This piece was originally published on the Peacebuilder blog

Not too long ago, I met up with a friend of mine who used to be an analyst for the State Department. One of the hot topics of our dialogue included the subject of peacebuilding efforts in Africa. During the conversation, he [...]]]> By Mara J. Roberts

This piece was originally published on the Peacebuilder blog

Not too long ago, I met up with a friend of mine who used to be an analyst for the State Department. One of the hot topics of our dialogue included the subject of peacebuilding efforts in Africa. During the conversation, he recounted a story about a project he was involved with where he was tasked with helping evaluate a peacebuilding project in Northern Uganda. The project involved building a peace center and culminated in hosting two peace conferences where the opposing parties were both brought to the table. The recipients of the money were very proud of their achievement, however when my friend asked them this question: “What difference have these conferences made to decrease conflict in the area,” they didn’t know the answer. This vignette highlights the difference between outputs (hosting a peace conference) and outcomes (a decrease in violence) and the particular complexities of trying to monitor and evaluate conflict.

My last post was about Ushahidi and its novel approach to monitoring conflict through the combination of SMS, Twitter and geo-mapping. At the center of the Ushahidi methodology for crisis monitoring is crowdsourcing: the use of the general public’s knowledge or opinion to provide information. Most of us benefit from crowdsourcing every day. When we shop on Amazon, we look at an item’s reviews. When we rent a movie on iTunes and Netflix, we look at its ratings. These both use crowdsourcing methods.

Weaknesses of a Ushahidi: Limits to Access
While there is great innovation in harnessing the general public’s information through crowdsourcing via SMS and Twitter, these methods have their drawbacks. First, Ushahidi utilizes a small army of volunteer computer programmers to implement a specific version of the map when a new crisis arises. The code is “open source” meaning that anyone can have access to it, but unless you are a programmer or know programmers, this is really of no use. Having the code open sourced also allows anyone to create their own customized version of the crisis map. In the recent uprising in Egypt, there were five different versions of crisis maps created by several different factions.

Another significant weakness to the method is that you do not know who is providing the information. Because of this, there could be disinformation sent. Ushahidi attempts to guard against this through validating both users and content. Perhaps Ushahidi’s greatest weakness is its dependence upon the general public’s access to cell phones and internet. Countries in Africa with the highest cell phone penetration include South Africa (85%), Egypt (70%), and Kenya (50%). The people who live in poverty typically are most susceptible to violent acts and marginalization and can rarely afford a cell phone.

An alternative to Ushahidi: Experts and SMS
A less expensive, lower-tech alternative to Ushahidi is using experts to relay information using SMS texting. This is what my company did in the 2010 Burundi presidential election to monitor the post-election violence. In Burundi, primary schools function as community centers where information is exchanged and where networking occurs. Because of this, primary school teachers were used as “experts” and were sent questions through SMS, asking about any election-related violence they saw or heard about from credible sources in their networks. The results of this surveillance indicated a low level of violence related to the election, which was validated through various media reports coming out of the country. This approach avoided many of the weaknesses of Ushahidi, especially given Burundi’s low cell phone penetration rate of only 10%.

Despite the challenges of monitoring and evaluating peacebuilding efforts, practitioners in the field have increasing access to a variety of tools that can strengthen the capacity to better evaluate their work and leverage their impact. As these monitoring and evaluation tools begin to be used more effectively, stories like the one in Uganda will hopefully occur less frequently.

Acknowledgements: David Roberts, who oversaw the technical details of the 2010 Burundi election violence surveillance, contributed to this article.

This piece was originally published on the Peacebuilder blog

Reports were trickling in from our friend and coworker living in Kenya that the situation was rapidly deteriorating. After what appeared to be a stolen presidential election on December 27, 2007, the resulting violence seemed to be drawn along tribal lines. The [...]]]> By Mara J. Roberts

This piece was originally published on the Peacebuilder blog

Reports were trickling in from our friend and coworker living in Kenya that the situation was rapidly deteriorating. After what appeared to be a stolen presidential election on December 27, 2007, the resulting violence seemed to be drawn along tribal lines. The 100 year old mission compound where Esau and his family lived seemed to always be insulated from national crises like this. But on January 9, my husband got the email. A flyer, causing mass fear as it flew over the base declared the following threats: “We swear by the sacred Mugumo tree that when we descend upon Kijabe, we shall not leave any Luo alive …” Afraid for their safety, Esau (a Luo) and his family moved to a friend’s house away from Kijabe to live in hiding for several weeks. At the end of the 59 day political crisis, the sobering death totals throughout the country were approximately 1,500 dead, 3,000 innocent women raped, and 300,000 people internally displaced.

