Andrew Peterson

Check out GHC on Huffington Post from the Fox News report aired on Sunday night (June 13th). A clip from the broadcast also appears at the end of the article.

You can watch the whole story on Hulu (it’s the last story on this episode).

Global Health Corps President Barbara Bush gave a great speech at the National Press Club and interview with CNN on how GHC is paving the way for a new generation of global health leaders.

Goodluck and I have been trying to understand what defines a good health facility in Kilwa to be able to replicate the model to other facilities. In my last video I described how it’s hard to analyze data by health facility because, for example, we don’t know if increased diagnosis at a given facility implies poorer health for their surrounding communities or better service provided to attract more patients to get treatment. Based mostly on qualitative evidence gathered from on site visits and patient interviews over the past month, however, we’ve concluded that higher aggregate numbers aare almost always an indication of exemplary medical services being performed. But what does “exemplary medical services” mean?

IDEO CEO, Tim Brown, summarizes a popular concept coined in Daniel Pink’s book A Whole New Mind saying, “once our basic needs are met − as they already have been for most people in the affluent societies of the West − we tend to look for meaningful and emotionally satisfying experiences. The value of services lies in the emotional resonance they create.” The implication is that when basic needs are NOT being met, i.e. in most third world countries and certainly all of the communities Goodluck and I serve in Kilwa, the human mind doesn’t care about emotionally satisfying experiences. Fulfilling basic needs is the primary driver behind what the mind desires.

In reference to our health facilities, I’d expect “exemplary medical services” then to mean that the necessary drugs are always on hand and ailments are successfully getting treated. And that’s it. This would also imply that each health facility we work with who has low statistics doesn’t have proper drugs in stock and that the medical staff are misdiagnosing patients who therefore aren’t getting treatment.

Goodluck and I know this is not the case. We’ve been delivering medical supplies to all facilities through the year and patient numbers remain the same. The medical knowledge of health staff, though indeed varied, doesn’t vary with the number of patient attendance (we’ve moved well-skilled health staff from a strong facility to a weaker one and after a year still haven’t seen much increase in attendance).

What we have seen is that health facilities with staff who enjoy working together, are organized with paperwork and office supplies (including drug stocks), who clean their facilities (even the cobwebs by the roof), who maintain equipments such as patient beds, and who even groom their grounds with rakes and flowers, are the facilities getting the most patients. These are the marks of exemplary medical services and they contradict Daniel Pink’s notion that only certain groups of people can afford valuing emotionally satisfying experiences. He would contend that the experiential enhancement of an inviting landscaping would provide little value in terms of increasing attendance at health facilities in Kilwa, Tanzania because it’s not fulfilling a basic need. Our experience here has suggested, however, that everyone values emotionally satisfying experiences.

What I think Pink misses in his analysis is that the definition of basic needs changes for people in the third world. Not everyone in Africa is living a stress-filled existence worried about fulfilling basic daily needs. Tanzanians in my village seem to have come to a knowing realization of what their life is like. They can depend on food sources based on the season and the amount of rain in a given season. They know the best places to get water to drink so as to avoid fatal illnesses. They know that any electricity service is always temporary. And they don’t celebrate the birth of a child because they know there’s a real possibility that the child will die in its first 6 months.

Basic needs being met in the US and basic needs being met in rural Tanzania look completely different. But from the point of view of the respective communities, basic needs are being met in the majority of cases. The implication being that it is incredibly important to think about how to create safe, enjoyable, satisfying emotional experiences when trying to achieve successful services of any kind. And in the context of critical experiences such as public health services in the third world, where there aren’t private alternatives to create natural competition, the responsibility lies on the system managers to seek out facilities who are creating this type of experience and hold them up as the standard experience all facilities should be striving to provide their patients.

Freshly planted flowers at Somanga Health Facility

At my last job in the US we desperately tried everything we could to avoid having meetings. We tried a “no meeting day” or tried to establish a rating system to get rid of meetings that received low scores.

In contrast, people LOVE meetings in Tanzania. Why? Because meetings here mean money.

Tanzania has the puzzling common practice of paying people to attend work meetings. They’re not paid for being the keynote speaker or even for presenting. They pay people JUST to ATTEND. So, as you might imagine, many of the training sessions or work meetings I’ve gone to have had many attendees but very little audience participation or engagement.

In response to this, Goodluck and I have tried different ways to facilitate learning and capacity building during meetings for health workers in Kilwa. Traditional trainings occur with large groups in a central location, requiring participants to travel there (and organizations to pay for their travel expenses as well as their attendance). Instead, Goodluck and I travel to them and do 2-on-1, on-site training with workers in the facility for shorter but much more focused and concentrated teaching sessions that we’ve found to be effective despite the short amount of time we spend in each facility (1-1.5 hours).

Despite the value of the on-site trainings, one of our goals is to build community between local groupings of health facilities as a means of establishing decentralized health management. Therefore, we do include one larger group training session in our training program where we pay participants to attend. However, we call it a Data Workshop instead of training and have designed a number of exercises and tests that have meeting attendees working together on analyzing data and identifying problems. In this way, we force participation and engagement much beyond the traditional sit, listen, collect money, go home that defines the current design of meetings/trainings.

We went one step further in our most recent data workshop this past Tuesday. Though Goodluck and I disagree with the ‘payment for meeting attendance’ method, we still comply with the culture. After all, it does seem to be a great way to ensure people actually come. However, we thought we could change the way an attendee earned their allowance and increase participant’s interest in the material in the process. Instead of getting a flat allowance for meeting attendance, we gave our participants two data tests, one at the beginning of the day and one at the end, and told them that they’d earn bonus money depending on how much they improved (we told them this after they took the first test).

Participants’ scores on this exercise had averaged ~2 out of 8 in the past and the first test of the day with this group was no different: they averaged 2.5 out of 8. After explaining our program to them, however, participants were much more engaged throughout the rest of the day’s training and finished the second data test averaging 7.5 out of 8 as a group (a 200% increase)! The results meant both bonus money earned by participants and increased confidence in their abilities to improve how they collect and analyze data in their own facility.

On top of that, Goodluck and I are particularly excited about the fact that the district health management team in Kilwa has started to adopt and incorporate many of these practices into other meetings and trainings they run. They were also very interested to hear, and we’re eager to report, the outcomes of our “pay for performance (not attendance)” method.

Goodluck and I are always on the lookout for ways to innovate and improve existing systems in our work and redesigning the meeting has been a great achievement for us so far.

Here are some videos of us mid-data workshop!

I just read a great article sent to me from my GHC mentor about product design and wanted to share: When Technology Flops: 6 Common Pitfalls for Product Design for Social Good

Pitfall #2 hit home for my project.

Pitfall #2: Using technology to solve a culture-based problem. Sometimes, the most fundamental issue isn’t tech-related. For instance, female infant mortality in many countries is largely the result of cultural value systems rather than lack of sufficient healthcare (although the latter is necessary as well). In these cases, well-designed medical devices aren’t going to solve the underlying problem of gender-based discrimination. Other forms of intervention are necessary for changing people’s mindsets.

Though there are many technologies that can and will help the health system in Tanzania, so much more work needs to be done that isn’t based just in developing a technological platform or tool. Unfortunately, solving culture based problems requires changing cultures which is often a much more difficult challenge to tackle with a more nebulous path towards a solution; especially when you don’t know the culture you’re trying to change that well in the first place.

Fortunately the GHC system for pairing local and American fellows has been incredibly helpful for navigating cultural issues and Goodluck and I are starting to see some real seeds of change.