NB Health Care
Creating an Exit Strategy for Aid (Part 1): Nonprofit mWater, in striving to eliminate diarrheal disease, runs like a for-profit Silicon Valley startup
Editor's note: mWater is a free, open-access system used to monitor water sources, offering a global map, a mobile phone app for recording sources and test results, and inexpensive water-testing kits. There are currently more than 4,000 mWater users in 59 countries. Even though mWater is a nonprofit, it's actively engaged in finding market-based solutions to water and sanitation issues because, as CEO Annie Feighery says, "Working in a revenue model ensures our product is always needed." Feighery, who earned a doctorate in health and behavior at Columbia University, talks below about the extent of waterborne disease around the world, and how mWater differs from other nonprofit tech startups. In the second of the two-part interview, she discusses why NGOs almost never go out of business, how mWater will know when it's time to shut down, and why paper is the firm's biggest challenge.
Kyle Poplin: What problems is mWater dedicated to solving, and how does it help solve them?
Annie Feighery: At its core, mWater is our best effort to eliminate waterborne (diarrheal) disease. We see this as the cornerstone to eliminating severe poverty on the planet. Diarrheal disease is the second leading cause of death for children under 5, but even that stat obscures how very bad it is. For the children who survive, diarrheal disease is the leading cause of malnutrition and the physical and mental stunting from malnutrition that cause lifelong disability. Entire communities are not as able to work as adults at the level they could if they had safe water as children. Physical stunting is also a top cause of maternal mortality and morbidity. There are many examples like this of the domino impact safe water (or lack thereof) has on communities working to escape the cycle of poverty.
The world first organized a global strategy for this problem in 1995 with the Millennium Development Goals, and the target for water – double the number of improved water sources by 2015 – was one of the few MDG targets met. But during that time, diarrheal disease incidence did not significantly decline. That is because we learned access to water may improve quality of lives, but it won’t save lives unless the water sources created are safe ones. Many organizations went out and built protected springs and dug shallow wells and within a few weeks they were just as dangerous microbiologically as the open ponds they replaced. A friend, John Oldfield, recently testified to Congress on this topic. He said, “Children aren’t dying from thirst, they’re dying from shit in the water." With the replacement goals, the Sustainable Development Goals, that (were) voted on by the United Nations, the target for water (includes) the word “safe” for the first time ever. With safe as a target, it means NGOs and governments who make water sources will also have the responsibility for making safe ones and for monitoring them for safety.
(Annie Feighery, left, with computer, at work in Tanzania.)
mWater is the only monitoring tool in the world that offers an affordable means to monitor water sources ($2 to $7 a test, depending on standards, and no equipment like an incubator is needed) and an updatable mobile monitoring and evaluation (M&E) app to map the water sources and update their quality over time. mWater’s global water database is a free, open-access registry of water sources and their most recent status details like functional status and microbiological safety. That this database is free and open access means organizations making, mapping and monitoring water sources can share that information with communities and governments at no cost to their local collaborators. The end result is a shared infrastructure that itself is the backbone for larger, sustainable water infrastructures that can grow independent of aid agencies running them. It’s an exit strategy for aid.
There is one other aspect to how we think this can help the world eliminate diarrheal disease. The free mobile M&E app is a gateway drug of sorts to sharing open data in the mWater global water database. The more we can populate this database, the more likely it is that we can datamine water. Because of the nature and history of aid and research, water data has historically been siloed, either on paper, hard drives, behind institutional review board-enforced firewalls, or out of a sense of competition with other aid entities. Now, the system is built for sharing. If we can datamine water, we can begin to understand patterns over time and geography that might allow local and international health professionals to get the jump on outbreaks of diarrheal disease before they occur.
Already, in collecting data and analyzing the way different institutions and governments survey diarrheal disease, we made a very big discovery. District health information systems and other major monitoring tools for diarrheal disease have always asked about diarrhea using the WHO definition: three or more loose stools in one day. When asking health professionals in diarrhea-endemic regions how they decide to record a case of diarrhea in a survey, we found a range of 17 symptoms including red eyes, weakness and fever. Loose stools was only the fourth most common response and it was always used in tandem with these other symptoms. Digging deeper, we found that in regions where many “healthy” adults never have solid stools because of the constant microbiological load of the water supply, loose stools are not a helpful symptom. And yet, global diarrheal incidence is tracked with this question. This example shows that collecting more data provides the opportunity to research data quality and patterns as well as the object the data is collected against.
KP: How did you become aware of the need for an organization like mWater?
AF: My husband and I make up two of the three founders of mWater. My doctorate is in public health and his is in earth and environmental engineering. We were both keenly aware of how siloed each of our educations and experiences in (for me) child survival and (for him) hydrological systems were and how that siloed pattern seemed to create imperfect approaches. We always wanted to work together to complement the holes in each approach.
In startups, it is important to mix technology experts with domain experts. Many startups fail because they go heavy on technology and create software that is fully functional but irrelevant to the real-world problem they are designed to solve. The best thing about our team is that we bring a world-class technology expert, our Chief Technology Officer Clayton Grassick, to the domain expertise of water and health. mWater is not just a software tool, it is an infrastructure for bridging health and water.
KP: What makes mWater different from other nonprofit tech startups?
AF: mWater tries to run like a for-profit tech startup, just like Silicon Valley startups. We use the same lean and agile management protocol with short sprints, rapid product iterations and a very lean (small) team. We have a team of seven around the world and our top competitors are at least 10 times that size.
mWater is entirely revenue based. We would love to accept funds from philanthropy but it has not come about so far. We find software built from requests for proposals (RFPs) is not lean enough, nor does it meet the local market holes that equate to end users. When we respond to RFPs with our user metrics focus, we turn off grant judges with a traditional, beneficiary focus.
We pointedly avoid running like an aid agency. Everything we do has the goal of creating an exit strategy for aid – that means building infrastructures that can run independent of an NGO – efficient, lean infrastructures that can be supported by the local market or by local tax and fee revenue.
Kyle Poplin is the editor of NextBillion Health Care.