Missing Populations:
I’m currently in the United Arab Emirates, attending a conference sponsored by the UAEU in Al-Ain to raise awareness of global health problems in the Middle East and neighboring Asia, and to draw attention to the region and its populations and health problems among the global health community. As a result, I’ve been thinking about the scope of attention in global health, and about populations and settings that are, for some reason, out of focus right now; one group in particular has come to mind.

This group is among the poorest in their country. Just under one in three lives in poverty (more than twice the overall rate).

• They have, on average, the lowest per capita income, earning less than half the average income of the general population.
• Nearly a quarter of their households are food insecure and as much as half of the population is unemployed.

Their families inhabit some of the most substandard housing in their country.

• Nearly 40 percent of households are without electricity.
• More than 30 percent lack a safe and adequate water supply and waste disposal system.
• Households are often crowded. The risk of death from tuberculosis is 600 percent higher compared to the general population.

Populations are often geographically isolated, living many miles from communities, employment and health care facilities.

• More than 60 percent of households have no landline telephone with most individuals relying on cell phones for routine communications.
• Migration to distant urban centers for employment is growing.

Overall the group experiences a major mortality disadvantage and significant burden of chronic diseases.

• The group shoulders considerable decrements in life expectancy and significantly higher rates of infant and maternal mortality.
• They suffer from increasingly high rates of debilitating chronic diseases tied to negative social and economic determinants of health.

Given this set of circumstances, I have long expected that the attention of the global health community would land on this group. The problems are compelling and the potential value of existing and promising social and technological interventions are obvious. For example, with widespread access to mobile phones networks, mobile phones could be used to deliver education, raise incomes, or improve health and health care. There are a host of applicable technological interventions that could mitigate poor housing or provide electricity.

Yet, very few academic or applied global health organizations include the group in their research focus or activities. I’m ready to see global health efforts applied to aid Native Americans.

Over the last year or so, I’ve encountered a tremendous push for innovation in the fields of development and disaster relief. Organizations big and small are looking for the ideas that will catapult millions of people out of poverty. The next clever gadgets that will cheaply and quickly filter water, prevent malaria, and stop the spread of HIV/AIDS. These ideas are almost by definition just over the horizon – because once an idea has been around for a few months, it’s not that innovative anymore.

And so what happens to those innovative ideas? What happens when the clever creator has received his fellowship grant and begins to work out the tricky details? From what I’ve seen, the funding organizations have moved on to the next ‘innovation’ and left the creator to work out the Boring Stuff on their own. My experience in Africa has pointed to the Boring Truth – 90% of what’s needed is not innovation but ‘capacity building’ – training, logistics, and equipment purchases. Building systems that can scale up to help thousands more people.

Take for example the work my fiancée does in health care. She is deploying an innovative new computer and mobile phone-based system to track and process health claim forms. It promises to reduce overhead and errors, increasing the rate at which health providers are reimbursed by funding agencies such as KFW (the German development bank). And yet the health providers she partners with, while supportive of her new claims system, are more excited by the equipment and training she is giving as part of the research. They’re excited about the opportunity to purchase laptops, check email, and learn how to track patients on Excel. And they want to do it on laptops, not smart-phones, as are being so heavily touted in development circles. They want to do things like we do in developed countries. Given the option, they’re taking the boring stuff before the innovative.

To a large extent I’ve found the same to be true in the work I do with water. The basic work – building gravity flow systems – has been done since the Romans! It’s not exactly cutting-edge technology. But the great improvements are coming from the Boring Stuff – GPS devices to mark pipe and tank locations. Creating a database to manage the hunt for new sources of water. These behind the scenes changes are making it much easier to build and manage a water system.

But unfortunately the Boring Stuff isn’t sexy enough to get funding. The truth is, nobody wants to fund it because they can’t put their names on it. The funding organizations can’t brag to their peers and donors about the Boring Stuff – “look we gave $10,000 to train X health practitioners on how to enter and process data!” But when they put out $10,000 to fund the Next Big Thing, out come the press, book agents, and dollars.

This trend points to a glaring fact – we in the developed world are more interested in creating a system that makes us feel good rather than creating a system that provides the resources people in the developing world need to succeed. And I will be the first to confess of this – I want to feel good about myself just as much as anyone else.

