The Global Forum for Health Research Forum 2009: Innovating for the Health of All took place in Havana, Cuba from 16-20 November. I was in Jamaica the week following the conference and completely offline. Now that I’m back in the U.S., I’m planning at least two more posts about Forum 2009. This is the fourth in a series of posts from the conference.

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.

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.

Read the rest of this entry »

As promised earlier, here is a brief account about the design+water workshop I conducted in Mexico in June.

Two months ago, I was in La Paz, Mexico at NGO Fundación Cántaro Azul, helping them build organizational capacity in human-centered design (HCD).  Cántaro Azul works to improve access to safe water and sanitation for disadvantaged communities, not only in Baja California Sur, but in other parts of Mexico, and abroad. Their interest in HCD is two-fold: to improve existing initiatives and to innovate new approaches.

I recently completed the workshop final report for the organization. In the hopes that the work may be helpful to others, I’m posting the synopsis of the report here, along with some workshop photos. If you’re interested in accessing the report, please contact me directly.

Design thinking workshop final report: Safe water options with rural community stores in BCS 

Fundación Cántaro Azul • La Paz, Baja California Sur, México 

Jaspal S. Sandhu, Ph.D. • July 2009 

This document describes the outcomes of a week-long design thinking workshop held at Fundación Cántaro Azul (FCA) in La Paz in June 2009. The workshop aimed to build design thinking capacity at the organization while working on a problem of actual importance to FCA. The most important practical outcomes of this workshop were two complementary models for providing a clean, affordable drinking water choice for rural people in Baja California Sur via community stores. The primary audience for this document is FCA. It is intended to help them with ongoing activities focused on the community store model and in incorporating this approach in their various activities. The workshop was designed and facilitated by Jaspal Sandhu, the report author. Workshop funding was provided by the Blum Center for Developing Economies at the University of California, Berkeley.

Shown below: Field research during Day 2 and Day 3 of the workshop. (1) Using an auto-servicio system in La Paz (top left); (2) interviewing a user at a rural, government-run purificadora in San Antonio (top right); (3) debriefing after the San Antonio research (bottom left); (4) and obtaining water samples to test from a home in Rosario (bottom right).

Update: Voting opened Monday and will close Friday 3pm Pacific time. We are expecting a high turnout. Your support will be critical. To cast a ballot voters need to select three projects.

NetSquared has a new social challenge “N2Y4“. Voting opens Monday and Melissa and I submitted a proposal called “ClaimsMobile” to the new competition. “ClaimsMobile” is a mobile phone and web database application for management of patients’ medical and financial information in a Uganda output-based healthcare project. We have been working with partners at the Mbarara University, the NGO Marie Stopes International Uganda, and small private clinics in the region. Check it out. Voting starts April 6th (Monday) 11 AM California time and runs for five days. If you like our idea, vote for it… and be sure to look through the range of amazing proposals – everything from education to international justice to community programs. The word cloud says it all.

There seem to be a lot of “social challenges” these days. In the past nine months, I’ve been asked to vote for a Peace Corps projects photo idea at NameYourDreamAssignment, a girls’ tuition fund in Burkina Faso, a geotourism project in Ecuador, a women in sport challenge, as well as support a handful of ideas among the 7875 proposals submitted to the popular Ideas for Change in America campaign; all hosted on platforms like Ashoka ChangeMakers, GlobalGiving, NetSquared, and Change.org.

These challenges, like California ballot initiatives, work best if voters take the time to learn the issues. Spend some time to select projects from an area you know or have a great deal of interest – the NetSquare’s word cloud is a useful first step to sort ideas. If that fails, Stoltz at Web2…Oh Really recommends picking the project with the least votes… and I’ll close by suggesting “ClaimsMobile” for your short list.

It’s been more than two years since we reported on Seattle as the new Geneva, that is, as the new epicenter of global health activity. An article in this morning Journal-Sentinel (Water-engineering firms see potential, challenge in developing countries) – which includes an exclusive interview with the Acumen Fund’s chief executive Jacqueline Novogratz – suggests that Milwaukee is angling to do the same for water technology:

It’s an issue that almost certainly will preoccupy business leaders in metro Milwaukee in their strategy to brand the region as an international hub of water technology. The metro area is home to scores of water-engineering companies. Gov. Jim Doyle and the University of Wisconsin-Milwaukee this month announced plans to invest millions of dollars for UWM to become a center of freshwater research.

An 2008 article from the same newspaper (Area’s tide could turn on water technology) provides more evidence:

[F]our of the world’s 11 largest water-technology companies have a significant presence in southeastern Wisconsin, according to an analysis of data from a new Goldman Sachs report.

…

Wall Street has tracked automakers, railroads and retailers almost since there were stocks and bonds. But water remains a novelty. Goldman Sachs Group Inc. didn’t begin to research water treatment as a stand-alone industrial sector until late 2005.

While several large MNCs have shown an active interest in clean water in developing countries (e.g., Procter and Gamble, Vestergaard Frandsen, Dow) open questions remain as to what role large MNCs will play in providing access to safe water for the one billion people who don’t have it.

