Image courtesy of kiwanja.net

Late last week I read news from three different sectors, all about “South-North” innovation transfer, a topic we’ve discussed here before, particularly in the context of mHealth. Earlier this year Fast Company reported on the concept of trickle-up innovation, citing the examples of yogurt microplants in Bangladesh (Group Danone, Grameen Bank) and Mosoko, touted as Craigslist for the next billion in Kenya (Nokia). In addition to these cases of MNCs from the global North testing out concepts in the South, Fast Company presented examples of corporations from the South, including ICICI (banking, India), Natura (cosmetics, Brazil), and Goodbaby (infant products, China).

Here are the three articles from this past week:

1. HEALTH SERVICES: To Fix Health Care, Some Study Developing World, Wall Street Journal, 2 Jul 2009. The University of Alabama-Birmingham AIDS clinic turned to Zambia for a model of increasing the number of patients who showed up for treatment. Based on early successes, they are continuing under the project name “Zambama”.
2. FINANCIAL SERVICES: DOCOMO to Launch Mobile Remittance Service, NTT DOCOMO press release, 2 Jul 2009. Later this month Japan’s DOCOMO will enable individual subscribers to use their mobile phone to remit money to other subscribers. Such a branchless banking/financial remittance service is certainly prompted by Safaricom’s M-PESA service from Kenya.
3. CLEAN TECH: Worldchanging Interview: Shawn Frayne, 2 Jul 2009. The interview is about wind technology, but touches on broader issues related to South-North innovation flow. Frayne thinks that “the constraints of the developing world can provide the necessary inspiration to make significant technological leaps that can benefit the Global South and Global North simultaneously”.

There are various other examples from the last several years suggesting a growing trend in countries from the North learning from the South. Here are examples just around financial services for the poor:

• Opportunity NYC was the first conditional cash transfer (CCT) program in the U.S., based on the Oportunidades program developed in Mexico.
• Less than one month ago international development micro-lender Kiva launched a pilot program in the U.S.
• Grameen Bank supports microcredit in places like Norway

Add to that the various management principles we’ve learned from the Aravind Eye Care System and Mumbai’s dabbawallas. Extending the argument presented by Fast Company, these examples show that South-North innovation transfer doesn’t have to be focused on corporations.

While it’s enticing to think about mining untapped innovation potential in the South for the benefit of the North, the real potential is much broader. Innovation can (and does) flow in all directions, not just South-North, but also North-South, South-South, and within countries. The challenge is to learn from different ways of approaching the same problem. Or even similar problems: see how Kaiser-Permanente visited a flight school to reduce medication errors and how the NHS worked with Formula 1 team to improve ICU procedures.

Given this potential, the big, open question is this… How do we increase global sharing of ideas and models to spur innovation?

This morning I attended “On the Move: Mobile Health” (session D2). From the conference website:

Presenters Discuss: the overall strategic approach to mHealth taken by the Millennium Villages Project and use the experiences of pilot testing and implementing mHealth activities and applications in Ruhiira Uganda (Uganda, Africa Region); the present use of mobile phone technology in the microfinance industry (MFI) and new and expanded applications for mobile-based services (India); why the mHealth Alliance was created and how it will develop and incubate the framework and solutions for the nascent mHealth sector (global); and how rapid HIV tests and handheld technologies are being used for population-wide door-to-door HIV screening (Kenya).

The cast:

• Moderator: Neal Lesh, PhD – D-tree International

Presenters and talk titles:

• Anita Katusiime – Millennium Villages Project-Uganda, Mobile Health Implementation Experiences
• Janine Schooley, MPH – Project Concern International, Connecting India to Disconnect Poverty and Improve Health
• Mitul Shah – United Nations Foundation, Inc., Development of a Mobile Technology Alliance for Health [multi-country]
• Martin Were, MD – Regenstrief Institute, Inc and Indiana University, Incorporating Technological Advances In Population-Wide HIV Screening [Kenya]

The issue of trust came up explicitly during two of the four presentations. In the Millennium villages project, one of the major challenges was CHWs “failure to explain the tool to household members”. In India, PCI found that the majority (~70%) of beneficiaries of a microfinance program felt the mobile phone based solution would increase trust.