Now, all this is not to say that innovation is inherently bad – far from it. It is only to say that innovation should not be the absolute focus, or even the primary focus. We need to support the Boring Stuff, the physical and educational infrastructure that will be the foundation on which the vast majority of people are lifted out of poverty.

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• United Nations population data for every country in the world (guardian.co.uk)
• The Gates Foundation’s Capitalist Manifesto (trueslant.com)
• Gates Foundation Pledges $35 Million for Banking Innovation (innovationtoronto.com)
• A conversation with Bill Gates (seattletimes.nwsource.com)

“Big Pharma as a Catalyst for Change”: GSK “Open Innovation” strategy

It’s estimated that one-third of the world’s population go without essential drugs–often drugs for treating diseases that disproportionately affect the world’s poorest. The pharmaceutical world proves to be especially difficult to navigate for those seeking to provide such medicines to underserved populations, however. Pharmaceutical science is a field with billions of dollars in R&D, ironclad patents and intellectual property rights that are prohibitive to making drugs available to the poor. Andrew Witty, CEO of GlaxoSmithKline, claims that he’s looking to change this nature of big pharma, in the same way that the open source movement has revolutionized the tech world.

I love the word “innovation” combined with anything related to global health, so the prospect of sitting in on a blogger’s roundtable with GlaxoSmithKline CEO Andrew Witty was exciting enough just from the topic at hand: “Breaking Down Barriers to Innovation and Access to Medicines in the Developing World.”

The ante was upped in a press conference this morning, when Andrew Witty announced GSK’s “Open Innovation” strategy to make drugs more available and break down barriers to access. This strategy includes several components.

“Open Lab” initiative
$8 million in seed funding has been provided establish an “Open Lab” at GlaxoSmithKline’s research facility in Spain. As many as 60 scientists from around the world will be able to work at this lab, which will be devoted to research for drugs that target diseases of the developing world.

13,500 malaria-combating compounds in the public domain
This is perhaps the most exciting announcement. GlaxoSmithKline has been collaborating for years with PATH and other organizations in the development of a malaria vaccine. Scientists at GSK have screened all compounds that have ever been created in their labs, and identified 13,500 compounds that successfully combat P. faciparum, the deadliest form of malaria. The big news? The chemical structures and other recorded data regarding these compounds will be open sourced, in hopes that malaria vaccine research will be accelerated.

New pricing model for GSK’s malaria vaccine candidate
GlaxoSmithKline is in the process of developing the world’s most advanced candidate for a malaria vaccine—it’s the only vaccine in Phase III clinical trials, and could be available to the public as early as 2012. Maintaining that a tiered pricing model simply isn’t feasible for a drug which is needed almost exclusively by the world’s poor, Witty announced a pricing model for the vaccine which covers the cost of the vaccine with a marginal return for GSK, all of which will supposedly be channeled back into R&D for “next-generation” malaria vaccines.

It goes without saying that some present at the roundtable were wary of the corporate world’s ability to selflessly decide change the mechanics of drug information and pricing in order to benefit the world’s poor. Witty has struck a nice balance between acknowledging that GSK is a profit-driven company but maintaining that he strives to keep a “restless” socially-conscious agenda.

And let’s be honest—GSK won’t be suffering much financially with this move. First of all, the malaria drug market isn’t very competitive to begin with, because of the very fact that it is a poor person’s disease. Secondly, GSK is already the developer of the leading candidate for a malaria vaccine. It’s unlikely that, even with the compound information made publicly available, anyone can come up with a vaccine to rival GSK’s in any short amount of time.

Indeed, as Witty acknowledged, making drugs and drug knowledge more universally available is an investment in the future. Drugs will not be provided for free, he stressed, but rather provided at a marginal price that won’t completely alienate other pharmaceutical companies from healthy competition for lifesaving drugs.

Regardless of motivation, it’s refreshing to see big pharma recognizing the issues of access to medicines for the world’s poor. Moreover, Witty’s emphasis on being in step with progressive intellectual property movements is laudable. Whether or not GSK’s initiatives will stimulate other pharmaceutical companies to follow suit remains to be seen.

