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Final keeping the promise

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Final keeping the promise

  1. 1. Keeping the Promise of Achieving MDGs– Reaching the Last Mile Dr Sharad Sapra, Unicef, June 6th 2011Based on current progress, it is estimated that almost 50 countries of the world will not achieve theMDGs by 2015. Most of them are in the area of child and maternal mortality; and most of them arein Africa. Sadly it could be another target left unachieved and another promise broken. But thatneed not be so.The science available to us today is sufficient to help us achieve the targets. The political will isexpressed repeatedly. Delivery systems have been put in place and yet after the initial rapid pace ofprogress, movement towards the last mile is slow. I believe that the strategies that have been put inplace have brought us to the point where we are today – very close to being successful but not yetall the way there.. However, I also believe that these strategies have delivered the results that theycould and doing more of the same will not take us towards achieving the targets.I believe some of the basic assumptions on which we based our programme strategies have changedand therefore need to be revisited. For example – in the water sector, we worked on the assumptionthat safe water is not available. We invested in drilling bore holes, putting in place piped waterschemes as close to the population as possible. While in Urban and peri urban areas in many caseswe were able to put the water point right into the house, in many areas people still have to walksome distance to collect water. Even when 95% of water sources provide clean drinking water, over90% of the water at the consumption point (household) is contaminated. As a result, the simplest ofall diseases – diarrhoea, is still rampant and diarrhoeal deaths are still one of the top 3 or 4 killers ofchildren in Africa. The question then is should the focus not also be to put at water transportationand storage and purification at the point of consumption, regardless of the source.I also believe that the last mile challenges we face today are not the challenges that can beaddressed by the sectors that face the challenges. The answers lie in other sectors. For instance, inthe case of immunization, the challenge is not really the vaccine or the technique of injecting oradministering the dose of the vaccine or effectiveness of the vaccine per se. The challenge is usuallythat of getting the vaccine to the right place at the right time – a logistics issue. The medicalprofession as we all know are trained in medical sciences, logistics not being one of the subjects. Butprivate sector companies, courier companies, transport companies, Coke and Pepsi, the Walmarts,game, pick and pay and Woolworths of this world are experts in logistics and distribution systems.Unfortunately they are not a part of or linked to the Health Ministry.Many efficiency gains within the current system can be achieved that can bring us much closer toachieving the MDGs by just focussing on removing the bottlenecks and delays in the deliverysystems.That brings me to this wonderful industry sector of communication – the Mobile Phones and the rolethat they can play in helping Africa reach its development objectives. Page 1
  2. 2. With over 500 million cell phone subscribers by September 2010 and a possible 850 millionsubscribers by 2015, Africa is the fastest growing cell phone market in the world. In fact Africa todayhas more cell phone subscriptions than US and Canada put together. In Uganda, 70-90% of volunteercommunity health care workers already own basic mobile phones. Powerful tools are already in thehands of those best suited to address last mile challenges.People often see a cell phone as a talking device. I see it in many different ways – 1. As a substitute for transport – many things can be done over the phone that earlier required the use of transport e.g. cash transfers 2. As a personal advisor/ educator – with appropriate services, a cell phone can become a tool where people can get advice, information and guidance in total privacy and on demand – already people are getting reminders for their next medical check up or taking their next dose of medicine and even getting private on demand English language courses. Also imagine a health worker in a remote area entering signs and symptom information about cases and immediately getting feedback on possible diagnosis, treatment and referral. 3. As a digital bridge between those who have fibre optic and other cable based internet connections and those who don’t – so we do not wait for the cables to reach before people have access to information and who know maybe the technology will advance in a way that no cables would be needed in the future in many of our African countries; 4. As key tools that can cut down delays between the time the information is acquired and acted upon. Significant investments have been made by countries in designing management information systems. To me these systems focus too much on managing information. Often they are data heavy and replicate the sequential process of moving data as was done with paper from one level to the next. As a result breakdowns are common and the system is only as strong as the weakest link. With cell phones, I believe we can work in developing systems that are not designed around Managing Information but systems that provide Information for Management. With cell phones the 4 or 5 bits of actionable and critical information can be sent to the server from where all the processing is done and feedback and aggregated data for action sent via sms or ussd to all levels almost instantly. Drug stock outs, teacher and student absenteeism are some examples. Birth registration, registration of vulnerable children and households and direct cash transfers are some of the examples that illustrate the point. 5. I also see the power of the cell phones in accountability, transparency and citizenship. Imagine an SMS being sent to hundreds and thousands of pre-enrolled subscribers asking if the water point in their village is working or not, or if the teacher is there in the classroom or not, or if the health center has a particular marker drug or not and getting instant feedback that gives the picture of the whole country in a very short time and at a very low cost. By doing this you are making the community aware of their entitlement, engaging them in monitoring their entitlements and giving them feedback as to what action can they take to address the problem. The aggregated information can also be shared with local leadership at various levels and a national public discourse can be undertaken to act on the problem. Page 2
