Nota bene: These are a few highlights from CGI – please do add your inspirations/ideas in the comments!

Clinton Global Initiative – Making things happen through Commitments

Action speaks louder than words. At CGI, you’ve got to commit – and that has an amazing impact.

What will your commitment be?

CGI was the birthplace, in past years, of projects like Matt Damon’s water program (water.org, expanding this year to Haiti), the Goldman Sachs 10,000 Women Initiative, and so many more. In the five years of CGI, there have been 1,400 commitments made (participants are required to make commitments to existing projects or commit to creating new projects), valued at $46 billion dollars, and impacting the lives of 200 million people in 150 countries. This year’s meeting will give birth to 30 more of these programs – more by Andrew Mersman over at Passport Magazine/ Change by Doing blog.

Check out CGI Commitments here.

Innovation!

Business Week highlighted innovation as a top priority for the global economy, and President Obama announced a new strategy for innovation: A Strategy for American Innovation: Driving Towards Sustainable Growth and Quality Jobs. Download white paper.

Judith Rodin of the Rockefeller Foundation identified innovation strategies that could be applied to social problems – user-driven innovation, crowd sourcing and collaborative competitions reported here by Alexandra Cheney at Fast Company.  And Innovate Today: 8 Ways Business can End Poverty - superb post by Steve Enders over at tonic.

A few people – including Muhammed Yunus and Ngozi Okonjo-Iweala of the World Bank at CGI had an Innovation Wish List. Yunus talked about the edible yogurt pot, and Judith Rodin announced a new initiative to help the poor – the Global Impact Investing Network. This gets my vote for one of the most exciting developments to come out of CGI – read the Economist article.

Investing in Women and Girls

Women make up half of the world’s population, but do 2/3 of the world’s work, produce 50% world’s food, earn 10% world’s income, own 1% of world’s property.

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In my work in the field, I am no longer surprised to see test stockouts, essential medicines stockouts, supply stockouts, broken or missing diagnostic machines, or patients who are afraid of healthcare workers. It is a complete tragedy, and as I work to help, I think of all the people who are sick or die because of failures of the healthcare system, who cannot tell anyone their stories. For those who do not work in the health system, or haven’t had an experience of health system failure, transparency and data on implementation is practically invisible – so there’s no public awareness of the issues.

So I was thrilled to see recent developments in accountability – the Stop the Stockouts campaign, and the creation of the Budget and Expenditure Monitoring Forum in South Africa.

Power to the People: Stop the Stockouts

Stop the Stock-outs , a multi-country Africa campaign, is using text messages sent by activists and members of the public to expose stock-outs of essential medicines at public health facilities and put pressure on governments to address the issue. It was launched in Kenya, Uganda, Malawi and Zambia by Health Action International (HAI) Africa. During Pill Check week in June, facilities were surveyed, and a map of stockouts was created. The image below incorporates July 2009 data. It was found that many government health facilities were routinely running out of, or just not stocking essential medicines to treat common diseases such as malaria, pneumonia, diarrhoea, HIV and tuberculosis (TB).

“We were finding availability levels in rural, lower-level health facilities of 40 or 50 percent for essential medicines,” said Christa Cepuch, a pharmacist at HAI Africa. Read more from IRIN here

Show me the Money: HIV Policy AND the Budget and Expenditure Monitoring Forum in South Africa

With a new government in South Africa as of May, there have been some very positive signs. Read the rest of this entry »

This year’s Clinton Global Initiative takes place from 22 – 25 September 2009, where heads of state, government and business leaders, scholars, and NGO directors work together to analyze, discuss, and debate possible solutions to urgent global issues. Each participant is then asked to take action on one or more issues by making a Commitment to Action.

The Economist calls the meeting ‘an important part of the global elite’s calendar’, so join online and watch the live webcast!

As noted in our post on Girls Count: The Girl Effect, one of the major themes this year is Investing in Girls and Women. The four focus areas are Innovation, Human Capital, Infrastructure, and Equitable Futures.

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Mayo Clinic, Global Health and Design Thinking. You might be wondering what those three terms have to do with each together. This is my partial recap on time spent at the Mayo Clinic this past week where I saw one potential vision of what the future of healthcare might look like. It was a great privellege to hang out at the Mayo Clinic for what was the best conference I have attended in a long long time or maybe ever (Amy Tenderich at Diabetes Mine also has a recap that I encourage you to read). The Mayo Center for Innovation hosted a TED style event – Transform, a collaborative symposium on innovations in health care experience and delivery, all the videos are online (highly recommended viewing). It is going to take me a few months to digest what happened there and wrap my mind around everything I heard. There were over 430 people from 23 states, 7 countries and over 1,350 tweets. The caliber and just genuine niceness of every person I interacted with was on some other level, the conversations were rich, deep and thoughtful. The conference organizers *created an open purposeful environment* that led to an incredible experience. The folks at Mayo certainly shaped and designed a great space to achieve the symposium goals (this all reminded me of the Winston Churchill quote – “We shape our buildings and afterwards, our buildings shape us”).  Let me stop before you think I have joined a cult. The direct connection to global health here – it was discussed by keynote speakers and my first tweet from Mayo was “this place reminds me of Aravind (Aravind Eye Care System). Jaspal, Mahad and I have written several articles and cases studies on Aravind and I continue to believe it is a premiere model for innovation and care delivery. More on this in a bit.

