* Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services
* Eric Rasmussen, President and Chief Executive Officer, InSTEDD
* Randi Susan Syterman, Director Governance and Innovation, World Bank Institute

What:

• The power of analytics in shifting the landscape of global health
• Stimulating the development of new applications for improved access to health-care
• Using competitions and challenge grants to motivate the public and private sectors, NGOs and communities to road-test ideas and solutions
• Open data, open innovation, and PPP to improve global health outcomes
• Using data and innovation to improve performance and spark action locally and globally
• Increasing transparency and accountability and greater citizen participation through innovation

When: July 13th, 9:30-11am

Where: World Bank J Building – 701 18th Street NW (Washington DC)

How: External Participants should RSVP to Selina Khan skhan8@worldbank.org

Todd Park (CTO, HSS) – using information to shift the landscape; empowering communities, enabling global action, improving lives

Todd Y. Park has been Chief Technology Officer (CTO) for the U.S. Department of Health and Human Services (HHS) since August 2009. Mr. Park Co-Founded Athenahealth Inc., in 1997 and served as its Chief Athenista from January 1, 2008 to August 31, 2008. Mr. Park served as Chief Development Officer and Executive Vice President of Athenahealth, Inc., since February 2004. He served as a Leading Management Consultant at Booz-Allen & Hamilton in New York. Mr. Park specialized in healthcare strategy, operations, and systems work at Booz-Allen, and served as a major thought leader on the evolving dynamics of the healthcare sector. Mr. Park’s accomplishments at Booz-Allen included: Development and implementation of “best practice” provider network, medical management, claims processing, operations, and systems infrastructure for multi-billion dollar clients; Design and rollout of innovative managed care products and services; Successful marketing and expansion planning efforts for high-growth healthcare networks and services; Development of groundbreaking strategic partnerships among major healthcare organizations. Before Booz-Allen, Mr. Park served as Director of Development for Summerbridge Cambridge, an Innovative Academic Enrichment Program serving gifted and underprivileged children. He served as Director of Athenahealth Inc. from January 1, 2008 to August 10, 2009. He focused on healthcare economics, business strategy and technological innovation at Harvard University. Mr. Park received his Bachelor of Arts degree in economics from Harvard University.

Eric Rasmussen (CEO, InSTEDD) – SMS to avert outbreaks, mobile technology, GIS and innovation for emergency response

Dr. Eric Rasmussen arrived as President and Chief Executive Officer of InSTEDD in October 2007. Previously, Dr. Rasmussen was both Chairman of the Department of Medicine within Naval Hospital Bremerton near Seattle, Washington, and an advisor in humanitarian informatics for the US Office of the Secretary of Defense. He holds academic positions at several institutions and has been a Principal Investigator for both the Defense Advanced Research Projects Agency (DARPA) and for the National Science Foundation. He sits on several advisory boards, including the Crisis Management Resources Board for the National Academy of Sciences and the US Crisis Response Working Group. He has a number of publications and has been awarded several personal, unit, and theater military decorations, including a Presidential Legion of Merit.

Dr. Rasmussen spent seven years enlisted in nuclear submarines before leaving the Navy to receive his undergraduate and medical degrees from Stanford University. After graduate work in molecular biology at Los Alamos National Laboratory and teaching in Haiti, he completed a Residency in Internal Medicine and re-entered the Navy as Chief Resident in Medicine at the Navy Medical Center in Oakland, California. Subsequent Navy positions included three years as Fleet Surgeon for the US Navy’s Third Fleet. Dr. Rasmussen served on the Afghanistan humanitarian support planning staff within US Central Command Headquarters (CENTCOM) in 2002, and later as a physician to the Iraq Disaster Assistance Response Team (DART) for the Iraq War in 2002-2003. As a member of the DART, he served as medical director within the International Humanitarian Operations Center in Kuwait and was later selected for the DARPA 2003 “Sustained Excellence in a Principal Investigator” award.

Further work as Director of the Strong Angel series of international humanitarian support demonstrations led to work in Afghanistan in 2004 and 2007, and in Indonesia as head of a Civil-Military Coordination Team for the tsunami response in Banda Aceh in early 2005. Later in 2005, he deployed with Joint Task Force Katrina in New Orleans, coordinating a small portion of the relief response after Hurricane Katrina. He was the medical lead for a UN mission to Tajikistan in 2009, and in 2010 he deployed to Haiti immediately after the earthquake for work within the UN’s Search and Rescue Dispatch Center on the Port au Prince airfield.