Patrick Meier had grown up in Kenya and happened to be back visiting his parents during the crisis. Articles with headlines like: “Kenya Is Not Burning,” were surfacing from the Kenyan government media outlets, who were trying to manage the national and international opinion through disinformation practices. He read these and wanted to do something to improve the ability to report human rights abuses resulting from the conflict. He enlisted the help of some Kenyan nationals to assist in realizing his idea. They called it Ushahidi (pronounced OO sha hēdē), which means “testimony” in Swahili. The system was simple, but novel in that it integrated Google Maps with Short Message Service (SMS) otherwise known as text messaging. It employed the idea of crowdsourcing, which harnesses eyewitness accounts of acts of violence from the general public. Ushahidi allowed people to send an SMS to a free, local number with their location and a description of what they saw.

Kenya post-election violence crisis map

The results of the experiment were extremely successful: several hundred texts were received with first hand reports of riots, death, property loss, sexual assaults as well as peace efforts throughout the country. Ushahidi had provided a method for creating real-time mapping that documented acts of violence and peacbuilding using common people. The system also provided a warning system, where people could automatically receive a text message if an alert was posted geographically close to a self-selected location.

This prototype system was modified to monitor election violence during the presidential election in Burundi in July of 2010, as well as Kenya’s constitutional referendum in August, 2010. In both of these cases, the system produced reports of little to no violence resulting from the elections.

Ushahidi was used most recently during the Arab Spring protests in Egypt and is currently monitoring the conflict in Libya. With the high penetration of the internet in cities like Cairo and Alexandria, the deployment in Egypt provided the opportunity to also incorporate Twitter tweets (in addition to SMS) into the conflict map.

Overall, this system, which simply combined multiple existing technologies, yielded a powerful conflict monitoring tool. This tool, however, is not void of weaknesses. In my next entry, I will discuss some of these weaknesses as well as a simple system alternative for monitoring election violence.

5. In December, Transpanency International published it 2010 Global Corruption Barometer Report which indicated that ninety two percent of Kenyans [...]]]> 6. Our Philanthropy Metrics team traveled to Burundi in June between elections there to perform a country wide survey examining the secondary impact of a three year neglected tropical disease project.

5. In December, Transpanency International published it 2010 Global Corruption Barometer Report which indicated that ninety two percent of Kenyans believe that the police force is the most corrupt institution in Kenya. We looked into this survey methodology to report some weaknesses in the study that likely bias the results towards those living in urban areas.

4. In April and May, we had a two part article on the importance of monitoring and evaluation. Philanthropies often focus on setting goals, but do little to measure if goals are met, leading to a lack of data and a crisis in writing the final report. In the first article, we provided options for those who find themselves without sufficient data upon completion of their project. The second article provides both basic and more advanced options for those who want to do M&E correctly.

3. In January, the world was drawn to a small island off the coast of Florida. The earthquake that rocked Haiti led to a herculean search and rescue (SAR) effort from the international community. Unfortunately, the benefit of human lives saved was small while the cost was massive, leading to an article questioning the rationale for large SAR operations.

2. The article on The Right and Wrong Way to Survey highlighted the fact that surveys are harder to do well than most people think and are often designed poorly, leading to faulty data that can lead to erroneous decisions being made. We provided a step-by-step guide for you to get started in doing your own survey.

1. In February, we were on a conference call with Sean Stannard-Stockton of Tactical Philanthropy hosted by Philanthropy Action looking at the role of qualitative metrics in good philanthropic practices. The highlight of the call was the need for a more blended approach by using both quantitative and qualitative tools for decision-making.

Philanthropy Metrics is focused on creating a tool that measures the impact of HIV educational programs.  This is one focal area for us because of the lack of efficacious questionnaires out there.   Over the past year, we have performed several pilot studies where our field team has implemented several iterations of a questionnaire.  In [...]]]>

Philanthropy Metrics is focused on creating a tool that measures the impact of HIV educational programs.  This is one focal area for us because of the lack of efficacious questionnaires out there.   Over the past year, we have performed several pilot studies where our field team has implemented several iterations of a questionnaire.  In 2011, our plan is to role out a beta version in Swahili which can run on both desktop and mobile devices.

