Thursday, August 20, 2009

What are you doing in Malawi

People ask - so what are you working on...

This is my first public policy/public heath type project and I dont have the jargon down - jargon being the signifier of intelligence and competance in our post-modern/post-structuralist/late-capitalist society.

My Project
I on a contract for UNICEF & an NGO of recent Columbia SIPA grads.

My Mission
Expand a pilot malnutrition surveillance project to eventual country wide deployment.
(This has recently been merged with a Mother/Newborn HIV/AIDS project - but that is for another post)

The History
The Malawi Ministry of Health collects data samples (ie surveys) of children's health indicators (mid upper arm circumference - muac, height/weight %). Based on these data samples the Ministry of Health and UNICEF monitor trends and deploys aid
through the country.

The Problem
The system was paper based. There was difficulty in collecting the data, getting the data back to headquarters, and entering the data into the system. At every level data was lost and corrupted.

The system had a 2 month lag. That means if a child is mildly malnurished in January, by March when she is processed in the system - she might be extremely malnurished.

The Solution
The NGO/Columbia SIPA students had a brilliant insight - move the data collection and processing online. In Africa, as in many countries, there is little internet penetration, however there is wide cellphone penetration.

The solution was to move this data collection to an text-messaging - ie SMS system. They partnered with UNICEF in NYC to program this based on RapidSMS (an open source python/Django framework pioneered by developers at UNICEF).

Moving from a paper based system to an SMS/technology solution is a fantastic advancemen.
Now UNICEF & MoH can monitor health crisis in real-time and deploy aid to greater effect.
Data collection and data quality is much better because the SMS system can send realtime feedback to the field workers (data collectors).
[Ohh I should write a novel - the data collector]

The actual work
In May, a pilot of this system was released for 3 health offices in May (there are 500 health office in Malawi). The head of the Malawi UNICEF Nutrition - Stanley (who is fantastic/helpful/visionary) wants to expand this to 15.

I'm here to upgrade the RapidSMS system, do some custom programming, hire 2 local programmers to continue the work when I leave, and to go into the field to train local health workers in using the RapidSMS system.

The Analysis
This whole project is based around statistics. From an academic,epidemiological perspective, the data is incredibly important to better understand the tradjectories of certain diseases. (e.g., are certain areas more prone to certain health issues, what sorts of measurements correlate to various diseases)

Statistics figures into this twice: first in the sampling of the data, and second in the determining of norms (we need norms in order to figure out who is deviating - who is sick)

But really do we need sampling? (You may want to stop reading now, insane rambling ahead)

We have the ability to collect and process massive amounts of data - why do we need to take a sample? Why can't we monitor every single child and deploy aid on an individual basis?

The bottleneck for processing data for EVERY child is data collection. It would be a massive undertaking to collect all this data for every child in Malawi. However if we had intelligent measuring devices that communicated their data via SMS back to the central system - we would solve much of the data collection issue. The final problem is how do we identify an individual child? (duh the chip implanted in their brain). I am thinking perhaps thumb print. This is very big brother and maybe statistical sampling prevents us from this sort of biopolitical control. (I am now having flashes of Agamben Homer Sacer and Bare Life). However I think if this data were open / open source - (and individuals were kept anonymous) - then perhaps you could avoid the sort of totalitarian techno-fascist control that is inevitable with this sort of solution... Should you even keep people anonymous? who are you protecting if you are protecting the identity of a malnourished child or a child with malaria? If all this data is open, perhaps illness based discrimination will end. (That is a radical and scary thought and I dont want to volunteer for the pilot :)

I think this is the ultimate end of technology/health/society - and we should direct it rather than hide our heads in the sand and wait for the government or business or some closed entity to control this information.

We are doing the next 13Bit documentary on water, the geopolitics of water,water and power, maybe we'll add something on the biopolitics of water - or water aid.

(I will be uploading pictures - once I get a non-unicef internet connection - hopefully tonight. I am starting to crave meat - how much longer will my pescatarianism hold out)

1 comment:

  1. Examine what a craving really is. Whatever you end up eating, think it through. What is it to crave? What does that involve? Where does it come from?

    Nice post, by the way.