In addition to his responsibilities at InSTEDD, he currently serves as Permanent Advisor to the United Nations Secretary-General’s High-Level Forum on Water Disasters, as a member of the US Congressional Task Force on Global Biosurveillance, and as a member of Kofi Annan’s Global Humanitarian Forum in Geneva.

Randi Susan Ryterman, Director, Governance and Innovation, World Bank Institute
Ms. Ryterman, an American national, joined the Bank in 1998 as Senior. Public Sector Management Specialist in the Europe and Central Asia Region.  She has since held various positions, her most recent assignment being Sector Manager, Public Sector Governance, in the Poverty Reduction and Economic Management Network (PREM). Ms. Ryterman studied at Wharton, University of Pennsylvania, and received her PhD from University of Maryland.

Suzanne Rainey talking about online communities for global health

Speakers and their presentation titles

* Bobby Jefferson, Futures Group “IQCare Technology Innovation for Low Resource Clinics”

* David Alyward, mHealth Alliance, “mHealth: The Future Success of Health Care Delivery in Developing Countries”

* Ashifi Gogo, Sproxil.com, “Simple Solutions to Complex Problems: How a Text Message Can Save a Life”

* Suzanne Rainey, Forum One Communications, “2 Ways to Build Community Online for Better Global Health”

Some major themes

Data is stuck in silos. There’s lots of IT in the developed world but the different platforms don’t work together. Innovations are happening and are funded all around the world but they’re not integrated in any way. Data mining is good for the developing world–companies that data mine can figure out your needs and uses to improve the products and services you use each day.

Knowledge out. Data in. When we think geospatially, especially given the advances of mobile technologies, the idea that people have to travel to clinics and mega-million dollar health institutions to receive care is becoming less and less a reality.

Take a Creative Commons Approach. By using freely available, reusable tools you can reach the most people.

We’re at an inflection point. Right now we can use technology to have a big impact on human health. The impact of mHealth on shortages of skilled personnel and facilities are immense. Mobile phones are a force multiplier and extender for health especially given the deep penetration of mobile phones in the developing world.

Reach the Un-Reached. What’s interesting is that villagers and people at the base of the pyramid are already reached with deep penetration of mobile phones. With the use of mobile devices there is the possibility of reaching the unreached.

Access vs. Quality? Why not both? Sproxil has aimed to address this question by working to prevent counterfeit drug product use, with their “buy & scratch/text&check” mHealth system.

Online communities can improve global health. How do we use online storytelling and professional networks to improve global health? Build a community around sharing, avoiding duplication, discussion, networking: who’s doing what, where?, story telling, engaging in debate and connecting via online events. The Healthy Newborn Network pools resources from 60 different organizations about what’s been done in global health as well as bring together different stories and features the different partners working to improve newborn health.

Tell your story about your experience in global health. Story telling is the heart of our human experience. We tell stories each day about our coworkers the guy that was singing on subway, etc.. Let’s talk about what’s going on in health by telling stories about connections with people. One thing to remember is that leadership in an organization who tell their story with a cause can actually make the organization more real and connected with the people they work with–lead by example. Check out Charity:Water with an example of story telling (here).  (btw the visuals on Charity:Water are incredible).

Q&A

How do you get a grasp of the technology available and get started? Answer(s): It’s not easy. Ministries of Health need to a lead on this to catalyze the ICT4Health movement. Don’t use technology for technologies sake–think about who you want to reach and their needs.

I asked, how are you addressing the issue of security and privacy? Answer: Ashifi said that they’re taking the best practices from the corporate security sector and applying those practices to their application with Spoxil. Bobby said Futures implements a three day security course to teach local technicians how to fix security issues that may arise. From the patient side, there’s data encryption. Facilities also sign a document to ensure security from the district level manager on down the decision making chain.

How do you move from the grant-funded stage to scale? Answer: David said that the mHealth Alliance is bringing together the requirements to scale to companies that need to scale. Ashifi says that you need to bring value with your product.  The grant-funding model is not sustainable.  If you’re idea or product has value for those at the base of the pyramid, then people will pay for it.

Interoperability? Answer: David says the the mHealth Alliance is asking what global stakeholders need and answer the question of interoperability.

