Wednesday, September 9, 2009

Back in the Office

Yesterday was my final trip in the field.

The RapidSMS Malnutrition project was originally deployed in 3 health centers in 3 different districts. Now we are scaling up to add 4 other health centers in these 3 districts. I went to the pilot health centers to collect feedback on the existing system, and also to collect feedback on some changes that I plan on implementing.

On change I am making is associating every report with a health worker and a health center. Originally, tracking was done by the number that send the malnutrition report, but workers share numbers and numbers change, so I thought we should just explicitly send the health worker number.

The health workers thought that was a great idea, because it would be easier for them to get credit for the work they were doing. Before, you could do this by looking up the phone number, but this is sort of a usibility issue. By explicitly sending their HSA id number,the health workers will feel a more personal connection with the system.

Another change I am making is something called a short id. So every health center has about 30 health workers. If we numbered health workers squentially on a national level we will easily hit 3 digits - and this would complicate sending messages. So what I did was create a key based on a short id (1-30) and the health center number. This is linked to a longer nationwide id number, but health workers can keep simplier numbering system in their centers. I also implemented the same change for patients.

One of the most interesting things about this process, is that it is not just a technological issue. The 3 health centers I visited varied widely on patient drop out rate and data quality. For example,the health center in Kasungu had a large drop out rate. Care givers just would not bring their children in, and health workers would not follow up.

In Dedza, however, only 8 children missed measurements, and only 1 child dropped out of the program - because he moved. The reason for the success was that they partnered with the local head man in the community. If a care giver missed a measurement session, the head man followed up.

In Salima, the success rate was also high, not as high as Dedza though. In Selima, health workers would go into the field if a care giver missed a measurement session.

All three locations stressed the importants of explaining to the caregivers and perhaps the head man - the goal of the malnutrition survelliance project.

In Salima and Dedza, the health workers overwhelmingly in praised the rapidSMS system for reducing child malnutrition. In Kasungu, the reports were not as positive. The success of the project lies not in the technology but the processes surrounding the use of technology.

The 13Bit Labs is going to spin off a humanitarian technology company. Our implementations will be holistic solutions integrating technology, with process and people management, and education. Too often technology is seen as the solution, but the solution is really a process enabled by technology. It is these other less 'rational' and perhaps less tangible aspects that make a system successful.

I am thinking of Ellul's The Technological Society. We should not reduce everything to a optimized process, where human beings are treated as interchangable commodities and completely compartmentalize in their execution of one particular task. However, we should put systems in place that allow projects to succeed - and to ignore this is to doom projects to failure.

Obsessivly reading Martin Meredith's the Fate of Africa

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