Posts Tagged ‘M4D’

Can We Text Our Way to Behavior Change?

Wednesday, August 17th, 2011

Jason Hahn is a Business Development Manager at the Grameen Foundation

Randomized Control Trials (RCTs) that show the evidence of mobile phone based development interventions do not come out every day.  At Grameen Foundation we look forward to them as they can help us shape our interventions with fact-based evidence of other interventions that worked - especially when they show an almost 25% change in behavior.

It was with great interest to read about one that did just that in a recent Lancent article on “the effect of mobile phone text-message reminders on Kenyan health worker’s adherence to malaria treatment guidelines”.  The article written by Dejan Zurovac, Raymond Sudoi, Willis Akhwale, Moses Ndiritu, Davidson Hamer, Alexander Rowe, Robert Snow from the Kenya Medical Research Institute - Wellcome Trust Research Program in Nairobi illustrated their findings after they text messages to health care workers encouraging them to follow treatment guidelines for pediatric malaria.  They sent two messages every work day for six months to rural health workers in 11 districts in Kenya.  The messages contained treatment guidance and an inspirational quote.  I’ve excerpted from the article one of the messages that was sent on Monday mornings:

Check ALL sick children <5yrs for any severe signs! Also check for fever, cough, diarrhea, pallor & any other problem.Quote: “Persistent work triumphs”

Health care workers who received the messages improved their management of pedatric malaria by 23.7% immediately after they received the six month intervention and by 24.5% when researchers went back 6 months later to check on them.  This compares favorable with a 9% success rate for traditional health care worker performance improvement programs which don’t use SMS.   The research this team did builds on other research that showed behavior change triggered by SMS messages among people living with HIV who were taking anti-retroviral medication for HIV.

Simple mobile tools to combat fake agricultural inputs

Friday, March 18th, 2011

Whitney Gantt is the Partnerships Manager for Grameen Foundation’s Community Knowledge Worker program in Uganda.

Poor farmers in Uganda routinely struggle with access to agricultural inputs, such as fertilizer and improved seed varieties, that would boost their crop yields.  Access to improved inputs is one of the highest impact scenarios for improving farmer productivity.  In the right context, the application of fertilizer can significantly increase  yields, by up to 300% - which means the potential to triple income.

Two of the chief constraints for a smallholder farmer to buy these inputs is lack of access to fertilizer in a quantity they can afford (inputs are often sold in large quantities priced beyond the means of a typical smallholder farmer) and lack of trust that the input is real and not a counterfeit product.  Smallholder farmers are risk averse - buying a fake product can mean financial ruin or worse so building trust in the efficacy of the inputs is extremely important.

The first constraint of high prices can be tackled through “sacheting” - the practice of breaking larger quantity products down into smaller sized or “sachets” which yields a price point that a small-holder farmer can afford.  The second constraint - knowing whether or not your seeds will sprout or the fertilizer will really work -  is a tougher problem to address.

One potential solution has previously been used to counter prescription medicine counterfeiting in West Africa.  Sproxil and mPedigree have developed a solution that uses a unique number on “real” products that can be sent via SMS text to a verification center which responds by SMS text that the product is “real”.  A client can send the SMS, or ask the seller to do it in front of him or her, to verify the medicine is real before they make the purchase.  This approach could easily be ported over to protecting agricultural inputs from counterfeiting.  At Grameen Foundation’s Uganda AppLab we are considering working with a few partners who are already planning to pilot such a program.

We would be glad to hear from you in the comments section of your opinion of this solution and any other ideas you might have to help farmers access agricultural inputs.

You still need to work in groups - even if you have a mobile phone!

Monday, March 14th, 2011

We have found that our Community Knowledge Workers (CKWs), much like the farmers they work with, often enjoy learning and sharing in a group setting.  While our model of information dissemination depends on mobile phones they don’t replace the help and support a good group can give to its members.

In the photo at left, taken on March 9th in Kapting parish, Binyiny subcounty, Uganda the discusion revolved around creating a model farmer network, following up and getting feedback from farmers on CKW services, managing CKW challenges while at work and timely meeting of monthly targets for providing information and collecting surveys.

So even with the phones - working in a group is still good!

What’s an AppLab and why partnering is important?

Thursday, March 3rd, 2011

Heather Thorne, Director of ICT Innovation at Grameen Foundation, closes her series of three blogs on our approach to M4D with a description of our work in the field and call for partnerships.

Today, GF operates three regional innovation hubs – AppLabs – in Uganda, Indonesia and Ghana – with additional M-Health efforts underway in India, Mobile Financial Services efforts in Kenya, and new health and agriculture efforts planned in Latin America.

  • Uganda – Agriculture and mobile financial services. Nearly 300 Community Knowledge Workers (CKWs) are currently deployed reaching >14,000 farmers with the goal of increasing their adoption of improved farming practices; utilizing support from Bill and Melinda Gates Foundation (BMGF) and  MTN Uganda to scale this agriculture program nationwide and beyond.  Mobile Financial Services work is in early stage development.
  • Indonesia – Entrepreneurship and livelihoods.  Over 5,700 micro-entrepreneurs are working in West Java, selling electronic airtime top-up and piloting social applications/services; reaching over 600,000 customers.  Approximately 50% of the entrepreneurs who have stayed in the program over 4 months (~15% of the total) have nearly doubled their average daily income.  This program utilizes funding and other in-kind support from Qualcomm Wireless Reach, and a partnership with telecom provider BTEL.
  • Ghana - Mobile Health. “MOTECH in Ghana” is a service that strives to increase the quality and quantity of prenatal care in rural Ghana.  “Pregnant parents” receive regular messages on their mobile phones designed to educate them about a healthy pregnancy and catalyze clinic visits for prenatal care.  Healthcare workers use the system to track who has received care and who may be in need of care.  Administrators at Ghana Health Service can review reports to identify where to focus improvements in health coverage.

A conceptual framework for all of GF’s M4D efforts is shown below:

Heather Post 1

In each of these innovation centers, GF has developed deep vertical knowledge, but also employs a common innovation process that leverages our expertise in needs assessment for the poor, rapid prototyping, user-centric development, pilot testing, launching new products and services, and supporting them in market.

Critical to creating social impact, and doing it in a sustainable way, is assembling a collection of partners who can contribute unique value, and derive unique perceived value from the effort, while collectively focusing on meeting the needs of the poor.  Some examples of how value may be contributed and derived include:


In order to reach millions of measurably poor people with mobile services designed to improve their lives and livelihoods, practitioners will need to develop enduring relationships with not only the partners above, but also multi-lateral organizations, research institutions, academics, think tanks, funders for ongoing innovation and for exit strategies, and regulators.   We believe that public-private partnerships, and multi-stakeholder management are key to addressing the multiple dimensions of poverty.

Going forward, our vision is for GF’s AppLabs to serve as a platform for broader scale and deeper innovation, allowing for ongoing validation and testing of new ideas that can be put through our rigorous rapid prototyping and in-depth piloting approach.  For the most promising concepts that emerge from the pilot process, we will seek additional funding from other sources to develop, test, launch, measure impact, and scale the services via our partners within each target country.  We will also work with our other AppLabs, within those countries’ intermediary networks, and among partners to maximize reach and impact.

With over 8 years of learning about what works (and what doesn’t) in social-mobile innovation, on-the-ground presence in multiple verticals and geographies, and a deep understanding of the needs of the poor and how to build products and services for them, GF intends to continue pushing the thinking in the M4D space.   However, we alone cannot create the change we seek in alleviating poverty.  We need others to partner with us, who share a vision for what is possible, and who will bring their talent and resources to bear.

How can mobile phones be used to reduce poverty?

Monday, February 28th, 2011

This is the second in a series of three blog posts on the M4D space by Heather Thorne, Director of ICT Innovation at the Grameen Foundation’s Technology Center.

Grameen Foundation approaches all of its work from a “Theory of Change” perspective, using this as a starting point to ensure activities and outputs are logically linked to the desired outcomes of each program.  AppLab’s Theory of Change is based on research showing that gaps in access to information and services (e.g., health, financial services, agriculture, markets, job opportunities, etc.) contribute to lack of economic opportunity and reduced welfare, therefore leading to or perpetuating poverty.  This is worsened by inability to act on information.  By leveraging mobile phones as a means to eliminate or reduce those gaps, and to reduce friction in systems, we believe it is possible to directly and indirectly reduce poverty. 

Given the potential for M4D efforts to benefit a broad audience but possibly miss the specific needs of the poor, we do a number of things to ensure a focus on the poor and poorest in AppLab efforts, such as:

  • selecting vertical areas known to have a statistical link to poverty (or lever for escaping it):  agriculture, health, livelihoods, or access to targeted financial services
  • incorporation of M&E frameworks and measurement approaches into each implementation
  • geographical targeting focused on regions known to have larger populations of poor and very poor
  • choosing mobile operators with the largest market share among poor populations we serve and choosing other NGO partners who share a poverty-focused mission
  • pricing models, such as cross-subsidization, making services available to those unable to pay

AppLab’s Theory of Change has evolved over the 8 years we have been working in the M4D space, starting first with the Village Phone replication program in Uganda, which extended to Rwanda, Cameroon and several other sub-Saharan African countries, as well as to Indonesia.  Building on this foundation, GF began exploring the potential for providing additional services through the phone nearly four years ago, leveraging the fact that low-end phones were beginning to penetrate even the most remote villages.  We launched AppLab Uganda in 2007 in partnership with MTN Uganda and Google, and spent the next two years developing partnerships with local content providers in agriculture and health, conducting ethnographic research, rapid prototyping and concept testing, developing and testing products, and launching a nationwide suite of applications called Google SMS (GSMS) in 2009.  In Indonesia, GF incubated an Indonesian-owned social enterprise called Ruma, which began to operate the Village Phone business in partnership with a large mobile operator focusing on the low-end market segment.   The model began to evolve as we learned that voice services no longer presented a viable business opportunity due to mobile phone penetration—and the Ruma entrepreneurs began to sell airtime, a similarly low-cost item that people buy frequently, in small denominations, which can be delivered through the phone by people with minimal skill and working capital– increasing and smoothing their cash flow. 

We recently completed what we believe to be the first ever randomized control trial designed to assess the impact of a mobile-phone based service aimed at improving the lives of the poor.  The service we sought to measure was Google SMS (GSMS) Health Tips, and our social impact measurement partner, Innovations for Poverty Action (IPA), performed the study. 

The learnings from the study were substantial, supporting some of our initial hypotheses and refuting others.  They indicated that when people are made aware of such services, there is indeed demand and usage of them, and that ongoing awareness efforts in general are critical to usage and thus impact.

We also learned, however, that the fundamental drivers of behavior change are not altered simply because of the phone, and if the phone is not addressing each of those drivers, behavior change is unlikely.  (You can read more about the study on Eric Cantor’s recent blog post)  Driving sustained adoption of the information and behavior change, or other outcomes that we envision, requires re-thinking aspects of the service—one of which is the often necessary role of a trusted intermediary in creating awareness and reinforcing the desired adoption of information and behavior change. 

You can read more about trusted intermediary’s and Grameen Foundation’s M4D work in Heather’s final blog post which will be posted later this week.

A few tweaks in the CKW intervention can deliver more impact to farmers

Thursday, February 17th, 2011

A scene from the local Pabbo, Uganda market

 Lydia Namubiru is the Partnership Analyst on our Community Knowledge Worker team in Uganda.

Samuel Olara’s chickens were getting weak and sleepy. He feared they had caught something that would kill them and he didn’t know how to save them. Fortunately, he knew someone who might know. He walked 2 kms to the local CKWs’ home to consult on chicken diseases and their treatments. The CKW in turn consulted his phone and advise Olara to treat his chicken with soda ash. They quickly recovered and were doing well three weeks later when a Grameen Founda­tion team visited his home in Pabbo.

Information can indeed positively change outcomes for many a farmer. However, sometimes, the information package needs to be deeper and more varied than a single remedy or other tip. Micheal Nyeko’s experience illustrates one rea­son why. He is a regular client to the local CKW. He says that he often asks for market prices. Unfortunately, he can’t al­ways put this information to good use. “Sometimes you learn that the price is so much better in the next district. It may even be double but you can’t afford to go there. Can your organization work with organizations that provide transport so they can connect us to those markets?” Nyeko asked the Grameen Foundation staff that visited Pabbo in January. He certainly makes a sound suggestion on how to remedy the situation; albeit one that requires significant investment. The CKW team also has an idea of a technology solution that might help overcome the farmer’s problem while bypassing the logistical requirements of sending out transporters to help farmers. Once the planned mobile market place applica­tion is deployed, we will investigate how much it pulls bulk buyers to rural farm-gates and in the process saves farmers the need to transport produce to physical markets.

Sometimes it takes less than a whole new technical solution to provide information that is complete enough to be actionable for the farmer. Take Alice Aya, an elderly farmer still in Pabbo. She and her farmer group learnt of the op­portunity to sell grain directly to the World Food Program (WFP) from their CKW and have agreed to work together to raise the quantities required by the warehouses. They have since raised 80 kgs of maize amongst themselves, well below the 3000kgs minimum the Gulu warehouse will store but a good start nonetheless. Unfortunately, they have now run out of storage space. “Can you build us some stores here in the villages where we can keep the produce while we raise the big quantities?,” the elderly woman also asked the Grameen Foundation team. Such stores as she suggests in fact already exist or are being planned. Based on her feedback, the CKW team will be publishing a comprehensive directory of WFP rural satellite collection and bulking cen­ters so that farmers like Aya will know where to store and/or minimally process their bulk purchase as they prepare to engage the bigger warehouses.

The valuable insights farm visits like these give us confirm and affirm the need to stay in touch with them. As we move forward with the CKW project, we hope to even further map gaps in the intervention and information it provides as well as those in the broader agricultural system that need to be filled. We are hopeful that this work will go a long way in delivering impact to the farmer.