were more likely to have reported social isolation and neglect in their communities; in Cambodia female PLHIV were more likely to have reported verbal abuse, physical harassment and physical abuse.
  • Women in Viet Nam had relatively low levels of knowledge about mother-to-child transmission of HIV and in Indonesia and Viet Nam, low levels of prevention of mother-to-child transmission. In Indonesia, less than two-thirds of pregnant HIV-positive women told their health provider of their status.
  • In Cambodia, India and Indonesia, women were less likely to have knowledge of condoms for HIV prevention.

The authors of the study are careful to point out that the results are not as robust as they would like and follow up studies are necessary. To read the full report here and the additional report on women and girls here.

15 December 2011

Things I Like: Villages in Action 2012

Villages in Action 2012 is right around the corner.  The first iteration took place in November 2010 and was born out of the frustration that all of the high level diplomats and world leaders were gathering in New York City to discuss 10 years with the Millennium Development Goals.  Missing from the conversation and the city, were the very people these leaders were discussing.  That same week, the Gates Foundation held the TEDxChange event which again was missing the very people the speakers were discussing.

TMS Ruge decided to start an event that would be back at his home, emulating the TED style, and try to find ways to allow people to speak for themselves and show their own capability.  One section I particularly liked was a group of boys who presented on how they disassembled broken stereo speakers and constructed their own using jerrycans to house and amplify the sound.

Stories of these kinds of innovations are only now starting to be told.  I have raved about Makeshift magazine as a place that is accessing the stories, DAWNS hopes to also do so through citizen storytelling, but VIA brings this to life through a live event.

The 2012 edition will take place January 14 in Kikuube Village, Uganda.  If you missed VIA 2010, you are in luck.  Check out this 90 minute video of the day-long event.

14 December 2011

How Not to Write About Privilege

Gene Marks writes in Forbes:
I am not a poor black kid.  I am a middle aged white guy who comes from a middle class white background.  So life was easier for me.  But that doesn’t mean that the prospects are impossible for those kids from the inner city.  It doesn’t mean that there are no opportunities for them.   Or that the 1% control the world and the rest of us have to fight over the scraps left behind.  I don’t believe that.  I believe that everyone in this country has a chance to succeed.  Still.  In 2011.  Even a poor black kid in West Philadelphia. 
It takes brains.  It takes hard work.  It takes a little luck.  And a little help from others.  It takes the ability and the know-how to use the resources that are available.  Like technology.  As a person who sells and has worked with technology all my life I also know this. 
If I was a poor black kid I would first and most importantly work to make sure I got the best grades possible. I would make it my #1 priority to be able to read sufficiently.   I wouldn’t care if I was a student at the worst public middle school in the worst inner city.  Even the worst have their best.  And the very best students, even at the worst schools, have more opportunities.  Getting good grades is the key to having more options.  With good grades you can choose different, better paths.  If you do poorly in school, particularly in a lousy school, you’re severely limiting the limited opportunities you have.
There are too many reasons to be disappointed in this article, but it starts with the fact that he has no understanding of how privilege works.  The whole thing feels like an exercise in "I'm not racist, but..."  I make no claim to know all in these regards, but having worked for a few years with the population that Marks describes. I can say with certainty that he is completely wrong.

What is sad is that there are many Americans who read the article shaking their heads in agreement as Marks spouted his uninformed nonsense.  I wish I could say that hard work has brought me to the present point in my life.  It would be a nice feeling, but I recognize it to be entirely false.

HT Dan Solomon

HoA Famine Top News Story in 2011?

TIME has rolled out its top 10 and top 100 lists on a range of topics from Top 10 Crime Duos to the Top 10 Twitter Controversies.  A slightly more serious category is the Top 10 World-News Stories.  Naturally, number one is Arab Spring and it is followed by the deaths of Gaddhafi and Bin Ladden as well as the disaster in Japan.

Coming in at number 7 is the Famine in the Horn of Africa.  Surely it is a great thing that the crisis is being recognized as an important news event in 2011, but the reporting on it does not seem to reflect the ranking.  Ironically, the way that TIME characterizes the crisis and the the picture it uses captures how the story of the crisis has been told since July.

Being that it can so easily be summarized in a single paragraph, it is no surprise that the stories have died down. As seen below, the news reports rose sharply around the official famine declaration, but fell quickly within a few months.

The famine persists, but the appetite to report more stories has waned.  New reports project the famine continuing into the middle of next year and there is good reason to be concerned about a famine occurring in the Sahel region of West Africa.  If a famine does take place, there is a good chance that the reporting trend will reflect that of the Horn of Africa.