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• Glaxo’s Witty Tries To Fix An Industry Problem (invivoblog.blogspot.com)
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• GSK offers to share data to help fight malaria fight (telegraph.co.uk)
• GSK offers scientists labs, data to fight malaria (seattletimes.nwsource.com)
• Malaria researchers given crucial data (cbc.ca)
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Repost: “Bringing ICTs and Solar to Rural Uganda”

It’s now been a month since Forum 2009, so it’s time to wrap up any remaining thoughts from the meeting. My intention with these posts was never to provide a comprehensive view of the conference. If you’re looking for that, or simply additional insights into the meeting, I recommend the following resources:

1. Priya Shetty’s coverage of Forum 2009 for the SciDev.Net blog, five posts
2. TropIKA.net comprehensive coverage of Forum 2009, including daily reports and session reports

On my Cancún-bound flight out of Havana, on the morning of the 20th, the woman sitting next to me asked me for help with her Mexican immigration forms. As I was helping her, I asked what she did. “Terapista”. She asked what I was doing in Cuba. Attending “un congreso de investigaciones de salud pública”. She was a Cuban physical therapist going on a three month medical mission to Tecate in the Mexican state of Baja California, via Cancún, Mexico City, and Tijuana. I spent most of the short flight asking about her experiences on previous missions, all to Mexico, and probing for more details about the Cuban health system. Most memorably, she was quite proud of a unique surgical treatment the Cubans have developed for Parkinson’s disease.

I spoke about the medical assistance Cuba lends to other countries in an earlier post. The photo below of the 20 convertible peso note reinforces this. It touts Operación Milagro (Wikipedia link in Spanish), a joint program between Cuba and Venezuela with official aims similar to Cuba’s other medical mission efforts.

While I was speaking to this terapista on the plane, it occurred to me how important the setting of the conference was given the innovation theme. I don’t think that this was lost on many of the conference participants given external interest in the Cuban system, Cuban participation on panels, and various site visits. Still, there were three circumstances that limited knowledge exchange between the visitors and the Cubans:

1. Language barriers. There wasn’t very much communication between the several hundred Cuban participants and the external participants, especially those from outside Latin America. This was due in no small part to language barriers. Simultaneous translation took place during the larger sessions (UN-style headsets), but the smaller sessions didn’t have any and the informal exchange was visibly limited between the two groups.
2. An apparently flawless system. The Cuban health system may have been the talk of the week, but it was presented without fault. Even though it may be one of the best systems on the planet, it is not immune to needing improvement. Without a realistic understanding of the challenges, it was hard to understand the true effectiveness of the system. (In comparison, Minister of Health Chen Zhu was frank in talking about elements of the Chinese health system that need improvement, for example indicating in his plenary talk that many public clinics in China operate like private clinics.)
3. No U.S. government employees in attendance. There were certainly Americans at Forum 2009, but because of the restrictions associated with the U.S. embargo – it’s a bloqueo the Cubans said, since an embargo implies wrongdoing – there were almost no representatives of U.S. government institutions. I didn’t realize this myself until a colleague from the WHO pointed it out to me. He cited the example of his colleagues from the CDC who were not permitted to attend. Looking through the participant list, I only spotted one, someone from USAID. It’s unfortunate because there was a big opportunity for learning in both directions. In any case there were strong suggestions that we are months away from ending the embargo/bloqueo. Time will tell.

And here’s a post Aman wrote for Global Health Ideas about the Cuban health system two years ago: Lessons from Cuba: Healthcare Infrastructure and Information Systems.

Female Feticide: from Motherland to Diaspora

Up- country: Diya, an activist who educated women on female feticide, was recently married. She was 20 years old, and about to give birth. She was riding in a car hurtling over potholed roads toward the town hospital. Although at home, they claimed they would be happy for any child, “We like girl-children as much as boy-children,” her father-in-law would say, but she knew the reality was far different. Her mother in-law was next to her, looking tense with anticipation. She lived with her in-laws, customary in rural India, and did not have good relations with them: they were angry she had a love marriage with their son and a mind of her own.

“You had better give birth to a boy,” her mother-in-law hissed to her, as Diya’s labor pains intensified.

City: Jassi, the wife of a successful, well-known Bombay businessman, and already mother of two beautiful daughters, was pregnant with a third child. The women in her society (apartment complex) were anything but congratulatory. They admonished her, “why don’t you have a test done?” implying that she should make certain not to have yet another girl.

I was shocked to hear these stories. Both of these women, loosely based on women I’ve known, had healthy baby boys. But their problem is real, and getting worse: the number of girls for every 1,000 boys (sex ratio) went from 962 in 1981, and with the improvement of sex-testing technology, dropped to 927 in 2001. It was as low as 814 in Delhi.