David Alyward from the mHealth Alliance

The Presenters and their Presentations

* Robert Lawrence, MD, The Center for a Livable Future Professor, Professesor of Environmental Health Sciences, Health Policy, and International Health; Director, Center for a Livable Future, JHU Bloomberg School of Public Health, “Food security and the right to health”

* Amy Lockwood, MBA , Exec Director, Project Healthy Children, “Development of a national food fortification program in Rwanda”

* Bonnie McClafferty, Head, Development & Communications, HarvestPlus, “Breeding better food: an agricultural innovation to improve public health”

* Obidimma Ezezika, PhD, MEM, Senior Fellow, McLaughlin Rotman Center for Global Health, University of Toronto and University Health Network, “Factors in the adoption and development of agro-biotechnology in sub-Saharan Africa”

Food security is important to the social determinants of health

With 6.8 billion people in the world and over a billion malnourished, food and food security is important to the social determinants of health. Dr.Lawrence spent time to explain that food is a basic human right. The basic idea of human rights in the context of human health is so eloquently put as:

My right to be me not interfering with your right to be you

The more we communicate the rules that govern relationships between states and oversee the obligations of states to their citizens, the more opportunity we have to advance the human rights of people everywhere.

When it comes to food security, however, economic and social rights have not been ratified.  The International Covenant on Economic, Social and Cultural Rights which was last signed by President Carter has still not been ratified by US Senate. The Covenant gives people the right to education, housing, food security, health, gainful employment, potable water, trade unions, benefits of scientific advances.

In Article 11, the Covenant exclaims that people have the right to food. Specifically interpreted as requiring, “the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals, free from adverse substances, and acceptable within a given culture.”

The right to adequate food means that food must be accessible, affordable and nutritious.  If these are the metrics to have the right to food, then 25% of the school children in NYC lack food security.

When we think about the rights that humans have to adequate food we need to redefine the beneficiaries of food as rights holders (not just ’starving’).  The duty bearers, i.e. the suppliers of food, must be held accountable and and fulfill their responsibilities to the rights holders.

The Hidden Hungry

When we talk about food security and not having enough food, we need to think about it from its short and long term consequences.  In the short-term, not enough food implies starvation. In the long-term, not enough food implies lower productivity of countries.

While the supply of food is important to the harsh realities of food security, it is the hidden hungry that we worry about most. Children and adults, today, are not only receiving adequate quantities of food but also the quality of food.  Take for example the following medical conditions:

* Neural Tube Defect (NTD)- Women with a deficiency of folic acid have a higher chance of having a child with NTD.

* Night blindness- Caused by a deficiency of vitamin-A. Vitamin A deficiency alone is responsible for 250-500,000 events of blindness in children worldwide.

* Goiter- Caused by not having enough or too much iodine. You ever wondered why they iodize your salt?

How could you prevent the above medical conditions through food?

1. A balanced diet: this requires access and being it affordable.

2. Suppliments (ex. vitamin pill): This mode of nutrition expensive and not sustainable.

3. Fortification (ex. adding directly into foods): On the one hand, the downfall of fortified foods is that it only reaches those who eat fortified foods. On the other, fortification is cheap and could prevent losses of national GDP up to as much as 6%.  The cost on average to fortified foods is USD 0.02-0.80/person/year.

Food fortification is obviously not the only means and must be integrated with other modes of nutrition and agriculture.

Lockwood and her team at Project Health Children have been working with the Rwandan government to combat the issue of malnutrition. With 22% of children underweight, half of the children born stunted, and half of the children born anemic, nutrition is a clearly a problem in Rwanda. By enabling nutrition through policy and legislation, food fortification standards, industry implementation and government regulation, the Rwandan government has begun to fortify salt, oil, sugar and maize flour to improve the lives of hundreds of thousands.

Concerns about food security and health

While impressive, most of these interventions have not been tackling the most paramount issue in food security, the price of food.  The Green Revolution believed that through science and technology we can feed the world abound. Adopted by multilateral corporations like Monsanto and DuPont, science and technology has not only helped ‘feed a billion people,’ so eloquently put by Norman Borlaug, but it’s also made a billion people go hungry and starving.  Food fortification and biogeneration of food through agriculture is another form of science and technology that is still not redefining the way in which food is accessed.

Food rebellions (not riots) are happening all over the world because governments cannot provide for its people affordable wheat, flour and maize. These rebellions are happening with or without fortified food and will continue to happen so as long as food prices remain in the hands of Wall Street and the aforementioned technology bearers. Investment banks on Wall Street have moved away from speculating on houses and mortgages to grain and food. The volatility of prices on food and grain is affecting the way people can access food through affordability.

I understand that in order to prevent the enormous amounts of deaths because of the quality of food we need to intervene with science and technology. But let’s not ignore the fact that if we really want to improve the health of billions through adequate food, we need to redefine access in the developing (and developed) world.