During the Q&A Ashifi Gogo probed further – he asked about the perceptions people had about their health information when it was collected using mobile devices. The panel answers were largely focused on technological measures to safeguard the data, so I thought it appropriate to mention Karen Cheng’s Angola study, last featured in the Bulletin of the WHO. I’m happy that I did because Patricia Garcia brought up a recent study she co-authored (Bernabe et al., 2008), a study that I didn’t know about, and a study that showed the opposite result. This Peruvian study examined the quality of data using PDAs to collect sensitive data compared to paper-based surveys. The results: there was a high level of agreement among PDA and paper-based responses and there were fewer inconsistencies within individual respondent surveys. [Note: I've only skimmed the paper this afternoon and plan to read it more carefully soon.] 

One of the key challenges Mitul Shah highlighted during his talk was better understanding the relation between people and technology. In his words, we need more “basic market research” and “impact evaluations”. Understanding how cultural perceptions of technology impact social desirability bias seems to be a critical gap since we’ve focused so many of our efforts on issues like cost-effectiveness, efficiency, and technological interoperability. That the Cheng and Bernabe studies showed such different results indicates that context matters. It’s not just a matter of phone (PDA) vs no-phone (np-PDA) – culture, age, gender all matter, too. If we can begin to understand these local factors, we can plan accordingly – e.g. how we train data collectors to prepare survey respondents – to achieve the gains we want in efficiency and cost.

After a holiday hiatus I should be back to blogging much more frequently. I did some desk clearing from emails that had gathered over the past month and naturally many of them were year end Top 10 lists. I thought it would be appropriate to capture some of these below. In addition to starting off with a couple of miscellaneous links, I included a section on business and global health. Once again I do this because I strongly believe it is important to understand the impact the business community/private sector is having on the issues we care about. In my opinion folks in the public health world are almost completely incognizant of what is happening with respect to this (and to be fair the opposite is also true). Enjoy the links below, I probably will have some more desk clearing to do as the week goes on. In particular the first link under the business and global health section below on Melinda Gates is quite interesting if you care to know more about her.

Miscellaneous
Global Health Photo Contest, link
The Global Health Council’s Photography Contest is dedicated to drawing attention to health issues that have a global impact. Deadline is Feb 15, 2008.

What can $611 Billion buy? Try this – feeding the world’s poor for 7 years. Link
via Good Magazine.

Top 10 Lists
*Top 20 Global Health Priorities, link
In one of the world’s largest public-health collaborations, 155 experts from 50 countries have a plan to tackle the world’s deadliest diseases. The result is a list, published in the journal Nature, of the top 20 research and policy priorities in chronic non-communicable diseases – which account for 60% of all deaths worldwide. It’s “a road-map” for action, says lead researcher Abdallah Daar at the McLaughlin-Rotman Centre for Global Health in Toronto.

*A Year of Worldchanging Ideas, link
Exec editor Alex Steffen of Worldchanging has compiled their best of list in several categories. The full list is below, I have selected a few that I liked: “Over the last year we ran more than 2,000 stories, including a number of pieces that I think are pretty much the best stuff we’ve ever done… here is my list of the top Worldchanging posts of 2007. It’s very subjective, though many of these stories have also been among our most popular (judged by visits) and provocative (judged by media coverage and blog links) posts.

• Tools for Understanding Poverty, link

• The Open Architecture Network and the Future of Design, link

• Transforming Philanthropy, link

*10 Highly Consequential Implications of Climate Change, link
A new report called The Age of Consequences, forecasts climate change in the coming century. It makes for fascinating if frightening reading. See table for impact on global health. via.

*Top 7 Social Entrepreneurship Blogs via Riches for Good
Finding and funding sustainable, scalable solutions to end global poverty

*Top 10 Wins For Women’s Health in 2007, link
Women’s health was a priority concern in 2007, as global donors, international agencies, and influential private foundations realized that investing in women’s health is investing in the world (hat tip – Pump Handle).

