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Human-Centered Design and the Last Mile

This is an excerpt from a blog post that originally appeared on Stanford Social Innovation Review.

Community health workers demonstrate a storage and inventory management system for commodities, diagnostic tools, and medicines. (Image courtesy of frog design</em>

Community health workers demonstrate a storage and inventory management system for commodities, diagnostic tools, and medicines.
Image courtesy of frog design

Despite many challenges, Uganda’s village health teams deliver care to some of the nearly 85 percent of Ugandans who live in remote, hard-to-reach corners of the country, or the “last mile.” During some months, these committed volunteers know that they will have the medicines necessary to treat children dying of pneumonia, malaria, and diarrhea. But during others, the teams are less sure. They’ve also come to expect inconsistent supervision and training.

The situation in Uganda is not unique—community health worker (CHW) programs throughout the world struggle from limited resources and sub-optimal design, often devolving from a national strategy into a patchwork of nonprofit programs and activity.

Why is this? The global health community understands that these same programs are important for reaching Millennium Development Goal 4 (MDG 4)—to reduce mortality among children under five from the current level of 6.6 million deaths per year to 4.3 million by the end of 2015. Yet many perceive CHWs as inadequate replacements for trained health professionals such as doctors and nurses.

We can flip this logic on its head and take a new approach by placing these workers at the center of our design strategies, recognizing that they provide a vital link between communities and the health system. We need a holistic framework that motivates and empowers them.

At the core of this framework, we would need integrated community case management (iCCM), which offers a systematic approach to delivering and expanding access to life-saving medicines. CHWs form the backbone of this approach; they can ensure that sick and vulnerable populations are correctly diagnosed and treated. If fully funded and implemented, it is estimated that iCCM delivered through CHWs could save up to 250,000 lives by the end of 2015. Accomplishing this would require a few important tools:

  1. Increased access to commodities, diagnostic tools, and medicines. Specifically, this would need to include malaria rapid diagnostic tests and respiratory timers for pneumonia, artemisinin-based combination therapies to treat malaria, antibiotics such as amoxicillin dispersible tablets for pneumonia, and ORS/Zinc to treat diarrhea.
  2. A solid community-based service delivery platform. The platform would have front-line CHWs at the center, with the necessary systems support for them to function effectively and efficiently. Support would include training and deployment (including retention and incentives), an effective supply chain that reaches the most peripheral levels, supportive supervision, and monitoring to maintain quality and skills.

With this in mind, in 2012, UNICEF, MDG Health Alliance, and Save the Children reached out to several other partner organizations, including USAID, with the goal of developing a holistic CHW system that could:

  • Serve as an assessment tool for existing country-level CHW programs
  • Outline a menu of best practices and innovations from across the globe while encouraging idea-sharing
  • Empower, recognize, and motivate CHW programs to serve as platforms for programs beyond iCCM—including newborn and maternal health programs

The team partnered with the innovation consulting firm frog design, which engaged more than 60 organizations—including global health experts, private sector corporations, and program implementers across Africa and Asia—and led the team through sessions and immersion exercises in Uganda and Senegal over 12 weeks…

To continue, please see the full blog post at Stanford Social Innovation Review.

FrontLines: Energy/Infrastructure

FrontLines January/February 2014: Energy / Infrastructure

Read the latest edition of USAID’s FrontLines to see how the Agency invests in energy and infrastructure projects around the world. Some highlights:

An Ethiopian-born entrepreneur from Canada was hoping to operate a mining facility in his homeland, but his plans were thwarted by one thing — a lack of energy to power the mine. Read how Nejib Abba Biya and the Ethiopian Government, with support from the United States, are working to use the country’s natural geothermal energy as a reliable, renewable power source.

Electricity 24 hours a day, seven days a week is the new — and welcome — normal for residents living in Haiti’s Caracol Village.

Waiting and waiting and waiting for a web page to load — that is so 1990s. Just ask the residents and aid workers at the refugee camp in Dadaab, Kenya, where high-speed Internet access is only a click away.