The room was packed, the debates and conversations lively and people left thinking about how to be a social entrepreneur in the space of global health using technology.

Presenter and their presentation titles:

Ashifi Gogo, Founder and CEO, Sproxil.com; Holekamp Family PhD Innovation Fellow, Thayer School of Engineering at Dartmouth, Workshop: How to advance global health through technology and social entrepreneurship

The first part:

Ashifi started out by explaining the value Sproxil, Inc (check’em out here) has giving the developing world.  What I appreciated most about Ashifi’s approach to this session was that he was teaching us how he and Sproxil did it. Going against traditional norms of business practice where you don’t share with ANYONE what your business plan, idea or process is in fear that the competition will devour you and steal your idea. Ashifi reminded me of Mario Batali from the Food Network. Batali goes on TV everyday and teaches the recipes he uses in his restaurant–how to make them, how they should taste, etc. The chances that you would take all his recipes he taught you, open up a restaurant right next door and compete against him is unlikely and silly. Thanks Ashifi for teaching us.

The workshop themes

1. Technology is an efficiency multiplier. If efficiency in your business is zero, adding technology to it won’t solve the problem (it might only exacerbate the problem). Technology doesn’t the solve the problem on its own.

2. Crowdsource your technology. If your idea has value, it helps to get your tribe/community to help you

3. Costs vs. Sustainability. Beware of costs and sustainability. KISS (keep it simple stupid) principle seems to work in the crowdsourced ethos of design. The more low-tech it is, the more it’s accessible.

4. Technology comes second to examining your health system. It’s important to examine your health system for what’s wrong before you even begin to insert technology–don’t use technology for technology’s sake.

5. Entrepreneurship is a useful model for global health. Too often the large sums of investments in global health are not bringing the results that we’d expect to see. By bringing entrepreneurship to global health can address the many challenges in global health (i.e. inefficiency, lethargy (from receiving funding to action takes a long time–sometimes the problem has changed), focus).

6. Social return on investment. The new metric on return on investment is to calculate social return on investments. While still fuzzy to quantify, if we can work toward metrics that can measure the impact of social investments then we’ll be on our way to improving health systems.

7. Who’s goin’ to pay for it? When we try to create value in global health, the million dollar question always comes up: ‘who will pay for it?’ People will pay for your service or solution if you bring value. When you have to answer this question as an entrepreneur you begin to focus, think about sustainability, rewards.

8. Some potential payers (in order of priority) for your value-added service/product:

• The end-user (private health professionals, patients, government)–Whoever you’re doing work for is your client. What about you yourself? There are no poor people when it comes to pay for value. Value will validate your concept.  Need to look at the incentives your product or service brings to different customers.
• Volunteers
• Crowdsourced funds
• Universities
• Grants
• Governments

9. Other things to think about
When is entrepreneurship not social? This is a tough question to answer. People who work in energy, oil, etc. all bring social value to society. The real point about social entrepreneurship is to be an entrepreneur, then add the social part.

10. Flaws in social entrepreneurship

• External market forces–people/organizations that don’t have global health at heart interfere with the deployment of your good/service
• Dual focus is challenging (social mission and organizational sustainability)

Workshop goals

We broke into small groups by interest (nutrition & infant health, HIV/AIDS, Malaria, [insert your favorite global health interest]) following these goals to present to the larger group: 1. state the problem, 2. come up with a solution using science and technology; 3. make it cost neutral.

One of the most interesting presentations was a small group who was thought about how to use technology to solve the problem of blood donations. The idea was to link a blood donation competition with the World Cup. Pretty cool stuff.

HOW CAN MOBILE PHONE TECHNOLOGIES IMPROVE FAMILY PLANNING,

MATERNAL AND NEWBORN SERVICES IN THE DEVELOPING WORLD

Online Conference May 5, 2010

The United States Agency for International Development’s (USAID) Strengthening Health Outcomes through the Private Sector (SHOPS) Project is launching an annual eConference to advance private sector innovations in the sustainable provision and use of quality family planning/reproductive health and other health information product. and services. The theme of the 20l0 eConference is mHealth which is the use of mobile technology to improve health program effectiveness and efficiency.