The [...]]]> First, as I sit here in Day 2, let me say that the mHealth Summit could possibly be the best conference I’ve ever attended.  I am use the the academic setting, where you have people talk at you.  Here, every session, both large and small, is a panel conversation with diverse panelists and participant Q&A. 

The session from “Lessons learned across the globe” was an excellent session, if you watch one session, watch this one.  Here is are some thoughts put forth:

Thought 1:  mhealth in the developed world is about improving the efficiency of the system.   In the developing world mhealth is about improving access to health care.

Thought 2:  Technology isn’t the issue in mhealth.  The technology is there and it’s the simplest, cheapest $5  phone that people own.  Yes, this means that smart phones are not the solution in the developing world.  Even as android the prices drop below $100, this still not approachale for most people.

Thought 3:  That said, the solution should be technology agnositic, with a systems approach that can utlize incoorperate the basic and smart phones for different solutions in different settings.  “Let a thousand flowers bloom.” 

Thought 4: Community buy-in is key.  Multiple panelist have indicated the need for social science research in assessing the community needs , perceptions, values. 

Thought 5:  There are thousands of pilot project going on, but very few scalable and sustainable projects in mhealth.  When the money runs out for these pilots, may ideas will die.   This goes back to what I wrote about yesterday with mobile applications being in their infancy.  It also highlights the need for an open source and open communication so work from various efforts can be built upon or combined.

8. Patient finanical account. With a [...]]]> 9. PDA for providers. The idea is to get medical information in the hands of providers – anyone from a family care physician in the bush who needs to look at a pharmacopia, medical guidelines or academic literature on the PDA, to a Maternal Health specialist aiding in a birth.

8. Patient finanical account. With a specific account number, a text can be sent to someone’s account so that they can receive health care.

7. Cell psurvey tool in recent household survey identifying pregnant women

6. Birth registration. In Kenya, villiage chiefs were given either a cell phone or minutes on their existing phone to call with village births, including still births.

5 “Core patient record.” Many of you will be familiar with how medical records are kept on cards that patients take with them in the developing world. The idea here is to provide a patient record that is downloadable in the field, and where information can be added to and uploaded.

4. Up-to-date CD4 Counts. Similarly to the idea behind the core patient record, there is a significant need to have an accurate CD4 count when providing care for people living with HIV.

3. Data gathering tool for decision makers. An example was seen in earthquake in Haiti, where cell phones were used to send and receive information in order to allocate resources to the proper places.

2. Money transfer. While not specifically medical, the lives of many Kenyans are being transformed by an innovative mobile phone money transfer service. M-Pesa is offered by Safaricom Kenya, has a monoply on the money transfer market. Along these lines, tranfering money to community health workers for bus fairs for patients with fistulas and cleft lips. CHW gets incentive of $3.5 once the patient comes in with the specific bus ticket receipt and the CHWs name. A simple solution that was hugely popular, helping many women long past childbearing years

1 . Text4baby. This is Health and Human Services’ mhealth poster child. It is a free mobile information service designed to promote maternal and child health that boast 98,000 users to date.

There were several key take always from the first session on the Impact and Future Vision of mHealth.   The first was that mobile applications in health [...]]]> Note: The conference is being telecasted online, and questions can be sent in for the main sessions via twitter.

There were several key take always from the first session on the Impact and Future Vision of mHealth.   The first was that mobile applications in health are still in its infancy internationally, but also domestically.  To date, there have been various efforts domestically, such has the electronic medical records (EMR), that have had mixed results.  For example, even with the best EMRs, physicians are infamous for entering data poorly or not at all.  Additionally, system structures and databases are proprietary and often incompatible with competing EMRs.

This weakness appears to be well known, as one of the main strategies that I heard from more than one speaker is the idea of open architecture.  One of the speakers, Deborah Estrin, a professor at UCLA, had a recent article on mHealth open architecture.  What this means is that software has code that is available that can be added to, or upgraded.  

Another take away is that, while there are more cell users in Africa now than North America, the statistic was shared that over 50% of people over 45 years old have never sent or received a SMS text message.  Given this, mobile solutions may be only applicable to a narrow portion of the global population.    Additionally, with 50-60% of the world being illiterate, visual and graphic alternatives to text-based communication need to be developed.  

The last take away is that there is currently more health data than we know what to do with.  I believe the term “massive amounts of data” was used multiple times.  Mobile phones are only adding to the data capture.  Given this, efficient databases and user interfaces that best allow users to access data are needed.  Addtionally, with “massive amounts of data” there is a significant problems in analysis.