It’s Sri Lanka’s version of “Back to the Future” as some of its citizens embrace rainwater harvesting, a practice dating back to the 5th century that today has a 21st century, enviro-friendly appeal.

If you want an e-mail reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

New Report Highlights the Hardships and Hard-Won Victories for LGBT People in the Europe and Eurasia Region

 

A demonstrator holds a rainbow flag in Bratislava

A demonstrator holds a rainbow flag in Bratislava on September 21,2013, during the Rainbow Pride Parade, a march for the human rights of non-heterosexual people and the celebration of LGBT (lesbian, gay, bisexual, transgender) pride in Slovakia. AFP PHOTO/SAM

As the recent winter Olympics in Sochi illustrated all too well, lesbian, gay, bisexual and transgender (LGBT) people in Russia face tremendous hurdles in their everyday lives, including openly hostile laws and an extremely difficult working environment for the grassroots organizations that advocate for social change in the face of grave personal risks. The situation in Russia is unfortunately not unique, with LGBT people facing increasing hostility, discriminatory laws, and escalating threats of violence in many countries around the world, whether in Uganda, Nigeria, or Eurasia.

The U.S. government and USAID are strong supporters of LGBT rights. The Agency’s new mission statement places a premium on the inclusion and the empowerment of marginalized people through our work across the globe. Our missions in the Europe and Eurasia (E&E) region have stepped up their efforts to ensure that LGBT issues are addressed through development projects and that LGBT people are able to participate fully and effectively in all that we do. Testing the Waters: LGBT People in the Europe and Eurasia Region, a new report that was just released by USAID today, was designed to support these efforts by comprehensively documenting the status of LGBT people across the region and describing in detail the challenges they face in seeking to claim their human rights and role as full participants in their communities and societies.

The challenges that the report reveals are daunting. Across the region, attitudes towards LGBT people are very negative, with openly derogatory remarks and homophobic sentiments commonly expressed in public and in private. LGBT people are not legally protected from discrimination in the region, and they frequently suffer physical attacks and intimidation.  Gathering places and offices of grassroots LGBT advocacy groups have been ransacked and destroyed. Harassment at home, in school, and at the workplace is a common feature of everyday life. Not surprisingly, many LGBT people in the region choose not to reveal their sexual orientation or gender identity, even to families and friends.

Despite all of these challenges, the report also makes it clear that LGBT people across the region are speaking up and making a difference. Grassroots organizations advocate for LGBT rights in every E&E country, provide safe spaces for LGBT people, and offer support and much-needed social services. Many people take on great personal and professional risks in their efforts to ensure that the societies they live in are accepting of all people, regardless of who they love or how they express their gender identity.

I hope you will take the time to read this report  and to think about what you too can do to ensure that no-one is left out of our joint efforts to create a world in which everyone is treated fairly and equally.

No Birth Should Be Left Up To Chance

Giving birth ranks among the scariest moments for any mother. It certainly was for me. I was living in Hong Kong at the time when my second child was born. And he was born in a hurry. He came so fast that I actually thought I’d give birth in our car on the way to the hospital! Fortunately, that didn’t happen and I safely delivered my son Patrick surrounded by a team of well-trained doctors and nurses, not to mention my loving (and relieved!) husband by my side.

Mozambican mother holds her newborn. Photo credit: MCHIP

Mozambican mother holds her newborn. Photo credit: MCHIP

But I’m one of the lucky ones.

As new research released today by Save the Children reveals, 40 million women give birth without any trained help whatsoever. What’s more, two million women give birth entirely alone.

I met one of those women in Nepal about five years ago. I was there visiting our programs in the south of the country and stopped in to see a mom who had given birth a month prior. She sat with us and talked quite matter-of-factly about how when she went into labor with her third child, she didn’t panic. She merely laid down in a clean part of her house, caught the baby when she came out, cut the umbilical cord and wrapped her to keep her warm.