Abstract submission deadline: March 17, 2010

Call for abstracts: The SHOPS Proiect and die mHealth Alliance invite you to submit an abstract by March 17, 2010 to present at this online conference which will focus on how mobile technologies can improve family planning, maternal and newborn services in the developing world. Priority will be given to those submissions that are evidence-based. Abstracts should fall into one of the five categories below:

• Family planning
• Pregnancy
• Delivery
• Post partum (newborn care. family planning)
• Cross-cutting (e.g.. gender barriers, low literacy populations, training requirements, administrative management, supply chain)

The deadline for abstracts is March 17th and the conference is on Cinco de Mayo. Let’s hope they have some results and some data,  all info in the image below:

It’s now been a month since Forum 2009, so it’s time to wrap up any remaining thoughts from the meeting. My intention with these posts was never to provide a comprehensive view of the conference. If you’re looking for that, or simply additional insights into the meeting, I recommend the following resources:

1. Priya Shetty’s coverage of Forum 2009 for the SciDev.Net blog, five posts
2. TropIKA.net comprehensive coverage of Forum 2009, including daily reports and session reports

On my Cancún-bound flight out of Havana, on the morning of the 20th, the woman sitting next to me asked me for help with her Mexican immigration forms. As I was helping her, I asked what she did. “Terapista”. She asked what I was doing in Cuba. Attending “un congreso de investigaciones de salud pública”. She was a Cuban physical therapist going on a three month medical mission to Tecate in the Mexican state of Baja California, via Cancún, Mexico City, and Tijuana. I spent most of the short flight asking about her experiences on previous missions, all to Mexico, and probing for more details about the Cuban health system. Most memorably, she was quite proud of a unique surgical treatment the Cubans have developed for Parkinson’s disease.

I spoke about the medical assistance Cuba lends to other countries in an earlier post. The photo below of the 20 convertible peso note reinforces this. It touts Operación Milagro (Wikipedia link in Spanish), a joint program between Cuba and Venezuela with official aims similar to Cuba’s other medical mission efforts.

While I was speaking to this terapista on the plane, it occurred to me how important the setting of the conference was given the innovation theme. I don’t think that this was lost on many of the conference participants given external interest in the Cuban system, Cuban participation on panels, and various site visits. Still, there were three circumstances that limited knowledge exchange between the visitors and the Cubans:

1. Language barriers. There wasn’t very much communication between the several hundred Cuban participants and the external participants, especially those from outside Latin America. This was due in no small part to language barriers. Simultaneous translation took place during the larger sessions (UN-style headsets), but the smaller sessions didn’t have any and the informal exchange was visibly limited between the two groups.
2. An apparently flawless system. The Cuban health system may have been the talk of the week, but it was presented without fault. Even though it may be one of the best systems on the planet, it is not immune to needing improvement. Without a realistic understanding of the challenges, it was hard to understand the true effectiveness of the system. (In comparison, Minister of Health Chen Zhu was frank in talking about elements of the Chinese health system that need improvement, for example indicating in his plenary talk that many public clinics in China operate like private clinics.)
3. No U.S. government employees in attendance. There were certainly Americans at Forum 2009, but because of the restrictions associated with the U.S. embargo – it’s a bloqueo the Cubans said, since an embargo implies wrongdoing – there were almost no representatives of U.S. government institutions. I didn’t realize this myself until a colleague from the WHO pointed it out to me. He cited the example of his colleagues from the CDC who were not permitted to attend. Looking through the participant list, I only spotted one, someone from USAID. It’s unfortunate because there was a big opportunity for learning in both directions. In any case there were strong suggestions that we are months away from ending the embargo/bloqueo. Time will tell.

And here’s a post Aman wrote for Global Health Ideas about the Cuban health system two years ago: Lessons from Cuba: Healthcare Infrastructure and Information Systems.

My reason for attending Forum 2009 was to participate in a session title “Innovation for Remote Populations”. This post is a about that session. What follows is taken from my recent report to the Global Forum for Health Research – edited only slightly.

Innovation for Remote Populations

Thurs-19-Nov-2009, 14:00-15:45, Global Café, Palacio de Convenciones, La Habana, Cuba

Coordinators/Facilitators:

• Patricia Mechael, mHealth and Telemedicine Advisor, Millennium Villages Project, Earth Institute, Columbia University, USA & Egypt (organizer & facilitator)
• Tim Hurson, Facilitators Without Borders (facilitator)
• Charles Gardner, Global Forum for Health Research (focal point)

Speakers (alphabetical order):

• Simon Adebola, NEPAD Council Global Health Commission, Geneva
• Najeeb al-Shorbaji, Director, Knowledge Management and Sharing, WHO
• Caren Serra Bavaresco, Student, Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil
• Karl Brown, Associate Director, Rockefeller Foundation
• Arul Chib, Assistant Professor, Wee Kim Wee School of Communication, and Assistant Director, Singapore Internet Research Center, Nanyang Technological University
• Dziedzom Komi de Souza, Ph.D. Student and Research Assistant, Parasitology, Noguchi Memorial Institute for Medical Research, Ghana
• Bastiaan Hoefman, co-Founder, Text2Change
• Bernardita Labarca, Project Coordinator, Zoltner Consulting Group, Chile
• Claire O’Neill, Chairperson, Cell-Life-South Africa
• Ravi Ram, Head, Monitoring & Evaluation, African Medical Research and Research Foundation (AMREF), Nairobi Kenya
• Marco Salmen, OHR-GMCP Initiative for HIV/AIDS, Global Micro-Clinic Project, United States
• Jaspal S. Sandhu, Design Researcher, College of Engineering, University of California, Berkeley, USA
• Joel Selanikio, co-Founder and Director, Datadyne.org, USA
• Garance Upham, General Secretary, Direction, Safe Observer International, France

Additional participants – from the audience:

• Elmer Zelaya – Fundación Chica/Nicaragua
• Timothy Dye – SUNY Upstate Medical School/USA
• Jane Kengeya – WHO
• Oyewale Tomori – Redeemer’s University/Nigeria
• Lishandu/Zambia (full name/affiliation not available)
• Vargas/USA (full name/affiliation not available)

Summary:

1. Diverse users and uses: The speakers presented a variety of mHealth/eHealth applications involving a wide variety of users, including both the health workforce and community members, e.g. educating teenagers about HIV/AIDS in South Africa (O’Neill), Internet access in western Kenya to improve uptake of HIV VCT (Salmen), mobile emergency response systems in Aceh (Chib), electronic IMCI in Tanzania (Brown), text-based health education and health service promotion in Uganda (Hoefman), training for health workers as a downloadable game package for phones in Kenya (Ram), telemedicine to improve the skills of health workers at primary levels in Brazil (Bavaresco), delivery of health information to communities in Chile (Labarca), a general set of tools for mobile data collection being used worldwide (Selanikio), and handheld computers to support rural healthcare delivery in Mongolia (Sandhu).
2. mHealth/eHealth is about enabling access: A common theme across diverse applications was that information and communication technologies are being used to enable access to health information and services in places where access is difficult because of remoteness and/or cost.
3. Coordination among the various players: Coordination among donors and projects is necessary to avoid unnecessary duplication of effort and to share what works. This is the role of the mHealth Alliance, supported by Rockefeller Foundation among others (Brown). While there were questions from the program side as to what data donors want (Chib), there was a simultaneous sentiment that donors need “stepwise” guidance (al-Shorbaji).
4. De-emphasizing technology: The mHealth Alliance has recently been discussing development of an “mHealth Toolkit”, to provide a common technical architecture and platform for those planning to implement mHealth programs (Brown). The existence of free technology platforms – in this case DataDyne’s tool – enables programs to focus on developing health content (Labarca). It is important to have a generalizable tool, as DataDyne has done, that can be used by anyone; if individual governments must approve technology “you’ve lost the battle” (Selanikio). Programs must focus on understanding people and applications more than technology; in response to a question from Dye about the use of ethnography in this field, three examples were given: ethnography of teen chat rooms in South Africa (O’Neill), multi-year ethnographic fieldwork as the basis for the program in western Kenya (Salmen), and design ethnography of the information management practices of rural health workers in Mongolia (Sandhu).
5. Defining good evaluation: There are challenges to seeing change in population health outcomes (Chib). It is difficult to measure behavior change (Hoefman) and to evaluate systems that provide health content to people (Labarca). Ethnography should be considered more seriously as a complementary evaluation strategy in mHealth (Sandhu). In evaluation, the metrics should match the intervention – mHealth is another intervention; in addition, we want to see the unintended effects of technology (Ram).
6. New modalities of engaging people: Mobile phones enable fundamentally new ways of engaging with people. As opposed to mass communication that is often used in social marketing, phones allow for interpersonal communication that can be tailored and cost-effective (O’Neill). There are two modalities, moving messages out to people and demand-driven services, where people demand the information that they need (Ram). Salmen lent his support to the importance of demand-driven services and argued that phones will bring more equity. This is all supporting the shift to citizen-centered healthcare (Mechael).
7. Cautions moving forward: In natural disasters, the cellular network is the first to go (Zelaya). An open question: Who owns the data? (al-Shorbaji). Nobody is thinking about “real sustainability” (Adebola). Reliable phone networks are a challenge (Lishandu). We should be careful that we don’t become too dependent on one tool (al-Shorbaji).
8. Need to think more creatively: We should be bolder with approaches; if we are, poor countries “could leapfrog” in health and development terms (Upham). Many of the applications discussed focused on SMS and telephony capabilities; we should think about leveraging more advanced capabilities of mobile phones (Kengeya).
9. Who should design technology? There is an assumption that Africans cannot develop software, but that is not true (Adebola). DataDyne software was already developed by Africans (Selanikio). Africans should develop software, but they shouldn’t redesign what has already been built (Brown).

