mHealth is by no means the magic bullet (I believe there is no magic in international development; every situation is so different and complex for one solution). But it could help to improve the public health workforce or women’s health in developing countries. In order to determine this, there needs to be further field research. And it needs to focus around the true impact of the intervention. While the social sciences are imperfect and it is very difficult to know an intervention’s true impact (meaning if the mobile device is removed, how different would the outcome be), there is a best practice to assess the true impact – Randomized Controlled Trails.

There are multiple examples of projects providing “evidence,” but they tend to only show who has been reached (reproductive health information was received by 20,000 mothers). We need further evidence to show that mobile phones and/or their content are creating the sought behavior change. mHealth could be like microfinance where there has been a lack of evidence showing the impact of it on families. But, knowing this, microfinance is still essential for the bottom of the pyramid to access necessary formal financial services (savings/insurance/credit). In the same light, mhealth tools help fill in gaps (ie sending information via text message instead of walking it in paper form). But does it really make a community health worker (CHW) more effective and efficient at their jobs? It will give women and families reproductive health information.  But does it improve ART intake or change a women’s behavior? These are the questions that must be answered in order to know the true impact of mhealth applications.

To the benefit of the sector, RCTs have and are being conducted. At the ICTD 2012 Conference in Atlanta a few weeks ago, Brian DeRenzi, who completed his Ph D at University of Washington in the department of Computer Science and Engineering, presented his paper entitled “Improving Community Health Worker Performance Through Automated SMS.” As the title indicates, the focus of his research was testing the impact of reminders via SMS to CHW’s follow up visits to their patients. The study was conducted in Tanzania and in collaboration with D-Tree International, Pathfinder International, and Dimagi. It included one pilot project and two larger studies. In the end, the reminders reduced the average number of days between follow up visits to patients by CHWs. This is a clear benefit to helping improve the care provided to patients. But the study also provided further knowledge into issues with patient reminders to CHWs. This included the benefit of having the supervisor of the CHWs receive a SMS reminder if their employee did not conduct a follow up visit. When the supervisor was taken out of the equation, the performance of CHWs decreased considerably. This is an important design aspect to the program that could have been missed without a RCT. By testing the removal of the supervisor, it showed that the mobile phones helped but combining it with the supervisor’s real time knowledge of their work provided greater incentive to the CHWs to follow up with greater regularity with their patients.

Another example of an RCT currently in progress is in Ethiopia. In a very similar study, Kate Otto, from the World Bank, is working in collaboration with Addis Ababa University to test the impact of mhealth interventions on the care provided by Health Extension Workers (HEWs) in rural areas to women and child (In Ethiopia, the HEWs are equivalent to CHWs in Tanzania).  The research question is “does the use of a mobile phone-based tool enabling patient registration, appointment reminders, and inventory management – in the hands of Health Extension Workers – result in improved maternal and child health outcomes in a rural Ethiopian setting?” The goal is to find evidence supporting the use of mhealth interventions with HEWs.

Since these RCTs seem very similar, it would be easy to say that the World Bank and Addis Ababa University should have simply copied the intervention and implementation of the best practices learned in Tanzania. But this is the power of RCTs. Since each region is different with varying degrees of complexity, solutions that work in one area will not produce the same outcomes in another. Just because a program and intervention worked one place does not mean the same model or theory will work in another setting (see m-Pesa). The benefit of RCTs is that it will assist in finding interventions that will provide a solution for the region/country. This is especially necessary in the mhealth sector as the complexity of each situation dictates the need for specific program requires. But we are not sure what those are. The benefit of RCTs is that it can remove these variables and focus directly on the how and why interventions work or not, especially in behavior change. And as shown in Tanzania, it helps us understand what is and provides insight into areas of improvements.

Funding is always going to be an issue with RCTs. But the knowledge gained makes up for the investment by further understanding the true impact (if any) of the device. In the end, we need to find answers to what changes behavior, especially the role of mhealth in the change. There has been a greater increase in RCTs in mHealth projects to test how mobile phones and their applications are improving health. But there needs to be more done.

For those interested in learning more about M+E in global health programs, there will be a panel through GHDonline.org at the beginning of April. Please find further information about the panel here.

An initiative being co-led by Conservation International (CI), the Council for Scientific & Industrial Research (CSIR), South Africa and the Earth Institute (EI), Columbia University, has been launched with a grant from the Bill & Melinda Gates Foundation.