The Global Health Convergence: “Design Thinking” and Innovation
There were many things that made this event great, however, in terms of extending your horizons and making you think, one of the most refreshing things was to see some convergence of disciplines and people from a variety of backgrounds. This is very hard to do and cannot be underrated. We all live in a sea of fragmentation,  in systems, in professions and fragmentation in how we solve problems. This is even reflected on a micro level – look at the mainstream peer reviewed journals in healthcare where you see severe fragmentation amongst the physician, nursing and pharmacy focused journals (some of this is for good reasons and some of it’s not). This conference was in part about ditching that fragmentation and about a convergence of ideas, people and relationships working collaboratively. In addition to innovative projects, new models of delivering care and how the process of innovation can be conceptualized, managed, and enabled was discussed. Much of this was encompassed under the umbrella of Design Thinking (innovating and problem solving using various methods). Tim Brown, CEO of IDEO, was a headliner on this front and re-emphasized a call for design to big, an ethic of design for social impact/change, which Jaspal and I have covered on this blog before (see our previous post – 8 Links for Design and Global Health).

If you were too look at the methods of design thinking you would see an amalgamation and convergence of mostly existing methods from a variety of disciplines (from engineering to ethnography to epidemiology to psychology to health services research to name a few examples). As Tim Brown said in his talk: “Design thinking begins with integrative thinking which is the ability to hold opposing constraints and opposing ideas and from those create  new solutions…this means balancing societal needs (desirability) with what’s possible (feasibility) and what’s sustainable (viability)“. When Tim Brown said “Design should not be left in the hand of designers” he hit the nail on the head – design thinking can be incorporated by non-”designers” to help innovate and solve problems. What we do has to be a participatory, collaborative effort. Tim Brown wrote more about this participatory perspective (How to Design a Participatory System in a post crisis economy world). There are many critically important reasons why this is a key factor, one of which goes back to Paulo Freirean educational tenets – people who participate in their own education, become engaged in the transformation of their own world. The other reason is because even though as brilliant as Tim Brown is, (and all the people working at organizations like his) he doesn’t have all the answers, or even the correct ones (read his other piece at FastCompany on HSAs where his point is highly debatable about the solution and at best has over simplified the problem).

The bottom line that I took away is that we need more of a participatory system, we should be open to new ways of approaching problems (“design thinking”) and we can provide some structure to the process of innovation. Besides design thinking the other major theme I want to point to is global health – as I said above in the keynote presentations global health made an apperance. Both Clay Christensen and Tim Brown mentioned the Aravind Eye Care System and Jaspal spoke entirely about global health. We have said on this blog before that there are many lessons that can be learned from outside our system where innovation is taking place due to extreme necessity, it’s not a choice (a lot of this is taking place over the web and with mHealth – mobile phones for health). In Global Health, there are hundreds, maybe thousands of innovative experiments going on using a wide area of technology (devices, drugs, the web, mobile phones, etc.), however, how we track these experiments, talk about failure, and share what has been learned seems to be highly inefficient and lacking.  We have covered a lot of this ground over the past three years, the easiest summary of examples can be found in this post:

42 “Extremely affordable” Innovations in Global Health

Clay C, Tim B, and Jaspal all pointed to global health as a place we can learn from. While there are some serious limitations, there is a ton to learn from the use of mobile phones in developing countries and how that might apply here – because overseas usage of phones is far beyond what is being done in the US. The other area to keep an eye on is chronic diseases. In some places, there is going to be an explosion of chronic conditions and new models will have to be devised to handle that tidal wave. I would love to see Amy Tenderich and her community do a brainstorming session on design for diabetes in developing countries. On this front see two previous posts:

1. Reverse South to North innovation – Borrowing innovation: health services, financial services, and clean tech
2. A massive wave of chronic disease in India and China

Let me leave you on a note of caution, a “design thinking” approach (remember using existing methods) can offer some powerful alternatives. However, there can also be something seductive about design thinking and a rapid approach (we’ve cautioned this on the graphics/visual side before). If you fall into that seduction, then this is just a fad for you, it’s on us to be rigorous, thoughtful and corrective when need be:

“The myth of innovation is that brilliant ideas leap fully formed from the minds of geniuses. The reality is that most innovations come from a process of rigorous examination through which great ideas are identified and developed before being realized as new offerings and capabilities.” IDEO website.

I have many more thoughts on this, if I get the time I’ll jot down a few more notes and quotes from the conference, in the meantime, it is well worth watching the videos from Transform.