(Thanks to Dr. Jessica Granderson for sending the link)

Cross-posted from Design Research for Global Health.

The California Management Review recently announced the winners of the 2009 Accenture Award: Sara Beckman of Berkeley’s Haas School of Business and Michael Barry, founder of design consultancy Point Forward and Adjunct Professor at Stanford, for their article, Innovation as a Learning Process: Embedding Design Thinking (Fall 2007, Vol. 50, No. 1).

From the award website (which is still on the 2008 winner as I write this): “The Accenture Award is given each year to the author (or authors) of the article published in the preceding volume of the California Management Review that has made the most important contribution to improving the practice of management.”

The paper makes a compelling argument that innovation can be achieved by management and provides a model for cross-functional, cross-disciplinary teams to engage in this process. The relevance to global health as I’ve discussed before (really what this entire blog is about) is that the process can help us improve health systems through innovation.

The challenge in coming years will be how to get organizations and institutions working in global health – foundations, Ministries of Health, NGOs, development programs, health research centers, etc. – treating innovation as a way of working, not simply an input or an output.

The abstract/lead-in isn’t openly available online so I’m copying it here:

Companies throughout the world are seeking competitive advantage by leading through innovation, some — such as Apple, Toyota, Google, and Starbucks — with great success. Many countries – such as Singapore, China, Korea, and India — are investing in education systems that emphasize leading through innovation, some by investing specifically in design schools or programs, and others by embedding innovative thinking throughout the curriculum. Business, engineering, and design schools around the U.S. are expanding their efforts to teach students how to innovate, often through multi-disciplinary classes that give students a full experience of the innovation process. However, what does leading through innovation really mean? What does it mean to be a leader, and what does it mean to engage in innovation?

There is a vast literature on leadership covering a wide range of topics: the characteristics of a good leader, how leadership is best displayed in an organization, leadership and vision, authority, leadership styles, and so on. There is also a growing body of literature on innovation and its various facets, much of it focused by application of the innovation process. Hundreds of publications describe the process of innovation for products — both hardware and software — and a growing number of publications focus on innovation in services. Further, there are dozens of books on innovation in building and workplace design.

Here we examine a generic innovation process, grounded in models of how people learn, that can be applied across these sectors. It can be applied to the design and development of both hardware and software products, to the design of business models and services, to the design of organizations and how they work, and to the design of the buildings and spaces in which work takes place, or within which companies interact with their customers. The model has evolved through two streams of thought: design and learning.

This video, which seems to be unaffiliated to the authors, summarizes the article [correction - I just found out that Shealy did work with the authors on this video - Tues-24-Mar-2009 12:18PM PDT]:

[vimeo vimeo.com/3475327]
 
[Innovation as a Learning Process from Roger H. Shealy on Vimeo]

Here are slides from Beckman and Barry’s presentation at the Inside Innovation 2007 Conference and the Google scholar view of who is citing this work.

[(Dis)claimer: Sara Beckman served on my dissertation committee and Michael Barry provided guidance on my applied research in Mongolia]

Cross-posted from Design Research for Global Health.

Giving talks is not one of my strong suits, but it seems to be a part of the job requirement.  Earlier this month, I had the opportunity (even though I’m no good, I do consider it an opportunity), to give a couple talks, one to the Interdisciplinary MPH Program at Berkeley and one to a group of undergraduate design students, also at Berkeley.  Despite the difference in focus, age, and experience of the two groups, the topic was roughly the same: How do we effectively use design thinking as an approach in public health?

The first session was so-so, and I suspect that the few people who were excited about it were probably excited in spite of the talk.  It started well, but about halfway through, something began to feel very wrong and that feeling didn’t go away until some time later that evening.  Afterwards, I received direct feedback from the instructor and from the students in the form of an evaluation.  I recommend this if it is ever presented as an option.  Like any “accident”, this one was a “confluence of factors”: lack of clarity and specificity, allowing the discussion to get sidetracked, poor posture, and a tone that conveyed a lack of excitement for the topic.

It’s one thing to get feedback like this, another to act on it.

The second session went much better, gauging by the student feedback, the comments from the instructor, and my own observations.  This in spite of a larger group (60 vs. 20) that would be harder to motivate (undergraduates with midterms vs. professionals working on applied problems in public health).  I chalk it all up to preparation and planning.  Certainly there are people that are capable of doing a great job without preparation – I just don’t think I’m one of those people.

Most of that preparation by the way was not on slides.  I did use slides, but only had five for an hour session and that still proved to be too many.  Most of the time that I spent on slides, I spent developing a single custom visual to convey precisely the information that was relevant to the students during this session (see image).  The rest of the preparation was spent understanding the audience needs by speaking to those running the class; developing a detailed plan for the hour, focusing on how to make the session a highly interactive learning experience; designing quality handouts to support the interactive exercise; and doing my necessary homework.  For this last one, I spent 20 minutes on the phone with a surgeon friend, since the session was built around a case study discussing surgical complications and design.