USAID and groups like ONE are trying to fill the present void through their advocacy campaigns, but seem to have yet to gain any significant traction.  That likely has less to do with their efforts than it has to do with the HoA being off the public radar.  The lack of news reports keeps it off the front page which then leads to a missing connection when a FWD commercial is seen on TV (saw them used this weekend when watching On Demand television).

Being listed as one of the top stories of the year is great to see, but the reporting needs to catch up to the other 9 included in the list.

13 December 2011

DAWNS + International Development Jobs List +2012 = Savings!

We have two big happenings coming up for DAWNS right now.  First, we have a special rate with a brand new partner for 2012 and we are excited to begin soliciting entries for our first grant round starting on January 2, 2012.

DAWNS inked a deal with our friend Alanna Shaikh, a blogger and American aid worker in Central Asia. At a special rate, you can subscribe to both Alanna Shaikh's International Development Careers List and the DAWNS Digest for one year.  From the IDCL you will get the latest job information and advice from a seasoned expert.  Readers are able to submit questions that Alanna will answer publicly to provide a forum for finding jobs in aid and development. Subscribers are also granted access to a IDCL LinkedIn group where you can communicate with fellow job searchers and recruiters. The cost for ICDL and DAWNS Digest runs at a total of $59.88 a year.  We are offering a special package for 2012 at a heavily discounted $49.99.  Please send us an email if you have questions or if you want to take advantage. If you already bought a DAWNS subscription and still want to take advantage of the offer, send us an email and we can work out a discount. 

More news will come in regards to the grants.  Check out the DAWNS mission statement to get an idea of what we hope to do with the money.  Also, we are creeping closer to a new website design and logo for early 2012!  Stay tuned!

OCHA Funding in Sudan

The UN Ofice for Coordination of Humanitarian Affairs has published a visual representation of its funding for humanitarian work in Sudan.  This might be a good idea for FWD to follow in the Horn of Africa.  There are not too many details, but the infographic provides enough for a larger audience.

09 December 2011

A cure for pilotitis? – Defining the role of NGOs in the evolution of mHealth

The following post is by Olivia Reyes, Program Support Specialist for Venture Strategies Innovations. The views expressed here are Olivia's and do not represent VSI.

On my flight home from the mHealth Summit, I began to think about how the past three days of presentations, debates and what appeared to be speed-dating with business cards, could genuinely improve the role that NGOs play in the epidemic of pilotitis. There were the obvious lessons learned and scale-up strategies shared that would improve projects and planning, but the actual role of NGOs – the organizations closest to the ground, implementing the programs, touching the people – was left awkwardly undefined. With vested interest in seeing non-profits succeed in the mHealth space, I couldn’t help but wonder why the conference left me with more questions than answers, seeking second opinions.

Why was there only a small contingency of implementing agencies working in LICs present at the Summit? 

Either I missed them amongst the crowd of 3,000, or the poster presentations should have received a spotlighted area in the exhibit hall – none of that quarantined “back in the far corner of the room” placement. The absence of a critical mass of program implementers reinforced the isolated nature of NGOs, with the Summit failing to apply its diversely skilled providers to its groups most in need.

During several conference sessions, it was suggested that coordination of mHealth efforts would reduce pilotitis and provide strength in numbers for NGOs to mitigate risks for mobile operators. This would enable larger groups to collectively bargain for better contract rates and ensure some longevity with affordable scale-up budgets. Yet the lack of implementing NGOs available at the Summit to build these critical relationships and platforms turned the responsibility of coordination into a hot potato – one that was dropped onto the [absent] laps of NGOs time and again by the funders and telecom companies pushing this responsibility away.

So why should NGOs be expected to see the forest through the trees? And why was there no suggested mechanism for coordination? 

What panelists conveniently forgot to mention (which David Aylward pointed out during a Q&A session at the GBC panel on 12/7), is that non-profits typically have limited resources, both human and financial, which are heavily influenced by the rules and regulations of their donors. Room for coordination efforts from the ground up are an American NGO’s aunt’s dream. Between our limited funding and tight donor reporting requirements and innovative thinking sessions, we are left to question ourselves with how and when could we possibly organize a coordinating body?

It appears as though coordination should be reframed as a shared responsibility that requires at least one dedicated catalyst. The CDC Foundation and Deloitte may be rising to the challenge in Tanzania, but there should be another mechanism made available in the short-term to continue the vast momentum of other country programs in a more collaborative manner. Without one, pilotitis could continue to spread quickly and potentially discourage and desensitize participants from further mHealth adoption.