*The Independent announces its top 6 social entrepreneurs, link
Last year, The Independent – in collaboration with The Schwab Foundation for Social Entrepreneurship and the Boston Consulting Group – began a quest to find the UK’s most successful social entrepreneurs. (hat tip)

*10 Videos to change how you view the world (all TED videos), link

*10 top global health issues according to WHO, link (via)

*10 Universities With the Best Free Online Courses, link (via)

Business and Development/Global Health

*Who is Melinda Gates?, link
Interesting read: “Years before Melinda French met and married Bill Gates, she had a love affair – with an Apple computer…Of all the tricks that life can play, it’s hard to imagine any stranger than what befell Melinda French. Today she is married to the richest man in America – and giving billions of dollars away…”

*Global pharma firms take a tropical dose, link
Multinationals focus on diseases in developing countries as they lose protection by patents at home. The big multinational drug makers are increasingly focusing their research on diseases that no longer afflict their home countries. As many as nine companies are developing medicine for tuberculosis, which claims two million lives every year. At least seven are focusing on malaria, another killer.

*IFC betting 1 Billion on Africa’s private sector to improve health, link
The IFC plans to set up an equity investment fund, ultimately worth up to $500m, including money from other donors, to invest in small and medium-sized enterprises in the health-care industry. It also wants to create a $400m-500m debt vehicle that will fund local banks that lend to such entrepreneurs. See also – http://www.ifc.org/HealthinAfrica

*On Malaria: Charity vs. Capitalism in Africa, link
Africa’s best hope to fight malaria is the wide distribution of mosquito-repelling bed nets. But who best serves that need: the public sector or private interests?

*2 Young Hedge-Fund Veterans Stir Up the World of Philanthropy, link
As hedge-fund analysts, Holden Karnofsky and Elie Hassenfeld made six-figure incomes deciding which companies to invest in. Now they are doing the same thing with charities…Their efforts are shaking up the field of philanthropy.

*Oprah effect brings microlending to Main Street, link
Kiva hit the publicity jackpot in September when Oprah Winfrey featured the organization on her daytime television program, attracting a tidal wave of interest from Middle America. Demand was so high the day the episode aired, every loan on the site was fulfilled.

*Heinz Pledges to Provide Free Micronutrient Assistance to 10 Million Children by 2010, link
The H. J. Heinz Company is working to develop solutions to reduce global malnutrition, a commitment underscored in the Company’s 2007 CSR report. The report lays out the Company’s plans to provide free micronutrient assistance to 10 million children at risk of iron-deficiency anemia by 2010.

We have blogged about the power of online social networks before as have many other bloggers. The Wall Street Journal has a brief review on online social networks and cause marketing that you can see below. For those of us in the public health space, we should be taking notes on how to leverage these ideas and what’s around the corner for reaching out to people (for education, involvement, philanthropy, documenting disease trends, etc.). This may not be directly related to global health yet or promoting a favorite cause, but check out the growing popularity of PatientsLikeMe (a social networking site of sorts where patients can discuss how they managed their conditions… and perhaps they can add a feature down the line for raising funds for a particular disease?).

A New Generation Reinvents Philanthropy:
Blogs, Social-Networking Sites Give 20-Somethings a Means To Push, Fund Favorite Causes
Wall Street Journal, August 21st, by Rachel Silverman

“Joe Alamo didn’t set out to become a do-gooder. But late last year, when the Geneva, N.Y., Web designer was surfing on MySpace, he chanced onto the profile of Kiva.org, a nonprofit that allows people to make zero-interest “microfinance” loans over the Internet to needy entrepreneurs in developing countries.

Young donors and volunteers, snubbing traditional appeals such as direct mail and phone calls, are satisfying their philanthropic urges on the Internet. They’re increasingly turning to blogs and social-networking Web sites…”Full story

A bit of diversion here, but an important one from the latest issue of Fast Company. I do not yet have an opinion on the 10 year retrospective review below, however, the numbers from Fast Company (if accurate) are dramatic. Dave Richards at “Defeating Global Poverty” has a more detailed post that you should check out and the author of “You Can Here Me Now“, Nicholas Sullivan, has published a letter countering this article (excerpts at the end of this post).