Three resources I found really useful:

1. Why Bad Presentations Happen to Good Causes, Andy Goodman, 2006. This commissioned report was developed to help NGOs with their presentations, but I think there is value here for anyone whose work involves presentations. It is evidence-based and provides practical guidance on session design, delivery, slides (PowerPoint), and logistics.  Most importantly, it is available as a free download. I was fortunate enough to pick up a used copy of the print edition for US$9 at my local bookstore, which was worth the investment for me because of the design of the physical book.  It’s out-of-print now and it looks like the online used copies are quite expensive – at least 3x what I paid – so I recommend the PDF.
2. Envisioning Information, Edward Tufte, 1990. I read this when I was writing my dissertation. Folks in design all know about Tufte, but I still recommend a periodic refresher.  This is the sort of book that will stay on my shelf.  Also potentially useful is The Visual Display of Quantitative Information. For those working in global health, don’t forget how important the display of information can be: (a) Bill Gates and the NYTimes, (b) Hans Rosling at TED.
3. Software for creating quality graphics.  The drawing tools built into typical office applications, though they have improved in recent years, are still limited in their capability and flexibility, especially if you’re looking at #2 above.  In the past 10 days, three people in my socio-professional network have solicited advice on such standalone tools, OmniGraffle (for Mac) and Visio (Windows): a graphic designer in New York, an energy research scientist in California, and a healthcare researcher in DC.  Both are great options.  I use OmniGraffle these days, though I used to use Visio a few years back.  If cost is an issue, there are open-source alternatives available, though I’m not at all familiar with them (e.g., the Pencil plug-in for Firefox).

Good read with insight into how Melinda Gates sets priorities for the Gates Foundation, also some fun tidbits with a more personal article, excerpts below (I should mention there has been some recent criticism of Melinda and the data she has cited on antimalarial efforts, see here and here):

Feb 2009, Vogue, Gates of Heaven

• “without Melinda there would have been no Gates Foundation. She is the reason they focus so heavily on improving the health of the world’s neediest inhabitants.”

• “You have to be humble in what we are doing, but you also have to be bold,” she says. “You have to ask yourself, Are we going to feed people or sit behind ivory towers and argue about how to do it? I want people to live and to survive, so we will get out there and try something. If it doesn’t work, we will try something else. And we will keep trying until we find something that works.”

• “the philanthropy’s true power lies in its willingness to apply the merciless principles of the business world to charity.”

• “There won’t be any Gates Foundation grants for National Public Radio or the Metropolitan Opera. (For that matter, the foundation does not fund research into heart disease, diabetes, or many types of cancer, either, despite the fact that those diseases kill millions of people in the developing world. They also happen to kill millions of people in the developed world, and that means governments and pharmaceutical companies have all the incentive they need to address them.) Instead, Bill and Melinda Gates focus on problems that nobody else seems to care about.”

• “Melinda has become immersed in the financial-services issue, which she sees as an essential prelude to providing security and equality for women…“When a woman’s husband dies of AIDS in Malawi, she becomes the property of her brother-in-law,” Gates explains. “And he goes to collect all the assets. But they belong to her, and if she has the smart card, he will take it to the bank and demand the money. But the bank will say, ‘This is not your card; it’s not your account, because it’s not your thumbprint.’ He can’t get her money. And these cards,” she adds triumphantly, “have become so popular that they are the number-one wedding gift in the country.”

1. HIV/AIDS, TB, Malaria Account for 80% of Disease Funding in Developing Countries, Report Says
2. More funds needed for lesser known tropical diseases, Link

The above two headlines on global health funding flows and allocation caught my attention. The original study was published in PLoS Medicine. The article has some great figures (some of which I have reproduced below). A few things immediately stick out – the amount concentrated on HIV/AIDS, TB and malaria is astounding. Second the US is providing 70% of the funding and on the surface one could argue that other countries really could be pitching in more. On that note, the Gates Foundation by itself is out funding the European Commission almost 4 to 1 – if that isn’t embarrassing I don’t know what is. Finally, the US Department of Defense is high on the list (surpassing USAID). Interesting stuff:

“HIV/AIDS, tuberculosis and malaria initiatives accounted for about 80% of the $2.5 billion that was spent on research and drug development for developing countries in 2007… However, pneumonia and diarrheal illness, which are two major causes of mortality in developing countries, received less than 6% of funding.”

Original Sources:

• PLoS Medicine – Neglected Disease Research and Development: How Much Are We Really Spending? Link
• WHO Top 10 Causes of Death, Link
  

[youtube=http://www.youtube.com/watch?v=XZaUD5OeVnk]

From Giving in a Digital World, read their full detailed post, excerpt below:
“Play It Forward (named after the movie, presumably) is a start-up that plans to launch a new online giving platform next month, offering individuals or groups of individuals the opportunity to fund specific projects around the world.

Ok. Sounds just like another Global Giving? However, Play It Forward looks like it’s going to have some special aspects to it that could make it stand-out as a distinctive player in the online nonprofit project crowdfunding world…” More here.