As a critical player in the mHealth field, what should be the priorities for NGOs to continue the Summit’s momentum and eradicate pilotitis? Any second opinions?

07 December 2011

#mhs11 Day 2: The Unknown #FailFaire

The following post originally appears in UN Dispatch.  Two sections were not included in the UND post and I should note are my personal reflections on the conference.  Hopefully, they are more constructive than griping. I would love to hear back from other attendees on how to strengthen the conference next year.
Day 2 at the mHealth summit can be summed up by one word: failure. A session on maternal and child health in Africa offers opportunities in which participants might learn from past mistakes.
Intervention Failure
Dr. Koku Awoonor-Williams discussed the Mobile Technology for Community Health (MoTeCH) project in Ghana; a collaboration between the Ghana Health Service, Columbia University and the Grameen Foundation, he told a story that was also shared at the World Bank’s FailFaire.  The preparation for the project seemingly had all of the elements needed for a successful pilot.  A survey found that 80% of households had access to a mobile phone, making it ideal for implementing a mobile-based health intervention.
Using a snazzy randomized control trial, the program sought to determine if mobile-phone-based health information can improve outcomes and information collection.  The trial was to focus on pregnant and new parents by providing weekly messages in the language and format (sms vs voice) chosen by the client.  Health workers in the trial used the phones to collect patient data.
The trial came back with surprising results about the clients and the health workers.  Despite the survey saying that the majority of women had access to mobile phones, the truth was that the men largely had control meaning that women were not seeing the messages.  The health workers were a bit more mixed.  They liked the simplification of the process, but problems arose when they did not complete all parts of the reports.
What the trial captured was a failure that will lead to an improved intervention; though it does highlight one of the challenges on the ground when it comes to ICTs.  There are plenty of big statistics about mobile phone use and penetration in Africa, but those numbers do not capture levels of access among users.
Study Design Failure
In the same panel, head of D-Tree International Marc Mitchell spoke of a trial to determine of a mobile phone based Integrated Management of Childhood Illness (IMCI) was better than the traditional paper based.  The trail split 18 health centers in Tanzania into a control and treatment group.  The control group was to continue following the standard paper-based IMCI while the treatment group were given an hour training in using mobile phone-based IMCI application.  Mitchell shared results that pointed towards the mobile phone intervention being used more correctly by health workers and improved outcomes for patients.
What this proves is that the treatment group had improved outcomes, but the cause is not quite clear.  One person asked Mitchell if it may have been the additional training that led to an improved understanding of implementing IMCI.  Could the phone be the incentive to act?  Mitchell deferred on the question saying that he would talk with the individual on the side, so the rest of the attendees were unable to know the answer to the question.
The interaction drove home one of shortcomings of mHealth research.  Even when there is impeccable design, the research is often limited to small groups of people in a single region.  The results make it hard to understand how this can be translated to national plans in a given country.
It is where interaction with practitioners is necessary.  These studies do not capture outside influences like when a government strikes a deal with a telecoms company and are forced to use a single network.  They do not take into account when an NGO is donated hundreds of phones and then must implement mobile programs on the donated device.  Such variances are not going to be captured in a small well-executed study.
Failure to Inspire
In day 2, attendees were provided a free lunch.  The price was to sit through a series of keynotes that made for little opportunity to connect with the very people sharing the table.  Each of the speakers were pleasant enough, but did little to captivate attention as people clanked away while eating their salads and roasted chicken breast.  Servers waited in posts to be as helpful as possible by serving salad dressing and trying not to make too much noise as they cleaned off the plates from the first course.  To add a pinch of irony to the lunch, Eric Dishman of Intel managed to frame the idea of moving 50% of health services out of ‘brick and mortar buildings’ in 10 years by saying that mHealth solutions should be practical and avoid hype.

Failure to Engage
I wrote on this yesterday, but it deserves further expanding; the setup of the conference has done little to enable collaborative and engaging discussions.  The problem is not the conference itself, rather it is the format that is utilized.  Each of the panels are packed with presentations that allow enough time for one or two questions per speaker.  Even if Mitchell was willing to engage in the question of trail design, he would not have had enough time to adequately answer the question.  As the sessions end people rush towards the speaker of choice to get in a comment or trade business cards.  Couldn’t this be achieved by reading the published paper and emailing the author?  With over 3,000 people who are involved in mHealth in the same building, the aim should be to find ways to share ideas that can improve health outcomes, program implementation, yada yada yada.