When she had finished telling her story, and I had stopped shaking my head in amazement, I couldn’t help but compare her experience to mine. After all, both of our children came into the world faster than we had anticipated. However, while my husband was there to drive me—fast—to a first-class hospital, this woman had no one. Her husband was away in India on business and her two daughters were in the next village. Even if she could manage to get herself to the nearest clinic, which was 2 kilometers away, she would have had to travel on foot. So she did the next best thing; she left it up to chance.

Fortunately for this mom both she and her newborn survived. But for too many women in the same situation, the outcome is much more tragic.

So many things can go wrong when a mother gives birth without a skilled birth attendant (SBA). Things such as prolonged labor, pre-eclampsia and infection—which are perfectly manageable when an SBA is present—can mean a death sentence in the absence of one.

For this reason, Save the Children is partnering with world leaders, philanthropists and the private sector to commit to ensuring that by 2025 every birth is attended by trained and equipped health workers who can deliver essential health interventions for both the mother and the newborn.

Because no birth should be left up to chance.

Crafting Economic Empowerment for Women in North Lebanon

On a sunny October morning, I was blinking back tears of pride as 39 women, hailing from poor families, some with Down syndrome, gathered on a terrace to receive certificates celebrating their completion of a handicraft and soap making training workshop supported by USAID. Atayeb el Rif (Rural Delights), a cooperative that specializes in local gourmet foods and delicacies, organized the training as part of a grant it received under the USAID Lebanon Industry Value Chain Development (LIVCD) project to enhance the economic status of women in North Lebanon.

The USAID LIVCD project is a five-year project that provides income-generating opportunities for small businesses while creating jobs for rural populations, in particular women and youth.

The USAID LIVCD project is a five-year project that provides income-generating opportunities for small businesses while creating jobs for rural populations, in particular women and youth. Photo Credit: DAI

North Lebanon, an area that has seen a large influx of Syrian refugees, had already been facing many economic challenges, most notably loss of income due to scarce employment opportunities. USAID has intensified efforts in this region to help Lebanese communities hosting Syrian refugees through targeted assistance. The grant, launched in May 2012, helps provide economic opportunities for women and youth in rural areas, and thereby decrease migration to already over populated urban areas and improve Lebanon’s economic stability. As part of the grant, a six-day training workshop, related to accessories, needle work, soap making, and soap decoration skills, was provided to 120 women in three areas in North Lebanon, Batroun, Koura, and Donnieh. In addition to the training, each woman also received a tool kit containing $150 worth of supplies, tools, beads, molds, and threads to enable them to start their own small production home-based enterprises.

I was impressed by the array of handicrafts on display, ranging from beautifully decorated soaps to beaded fabrics, done with meticulous attention to detail and most of all passion. In fact, it was easy to sense that passion as the women enthusiastically shared their stories with us. “This training opened new opportunities. I will start producing accessories soon, and I hope to be able to open my own little shop to sell them. I also plan to benefit from the project’s assistance in marketing and to attend exhibitions and fairs to display my handicrafts,” commented one of the participants. But it was a 23-year old participant with Down syndrome, whose testimonial touched all attendees as she spoke with courage and pride about the prospects of this opportunity in ensuring a better income for her family.

The USAID Lebanon Industry Value Chain Development continued support to the women after their training graduation by providing ongoing coaching. USAID also facilitated the women’s access to markets by helping them to rent space at holiday events and fairs to sell their products to generate additional income. The USAID LIVCD project is a five-year project that provides income-generating opportunities for small businesses while creating jobs for rural populations, in particular women and youth.

I walked away with a basket of beautiful soap accessories that I can hang around the house for a profusion of scents. But most of all, I walked away inspired by the determination of these women to go beyond their potential in order to be the catalysts for change and growth in their community and country.

Participants receiving their certificate of attendance. Photo Credit: DAI

Participants receiving their certificate of attendance. Photo Credit: DAI

Pounds of Prevention – Focus on Peru

Community members living in high-altitude neighborhoods of Puno map hazards and emergency response actions.

Community members living in high-altitude neighborhoods of Puno map hazards and emergency response actions.