Conclusions/Recommendations:

1. There is a need for increased knowledge-sharing about mHealth/eHealth within the global health community. This should definitely include policymakers. As Prof. Tomori elegantly stated, while we are thinking about how to reach remote populations, we should think about “hard-to-reach” African leaders.
2. While there was discussion of both eHealth and mHealth, the discussion focused primarily on the latter.
3. There is a need for a continuing dialogue about mHealth. It is unrealistic to expect policy recommendations to come out of this meeting given the state of the field (many open issues) and the limited engagement at the meeting.
4. Major mHealth topics to be discussed at future meetings: definitions; standards, including how to conduct evaluation; and successes and failures from the field.
5. The value of the meeting was threefold: (1) it helped extend the network of those working in mHealth; (2) it provided those outside the field with an understanding of the opportunities and challenges of using mobile phones to improve population health; and (3) it placed a much-needed emphasis on prioritizing people and applications over technology.
6. Mechael suggested reviving the Mobile Metrics and Evaluation Group as a means of maintaining an active mHealth community discussion outside of official meetings.

Other observations:

1. The fishbowl format was successful in eliciting relevant commentary from a large group of speakers as well as from the audience. Time was an issue, though, as several invited speakers only spoke once and several audience members had comments or questions that they were unable to share.
2. One key issue that was not explored – as I stated at the end of the session – was the link between social entrepreneurship and mHealth. This is especially relevant to issues of demand, incentivization, and sustainability.
3. There is a need for an ongoing discussion of these issues at Forum 2010 and beyond – while the conversation will continue in other settings, the Global Forum for Health Research should continue to be involved because of its systems focus, its emphasis on actionable research, and the unique mix of parties (policymakers, donors, implementers) it brings together.

In early 2009, Oxfam released a report Blind Optimism critical of the private sector’s role in healthcare in poor countries. It drew attention to the cause of those who believe that any private involvement in healthcare in these countries is harmful. The arguments, evidence, and position of the report were flawed in numerous ways; sound responses to the report were provided by April Harding and the World Bank:

• Oxfam — This Is Not How to Help the Poor
• World Bank responds to new Oxfam health report

The reasonable conclusion one would come to from working in the field and from studying health systems is that a mix of private and public approaches will be most effective – and that the need for different approaches should be dictated by local context. Ideological extremism – pro-private or pro-public – doesn’t serve anyone, most especially the people who need access to health.

At Forum 2009, there was much stronger representation of the private sector than at the previous meetings. In addition to pharma and biotech, there were several sessions and plenary speakers dedicated to talking social entrepreneurship. One of these speakers was Al Hammond, Senior Entrepreneur-in-Residence at Ashoka. Al spoke during Wednesday’s plenary - Enhancing national environment for innovation: perspectives on low- and middle-income countries (TropIKA.net post about the session) – about Ashoka’s Healthcare for All pilot Punjab, India.

During Q&A Claudio Schuftan of the People’s Health Movement criticized Dr. Hammond and Ashok [sic] for: (1) bringing electronics to people where there is no electricity or way to repair devices, (2) supporting the interests of multinational corporations, and (3) making people dependent on products. Dr. Hammond began his response by saying, “We are aware that there is hostility towards private sector approaches”. He explained that they use market approaches to achieve efficiency and that all the programs he presented are social enterprises started by NGOs. Based on the success of the three pilots so far, the Punjabi government has requested 600 additional units. “Take what you will from that”, he ended.

Dr. Schuftan’s comments are well-aligned with the Blind Optimism ideology. Such comments attempt to polarize policymakers, donors, and implementers. In doing so, they actually keep us from thinking critically about the private sector and social entrepreneurship. Fortunately, this was not the overall tone of the meeting.

