Automating Routine Tasks for CHWs

What struck me most about Brian's presentation was the IDEO-esque way the team engaged the community stakeholders and users to help gather user requirements, brainstorm and prototype solutions for CHWs. This model of user-centric design continues to infiltrate its way into technology-based development projects and it always surprises me that it has taken so long for us to understand the importance of involving the user in the design of the solution or intervention.

While "user vision" and ethnographic research are all the rage at the moment it does seem kind of ridiculous that we are just figuring out the value in engaging users particularly in the creation of solutions for the developing world. Sometimes we are so smart we are stupid.

Sonesh & Aravind

I've been lucky to have spoken to Sonesh about his work at Aravind a few times before as well as others who have worked at Aravind so while his presentation was great I had heard most of the information before.

As always, Aravind continues to amaze me and proves to be an incredible case to learn from and to try and better understand. The Aravind story and model highlight a number of critical lessons about health technology projects in the developing world and more about these particular types of projects in India. What always strikes me the most is how well the subsidization model works for Aravind while it may be seen as "classist" or exclusionary in other regions.

I do wonder how many different regions would welcome such a model (having two clinics for different socioeconomic classes such that one subsidizes the other) and how to best test or measure for that. I haven't come across any social science publications that analyze this type of care in depth although I'm sure more will begin to crop up as ethnograpy/anthropology etc become more mainstream in ICTD as they have begun to become over the past few years.

Final DRCA Class

I have been terrible about keeping up with my blogs so I'm trying to catch up now and am starting with the last class and working my way back.

In terms of projects I'm brainstorming about or would be interested in working on in the future, I guess I'm in a bit of a different situation as I'll be graduating next week and am off to work on a project that falls into the category of "dream project." I've been working with the GSMA Development Fund for about 7 months now trying to help them understand the opportunities within mobile health (mHealth) and ways in which they can accelerate the market for mHealth services from a social venture perspective.

I just found out that I'll be staying on until April to develop a proposal for (and hopefully launch) a full-blown mHealth program and helping to lead the GSMA in its strategy around mHealth. This of course may completely crash and burn but my hope is that it will allow me to continue exploring this area and put all my debt, excuse me education, to some good use.

Neil Patel - Experiences Designing Information Systems for Rural Gujarat

Neil's recent presentation was incredibly informative and very useful for me as I tend to hear only about health-related initiatives as of late. I was particularly interested in his comments about the Jatan Certification Program he was involved with and the way the local farmers and community established standards for themselves. The exercise and process Neil outlined once again reminds me of the importance of involving the end-user and key stakeholders in any project of this type (i.e., development focused). Neil's comment about a bottom-up approach as opposed to the typical top-down approach in order to develop a scalable and sustainable certification system particularly resonated with me and with the focus of this course.

Using a scalar approach and establishing a scorecard is a novel way to ensure consistency and provide clear feedback to the farmers involved in the certification program. I was very impressed with the rigor the team used to test different types of metrics with users and determine which they would ultimately use. Talk about creating buy-in! The scorecard reminds me a bit of a program used with doctors here in the US and I'm curious whether a similar system would have applications for rural health down the road.

Jhai & Telemedicine

I must say that hearing Lee Thorn talk about Jhai was very inspiring and exciting especially since rural telemedicine is something I'm quite interested in at the moment. Clearly Jhai, along with its telemedicine partner, Neurosynaptic, is positioned to lead the way in this field and it appears they have figured out how to do it sustainably (at least in terms of financing). That being said, I still struggle with so many of the questions I'm sure everyone is tired of hearing me ask but once again I have to harp on some key issues:

• How do we (and ultimately, should we) transition (both from a behavioral and cultural standpoint) beyond the provision of health care as a social service/public good and is this possible across different regions? Is there a willingness to pay for care in some places - and is this seen as acceptable - that will enable the development of market-based ICT solutions for health care? How do we control or balance the issue of health care as a "right" versus health care as a commodity that can be controlled by price?
  
• Most of the models for telemedicine that curently seem feasible are in Southeast Asia - how do we adapt and scale these models to other regions like sub-Saharan Africa?
• What is the role of the government and institutions like Ministries of Health in the creation and implementation and ongoing deployment of ICT-based health solutions? Is there a clear threshold below which the government should provide basic primary care and above which the market should be responsible for or better able to provide?
• How do we ensure quality and consistency of care with all of these models when we have now agreed upon standards and are still struggling with these issues in the developed world? Should the solutions and the regulations and standards all be developed in tandem? What will we do with all this data and who will own it?
• How do we rebuild broken or non-existent health systems that can use ICT solutions but that vary so substantially in terms of culture, tradition, politics, and economies?
  

Ok, enough with the questions for now. Off to investigate more thing health and technology related.

Thoughts on Neal Lesh's Presentation

I really enjoyed Neal's presentation and am looking forward to speaking with him in more depth when we meet tomorrow morning. He really is a trailblazer in the health ICT4D arena and hearing about his experiences in the field was both informative and inspiring.

Neal's presentation raised a number of questions in my mind - many that have been floating around in there for some time - and I have to admit that while I left the class excited I was also a bit frustrated. The same dilemmas regarding funding, sustainability and impact measurement seem to be incredibly evasive particularly for health-based ICT solutions and this is something I hope we can continue to discuss throughout the course. I continue to remain conflicted as to whether or not basic health care is a "right" to be provided as a social service by a government or public entity (and if so, at what level do we surpass basic care?) or whether the creation of a market opportunity and the subsequent delivery of quality, timely and appropriate care is the route to follow. In terms of technological solutions, the potential to provide scalable quality care seems evident yet the model with which to fund and sustain such technology does not appear to exist. In particular, in relation to Neal's work with EMRs (and based on my previous experience with EMR/EHR/PHR initiatives and development), I would state that the implementation of such technological solutions may be better positioned as a business opportunity in oder to improve the delivery of health and may not fall within the purview of "basic health provision." Therefore, would such solutions benefit from a market-based strategy?

Me on vacation

Here I am, enroute to the beach, relaxing at a roadside pitstop sipping a Turkish coffee and taking care of some really important business.

Apparently my behavior is photo-worthy: