Hello, I am Merrick Schaefer – I work at UNICEF on the Division of Communication’s Innovation Team. We look at ways changing technologies can be applied to existing problems. Though I was a web developer for 10 years, I have, of late, taken on the role of Project Manager.
For those that don’t know, UNICEF is a UN agency not an NGO or non-profit. Our mission is to support all aspects of children’s development from health and nutrition, to water, to education to emergencies and protection. We work in 186 countries giving a truly global scope to our work. What UNICEF is to you depends where you are from: in the US it is the orange box at Halloween, in other countries, it is a service provider - of education, of healthcare services. But what is UNICEF really? [Party line] (pt.1) UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. What is UNICEF not? [Dispelling misconceptions] (pt.2) Not an NGO. Not a non-profit. An agency of the UN - an IO - Intergovernmental Organization.
In our day to day work UNICEF acts similar to a consultancy to governments, advising on policy, working directly with ministries. But we also help provide logistical services from planes to trucks and sometimes even donkeys. Due to the global nature of our operations we operate in economies of scale. So what is UNICEF in practice? UNICEF is actually a consultancy. UNICEF operates ‘in country’ at the pleasure of the national government. UNICEF has teams of experts UNICEF works directly with ministries, such as Health and Education, to advise and help develop policies UNICEF is also a logistical services provider. UNICEF has a 25,000 sq ft distribution centre in Copenhagen Further three major distribution hubs in: Shanghai, Dubai, and Panama. Standard stocks can supply needs of 1/4 million people for 3 weeks Most well-known products: School-in-a-box, Emergency Health Kit UNICEF leverages economies of scale to negotiate purchasing for essential services Largest purchaser of vaccines - roughly 40% of world’s supply Fleets of planes and trucks around the world Where the going is rough, we have put donkeys on contract for deliveries! Satellite communications systems - helpful for emergency service provision And a nifty control room in our basement.
We are known for being one of the worlds largest purchasers of vaccines, but a little known fact is that we are also the world’s largest purchaser of pencils! I am here today to talk about one specific program my team worked on last year that has had a lasting impact on a governments ability to provide health services.
In 2008, the UNICEF Innovation team went to Malawi. Malawi is a small, English-speaking country in East Africa of about 14m people. We were there to analyze the collection of malnutrition data on Malawian children.
As with many of our projects we did this one in partnership. We partnered with 6 grad students in the International Relations program at Columbia University and with the Malawi Ministry of Health.
UNICEF, WHO and others have found an extremely accurate way to measure malnutrition requiring only a few indicators: age, height, weight and upper arm circumference. It is accurate enough to catch mild cases as well as extreme ones.
The process we modeled was this, the community health worker, there are very few nurses or doctors, recorded these measurements and then sent them to the government. Unfortunately they did not understand why they took the measurements or use them to diagnose malnutrition but used less accurate methods such as the texture of children's hair. So, if we remember, this is the Nutritonal Monitoring system we saw in 2008: Linear, Unidirectional 1) Community Health Worker (CHW) collects nutritional data 2) The CHW sends the data to the Ministry of Health (MoH) via post (or other) system delivery 3) No feedback to the CHW, caregiver, or child. Data is utilised primarily for long term planning
When we asked the ministry to look at their data, so we could start building our databases, we found the data in unopened envelopes under a desk. The government wasn’t actively using the data, but might at a later point for policy planning. There were lots of problems for us to work on. Now, the data is actually used, eventually. The government will assign a team to review the data and generate a report on the results. This report will effect future government policy and help strengthen service delivery. The problem is that retroactive analysis and policymaking only utilises half the value of the data. There is no immediate feedback loop, no direct response for children, no dynamic modeling or reaction. The data gets stale and the value erodes.
One of the amazing technological trends in Africa in the last 10 years has been the explosion of cell phones. In 1998 there were 2 million, by 2010, 500 million and current cell phone penetration rates are 60%. Most importantly for us all the community health workers had them.
So we taking advantage of this, we and partners have built and open source framework for building SMS-based software systems. We try to augment current working practices with technology to improve their effectiveness. In this case we are swapping paper for SMS on phones. RapidSMS Our next success was inspired by the explosion of mobile phones in the developing world. The reach of SMS in developing countries is second only to radio. We were inspired the constraints of the medium and overcome some of the most frustrating limitations by treating the SMS as a “command line” that interacts with powerful backend software in a multi-modal system.
If you ask what can we do with only 160 characters the answer is actually a tremendous amount. In this case all the malnutrition indicators fit into one text message. This paired with powerful software on the servers gives us an amazingly influential real-time data collection tool.
Additionally the system is very cheap to implement, since the health workers already had their own phones UNICEF only had to pay for the cost of training and the cost of the SMS messages themselves.
