Each year, the GBCHealth Business Action on Health Awards highlight outstanding company achievements and help set the agenda for the future of the fight to defeat the greatest health threats of our time.The awards recognize the best corporate programs developed to address global health needs.

Awards will be presented to the winning companies during GBCHealth’s annual conference on May 14th and 15th at the Roosevelt Hotel, New York City. The full list of winners is available on the GBCHealth Awards’ website.

The full press release is available here.

In collaboration with implementation partners Dimagi, Inc. (USA), Catholic Relief Service (India) and Ugunja Community Resource Center (Kenya), the recipients were awarded $100,000 to further their research to improve the lives of mothers and children in resource-limited settings. Content experts in business, public health, and engineering selected CommCare among a pool of highly competitive proposals that had collaborations with over twenty different institutions.

The full press release is available here.

To a Western audience, these headlines in a respected daily newspaper would turn heads and draw jeers.

“Woman rewarded for sparking ‘toilet revolution’ in her village”

“Half of Indian popln defecate in open, but more have mobile”

“Women want mobiles, not toilets, says Ramesh”

To many, they are the signs of impoverished nations, racing along a chaotic track of development.  Perhaps.  The headlines are even sensationalist to a certain degree here, in India (but here, that is why they get published in the newspaper in the first place.)

Upon closer inspection, outside of the sensationalism, I think they illustrate a momentous trend.  Mobile cell phones are transforming lives.

Think back ten or fifteen years ago.  Did you have one of the early model mobile phones?  What did you use it for?  Was it a supplement to your daily life?  A new-fangled, must-have gadget?  A leash for your spouse, parents or children?  Or was it a lifeline, a symbol of your livelihood, a technology with the potential to transform your economic outlook.

To many in the Western world, cell phones complement our daily lives, bringing information to our finger tips, connectivity in remote places to our loved ones, and near constant connection to an interconnected world.  In many developing countries, however, the potential is so much greater.

Yes, I can quote impressive numbers of mobile subscribers in India or the growth rate of mobile phone penetration.  I can link to fancy graphs of mobile phone penetration per 100 people or a host of other hard stats, facts, and blurbs – but these astronomical numbers have a hard time conveying  the reality on the ground.  Mobile phones are changing the behavior of millions of people, something that non-profit organizations and NGOs have been trying to do for decades through health and education outreach.

Take the first article mentioned above, “Woman rewarded for sparking ‘toilet revolution’ in her village” published in the Hindustan Times on February 16, 2012.  The first paragraph reads:

“A woman has been rewarded for her “bold” decision to leave her marital home within days of the wedding to protest the lack of a toilet in the household, an official said on Thursday. Anita Narre was handed $10,000 by Sulabh International, a non-profit group, for refusing to defecate in the open and sparking a “toilet revolution” in her village in central Madhya Pradesh, according to the district magistrate.”

This first article isn’t so much about mobile phones, but is here to set the scene.  Extremely traditional values of marriage and the role of a wife are thrown to the wind as she protests at the lack of a toilet in the household.  Often viewed as ‘dirty’ if they are inside a home, the majority of Indians relieve themselves almost at will, anywhere they see fit (its not uncommon, even in Delhi, for cars/scooter to pull off of the road, stop traffic, and go to the bathroom on the sidewalk.)  But I digress…  The barriers of sanitation and hygiene are tough to break – and sometimes its something so counter-cultural, like a wife’s bold decision to leave her husband over the matter that makes a bold enough statement to draw attention.

“Half of Indian popln defecate in open, but more have mobile” - Hindustan Times – March 14, 2012.

“Half the country’s population may not have a toilet at home but they are not without a mobile phone. Bringing to light this feature of the population, Census 2011 data on houses, household amenities and assets released today said 49.8 per cent Indian households defecate in open but in sharp contrast 63.2 per cent households own a telephone connection, 53.2 per cent of them a mobile. The data reflected the controversial remarks of Union Rural Development Minister Jairam Ramesh who said recently that women demand mobile phones but they are not demanding toilets.”

This headline may also be an eye opener – but only to Western eyes.  To many in the developing world, this is a no brainer, as mobile phones are one of the first items a family invests disposible income in when they start to move up the economic ladder.

Jonathan Donner, a thought leader in the field at Microsoft Research, explains in a paper in much more detail and eloquence outlined here the power of a mobile for the developing world.