In this next installment in the Pounds of Prevention series, we travel to the southeastern regions of Puno and Cusco in Peru. Here USAID’s Office of U.S. Foreign Disaster Assistance has been working through its partners with the government and the private sector to help communities prepare for future disasters. Villages that never before received local weather information now benefit from daily forecasts as well as early warnings and alerts to severe weather. These same communities received disaster preparedness training and may even one day benefit from the work to design climate-appropriate transitional shelters should the need arise.

Benjamin Franklin is famous for the adage “an ounce of prevention is worth a pound of cure.” Today, we are faced with great challenges brought about by increasing population and urbanization, a changing climate, and a demonstrated increase in the frequency and severity of natural disasters. To continue to tackle these challenges, what has become clear is this: We need more than an ounce of prevention; we need pounds of prevention! Read more >>

Satellite Data for the People: USAID Supports Launch of New Forest Watch Tool

How is the latest U.S. satellite and mobile technology helping 350 million of the world’s poorest people – including 60 million indigenous people – safeguard their homes and livelihoods?

More than 300 development experts heard the answer at today’s launch of the new high-tech Global Forest Watch tropical forest monitoring tool, developed by World Resources Institute with support from USAID, Google, Norway and other partners.

“Global Forest Watch is democratizing information,” USAID Administrator Dr. Rajiv Shah told a full house at the Newseum’s Knight Conference Center in Washington DC. Juan Carlos Jintiach, a leader of Ecuador’s Shuar Nation of peoples, agreed. “Global Forest Watch is a way to share our voices and histories,” he told the crowd.

But Global Forest Watch does much more than share stories. This powerful new tool combines satellite imagery and overlay maps with the latest open data and crowd-sourcing technologies to open up near-real-time information about the state of tropical forests to anyone with an internet connection. Currently, tropical forests are being destroyed at a rate of about 50 field soccer fields per minute.

Dr. Raj Shah voices USAID's support for innovative new technology working to dramatically reduce tropical deforestation

Dr. Raj Shah voices USAID’s support for innovative new technology working to dramatically reduce tropical deforestation. Photo Credit: Ralph Alswang

The loss of tropical forests is a big problem for the earth’s climate, causing up to a fifth of the carbon pollution linked to climate change. It’s also an immediate threat to the health and well-being of an estimated 1 billion people around the world, who depend on forests for food or livelihood activities.

Worse still, for more than 350 million of the world’s very poorest people – those who use forests intensively for subsistence and survival – forest destruction can mean life or death. This number includes some 60 million indigenous people, among them a small number of tribes in the deepest reaches of forest who have yet to be contacted by modern civilization.

Global Forest Watch unites more than 40 government, business and civil society partners to curb forest destruction by putting free and transparent information in the hands of people who care most about forests. Anyone with an internet connection can visit the GFW website and upload information about what is happening in their section of forest. And any government can visit the GFW website and find near-real-time information about what is happening in their forest territory, in near real time, on the ground.

“Now governments and people will have access to the same information [as private companies],” said Felipe Calderon, Mexico’s former president, who spoke at the February 20 GFW launch.

GFW partners and supporters include many of the same partners of the Tropical Forest Alliance 2020, a private-public partnership kicked off by the United States and the Consumer Goods Forum network of more than 400 global businesses in 2012. USAID contributed $5.5 million to GFW, in the process helping to mobilize more than $30 million.

Thinking and Working Politically

A couple of weeks ago, I attended a workshop hosted by the Australia-based Developmental Leadership Program with the fanciful title of Thinking and Working Politically.  This was the second meeting of this ad hoc group of donors, think tankers and implementers. The first meeting took place in New Delhi in November and Oxfam’s Duncan Green enthusiastically blogged about the first meeting and the second meeting, which I attended.

