Community based early warning

So as I mentioned in another blog post I have been asked to return to Ethiopia to help assess feasible approaches to integrating (I)nformation (C)ommunication (T)echnoloy (ICT) into a drought early warning program.

While for many project the T often supersedes the I & C, I’d like to think that this project has evolved in a bit of a different way.

Back in 2006 during my emergency medicine residency training at HAEMR I had the opportunity to support an international NGO with a regional office in Addis Ababa. A severe drought had just affected the southern pastoralists communities and all but decimated their primary livelihoods- their livestock. So how does this affect the health of communities? And for those of us who think primarily in terms of human health, how does this connect?

Well its all an intertwined ecosystem. Between access to water, rainfall, growth of pasture, ability for animals to produce milk for human consumption. And during times of stress the ability of people to buy and sell in the markets to purchase grain for food. And access to food or the lack there of… spins a dangerous web for only the health of already undernourished children but of pregnant women, the elderly and communities as a whole.

For this project a public health lens for drought early warning needs to come from the perspective of the communities. An as I learned, it’s just as much about the pasture as it is about the number of visits to the health center.

One of the reasons this project came about was to complement the existing early warning systems. In the minds of many, the existing more traditional EWS often struggle to collect timely and actionable information to prevent the deleterious outcome of droughts/famine.

And so the approach began with conversations with women in Tuka, Arganne, and Danmbi. (focus groups) and learning about the communities perspective on early signs of drought, coping mechanisms and ongoing community needs.

US Telco….Getting the better of me… for a moment…..

I’m in a reverse warp zone. In a large volunteer attempt to help run a the technology portion of a training simulation, while technology is touted by many as an amazing liberalization of information and communication, there are many details that go into an often nuanced process to make this a realization.

I’ve  purchased USB sticks, quad band/tri band phones, broken the locks on many more and retrofitted safaricom/att unlocked and motorola phones for my research, consultancy work and prior simulations. But this year has been a colossal doozy. I’ve come head to head this year with US telco in 2012.  For the SIM we began with 5 volunteers and 40-50 students, and now we’ve expanded in exciting ways to a team of 30-40 volunteers and over 120 students. With this comes a feat in preparation and logistics.  I’ve spent over 2 hours on the phone with T-mobile trying to active 2 SIM cards. While i’ve purchase SIM cards all over the world, placed them in my unlocked phones/USB sticks with very little hitch, retrofitting the same plastic sim card here in the United States has cause more confusion around the world with T-mobile than you can imagine.

After multiple phone calls with pre-paid customer service who transferred me to post back to pre and post again finally back to pre-paid.  Questions like you have a sim card but not a new phone? sim for voice, text, another sim for broadband? (yes, because T-mobile has limitations) oh. you have usb sticks already? but no SIM card?  ……..I spent another 30-45 min with a very nice woman over a bad connection (which I think may have been due to a distant call center) I had to recite a litany of numbers that she couldn’t hear. Repeat, Repeat, Repeat.  Speaking over shotty network is common around the world, where you decide it’s better to text, rather can call, or just get used to the nature of it, but it’s always humbling to realize that back here in the US we’re a bit backward about mobile flexibility.

Where the idea of walking down the street to a kiosk, purchasing a 50 cent sim card, topping it off and calling it a day is non existent here.  We’re locked into this labrynth that’s hard to work around and retrofit.  Especially for learning purposes that try to simulate the humanitarian environment during crisis.

And while all the technology is cool and exciting it’s these frustrations that field staff talk about during emergencies. There often is an answer, from a skilled person very far from the field, or half the answer with a set of new and larger inflexible challenges because the fixer doesn’t understand the limited environment… (really? no electricity all day?) Or a new policy that can “open doors” but maybe not right now. Or just more time that we all don’t have during a crisis– to make it work.  And all of these components are absolutely key for change, but until that time comes, operations still continue and we have to deal with the immediate challenges.   And the more we can learn, teach and improve this part of the space the more we’ll help close the gap with the large ecosystem of humanitarians.

Two things ring out for me with this revisited experience. One, as a non techie, but one who advocates for accessible usable technology in crisis, if we can’t iron out these seemingly mundane details. (like  just get the sim card to work…..) then the more highly complex questions take on a different meaning . What’s left is the sweat and frustration and unheard conversations of community of users struggling with the basic low tech challenges with large implications; for not only sustainability but adoption.

The second thing that rings out to me is that…. some of you may say… well it’s just US Telco.  Yes, true, but how many US local communities with somewhat similar skills and resource limitations will or have already faced similar problems?   Vulnerability is global, across all divides and as we continue to address these issues in “far away” places (in the minds of some), we should also think of how to fix them locally, and hence participate in global change.

Wading through molasses and then KAPOW!