“The burst of connectivity in the developing world during the decade of 2001-2010 has made telecommunications accessible for half the world. This promises to change the configuration of people to each other and to the formal/global economy, which has excluded so many of them. It is going to do so in ways that are tied to social locations as much (if not more) as to economic transactions. Symbolically, blurring reflects and drives societal beliefs about the mobile. The telephone helped shape the economic landscape of the 20th century, reflecting and reinforcing some locations in economic and production networks, while excluding others. Widespread mobile use promises to reduce that exclusion. Yet, for individual users, the mobile it is not merely a symbol of economic development or productivity. Rather, it is one of self-expression, agency, and social connection as well.”

And to tie it all back to toilets, the last article in the Hindustan Times: “Women want mobiles, not toilets, says Ramesh”.

“Sanitation is a much more difficult issue (than telecommunication). Now we are talking of behavioural changes, and women demand mobile phones. They are not demanding toilets. That is the mindset we have.”

The article goes on to state, “Ramesh said that India is a land of paradoxes, as the country accounts for almost 60% of those relieving themselves in the open across the globe – at a time when it has 700 million mobile phones. “(There is) 60% of open defecation in a country which has 700 million mobile phones. ….We build toilets but the toilets are not used.”

I can assure you that those 700 million mobile subscriptions are being used.

Matt Theis is Dimagi’s Country Director of India.  His work includes managing Dimagi’s CommCare projects and growing field team in India.  He has also acted as a Field Director for Dimagi in Lusaka, Zambia.

I love my smartphone. Prior to arriving in India last month I had never had a smartphone.  My previous India life consisted to a large extent of trying to find the next Internet café so that I could stay connected or print out a crucial document. Now if I need to look something up or do a quick email check, I just reach into my pocket. This past week I made it through a flight and a train ride without printing anything out myself—I just brought my phone and the tickets that I had downloaded.  It may sound trivial, but it felt like a victory in this country that loves it forms and stamps and seals and paper copies.  I used the map feature to navigate an awesome two hour walk home last night, something that would have been very challenging just asking people and try to think of landmarks that people might be familiar with.  I can see how it could be a quick slide into email/phone/connectivity obsession, but so far so good.  And now here I am getting to work on one of Dimagi’s first smartphone app deployments.

Over the past several weeks in India I’ve gotten a massive dump of Dimagi’s last year or two of cumulative experience in India developing apps and carrying out trainings.  But now that I’m on my own, I have found myself getting to think about how to train healthcare workers on a very different phone and new operating system.  I know that smartphones present a unique set of challenges and opportunities.  In my previous job in the military I participated in a number of meetings where we discussed how tablets and smart devices can themselves be used as training devices for a lot of “real world” activities because the interface can be so straightforward, flexible, and intuitive. I often find that to be the case — I think to myself, I should be able to change the title of this or the order of that clicking here — and when I try, it usually works! The intersection of clever software designers and solid hardware helps make this so. Yet I’m still not quite sure if the massive flexibility and slick interface of smart phones is going to make smart-phone CommCare deployments and trainings more challenging, less challenging, or just an entirely different game.

These musings made me realize that the last couple of weeks have gotten me thinking about how much I’m learning about learning.  I was privileged to participate in a training session with a couple other Dimagi field fellows, representatives from a local NGO, and about 20 community healthcare workers.  Watching the training and working with the healthcare workers it was interesting to observe what different approaches make things click for people. The tools employed include lectures, skits, analogies, group/team exercises, and one-on-one work.  There were also some cool approaches to explaining complex topics. For example, navigation in a phone can be challenging to explain to a new user.  While concepts like “forward” and “back” may seem simple to experienced users of computerized media, when you are starting from scratch it can seem rather abstract.  So one of the field fellows spent some time using good old fashioned paper charts to explain how you could move back and forth between different screens and menus.  When the more complex topic of skip logic came up one of the local NGO workers stepped up with an extended metaphor about how you choose your path home from the field means you will encounter a unique set of obstacles and situations. Employing such a mixture of techniques and explanations hopefully enables reaching a broader audience and at the very least makes things more entertaining and engaging.

