From Unite For Sight 2011: Community Level Approaches to Health
Editor’s Note: The following is another in a series of guest post on the Unite for Sight Global Health and Innovation Conference, which took place earlier this month.
As a seasoned (as in, once-before) Global Health and Innovation Conference attendee, I knew I was in for a weekend of astonishment, passion, and creativity-but also one of perplexity and frustration. As speakers introduced their specialized perspectives on innovative technologies or pioneering ideas, they also introduced the urgency or intensity of a problem-a problem that has been and will continue to be a problem if enterprise does not make the leap to encompass social impactand vice versa.
The session “High-Impact Entrepreneurship” at Unite For Sight’s Global Health & Innovation Conference offered insights into how this is being done on the ground-level. The World Health Organization (WHO) has long-recognized that unsanitary or contaminated water is one of the biggest obstacles to human health and well-being in the developing world. Water.org explains that the water crisis today is not a function of scarcity, but of access. Approximately one in eight people lack access to safe water, according to WHO and Unicef’s 2008 “Progress on Drinking Water and Sanitation” (pdf). And, rather sardonically, according to the 2006 United Nations Human Development Report, the poor in urban areas pay five to 10 times more per liter of water than more affluent households.
Gary White, Executive Director and Co-Founder of Water.org, can speak to such exploitation and injustice first-hand. He has seen countless examples of poor people in India having to purchase high-interest water from “the water mafia,” manipulators and schemers who control local water supplies and can thus charge exorbitant prices. Gary and his collaborators took this inequitable system and turned it into an opportunity for enterprise with the WaterCredit Initiative.
WaterCredit functions under the philosophy that by providing loans to people with little water access or negotiating power, the poor can be empowered to formulate local solutions to local water problems. Because of the intensity and magnitude of the problem, Water.org believes grants and water charities, while well-intentioned and marginally effective, are not sustainable approaches to solving the global water crisis. WaterCredit establishes a revolving fund in which loans given to the poor for start-up water access projects are repaid and then later re-deployed in new investments. They say that, after 10 years of loan cycles, an astonishing five times as many people will have viable water access systems than they would have under traditional grant modeling. One of the most promising byproducts of philanthropic investments in WaterCredit is their ability to spur commercial lending. In one Indian district, Water.org has seen an Indian bank commit to $2 million in funds for water and sanitation loan portfolios based on the high repayment rates it was seeing among loan recipients. As for the future of WaterCredit, Water.org is hoping to continue bridging partnerships between microfinance institutions (MFIs) and the not-for-profit sector.
Also in favor of providing purchasing power to the poor and generating for-profit models in developing countries was presenter Iqbal Quadir, founder and director of MIT’s Legatum Center for Development and Entrepreneurship. Inspired by Muhammad Yunus’s microcredit model via Grameen Bank, Quadir dreamed up GrameenPhone, a ridiculously successful telecommunication enterprise in Bangladesh. The seedling for this venture was planted when Quadir, as a young boy living in Bangladesh, was asked by his mother to walk several kilometers into town to obtain medication from the local pharmacist. After traveling for hours, he reached the pharmacy only to find out the pharmacist wasn’t in that day. Many years later, this instance solidified into a simple insight:
Connectivity = Productivity
If we connect people, we enable them;
If we disconnect people, we disable them
There were a lot of cell-phones-as-development-solutions enthusiasts at this conference. Quadir saw this same potential back in 1994 while searching for a way to connect people in one of the poorest countries in the world to each other. After seeking a partnership with a foreign telephone company and finding it in Norway’s Telenor, Quadir sought partnership with the Grameen Bank itself. Grameen at first was reticent to involve itself with a telephone company, but such collaboration was more alluring after Quadir proposed issuing loans to reliable Grameen microcredit customers, allowing them to engage in income-generating activities in their own villages. Now, village entrepreneurs in even the remotest areas operate telephone booths, charging their neighbors market rate to make calls. In the age of information, interconnectedness is power. And with 300,000 retail entrepreneurs and 28 million subscribers, GrameenPhone is doing pretty well to give that power to the poor.