By the afternoon I was feeling like I’d been renewed to the value of randomized controlled trials, rigorous methods, and a sense or order.  Although order in my mind is all relative term, I was beginning to think that impact evaluation and its cross-links to the humanitarian sector were fewer and farther apart than I had hoped.  Dang it… although I was minding the gap, it was widening.  Not what I had hoped for.

I told many of you that I was coming to this conference to learn more about evaluation and methods. The second to last session was on quasi-experimental design.  I sat down with my coffee and the lecture was actually about experimental designs instead— in other words randomized control trials.  And If I’ve lost you now, here is a link to the glossary that I’ve used today many time. Have at it.

I’ve struggled with the ethics and feasibility of RCTs in the humanitarian emergency context and will leave those musing for another blog, but decided to check out another session, “How to institutionalize evaluation”

and KAPOW!!! What a great session.

Looking for the fix, but forgetting the source

The discussions this morning and early afternoon have been more about the numbers, data and analysis. How to make sure that when the data comes in they are comparable. But discussions about how you get the information, and through what lens you receive it is a whole other issue.

For health, it’s relatively easy to ask someone if they had diarrhea in the past 2 weeks. Once you know the definition ( > 3 soft stools in 24 hours) either you did or you didn’t.  When it comes to what many call health behaviors, it gets a little grey.  Hand washing for example… What constitutes hand washing? Someone tells you they washed their hands? Someone else reports that it happened? Someone observed that it occurred? One time, all the time? Maybe you’ve been part of a hand washing and hygiene program in Mozambique and now someone wants to know if you’ve washed your hands? Maybe you kinda think you did…. you know you should have…. yeah… you think you did. It’s complicated.

Less than 24 hours ago we discussed analysis and aggregation in the humanitarian context at the OCHA Libya/Japan washup.  Members in the meeting were musing about the fixes for data fusion and extraction.  Humanitarian practitioners shed some light on the upstream challenge of just receiving the data in the first place.

Once the data is there, the doors are open to the technical challenges of analysis, aggregation, or even fusion. Data may not arrive maybe because your study population just fled due to another conflict….or they didn’t use your food provision that you need to measure because it had higher value in the market and wasn’t what communities believed they needed. You could even have a great information management system and a common operational dataset for the acute phase of a disaster but organizations in the cluster just can’t seem to gather the data efficiently…….. or better yet, they are just too busy to send you the information.

whatever the reason…… for the moment…it’s bunk.

The similarities here are about information…. from which source or whom? information described (or reported) through whose eyes? and by what communicating vehicle?

If you can control for all of these things.. for which I think many impact evaluation studies aim to achieve… then maybe you can talk numbers.

Finding the answers– from whom and with whom?

I’m sitting in a series of presentations about water, sanitation, and health impact evaluations.

As I blog on my iphone, I’m wading through epidemiological methods bringing me back to my training in public health and medicine. I’m humbled by the vast field of epidemiology, biostatistics and now impact evaluation and how seemingly rudimentary my education has been. Swimming in terms like balance, bias, propensity scoring, matching and sample size—I must brush of the dust in this part of my brain. I’ve been embedded in thought about networks, trust, adaptive change, and innovative technology learning cycles this past year building the crisis dynamic program.  As I revisit this forgotten, but highly respected knowledge space, I find my self asking the following questions…….

where are the people? And where are they in this process?

I guess much of the reason why this has been percolating in my mind is largely due to being steeped in my recent inquiry into participatory mapping research and practice.

While I’m amazed by the epi, statistics and experimental designs, and coming to a stronger understanding of the counterfactual, many of the questions that linger in my mind when well designed study findings are presented are……… why?

Why do fewer woman have access to irrigation pumps? Why do people living in urban slums in Yemen have more diarrhea when having increased access to water and sanitation?  What do these findings mean? They may make a great peer-reviewed academic article, but In order to use these findings in programming we need to know why they are occuring.

Where are the voices of communities to provide some of the answers from their perspectives?

3ie Minding the Gap Conference

I’m at the 3ie Minding the Gap conference here in Cuernavaca, Mexico, just 7 hours from landing from NYC where I attended the after action/washup review for OCHA and the Crisis Mapper’s community activities in Libya and Japan.

The focus of this conference is about impact evaluations and translation to policy in the development sector. From the perspective of a humanitarian researcher, practitioner and crisis mapper there is another gap which has brought me here today.

Where do the cross-links lie between evaluations, theories of effectiveness and impact in the humanitarian and development ecosystems?  What can we learn from the development sector and where do we share common assumptions, theoretical, structural and practical challenges.  What are some of the fundamental differences that reshape how humanitarians look at the purpose, scope, methods and impact of evaluations? And perhaps even more importantly……. do we perceive differences when in reality we are closer than we think.
I’m looking forward to shared learning.