At first glance, it seems like this is an economic issue, as some middle class families claimIn Spite of the Gods: The Strange Rise of Modern India, he talks about a woman from such a wealthy family, that her dowry included a Mercedes and Switzerland vacation. Even she was forced by her husband’s family to abort her baby girl, although many women themselves believe in this practice.

Shockingly, this practice continues in the US. Census data shows that for every child born subsequent born after the first in Chinese, Indian, and Korean families, the likelihood of that child being a boy increases.

Female feticide is because of many traditions and perceptions, as well as economic and social factors coming together. Girls are seen as economic liabilities destined to leave their homes, as they traditionally go live with their husband’s family after marriage. Male children, who never leave their parents (and doing so would raise eyebrows), support them in old age. Male children earn money for their parents through jobs and dowry. Female children, however, do not. Many are not allowed to work nor offered education, and dowry continues, even among educated, well-traveled, urban elites – furthering an already insidious gender bias.

There are some successful interventions, like empowering women through education, economic power, and allowing them to take greater control of their lives – and this is where I’d like my life to focus. Before translating and preparing training materials at CORD, I never realized how deeply rooted this practice is in Indian culture. To me, Indian culture is laced with quirks, visible and invisible, but I always felt some pride and loyalty in my heritage. But this level of hypocrisy and brutality is astounding. A sign in Mumbai reads, “It is better to pay 500 Rs now than 50,000 Rs (in dowry) later”.

Though the topic makes periodic appearances in international news, and many interventions are taking place, ultimately it rests on changing social norms: At weddings, including mine, there is a prayer to bless the new couple. It states tellingly, “May you have sons”. But Babaji (my grandfather-in-law), the eldest person at the event, added “or girls, because everyone is equal now.”. Andhra Pradesh, a more progressive state, offers hope with a girl-favoring sex ratio, closer to natural patterns. – but female feticide is rising fastest among wealthier couples. In Edward Luce’s

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Thanks for checking back to this blog after a long time! I’m getting re-started, and continuing to explore issues in public health that pique my interest (or deeply sadden me, like this one). You’ll notice some changes in the look and layout, all to be easier for you. Would love your feedback, or forwards this if you know someone interested!

My reason for attending Forum 2009 was to participate in a session title “Innovation for Remote Populations”. This post is a about that session. What follows is taken from my recent report to the Global Forum for Health Research – edited only slightly.

Innovation for Remote Populations

Thurs-19-Nov-2009, 14:00-15:45, Global Café, Palacio de Convenciones, La Habana, Cuba

Coordinators/Facilitators:

• Patricia Mechael, mHealth and Telemedicine Advisor, Millennium Villages Project, Earth Institute, Columbia University, USA & Egypt (organizer & facilitator)
• Tim Hurson, Facilitators Without Borders (facilitator)
• Charles Gardner, Global Forum for Health Research (focal point)

Speakers (alphabetical order):

• Simon Adebola, NEPAD Council Global Health Commission, Geneva
• Najeeb al-Shorbaji, Director, Knowledge Management and Sharing, WHO
• Caren Serra Bavaresco, Student, Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil
• Karl Brown, Associate Director, Rockefeller Foundation
• Arul Chib, Assistant Professor, Wee Kim Wee School of Communication, and Assistant Director, Singapore Internet Research Center, Nanyang Technological University
• Dziedzom Komi de Souza, Ph.D. Student and Research Assistant, Parasitology, Noguchi Memorial Institute for Medical Research, Ghana
• Bastiaan Hoefman, co-Founder, Text2Change
• Bernardita Labarca, Project Coordinator, Zoltner Consulting Group, Chile
• Claire O’Neill, Chairperson, Cell-Life-South Africa
• Ravi Ram, Head, Monitoring & Evaluation, African Medical Research and Research Foundation (AMREF), Nairobi Kenya
• Marco Salmen, OHR-GMCP Initiative for HIV/AIDS, Global Micro-Clinic Project, United States
• Jaspal S. Sandhu, Design Researcher, College of Engineering, University of California, Berkeley, USA
• Joel Selanikio, co-Founder and Director, Datadyne.org, USA
• Garance Upham, General Secretary, Direction, Safe Observer International, France

Additional participants – from the audience:

• Elmer Zelaya – Fundación Chica/Nicaragua
• Timothy Dye – SUNY Upstate Medical School/USA
• Jane Kengeya – WHO
• Oyewale Tomori – Redeemer’s University/Nigeria
• Lishandu/Zambia (full name/affiliation not available)
• Vargas/USA (full name/affiliation not available)

Summary:

1. Diverse users and uses: The speakers presented a variety of mHealth/eHealth applications involving a wide variety of users, including both the health workforce and community members, e.g. educating teenagers about HIV/AIDS in South Africa (O’Neill), Internet access in western Kenya to improve uptake of HIV VCT (Salmen), mobile emergency response systems in Aceh (Chib), electronic IMCI in Tanzania (Brown), text-based health education and health service promotion in Uganda (Hoefman), training for health workers as a downloadable game package for phones in Kenya (Ram), telemedicine to improve the skills of health workers at primary levels in Brazil (Bavaresco), delivery of health information to communities in Chile (Labarca), a general set of tools for mobile data collection being used worldwide (Selanikio), and handheld computers to support rural healthcare delivery in Mongolia (Sandhu).
2. mHealth/eHealth is about enabling access: A common theme across diverse applications was that information and communication technologies are being used to enable access to health information and services in places where access is difficult because of remoteness and/or cost.
3. Coordination among the various players: Coordination among donors and projects is necessary to avoid unnecessary duplication of effort and to share what works. This is the role of the mHealth Alliance, supported by Rockefeller Foundation among others (Brown). While there were questions from the program side as to what data donors want (Chib), there was a simultaneous sentiment that donors need “stepwise” guidance (al-Shorbaji).
4. De-emphasizing technology: The mHealth Alliance has recently been discussing development of an “mHealth Toolkit”, to provide a common technical architecture and platform for those planning to implement mHealth programs (Brown). The existence of free technology platforms – in this case DataDyne’s tool – enables programs to focus on developing health content (Labarca). It is important to have a generalizable tool, as DataDyne has done, that can be used by anyone; if individual governments must approve technology “you’ve lost the battle” (Selanikio). Programs must focus on understanding people and applications more than technology; in response to a question from Dye about the use of ethnography in this field, three examples were given: ethnography of teen chat rooms in South Africa (O’Neill), multi-year ethnographic fieldwork as the basis for the program in western Kenya (Salmen), and design ethnography of the information management practices of rural health workers in Mongolia (Sandhu).
5. Defining good evaluation: There are challenges to seeing change in population health outcomes (Chib). It is difficult to measure behavior change (Hoefman) and to evaluate systems that provide health content to people (Labarca). Ethnography should be considered more seriously as a complementary evaluation strategy in mHealth (Sandhu). In evaluation, the metrics should match the intervention – mHealth is another intervention; in addition, we want to see the unintended effects of technology (Ram).
6. New modalities of engaging people: Mobile phones enable fundamentally new ways of engaging with people. As opposed to mass communication that is often used in social marketing, phones allow for interpersonal communication that can be tailored and cost-effective (O’Neill). There are two modalities, moving messages out to people and demand-driven services, where people demand the information that they need (Ram). Salmen lent his support to the importance of demand-driven services and argued that phones will bring more equity. This is all supporting the shift to citizen-centered healthcare (Mechael).
7. Cautions moving forward: In natural disasters, the cellular network is the first to go (Zelaya). An open question: Who owns the data? (al-Shorbaji). Nobody is thinking about “real sustainability” (Adebola). Reliable phone networks are a challenge (Lishandu). We should be careful that we don’t become too dependent on one tool (al-Shorbaji).
8. Need to think more creatively: We should be bolder with approaches; if we are, poor countries “could leapfrog” in health and development terms (Upham). Many of the applications discussed focused on SMS and telephony capabilities; we should think about leveraging more advanced capabilities of mobile phones (Kengeya).
9. Who should design technology? There is an assumption that Africans cannot develop software, but that is not true (Adebola). DataDyne software was already developed by Africans (Selanikio). Africans should develop software, but they shouldn’t redesign what has already been built (Brown).