The Africa Monitoring System (AMS) tool will track, monitor and diagnose agricultural productivity, ecosystem health, and human well-being in African landscapes with near real-time data to better understand the opportunities and trade-offs of increased agricultural production. The system will provide tools to ensure that agricultural development does not degrade natural systems and the services they provide, especially for smallholder farmers.

The three-year $10 million dollar grant was announced by the co-chair of the foundation, Bill Gates in Rome at the 35^th Session of the Governing Council of the International Fund for Agricultural Development (IFAD) held in February. The grant lays the foundation for a new integrated monitoring system in five regions of Sub-Saharan Africa, including Tanzania, Ghana, Ethiopia, and two other countries to be determined, where agricultural intensification is targeted to meet the needs of Africa’s growing population.

Dr. Sandy Andelman, a vice president of Conservation International who will serve as Africa Monitoring System executive director said, “We face this enormous challenge that boils down to this key question: How are we going to feed nine billion people on the planet without destroying nature, especially in the face of climate change which in itself brings vast uncertainty. The answer is that we can no longer afford to make decisions without really seeing the full picture of what is happening to the planet.”

The Africa Monitoring System (AMS)

The success of the system will depend on the accuracy and timeliness of the data collection process which will happen at multiple scales to create the most accurate possible picture. This will include

• A household scale, using surveys on health, nutritional status, household income and assets;
• A plot scale to assess agricultural production and determine what seeds go into the land, where they come from, what kind of fertilizer is used, what yield of crops they deliver, what happens after the harvest;
• A landscape scale (100 km2) measuring water availability for household and agricultural use, ecosystem biodiversity, soil health, carbon stocks, etc.; and
• A regional scale (~200,000 km2) that will tie everything together into a big picture, to see the scales at which agricultural development decisions are made.

The raw data will be fully accessible and synthesized into six simple holistic indicators that communicate diagnostic information about complex agro-ecosystems, such as:  availability of clean water, the resilience of crop production to climate variability or the resilience of ecosystem services and livelihoods to changes in the agricultural system. The near real-time and multi-scale data will be pooled into an open-access online dashboard that policy makers will be able to freely use and customize to inform smart decision making.

“Rather than having a set of data over here for one issue, and other sets of data over there for other issues, what this system will essentially do is assemble the different puzzle pieces into one clear image that will allow decision makers to transparently see the parts and their sum in one centralized location”, Andelman explained.

CI Chairman and CEO Peter Seligmann praised the grant as a landmark moment in conservation which would inspire others.  “We are honored to be entrusted by the foundation to shepherd their largest investment to date in examining the relationship between agriculture and the environment, and I could not be more encouraged or appreciative for their leadership, concluded Seligmann.”

CI, CSIR and Earth Institute will collaborate with governments, other non-governmental organizations, the academic community, the private sector and key international partners over the next three years to design and implement the Africa Monitoring System. This period will represent Phase 1 (three years) of a three-phase process (10-15 years) to create an Integrated Global Monitoring System for Agriculture, Ecosystem Services and Human Well-Being, and developers expect to mobilize additional resources to leverage the Foundation’s investment.

Many in the aid and ICT4E community know NEPAD — the New Partnership for African Development (NEPAD) — and probably remember the launch of the e-School Initative, first announced during the Africa Summit of the World Economic Forum in June 2003.  As part of the overarching objective of the NEPAD program to enhance Africa’s growth, development and participation in the global economy, the e-School component involves a complex implementation strategy involving a multi-country, multi-stakeholder, and multi-stage approach to introduce ICT use and support to 600,000 schools across Africa.  But now, close to ten years after the initiative was first introduced, what progress has it made?

That’s what participants and leaders of the NEPAD e-School Initiative discussed when they gathered in Accra, Ghana earlier this week for the two-day NEPAD e-School Regional ECOWAS Conference.  Reverend Emmanuel Dadebo, Head of the Teacher Education Division of Ghana Education Service, led the discussion and press event, emphasizing the project’s need for a business plan that promotes private sector investment by introducing a new Private Public Partnership (PPP) model.

The conference comes after five years of discussion and debate concerning the key findings made during the initial phase of the e-School Initiative — the “NEPAD e-Schools Demo”. The purpose of the Demo was to accrue a body of knowledge, based on real-life experiences of implementing ICT in schools across the African continent, in order to inform the rollout of the NEPAD e-Schools Initiative. The program was implemented in six schools in each of 16 countries across Africa through partnerships that involved private sector consortia, the country government and the NEPAD e-Africa Commission (eAC), which is responsible for the development and implementation of the NEPAD ICT program.

