Those of us working on implementing digital solutions at scale are probably very familiar with these roadblocks:
You schedule a meeting, but no one shows up.
Someone forgets their password, but never asks for a new one.
You launch a successful pilot, but can’t figure out how to pass on ownership to the government.
Many of these issues — large and small — feel unsolvable when they arise, and everyone is pointing to someone else to pick up the blame. We end up with a list of things we tell ourselves to make it seem OK.
“It was a training problem.”
“We didn’t have capacity.”
“The Minister was called away on urgent business.”
“Funding ran out.”
“We’ll catch up next month/year.”
Why doesn’t anyone care about this project as much as I do?
These self-assurances are the tell-tale signs that we are not tackling the problems that matter. Problems that matter keep leaders awake at night. They drive governments and businesses. They don’t die quiet deaths.
Identifying Problems that Don’t Matter
Too many of us work on problems that don’t matter. We look for a need to fit the toy we want to play with today, at the expense of ignoring pressing challenges that could yield much higher impact.
I was once the culprit of this mistake. Before working at Dimagi, I spent years setting up a rural network technology in hospitals in West Africa and building a consultation platform for specialist doctors. It seemed obvious to me that there was a need for specialized medicine, such as neuroradiology and immunopathology, and my goal was to ensure such expertise was provided more widely.
Meanwhile, doctors at the hospitals I worked at were finding it impossible to unearth lab results for their patients. They were receiving dozens of referrals a day for patients in critical condition, but without any decipherable medical record information. Never mind the one percent of patients that needed to consult with a neuroradiologist: what about the 90 percent that needed better continuity of care?
I was missing a key piece of the puzzle. The problem I was focused on was not the problem that mattered most to the doctors, and it definitely was not the problem that mattered most to the hospitals and health systems for which I was setting these tools up. Yes, the need existed, but it was not the problem that matter most.
Today, the rural network technology I used for that remote consultation platform has literally been more appropriately used for inter-satellite communication than for the rural African networks I was trying to make it work for.
I am not alone in this mistake. I have seen interventions that sought to improve visibility into drug shipment and delivery, even when there was no stock in the country to deliver. Another project spent years trying to provide Ready to Use Therapeutic Food (RUTF), also known as Plumpynut, to communities that did not want it and where food was readily available. The list goes on and on.
I took this is a picture in 2011 during my fieldwork in Afghanistan. There was no shortage of problems here, but which ones really mattered?
How to Focus on the Right Problems
How we decide which problems to focus on is a complex and fundamentally hard problem. I don’t have all the answers, but I can share what I do to identify the right problems to solve.
The first thing I do is look for the right people to work with on a project. I map out who needs to sacrifice their non-existent time, budget, and energy to make a project successful. Perhaps our government counterparts have designated a focal person to streamline communication, but if that focal person is not the decision-maker then we need to make sure the decision-maker is compelled and committed to our scope of work. Many people are typically involved in the work, but the real question is, are the right people committed — who will champion the project?
As I work with these champions, I strive to understand their macro-level priorities. Even on a specific grant, with a focused scope of work, it behooves me to understand how my work fits into their work, life, and calendar. This is not a time for tunnel vision. What are the programmatic priorities? What does my work compete with for budget? Sometimes, these frank, honest questions help me to wind down a poorly-conceived project very early — to everyone’s benefit. These questions are deceptively simple, yet incredibly useful, particularly as stakeholders, priorities, program, and budget are constantly changing.
As a result of this continuous evaluation, I have at times completely restructured projects, and even cut programs that had run their course. It requires a harsh but invigorating kind of honesty with ourselves, our funders, and our partners.
Problems that matter will draw the attention of the Minister of Health or the Country Director. They will not just look at the results. They will demand them. They do not need to be convinced that this data is interesting. They will see it and know.
If we struggle to get our stakeholders in the room and write-off our roadblocks we need to ask ourselves whether we are truly tackling the problems our stakeholders care about. If we are not doing that, then what are we doing?