Has Grameen’s Village Phone Program Gone Obsolete? Fast Company Magazine September 2007
“At first, they all came…And then, one by one, each talked on Laily Begum’s wondrous new possession, a cellular telephone. A caller might come to check on money that her husband was supposed to send from his job as a day laborer in Dubai…But that was in the beginning, a decade ago; these days, cell phones are so commonplace that most visitors come only for a haircut, a shave, groceries, or a place to sleep, all of which Begum offers now. The few wireless calls are no longer made from her home but from one of her nearby shops–usually the one with the barrels, drums, and cans of motor oil out front and lining its walls. In March, when I visited her home in Patira, a stretch of dusty intersections 90 minutes northeast of Dhaka, she told me, “Hardly anyone uses my phone anymore.”

“Begum’s success has become legendary, embraced by the media and the world of economic development as an example of how microcredit and technology can help those born in poverty escape it, largely through their own entrepreneurship. The Grameen organization continues to boast that its Village Phone Program “has been incredibly successful … establishing a clear path out of the poverty cycle”…But as it turns out, the legend is far out of date…In Bangladesh today, the only one making real money on GrameenPhone’s wireless service is … GrameenPhone.”

The Village Phone Program no longer sustains its entrepreneurs — yet Grameen continues to recruit operators…” Full story

Counterpoint by Nicholas Sullivan:

“Dear FC,

Re: “Unplanned Obsolescence” (September), I wonder if you don’t miss the forest for the trees. The big story is that Bangladesh has increased its phone penetration from 1 per 500 people in the mid-‘90s to 1 per 7 people today. The phone ladies, whose income and profits are surely declining as noted, and who represent at most 3% of GrameenPhone subscribers, are not the raison d’etre of GrameenPhone; distributing tens of millions of phones throughout the country is the company’s mission and has been from the start. Utilizing Grameen Bank’s network in 60,000+ villages was merely a way to deliver phones into remote rural areas where there was and still is no reliable electricity or roads. The fact that the foreign investors behind GrameenPhone (Telenor of Norway, Marubeni of Japan, and Gonofone of New York) endorsed this strategy while also perceiving its developmental impact in lifting people out of poverty is one of the most positive business stories in recent memory.

Read the full letter here…

I think this is a brilliant idea, partial excerpts below (via Salon), full story of “A Business School for the Indian Poor”:

“In an age when business schools have become synonymous with stratospheric tuition fees and blue-chip faculties, the Mann Deshi Udyogini, or Udyogini Business School (estb. January 2007) is India’s, and perhaps the world’s, first and only B-school for unlettered rural women…”

“Funded largely by HSBC, one of the world’s largest banks, coaches poor women in entrepreneurship, accountancy, bank finance, marketing skills and confidence-building for a piffling Rs150 (US$3.70) for a three-month basic course and Rs600 for a six-month advanced one…Plans are also brewing for a “Business School on Wheels” to target women in remote areas who can’t travel to Vaduj.”

Founder Bio:
“Economist, farmer and activist, Gala Sinha works for social change in some of the poorest and most drought-stricken areas of rural India…Her bank is the first in its region to provide life, accident and hospitalization insurance for women…Gala-Sinha has succeeded in changing government policy and law regarding property rights for women…”

Full news article here.

The Paris Microfinance Network has a good post from last month that I wanted to note:

“An interesting approach, applying microfinance principles, was launched by the organization ‘Water Partners international’ with an initiative called the WaterCredit Initiative that we believe provides a hopeful unique model. By making small loans to communities and individuals who do not have access to traditional credit markets, WaterCredit helps finance the upfront cost of water and sanitation systems…A working example: in India, WaterPartners provided $105K in loans for safe drinking water and household toilet facilities for urban slum residents.” Read the full entry.