The most apparent disparity can be seen between the international and domestic cohort.  The domestic side seems to hold the all of the cards as most panels are focused on US mHealth.  Even the keynotes lack an international perspective.  There are certainly points of intersection between international and domestic, but it is safe to say that the Tanzanian Ministry of Health is probably not over at the Verizon display to see what they have to offer.

Failure to Fail
This round up should end on a high note, because this has been a great conference so far.  The summit has pulled together a diverse group that will support the growth of mHealth.  As I write this, I am sitting in on a panel that looks critically gathering evidence to know more about mHealth.  The growth of the conference in three years from 300 to 3,000 is a sign of the growing sector.  Innovations that are here in the National Harbor and others designed in the field right now will help to close the gap in health services around the world.

06 December 2011

Half-Hearted Democracy Promotion: Is the International Community Asking for Post-Election Violence in DRC?

The following is a gust post by Ben Brockman and originally appears on the UPenn SID blog. Ben is a Senior studying International Relations at the University of Pennsylvania. He is currently conducting his thesis research on the legitimacy of elections in Sub-Saharan Africa and its effect on prospects of post-election violence.

This Tuesday, December 6th, the National Election Commission of the Democratic Republic of the Congo (DRC) is due to announce the preliminary results of last week’s tense Presidential contest. Analysts and academics have warned all week that some degree of violence will likely follow the flawed election between incumbent Joseph Kabila, opposition leader Etiesnne Tshisekedi, and the nine other candidates in the running. If violence does ensue, to what extent is the permissive environment created by the international community to blame?

The election process to this point has hardly been a peaceful one. The month long-campaign before the vote was marred by more than a dozen civilians gunned down by state security forces and Molotov cocktails thrown by the opposition in the streets of Kinshasha. Election Day faced similar challenges, with violence erupting in the southeastern city of Lubumbashi and numerous polling stations going up in flames in the Kasai Provinces, Tshisekedi’s homeland. 

Allegations of ballot-box stuffing, ghost polling stations, and thousands of disenfranchised voters abounded, calling into question the legitimacy of what already was expected to be a close election. Tshisekedi’s campaign has openly suggested says they will take to the streets when the inevitable result is declared, those close to Kabila say those who take to the streets will be “smashed”. It’s not hard to see why many fear violence.

Imagine for a minute you are 78 year-old opposition leader, Etienne Tshisekedi. Given your age, this is likely your last election. Furthermore, your loyal opposition to former U.S. strongman Mobutu Sese Seko has not endeared you to those in Washington over the years and you can’t count on them to put pressure on Kabila to play fair. You know that Kabila is increasingly unpopular in DRC and that given a fair vote, the election would, at minimum, be close. With the President’s friend running the electoral commission, you also know that this is unlikely to be the case. You want to be and think you deserve to be president, so what do you do?

At this juncture, inciting violence seems like a smart - even rational - strategy. Why not call for a massive street protest in your political stronghold, Kinshasa? Kabila has shown his hand; he will crack down with force. Why not then appeal to the Diaspora, who is firmly behind you, and the international media with a simple message - “Kabila stole the election and now is brutally suppressing the will of the people in the streets”, building off themes from the Arab Spring in the process? As the violence picks up in the streets, the Western media will continually note the irregularities in the vote tally that you are calling into question. Suddenly, you have significantly increased your bargaining leverage vis-à-vis Kabila in the domain of international politics.

Now, the ball is in the international community’s court, which to this point has been preoccupied with Egypt’s election – which took place the same day as Congo’s - and with the ongoing crisis in Syria. Would the international community seek a power-sharing agreement like in Kenya in 2007 or Zimbabwe in 2008 to quickly end the crisis in the name of stability? In both of these cases, leaders who lost elections and resorted to violence were rewarded by the international community with seats in government. Similarly, in Cote d’Ivoire last year and Kenya in 2007 opposition leaders who protested violently also won at least a share of control of the state.

It is unlikely that the U.S., EU, or UN will go out of their way to support Tshisekedi, but given a severe crisis it is hard to imagine the West will go out of their way to back Kabila. In the end, the international community is first and foremost interested in peace and stability.

From this point on, it’s anyone’s guess on how things will play out. One thing is sure; inducing a violent reaction to the election results is more effective than appealing to a disinterested international community for help.