Larry Garber

Larry Garber serves Senior Advisor to the Bureau of Policy, Planning and Learning

The workshop provided a useful forum for sharing perspectives among those advocating a more political orientation to donor development programming and for identifying the challenges that we face in making this effort a reality.  This subject has seen an academic rejuvenation during the past year, inspired by Tom Carothers and Diane De Gramont’s 2013 book, “Development Aid Confronts Politics: The Almost Revolution,” and more recently a book edited by Verena Fritz, Brian Levy and Rachel Ort in 2014, “Problem Driven Political Economy Analysis: The World Bank’s Experience.”

As Carothers and De Gramont describe, many development practitioners implicitly recognize the need to understand the political context of the societies in which they are working, but often shy away from acknowledging that they are operating “politically.” Even at USAID, where we were the first bilateral donor to explicitly embrace political work through the creation of a Center of Excellence for Democracy and Governance in 1994, we debate whether we should substitute the word “contextually” for “politically.” And yet, understanding political context is essential for maximizing the results of our development investments whether our specific objective is increasing economic growth, spreading the availability of water and energy supplies, or improving health and education outcomes.

At USAID, we are seeking to help staff think and work politically through several initiatives.  The new Strategy on Democracy, Human Rights and Governance (DRG) issued in June 2013 emphasizes the importance of applying political economy analysis (PEA) across all of USAID’s programming sectors.  USAID is currently in the process of developing a tool to guide all USAID staff in the conduct of a PEA and will support pilots of the new tool as well as training programs for staff across the Agency.  The Agency is also looking to integrate inclusive growth diagnostics, which seek to prioritize constraints to growth, with PEA into a unified analytic approach for identifying the specific constraints to achieving sustainable development outcomes in particular country settings.

A USAID-funded example of applying a “thinking and working politically” approach is documented in The Asia Foundation’s 2013 publication, “Built on Dreams Grounded in Reality: Economic Policy Reforms in the Philippines.” The book traces the political battles involved in promoting reform in several key sectors including telecommunications, civil aviation and sea transport. According to the authors, USAID-funded activities contributed to several of the positive outcomes by carefully analyzing local political context, relying on local leaders who assume personal responsibility for achieving development outcomes, seizing opportunities as they emerge and exercising perseverance over time.

We are collecting other real-world examples of USAID consciously applying a “thinking and working politically” approach and invite readers of this blog to comment on their experiences.  Moreover, as we pursue this agenda within USAID, we are mindful that other donors have been considering these issues for several years and we will continue to participate in donor gatherings where we can learn from others while sharing our experiences and perspectives.

Business Students Tackle Childhood Pneumonia in Uganda

A collaboration between USAID’s Center for Accelerating Innovation and Impact (CII) in the Global Health Bureau and the Kellogg School of Management at Northwestern University led to teams of business students from around the world competing on ways to reduce child deaths from pneumonia in Uganda.

The 11th annual Kellogg Biotech and Healthcare Case Competition brought together eleven teams representing nine business schools from the US, Canada, UK, and Mexico on January 25th in Chicago. This year’s winning team was from the Haas School of Business at the University of California, Berkeley and the runner-up from the University of Chicago Booth School of Business.

The winning team from the Haas School of Business, University of California, Berkeley.

The winning team from the Haas School of Business, University of California, Berkeley. Credit: Jason Brown

Thirty-two teams applied to participate from twelve different schools around the world. The teams invited to compete had impressive credentials; many of the participants worked at global healthcare companies and several had medical degrees.

Judges of the event were pharmaceutical executives who evaluated the teams’ business-minded supply and demand solutions. Pneumonia is the largest killer of children in the developing world and can lead to death if not correctly and quickly diagnosed and treated appropriately.

“This is business education at its finest,” observed Tim Calkins, clinical professor of marketing at Kellogg and one of the directors of the case competition. “In this competition we have teams of students working to address a major global health issue. In the process, they are learning an enormous about global health, team dynamics and the power of business concepts.”

The case was developed over the course of several months by students and professors at Kellogg in close collaboration with CII. Students performed research and interviews throughout Uganda.