  3. 3. Suddenly, with minor investments, the voice of the people is influencing national action and policy letting people know that their participation and their VOICE Matters. 6. As a major nano enterprise where hundreds of unemployed young people can be engaged in reporting, data entry, charging cell phones, working in small groups as cash transfer centres etc.I can go on and on and these are not dreams or just flights of imagination but are currently beingrolled out in many countries in the region.In Uganda, we are working with the Government, and partners like WHO, Find Diagnostics, andMVP, to roll out a complete mHealth package that spans the continuum of care. For UNICEF, thefocus is not on the technology or the hardware – which is the easiest part to address - but onbuilding the capacity and skills of the people who will be asked to use these new tools and respondto new types of information.The health package being developed in Uganda covers everything from creating demand for servicesand providing people with information so they can make informed choices, empowering communityhealth workers with tools that allow them to send reports – such as disease outbreaks at point ofcontact, and providing District Health Teams and Health Facilities - with information to bettermanage their resources. Separately, we only get a small part of the picture – for example we mightknow we have an increase in community outbreaks of malaria, but have no idea if they can accessdrugs at their local community. But when the entire continuum of care is addressed, we can pinpointexactly where in the chain the breakdowns are occurring and immediately address them.However, one of the challenges we are seeing is a growing fragmentation of the health sector asmore and more development actors pilot ICT initiatives. In Uganda, there are over 60+ separateprojects by last count. Many of them duplicate existing efforts, some of them do not follow generalbest practices or rely on expensive, unscalable hardware, and a large number of them fail to ensuretheir data is actually integrated into the existing government health information systems. Most ofthese initiatives operate outside the knowledge of the Ministry of Health. This is posing a seriouschallenge to designing national systems meant to scale. There is a desperate need for nationalstandards, consensus on platforms and technology, and collaboration between agencies anddevelopment actors.That brings me to the final point of this conversation – the role of Private Sector and the cell phoneservice and hardware providers. Many of you are involved in Philanthropy, and that is good.However, I am more interested in seeing how business models can be worked out where corporatesocial responsibility and core business models of the cell phone industry can come together. Becausethat is what is needed to have a strong and long-term sustainable relationship between nationaldevelopment objectives and the core business objectives. Also investing in poor makes goodbusiness sense as they are the largest proportion of the population and their well being is good foryour business.I want to mention an exciting birth registration initiative in Uganda that has paired UgandaTelecoms, one of the biggest mobile phone operators in the country, with the Ugandan Registration Page 3
  4. 4. Services Bureau. Early on in the process, UNICEF gathered all the key stakeholders – includinggovernment, NGO and academia, working on similar initiatives – to get broad consensus and buy-in,and avoid duplication.Uganda Telecoms then developed, at an estimated cost of $50,000 in programming time, a simpleUSSD and online / off-line application to enable duty bearers to register new births. Certificates areprinted and available in real-time, and the national offices can access up-to-the-second records fromanywhere in the country.Now, what is important here is understanding why Uganda Telecom is engaging in this initiative.From the beginning, UNICEF was not interested in a Corporate Social Responsibility project. Wewanted this system to make good business sense for the Uganda Telecom.Recent market surveys show that the telecoms are no longer looking at voice as their primary sourceof revenue. They are instead using voice to direct consumers to their main money making areas:SMS and Value Added Services. The most strategic objective for operators currently is on networkexpansion, improving market share and driving customer loyalty.Knowing this, we were able to make a good case for Uganda Telecom to work with UNICEF andgovernment counterparts on this initiative. Uganda Telecom significantly subsidizes the hosting anddata transfer costs for the birth registration system, making it possible to conduct an entire birth“transaction” for less than 1 cent. With costs this low, we have a scalable solution that theGovernment of Uganda can afford.In return, Uganda Telecom sees an opportunity to expand their network of users to at least one“birth registration focal point” in every village. Uganda Telecom envisions this person, who will beactively engaging with countless households as part of the birth registration work, also acting astheir mobile money operator. Additionally, while the core service of birth registration is offered atnearly no cost, Uganda Telecom will be providing premium value added services such as an easy wayto notify your family and friends of the birth.In light of this, I would pose the following questions to those engaged in this field: 1. Can the private sector assign a proportion of their programmer’s time to work with various Government Ministries pro bono to understand their major communication, logistics and data movement constraints and design solutions that are not tied to one specific service provider and that can work for them; 2. Can the private sector assign some time of their technical staff to build capacity of the young in various universities and vocational schools to build national capacity in this area; 3. You already offer many free services on your carriers, can some of these be for public good and crowd sourcing vital development information; 4. Can each of your retail outlets act as data and voice gathering centres so that the observations and voices of the ordinary and the marginalized can be heard in the highest levels of the government; Page 4
  5. 5. 5. Can each of your retail outlets be a learning point for the young with a combination of free and chargeable services for public good; 6. Can you all work together on certain public good initiatives so that the programmes of one can work on the platforms of others as well 7. Can we all have a common portal where we share within the country and in the region, perhaps even globally what we are working on so that we can harvest the energies and resources already invested by others in addressing the same challenge and not duplicate each other’s efforts but benefit from them. Can we all also agree on certain standards which all of will abide by so the solutions are robust, scalable, easily shared and replicated.I know that many of you are already doing a lot of this but there is room for more and this criticaljuncture where we have only few years left to achieve MDGs, you all can be a critical player.Thank You Page 5

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