So, how did we get to this point? I’d argue that Western half-hearted democracy promotion in countries like DRC is at the core of this incentive structure. The international community begrudgingly gave just enough money and just enough logistical support for the election to be held on time. The international community declared that pre-election trouble signs from logistical concerns, to voter registration, to violent incidents were “troubling” but did not warrant increased attention. They say the International Criminal Court is watching, but with little support from the U.S. will the opposition really be the one worried about prosecution? After all, in the violence that followed Cote d’Ivoire’s recent election, the opposition leader Alassane Outtara ended up as President and incumbent Laurent Gbagbo just arrived in The Hague.
To be sure, those who incite violence should ultimately be held responsible. We must, however, rethink a system that requires a crisis, and only a crisis, for the international community to engage. If elections are going to be the centerpiece of Western democracy promotion, it is important to do it right. Minimum acceptable standards must still resemble a democratic process. Otherwise, elections in many countries will continue to be an expensive exercise for donors - more likely to lead to violent protest than the embodiment of the will of the people. Is this what we are asking for?

The Day 1 Runaround from mHealth Summit

This post originally appears on the UN Dipatch.
The 2011 iteration of the mHealth Summit is currently being held at the National Harbor through this Wednesday.  Day 1 kicked off with high power keynotes from Dr. Patricia Mechael of the mHealth Alliance and Kathleen Sebelius, Secretary of the US Department of Health and Human Services.  Dr. Mechael welcomed everyone to the conference and expressed her hope that it would allow “the global, national and personal perspectives to come together.”
Sebelius brought the perspective of public incubation of innovation for mHealth.  However, it was Dr Eric Topol, Vice Chairman of the West Wireless Health Institute, which captured the attention of the 3,600 attendees. The peak came when he did a live demonstration of a sonogram of his heart by using lotion from the hotel for the probe since he forgot to pack the gel.
He breezed through a presentation that was equally a survey of the promise of mHealth as it was a lesson on how to effectively use power-point.  At the heart of his talk was the idea of “creative destruction” made popular by economist Joseph Shumpeter.  The stethoscope, long seen as the sign of medicine is being replaced by handheld devices.  “I have not used a stethoscope in two years,” declared Dr. Topol.  The rapid growth of technology, he argued, will transform health in ways that we could have never predicted.
With the end of the keynotes, the exhibition hall opened at the bottom floor. It is set up like a standard trade hall with organizations and companies at each table.  The big players lead the way as giant showcases areas from Verizon and Qualcomm serve as the welcoming hub to the space.  However, it was the smaller tables that offered some of the most interesting discussions.  Private companies dominate the scene at the summit, but governments are not being left out.
The Ministry of Health and Social Welfare from Tanzania has a table where I had the opportunity to speak with systems analyst Marcos Mzeru and mHealth Country Coordinator Dr Mwendwa Mwenesi.  To encourage collaboration among mHealth practitioners and organizations, a Community of Practice was established by the Ministry of Health and D-Tree International. The collaboration between public and private has created a space where 40 programs participate in quarterly tele-meetings and an active Google Group.
The four session tracks, technology, business, research and policy, have set the tone for the event.  Missing from these sessions are the practitioners.  Because of this gap James Bon Tempo of Jhpiego and Linda Raftree of Plan have collaborated to host a ‘Reality Check’ booth.  The hope is that practitioners can connect through discussion with each other and individuals who are a part of the four tracks.  “It offers a space to share and learn from peers who implement mHealth programs on the ground and to get advice on resolving the kinds of difficulties that probably won’t be highlighted during the official presentations,” James wrote.
In the short time I got to spend at the booth yesterday, I had the opportunity to hear about the implementation challenges of Medic Mobile from Isaac Holeman which led to further conversation with people visiting the booth focusing on funding streams.
After spending time downstairs, I listened in on the maternal and health special session.  Leena Dhande of Lata Medical Research Foundation focused on breastfeeding in India.  The trial she presented sought to test if cell phone counseling and sms reminders from midwives can lead to more mothers exclusively breastfeeding their children in the first 6 months.
The randomized control trial was conducted in 4 hospitals that average over 9,000 births a year.  The participating mothers were split into two groups.  The treatment group was served by ‘lactational counselors’ who made 70-80 calls a day and sent 500-600 bulk SMSs daily.  The cell phones of the mothers were programed to have their respective counselor on speed dial and they were encouraged to conduct the calls on speakerphone.  Dhande said this was done because many household decisions are made by the senior members.
The results of the trial are promising.  The women provided the counseling and reminders were more likely to exclusively breastfeed, introduce complementary foods at the right and were less likely to bottle feed too early and need hospitalization for the children.  The most exciting part of the results is the fact that the intervention is so cheap and easy.
Today, day two kicks off and I will be attending sessions on maternal and child health in Africa and mHealth design.  Be sure to follow the conference hashtag #mhs11 to keep up with the latest happenings.