At the end of a session examining the role of governmental policy in supporting social entrepreneurship, Julius Mugwagwa of the Open University (UK) asked a question about the “backlash” that might occur if something went very wrong with one of these social entrepreneurial models. This is the type of balanced discussion we really need.

Driving back from the Lesotho border, my eye caught the last brilliant light of the day on a young man carrying wood he had gathered for the fire. I thought back to the teenagers who guard cows all day, of the women waiting, waiting by the side of the road, sitting in the tall grass for hours with small children in the hot sun, waiting for a lift.

And in a world where anything is possible for some of us, is that really true for all of us?

Yes, we can now have video night in Kathmandu, but television only allows you to receive. The real catalyst is the internet, where you become a global citizen – you can learn and participate and create.

You can always just read the news to fall headlong into THINGS THAT ARE GETTING WORSE: “Dubai Debt Woes Raise Fear of Wider Problem”, “Traumatized Russians View Their Dead After Train Bombing”, “Afghans Detail Detention in ‘Black Jail’ at U.S. Base”.

But what the soul needs to live is hope, and dreams.

Innovation Journalism brings us ideas that can change the world by reporting on people, processes and practices of innovators, as well as risks and opportunities. It is a ‘horizontal’ beat, reaching across politics, technology, health et al to report on how innovations arise, and helps shape our future by giving us new language to talk about new ideas.

Crowdsourcing is harnessed brilliantly by Innocentive, the innovation marketplace, where Seekers pose challenges they are having difficulty solving on the internet. A stunning 50% of these questions are successfully solved, and Innocentive has just publicized a study on how successful Solvers tackle problems – which can help us all problem solve better!

But what if you live in rural Uganda, and the roots of your cassavas are rotting? Question Box to the rescue! You can ask a question in your own language that can be answered by someone with access to research, the internet and a question archive informed by local knowledge. If you want to sell those cassavas in Ghana you can text TradeNet (and in Zambia, too) to get the current market prices, so you don’t sell yourself short.

In Mozambique, Village Reach decided to extend services to the last mile.. all people should have access to essential medicines, and they decided to bring in energy sources to preserve the vaccine cold chain. By creating an energy market, now fishermen could refrigerate their catch, and the entire local economy improved.

But how to create social change? We can improve the essentials of life, but to start movements, we must collaborate. Witness the effect of Twitter on the Iranian elections. My cousin’s post on Facebook alerted me to Open Access Week, which encourages the immediate sharing of published research results with everyone, everywhere, for the advancement of science and society. But social change must also come from the grassroots, like City Year, which brings young people together for a year of citizen service, to find their place in the world, and to break down the barriers of race, class and education to change our future. Nelson Mandela saw the potential of these young leaders when he visited Seattle, and asked City Year to come to South Africa to help heal the country. But it shouldn’t be up to one person to spread the word.

Ideas this good shouldn’t be kept to ourselves, they should be shared. And then we can say, “Yes, things ARE getting better.”

Ashoka: Innovators for the Public are hosting Tech 4 Society, a conference exploring technology, invention and social change, in Hyderabad, India, in February 2009. Find out more about the conference here. This blog post is an entry in their competition to find the official blogger to travel to and cover the event.

What happens when we put people at the center of evaluation (as Jocelyn Wyatt puts it)? In this context, it means recognizing that people are preoccupied with more important tasks than spending long amounts of time in front of dashboards and data visualizations.

This is true in any setting, and in our case it was driving. The role of visualization should not be to demand full attention, but to support the priority task and improve it through feedback loops. The challenge is not just to display how you are doing right now, but also to figure out how you could do better. So, what does this mean for the visualization itself?

Every form of visualization should tell a story. Unfortunately there is limited attention and time to process all the stories. So the gist of the story, or its immediate impact, should be visible right away. The term I like to use for this principle is “glanceability.” What does a visualization tell us before we take time to analyze it? I invite you to look at the following chart and image for 10 seconds each and compare. What did you see? What did you feel?

Modified from Azar Askin’s reproduction of a poster by Muenster Planning Office, Germany

A followup post talks about understanding how data is presented. How can you tell what is fact and what is fiction? What basic questions should you ask of the graph? How do you know if you are being taken for a ride?

Super-cool. Now, if you’ll excuse me, I’m going to go curl up with some of the other posts here – How Can We Measure What’s Most Meaningful? and In Non-Profit World, Numbers Don’t Tell the Full Story.. (something a friend of mine always used to tell me).

Read all about it! @ Innovation in Evaluation.