As I was trying to think of different techniques and approaches to training on smartphones I realized I was just trying to follow the same model I had learned that Dimagi had used over the past years and substituting smartphones for the simpler handsets.  That certainly seems like a good start—after all there is extensive experience in those approaches that is now well documented.  But relying entirely on training plans, guidelines, and rules of thumb may get you locked into a particular way of doing things, when there could be entirely different approaches out there that would work even better.  Usually training means someone something fairly specific — one or two people stand up and talk while everyone else listens. Then there are some practice and group exercises to make sure everything actually makes sense.  Finally there’s the classic one-on-one walking through it all.  But it does make me wonder if we’re missing out on other structures or tools of training and learning.  I’m not even sure what that might look like, but perhaps it could be a “training program” that walks the user through the app, or employs other apps/phone features as steps up to using the our more complex apps.  Even though we as Dimagi are not necessarily determining how training is done, it’s definitely something I want to learn about in the coming months as many projects scale up, the sheer volume of training increases, and the smartphone app becomes more widely used.  Our accumulated experience can continue to be a resource to our partners and the broader ICT4CHW community.

And thinking about how to learn hasn’t stopped at work!  It’s always been interesting to me to explore alternative teaching/learning methods.  Last time I was in India I spent some time with an NGO that encouraged people to drop out of school.  While I was pretty confused by this at first, I came to understand that they were promoting an alternative model of education.  Instead of the didactic Indian system they proposed experiential learning and knowledge transfer among people. Know how to fold bags out of newspaper? Good, show your neighbors how to do it. Know how to market artisan crafts?  Pair up with these soap makers. Did you write a song about how to use a cell phone? Let’s see how useful it is!  The main idea was that in a world where often having a hard skill could be more financially viable than being able to pass the eighth standard, maybe forcing children down a traditional education/training path won’t necessarily equip them well with a livelihood.  It’s a big world of techniques, approaches, and ideas out there.

While I’m not sure how this all translates into apps and public health, I think the main takeaway is that as apps and phones evolve there will be cool new ways to learn how to use them and to get feedback about how to improve the technology.  It will remain critical to keep in mind linguistic, regional, and individual variation in knowledge acquisition.  Hopefully we’ll be on the way forward with increasing input from local partners (who are best placed to be effective communicators and teachers) as well as by keeping an open mind to novel techniques and approaches that may come at us from outside of the public health and NGO worlds.

Jeremy Wacksman lives and works in Mumbai, India as a Dimagi Field fellow. His work includes design, development, testing, training, and evaluation of CommCare mobile applications for use by community health workers in rural India. To learn more about CommCare, please visit www.commcarehq.org

This lecture focused on the need for innovation in global healthcare information technology, a case study of CommCare, and the challenges for the adoption of global healthcare information technology innovation.

Finalists now progress to a rigorous assessment phase by GBCHealth’s external panel of expert judges, from which one winner and one to three commended companies per category will be chosen to be honored at GBCHealth’s 2012 Conference and Dinner, May 14-15 in New York City.

GBCHealth is a coalition of more than 200 member companies and organizations committed to investing their resources to making a healthier world … for their employees, for the communities in which they work, and for the world at large.

The Buckminster Fuller Challenge is an annual international design Challenge awarding $100,000 to support the development and implementation of a strategy that has significant potential to solve humanity’s most pressing problems.

The jury will select a winner who will be revealed at a conferring ceremony in New York City on June 6, 2012. The winner will be presented with the OmniOculi sculpture and the $100,000 prize money to honor and encourage further development of their work.

A page is created for each Semi-Finalist proposal. CommCare’s proposal page is available here.

With generous funding from the Norwegian Agency for Development Cooperation through a grant from the Innovation Working Group to support maternal, newborn, and child mobile health programs, a new grant opportunity is available. Dimagi and CORE Group are pleased to announce a learning collaborative designed to help organizations to develop, implement, and evaluate the CommCare mHealth tool in low or middle income countries. This activity will not only give organizations a chance to test out a specific tool within the context of a specific project or program—but will also build mhealth capacity in a larger sense.

The objectives of this RFA are to:

• Build capacity for organizations to implement mHealth solutions for community health workers (CHWs).
• Create and evaluate several open source mHealth applications and content focused on community health programming.
• Share lessons and document best practices through a learning collaborative of several organizations going through this process together.

Please view the full RFA details and find the application here.