Conclusions/Recommendations:

1. There is a need for increased knowledge-sharing about mHealth/eHealth within the global health community. This should definitely include policymakers. As Prof. Tomori elegantly stated, while we are thinking about how to reach remote populations, we should think about “hard-to-reach” African leaders.
2. While there was discussion of both eHealth and mHealth, the discussion focused primarily on the latter.
3. There is a need for a continuing dialogue about mHealth. It is unrealistic to expect policy recommendations to come out of this meeting given the state of the field (many open issues) and the limited engagement at the meeting.
4. Major mHealth topics to be discussed at future meetings: definitions; standards, including how to conduct evaluation; and successes and failures from the field.
5. The value of the meeting was threefold: (1) it helped extend the network of those working in mHealth; (2) it provided those outside the field with an understanding of the opportunities and challenges of using mobile phones to improve population health; and (3) it placed a much-needed emphasis on prioritizing people and applications over technology.
6. Mechael suggested reviving the Mobile Metrics and Evaluation Group as a means of maintaining an active mHealth community discussion outside of official meetings.

Other observations:

1. The fishbowl format was successful in eliciting relevant commentary from a large group of speakers as well as from the audience. Time was an issue, though, as several invited speakers only spoke once and several audience members had comments or questions that they were unable to share.
2. One key issue that was not explored – as I stated at the end of the session – was the link between social entrepreneurship and mHealth. This is especially relevant to issues of demand, incentivization, and sustainability.
3. There is a need for an ongoing discussion of these issues at Forum 2010 and beyond – while the conversation will continue in other settings, the Global Forum for Health Research should continue to be involved because of its systems focus, its emphasis on actionable research, and the unique mix of parties (policymakers, donors, implementers) it brings together.

In early 2009, Oxfam released a report Blind Optimism critical of the private sector’s role in healthcare in poor countries. It drew attention to the cause of those who believe that any private involvement in healthcare in these countries is harmful. The arguments, evidence, and position of the report were flawed in numerous ways; sound responses to the report were provided by April Harding and the World Bank:

• Oxfam — This Is Not How to Help the Poor
• World Bank responds to new Oxfam health report

The reasonable conclusion one would come to from working in the field and from studying health systems is that a mix of private and public approaches will be most effective – and that the need for different approaches should be dictated by local context. Ideological extremism – pro-private or pro-public – doesn’t serve anyone, most especially the people who need access to health.

At Forum 2009, there was much stronger representation of the private sector than at the previous meetings. In addition to pharma and biotech, there were several sessions and plenary speakers dedicated to talking social entrepreneurship. One of these speakers was Al Hammond, Senior Entrepreneur-in-Residence at Ashoka. Al spoke during Wednesday’s plenary - Enhancing national environment for innovation: perspectives on low- and middle-income countries (TropIKA.net post about the session) – about Ashoka’s Healthcare for All pilot Punjab, India.

During Q&A Claudio Schuftan of the People’s Health Movement criticized Dr. Hammond and Ashok [sic] for: (1) bringing electronics to people where there is no electricity or way to repair devices, (2) supporting the interests of multinational corporations, and (3) making people dependent on products. Dr. Hammond began his response by saying, “We are aware that there is hostility towards private sector approaches”. He explained that they use market approaches to achieve efficiency and that all the programs he presented are social enterprises started by NGOs. Based on the success of the three pilots so far, the Punjabi government has requested 600 additional units. “Take what you will from that”, he ended.

Dr. Schuftan’s comments are well-aligned with the Blind Optimism ideology. Such comments attempt to polarize policymakers, donors, and implementers. In doing so, they actually keep us from thinking critically about the private sector and social entrepreneurship. Fortunately, this was not the overall tone of the meeting.

At the end of a session examining the role of governmental policy in supporting social entrepreneurship, Julius Mugwagwa of the Open University (UK) asked a question about the “backlash” that might occur if something went very wrong with one of these social entrepreneurial models. This is the type of balanced discussion we really need.

Driving back from the Lesotho border, my eye caught the last brilliant light of the day on a young man carrying wood he had gathered for the fire. I thought back to the teenagers who guard cows all day, of the women waiting, waiting by the side of the road, sitting in the tall grass for hours with small children in the hot sun, waiting for a lift.

And in a world where anything is possible for some of us, is that really true for all of us?

Yes, we can now have video night in Kathmandu, but television only allows you to receive. The real catalyst is the internet, where you become a global citizen – you can learn and participate and create.