So the system we put in place looks like this. The health worker enters the data directly into the phone as an SMS. The server can parse the message, sorting out errors and maps and graphs it, giving the government real-time information it can immediately use to pinpoint problems and react to them.
Additionally, the data is in the cloud where UNICEF and other development and humanitarian partners can use it and not just locally but at a country level, a regional level and even a global level, cross-comparing regions and tracking progress.
Our greatest insight came from a suggestion that one of our developers made. The health workers had not known why they recorded the data before much less been thanked. Why not send a thank you. Then we realized if we sent a thank you, why not send a diagnosis as well. The servers were already doing the calculations.
So the system sent back an SMS with a diagnosis and the health worker was empowered by the information to act to help the children, maybe with daily feedings or just monthly checkups depending on severity. So the act of collecting data was turned into an action which directly benefited the children themselves.
This project was a great success and won the Netsquared 2.0 challenge by USAID. We have used the same software for all sorts of projects; tracking food distribution in Ethiopia and bed nets in Nigeria, monitoring neonatal health in Zambia, even as an incentive to teach literacy in Senegal. We have 23 projects coming up in the next year.
But throwing phones or any technology at problems do not necessarily solve problems. The real question is how much can our work affect the way our organization functions? How can UNICEF adapt its work to take advantage of real-time data as well as do long term planning. And this is something we are going to be really working on in the next year. Technology is only one element of innovation: Innovation is not just throwing mobile phones at the problem, although it is a tempting approach. People have asked us in the past how many mobile phones they should order before we come... Instead, innovation is a mentality that asks people to overcome resistance to institutional change. Can institutional practices keep pace? Can we keep pace? Is there a space in a tightly run organization with rigorous and long-established guidelines from everything from procurement to M+E to move quickly? Can we be global, effective - and nimble? Demonstrating success and creating needs: Show success: identify areas where projects have worked and replicate principles and approach. Success is particularly compelling when the project does not only function but improves upon existing systems. Creating need: demonstrate the value proposition. Sell the efficiencies and improvements in service delivery - not the innovation itself - as the primary reason for innovation.
So if you would like to learn more visit our website at unicefinnovation.org or the projects at rapidsms.org. You can also get the rapidSMS source code off of github and we have an active community in our IRC room. Thanks for listening and feel free to find me later to ask questions.
Merrick Unicef Gov2.0
txts 4 Africa
What is UNICEF? <ul><li>UNICEF is a UN agency, not an NGO or non-profit. </li></ul><ul><li>UNICEF supports child health and nutrition, good water and sanitation, education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. </li></ul><ul><li>We work and raise money in 186 countries and have a truly global scope. </li></ul>
What is UNICEF? <ul><li>UNICEF is similar to a consultancy </li></ul><ul><li>Advise government policy </li></ul><ul><li>Work directly with ministries </li></ul><ul><li>Help provide logistical services </li></ul><ul><li>Planes, trucks, even donkeys </li></ul><ul><li>Economies of scale </li></ul>
what is UNICEF? We are also the world’s biggest purchaser of vaccines... and of pencils!
Malawi Malnutrition Project <ul><li>UNICEF Innovation Team </li></ul><ul><li>Looking at ways changing technologies can be applied to existing problems. </li></ul><ul><li>Partnered with SIPA at Columbia University </li></ul><ul><li>Partnered with Malawi Ministry of Health </li></ul>
Malnutrition can be accurately measured with Age + Height Weight Upper Arm Circumference
Changing Technological Landscape <ul><li>The adoption of cell phones in Africa has been one of the quickest technological adoptions in the world. </li></ul><ul><li>1998: 2 million 2010: 500 million </li></ul><ul><li>Current cell phone penetration is at 60% </li></ul><ul><li>Most importantly all the Community Health workers had them. </li></ul>
<ul><li>Open source framework for building SMS-based systems </li></ul><ul><li>Build on existing working practices with an appropriate technology </li></ul><ul><li>Swap paper for phones </li></ul>
<ul><li>What can you do with 160 characters? </li></ul><ul><li>All the Malnutrition predictors fit </li></ul><ul><li>Pair it with powerful back-end software </li></ul>
<ul><li>Costs low since health workers have cells </li></ul><ul><li>Training </li></ul><ul><li>Costs of SMS messages </li></ul>
Broad Application <ul><li>Ethiopia: Tracking food distribution during famine </li></ul><ul><li>Zambia: Tracking neonatal health HIV/AIDS infected mothers </li></ul><ul><li>Nigeria: Tracking distribution of malarial bed nets </li></ul><ul><li>Senegal: Using SMS as an incentive and tool for teaching literacy </li></ul>
Changing Institutional Practices <ul><li>Technology is only one element of innovation </li></ul><ul><li>Can institutional practices keep pace? </li></ul><ul><li>Now that we have real time data how can we change our work methodologies to take advantage of it. </li></ul>