I decided to fool around a bit to see if I could get any meaningful analysis out of analyzing a twitter hashtag for the conference we just attended at Mayo. Sadly after spending a decent amount of time it was a bit of a flop. It is kind of absurd that there is no easy to use website where you can check out trends and stats from twitter hashtags (will someone please develop this?). Chris did a great job that was time intensive from another health conference earlier this year. Definitely check out his presentation and what he found – great stuff: Health 2.0 Tweet Stream Analysis.

I went and grabbed what I think is 90%+ of the tweets from txfm09 and put them into a spreadsheet (after using notepad). There were over 1350 tweets as of this Friday (3 days post conference). For anyone who has more time and programming skills than I do, I have uploaded this dataset for anyone to grab at IBMs Many Eyes (thanks again to Chris for this tip). You can check the hashtag #txfm09 or if you want to see more cohesive thoughts by person, there is no shortage. The below is one visualization of 2 phrases (as opposed to 1 word) that is highly flawed (email me if you want details or ping me on twitter – @ghideas). Let me say this again – this graphic is highly flawed, but you can gather some very general overarching trends (it looks like there was lots of linking bcs of the prominence of bit ly and you can see the popularity of other terms and folks who were most prolific). Did I say this was flawed? For some reason the quality o of the picture below is poor, I have a slightly better and larger one, ping me if you want me to send it to you. Enjoy:

A quick link drop on posts we have done related to design and global health, there are more, but here are the most explicit ones:

1. Design thinking + safe water: workshop report from Mexico
2. Innovation as a Learning Process
3. 7 steps for building low cost open source technologies for global health
4. healthcare + design award: fighting pneumonia in remote areas
5. Linking Clinic Design to Health Outcomes
6. Design for Global Health: Doctor White Coats Spread Disease?
7. Designing for Better Health: 11 Cent Sanitary Napkins, Waste Mangement and Oral Health
8. “Design Thinking” in Harvard Business Review (Tim Brown)

Related external links:

- What is Design Thinking?
- Kaiser Permanente – Innovation and Transfer (very large PDF)
- Rethinking-DesignThinking-Healthcare (Fall 2007)
- New Thoughts on Health and Design, Diabetes Mine (fantastic blog/site)
- Hard-won Wisdom from Successful Healthcare Services Research Innovators
- IDEO’s Besider
- Creating a Culture of Patient Safety through Innovative Hospital Design
- Applying Customer-Driven Innovation to Health Care
- Tools and Models from the Harvard Converge website

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• IDEO’s guide to designing for social impact (ted.com)
• Book Review: Change by Design by Tim Brown (ericbrown.com)

“Women hold up half the sky,” says the Chinese proverb, but in most of the world women are second class citizens – “girls are uneducated and women marginalized, and it’s not an accident that those same countries are disproportionately mired in poverty and riven by fundamentalism and chaos.” If girls and women cannot reach their full potential, then we as a world cannot either. In this century, the great moral imperative is empowering the women of the world, write Nicholas Kristof and Sheryl WuDunn in an impassioned article in the New York Times Magazine special issue on Saving the World’s Women

Investing in girls and women is the new focus of foreign policy. The brilliant Girl Effect video and New York Times special were based on the report Girls Count: A Global Investment and Action Agenda by Ruth Levine and colleagues from the Center for Global Development, who are releasing a report on the global health agenda for adolescent girls today. See here for Ruth Levine’s reflections on the NYT article. And, the Clinton Global Initiative is dedicating its annual conference starting on 22 September to the issue (join online on the webcast or podcasts).

In a chilling expose today, Toxic Waters – Clean Water Laws are Neglected, at a Cost to Health, Charles DuHigg of the New York Times covers the impunity of polluters and lax regulation of clean water laws. The NYT then goes a step further – creating transparency through a public database of violations which is ‘more comprehensive than the states or the EPA‘, that you can access to find polluters near you on an interactive map. There is also a nice interactive graphic of the Clean Water Act enforcement record in all 50 states. Deep cuts were made in government funding, and now clearly our Environmental Health Monitoring system needs repair. Democracy needs a strong, free media who reports and then acts. Who knew the NYT would be a key environmental health policy innovator overnight?

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Beyond the current debate on US health reform, which has us all posting on Facebook “No one should die because they cannot afford health care, and no one should go broke because they get sick “, the fact of the matter is that the accident of your birth largely determines your future health.

And no, it isn’t fair. If you are born in Sierra Leone, 1 out of 6 babies do not survive. In the developed world, 1 out of 10,000 babies die.

The WHO released a landmark report last August on health equity “Closing the gap in a generation”

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others….Within countries there are dramatic differences in health that are closely linked with degrees of social disadvantage. Differences of this magnitude, within and between countries, simply should never happen.

With a rapidly urbanizing world – projections of 60% of people will live in cities by 2015. Most of these people are escaping rural poverty, and will live in informal settlements in the developing world.

Guidelines must be developed to ensure health equity, but we also need tools to help us plan.

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