You can always just read the news to fall headlong into THINGS THAT ARE GETTING WORSE: “Dubai Debt Woes Raise Fear of Wider Problem”, “Traumatized Russians View Their Dead After Train Bombing”, “Afghans Detail Detention in ‘Black Jail’ at U.S. Base”.

But what the soul needs to live is hope, and dreams.

Innovation Journalism brings us ideas that can change the world by reporting on people, processes and practices of innovators, as well as risks and opportunities. It is a ‘horizontal’ beat, reaching across politics, technology, health et al to report on how innovations arise, and helps shape our future by giving us new language to talk about new ideas.

Crowdsourcing is harnessed brilliantly by Innocentive, the innovation marketplace, where Seekers pose challenges they are having difficulty solving on the internet. A stunning 50% of these questions are successfully solved, and Innocentive has just publicized a study on how successful Solvers tackle problems – which can help us all problem solve better!

But what if you live in rural Uganda, and the roots of your cassavas are rotting? Question Box to the rescue! You can ask a question in your own language that can be answered by someone with access to research, the internet and a question archive informed by local knowledge. If you want to sell those cassavas in Ghana you can text TradeNet (and in Zambia, too) to get the current market prices, so you don’t sell yourself short.

In Mozambique, Village Reach decided to extend services to the last mile.. all people should have access to essential medicines, and they decided to bring in energy sources to preserve the vaccine cold chain. By creating an energy market, now fishermen could refrigerate their catch, and the entire local economy improved.

But how to create social change? We can improve the essentials of life, but to start movements, we must collaborate. Witness the effect of Twitter on the Iranian elections. My cousin’s post on Facebook alerted me to Open Access Week, which encourages the immediate sharing of published research results with everyone, everywhere, for the advancement of science and society. But social change must also come from the grassroots, like City Year, which brings young people together for a year of citizen service, to find their place in the world, and to break down the barriers of race, class and education to change our future. Nelson Mandela saw the potential of these young leaders when he visited Seattle, and asked City Year to come to South Africa to help heal the country. But it shouldn’t be up to one person to spread the word.

Ideas this good shouldn’t be kept to ourselves, they should be shared. And then we can say, “Yes, things ARE getting better.”

Ashoka: Innovators for the Public are hosting Tech 4 Society, a conference exploring technology, invention and social change, in Hyderabad, India, in February 2009. Find out more about the conference here. This blog post is an entry in their competition to find the official blogger to travel to and cover the event.

The International Conference on Family Planning is taking place in Kampala, Uganda this week. Supported by The Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University, the Johns Hopkins Bloomberg School of Public Health, and Makerere University, the conference is focused on research and best practices in family planning.

After a keynote address on Sunday by the first lady of Uganda, the conference had many interesting sessions on the intersection of family planning and other related areas, such as the MDGs, vulnerable populations, integration with HIV care, maternal-child health and adolescent health.  In addition, there were sessions on community distribution, effective service delivery, and franchising of services.

A particularly well-attended session entitled “Men and Family Planning” included a number of good ideas on how to integrate men into family planning service delivery, and initiated a heated but stimulating Q&A.  A presentation about acceptability and feasibility of vasectomy was questioned about the adverse effects of vasectomy, and clarified that vasectomy is not castration, and that provision of a vasectomy should still go hand-in-hand with frank discussions about responsible sexual behavior and prevention of STIs.  Another presentation reported results of a randomized intervention study from Nigeria that showed remarkably increased uptake of family planning by women whose husbands accompanied them through the entire labor and delivery process.  The presenter theorized that the increased uptake of contraception came from both the men’s presence at postpartum counseling sessions, but also their presence during the delivery and seeing all that women go through in labor.

Evening sessions have included workshops on applying for funding, training on family planning methods, translating research into policy and costing for program scale up.  A Technology Café by the Implementing Best Practices Initiative provides an opportunity for conference attendees to gain hands-on experience using electronic tools being offered by various organizations.  A cocktail hour hosted by Marie Stopes introduced a new calculator for measuring the impact of family planning programs, and a session this evening by Venture Strategies will discuss Menstrual Regulation (M.R.) – the practice of bringing on a woman’s late menstrual period without knowing whether or not she is pregnant.

CORRECTION: The original post indicated that The Bill and Melinda Gates Foundation for Population and Reproductive Health was a sponsor of the conference; however, the Gates Foundation itself was not a sponsor. As has been corrected above, The Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University was a sponsor. -Jaspal, 30-Nov-2009