To see Quadir give a TED talk on his runaway technology, click here. Check out Ode Magazine’s feature on Quadir’s enterprise here. And discover The Economist’s take on how mobile phones are transfiguring the poverty landscape.
Another of the sessions I attended at “Community-Level Health Social Enterprise Pitches,” exhibited the heart and soul of the Conference’s intent: allowing innovative thinkers opportunities to share their ideas, network and receive constructive feedback. The general theme threaded throughout all the presenters’ projects was social impact through technology.
My most-favorite revelations: In November, Benjamin Chi and Jeffrey Stringer of The Lancet published an article entitled “Mobile phones to improve HIV treatment adherence.” The authors open by hailing the expansion of antiretroviral (ARV) therapy access in sub-Saharan Africa, which has increased 30-fold since 2003. With many more HIV-positive individuals on ARVs, however, comes the challenge of ensuring that drug adherence is maintained.
To address this challenge, WelTel in Kenya designed an SMS intervention for HIV-positive patients. In its initial randomized trial, WelTel sent weekly text messages to patients, inquiring about their well-being. If the recipient didn’t respond within 48 hours, or if he or she voiced a complaint, the primary healthcare provider initiated a follow-up phone call. At the end of the trial, those in the SMS intervention group had a rate of adherence of 62 percent, whereas those in the standard treatment control group only had adherence of 50 percent. The invention group also had a higher rate of virological suppression (57 percent vs. 48 percent in the control group).
I’ve heard for awhile now that there must be some less time/financially-consuming alternative to directly observed therapy (DOT), which involves direct monitoring and surveillance of medication-taking, typically by community health workers who travel long distances to reach patients in rural or hard-to-reach areas. Could cell phone technology be the answer? What obstacles will this type of intervention confront? What cultural considerations need to take place to make such a model replicable?
Leave it to Dr. John Piette to answer some of those questions. Dr. Piette has worked for several years to improve health outcomes for patients with chronic diseases in Latin America. One particular intervention he discussed was the use of “telemedicine” to address issues in diabetes management in Honduras. Approximately 80 percent of adults in Latin America have cellphones, a huge asset on which Dr. Piette and his colleagues have capitalized. With 25 percent of Honduras’s population being illiterate, though, Dr. Piette devised an innovative way to send and receive mobile messages about patient health. By using interactive voice response (IVR) instead of text messaging, patients can receive an automated survey from a cloud-computing center and all they have to do is press numbers on their keypad to respond to questions about diabetes management.
Other speakers in this group, like t;Hesperian Foundation Editor Dorothy Tegeler, also spoke to the power of technology for education and consequent health improvement. For a long time, I have admired Hesperian’s commitment to publishing high-quality, culturally sensitive instructions and illustrations for community health workers (CHWs) around the world. (If you’re looking to implement a community-based health intervention and need some highly specific topical material or comic-book-style brochures with colorful, easy-to-follow health lessons, especially for low-literacy demographics, turn your attention to Hesperian). Hesperian workers are currently working on their website so CHWs around the world can adapt Hesperian’s learning materials to suit their specific needs. So, if a CHW in Vietnam wants to print a flyer in local dialect and change the standard prototype images so that the cartoon people look more Vietnamese, he or she can. Cool, eh?
Of course, with any intervention involving technology or telecommunication, you’re going to run into logistical obstacles. While cell phone capabilities and Internet capacities have been rapidly expanding to reach rural populations, there are still many remote villages that will remain impervious to technological interventions like these if infrastructural improvements aren’t made.
Nevertheless, it’s encouraging to see that there are individuals acting on revelations that cell-phone technology could remediate poor health information access, or that CHWs hold much promise in influencing community health practice. We know the parameters of certain problems in our world. And we need enterprising, intuitive people to think creatively about how to address them.
For another impressive innovation in health and mobile technology, check out Cellscope, a microscope cellphone that can transmit images of samples from remote village outposts to centralized hospitals and clinics with the diagnostic capacities to analyze them.