Though various stakeholders and members of the aid community consider the Demo successful in some ways, like introducing ICT hubs into rural communities, most agree that it remains unsustainable in its current form.  A report released by infoDev and the Commonwealth of Learning (COL) back in 2007 entitiled “The NEPAD e-Schools Demonstration Project: A Work in Progress”, highlights the realization of this challenge within the early stages of the Demo and stressed the need for dialogue between all stakeholders:

“The expectations that implementation of the Demo would occur within a few months of it being announced in the participating countries, and, that a Business Plan would be developed to address sustainability and future rollout, were not met, and explanations for the delays were not effectively communicated.  The disappointment and cynicism that resulted in some of the participating countries underlines the oft-learned rule of project management: Communicate! Communicate! Communicate!”

Like many development projects of this kind, and on such a large scale, lessons like these take time to learn and often come from trial and error.  Shafika Isaacs, the founding executive director of SchoolNet Africa and a member of the monitoring and evaluation team for the report concluded saying this:

“Never before has there really been a program that mobilised national government participation and leadership at the official continental level in the way the NEPAD e-Schools vision has.  Further, it has brought the private sector into partnerships that, while experiencing growing pains, has mobilised resources in a way that few other projects have been able to do. And there is much yet to learn about doing this in an optimal way.”

Exactly how much has been learned between 2007 and now, has yet to be seen.  Several news articles have claimed that the program has already benefited several schools in Ghana and according to a statement given in Accra at the e-Schools conference, Ghana will launch the next phase of NEPAD e-Schools later this year.  The program’s methods of monitoring and evaluating these benefits and ensuring effectiveness and transparency are unclear.  However, with more buy-in from the private sector and the introduction of a new business model, it’s clear that some progress is being made and a more sustainable future for the e-Schools Initiative could be within reach.

One of the new ICT solutions that I have discovered and love to share with agricultural commodity value chain implementers is 8Villages, a mobile platform that links farmers to their communities of peers, input suppliers, and their external business partners.

Below is a short discussion that I had with the Founder and CEO of 8villages Mathieu Le Bras, when I spoke to him on skype from Singapore this week:

Question: A social network app for farmers – what type of farmers are you talking about?

In his response, Mathieu who is an agronomist by profession with over 10 years of experience working with smallholder farmers in the developing nations was very confident of what his ICT solution is all about. His answer was yes, a social network platform for smallholder farmers.

Of course, the follow-up question was what is the literacy level of these smallholder farmers that you are talking about?

With the current focus of 8Villages solution on Asia, beginning from Indonesia, the CEO painted a bright picture about the literacy level of the targeted farmers which is in contrast to the situation in Sub-Saharan Africa. The Global Educational statistics shows that about 48% of Indonesians live in rural villages with around 42% of its labor force in agriculture. The interesting part of this statistics is that, most children in Indonesia have high literacy rate, with around 90% of adults able to read and write. The CEO confirms this that, a very high percentage of the users of the platform are able to read and write and are perfectly using the online platform.

That said, the literacy barrier may be overcome for the users of 8villages mobile platform.

My next concern was about content for the users. Mr Le Bras as an agronomist perfectly understands the importance of quality agricultural content for successful farming by the smallholder farmers. 8Villages according to the CEO, depends on user-generated content by the users of the platform. 8Villages then uses its platform to extracts and share the content with the potential users.

So how is this done?  Mathieu described the system as an online network that combines voice, SMS and the Internet to connect farmers and their partners. The platform allows users – farmers and agribusinesses to generate microblog posts about their products, share brand comparison, give feedback on products and farming techniques, and attend trainings provided by experts.

On the nature of the existing social network among farmers, Mathieu argued that for most of these ICT solutions to work, developers and program implementers need to understand how farmers behave. He explained that smallholder farmers have strong and rich social network within their communities and these networks should be utilized when thinking of communication tools for the farmers.

For more information on why the platform, and the potential benefits to the users, visit 8Villages.

WaterWiki.net, a UNDP, UN-Water initiative recently relaunched and added more features such as a LinkedIn discussion forum. WaterWiki is a useful resource and popular forum for practitioners and agencies. It features over 800 articles, case studies and reports.

Some of the best features:

• articles with embedded videos on specific projects
• over a hundred national case studies
• links to international organizations
• lists of transboundary water basins
• regionally specific publications
• instant WaterWiki news feeds