Professor Calkins and Kara Palamountain, Director of the Global Health Initiative at Kellogg, then wrote the case outlining the many barriers to increasing the use of antibiotics in a country with limited resources. At the end of the case students are asked to propose solutions from several options within a given budget to maximize lives saved.

“This case forced students to think both analytically and creatively. The challenges are significant; it isn’t a case with a simple answer,” said Calkins.

CII actively looks to support the already strong work across USAID’s Global Health Bureau by engaging a range of new thinkers and perspectives, many from the private sector. This event demonstrated the value of seeking out these new perspectives; many of the teams proposed promising, well-structured, and feasible solutions based on frameworks and analysis from their business school curricula. Some of the teams will be invited to present their proposals to the Pneumonia Working Group based at UNICEF to inform ongoing global scale-up efforts.

Kellogg Professor Tim Calkins discusses the case following the competition

Kellogg Professor Tim Calkins discusses the case following the competition

Exposing business students to the challenges and opportunities in these developing markets now will likely benefit them in their future healthcare careers. Many countries in Africa and South East Asia are among the fastest growing pharmaceutical markets in the world. Calkins noted, “I was delighted to use a pharmaceutical related case from Africa, since this is where some of the greatest needs and opportunities will be found in the healthcare world.”

In addition to this competition, the case will be a permanent teaching tool in a global health course at Kellogg.

Schools represented include:

  • Carlson School of Management, University of Minnesota
  • Desautels Faculty of Management, McGill University (Canada)
  • Haas School of Business, University of California, Berkeley
  • IPADE Business School (Mexico)
  • Judge Business School, University of Cambridge (UK)
  • Kellogg School of Management, Northwestern University
  • Rutgers Business School
  • Stephen M. Ross School of Business, University of Michigan
  • University of Chicago Booth School of Business

Defending Civil Society Organizations in Egypt

While Egypt’s civil society plays an important role in defending civilian rights and promoting development, civil society organizations frequently find themselves under criticism. Our contributions are belittled. Our work is obstructed. Our motivations are called into question.

To counter these ongoing distortions, my organization, the Egyptian Center for Public Policy Studies, launched a community advocacy campaign, in cooperation with the United States Agency for International Development (USAID) and its implementing partner The International Center for Not-for-Profit Law (ICNL) to raise awareness about the need to defend freedom of association and lift the restrictions on civil society.

Still from ICNL's video on funding for civil society organizations. Click to view video (in Arabic)

Still from ICNL’s video on funding for civil society organizations. Click to view video (in Arabic)

Specifically, we developed two short films about the role of civil society and the benefits it provides to regular citizens. The first film addresses the question of “What is Civil Society?” by summarizing the role civil society organizations play in modern day Egypt, and highlighting several examples of our impact in education, health, and promoting civic freedoms and rights.

The second film addresses funding for civil society organizations, particularly contributions from international donors. This issue has generated a heated debate over the past few years, and many have tried to cast doubt on our work by highlighting our partnership with international donors. We tackled this issue by discussing the reasons why international donors provide funding for Egyptian civil society, what types of activities and services they provide, and how these activities contribute to the development of society and the economy.

To supplement these films, we produced two research papers: the first provided answers to questions about the funding of civil society, and the second pointed out several flaws in an Egyptian law which, which regulates our activities and constrains our ability to effectively serve our communities.

As a result of this campaign, the general public and the media began to pay attention. A dialogue was launched about the role of civil society and the campaign against our work. In particular, Dream TV, an Egyptian TV station, aired portions of our videos and provided a platform for two of our representatives to explain the purpose of civil society and the concept of foreign funding to the Egyptian public. In addition, several newspapers and online websites reported on our campaign and films.

While many challenges remain for organizations like mine in Egypt and around the region, we are hopeful that our efforts help expand the role that civil society can play in the democratic transitions underway and increase the role for citizen voices. Our work to promote freedom of association in Egypt and lift the restrictions imposed on Egyptian civil society will continue. Over the past few years we have learned that the united voice of citizens cannot be ignored. By making citizens more aware of the important role civil society plays, we are helping our democratic transitions succeed.

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