It’s what you say, not just how you say it

What do they call it?

I work at BRAC Centre, 75 Mohakhali Ave.  Every morning when I hail a rickshaw, I say, “How much to go to TB gate?”  The office is next to the Chest Disease and Lung Hospital, hence “TB (Tuberculosis) gate.”  If I said “BRAC Centre” or “75 Mohakhali Ave,” who knows where they would take me—likely for a long ride that ended will an expectation for a nice, big payment.  Maybe BRAC University or BRAC bank, if I’m lucky.  But “TB gate” works any time, except on the rare day when I get a rickshaw driver on his first day in Dhaka.

There’s a whole informal language of landmarks in Dhaka. Some of them are still there, but others are remnants of names long gone.  To the rickshaw drivers, the International Centre for Diarrheal Disease is the “Cholera Hospital,” as it was called decades ago.

Is death the best measure, or the easiest?

Few things are more energizing than teaching a bright group of young people.

Last Sunday I led a session on “natural hazards and health: application of the problem solving method”.  Frankly all I know on natural hazards I learned while writing the paper for the Lancet.  So I was a bit nervous about getting up in front of a group of students and teaching them about the subject.  What if they had questions?!

But what I’ve realized, having taught a fair numbers of times now, is that the instructor has an incredible amount of power in directing the class in various directions.  Most classrooms have a “teacher as expert” feel, where knowledge and information flows one way.  Students are recipients of knowledge.  I prefer a more egalitarian classroom, where the goal is to draw on the collective knowledge and analysis of the room, and enable a discussion of critical thinking.  I’m most interested in showing the students that in 99% of cases, there is no easy “right” answer or decision.  Rather one is always faced with imperfect information, resource constraints, and trade-offs.

Case studies are a great tool because they let the students get into the shoes of various characters in a complex environment.  Students can analyze the situations and decisions, and through the help of a good teacher, see the pros and cons of multiple strategies.  I first began to appreciate this when I saw Michael Porter teaching at the business school.  At first he’d let the class paint a picture of why one option was the obvious right choice.  Then he’d let us convince him that in fact it was incredibly stupid.  And we’d do this for a few different strategies.  Students walked away not convinced of an answer, but stimulated in terms of understanding the complexities of decision making.

The middle isn’t always evil

I was out at dinner with a friend in San Francisco a few months ago, and when we were leaving, he pulled out his i-phone.  Using the Uber app, he called us a taxi.  A guy showed up in his own car, we climbed in the back, and off we went.  This is insane, I thought.  I just got in the car of a total stranger. And yet, Uber like many other online companies, Airbnb, Amazon, Etsy, and so forth, has realized that if they can gain the trust of both drivers and riders, both will become heavy users of their system.  They hold the money until the transaction is complete.  Drivers and riders rank each other and that information is shared with the entire community, creating some social accountability and potential consequences for poor behavior.  Everyone wins—except of course the vested interests that are being disrupted by this new service.

In development, we would call Uber a middleman (dalal in bangla).  It’s not a compliment. And they would have lots of company.  Poor public infrastructure, limited regulatory capacity, and weak property rights give rise to ample opportunities for creative services.  Want to get a driver’s license?  Good luck, unless you have “a guy”.

This is not the same as a bribe.  A bribe is an extra tax on a service.  Anyone can still get the service if they are willing to pay.  Dalals are about access; if your access is dependent on a third party, that’s the situation I’m talking about.  Often they are related, but in many ways, bribes are much simpler problem to address than one with social networks, multiple stakeholders, and so forth.

Data and digital financial services......So hot right now

I just wrote a series of posts for the BRAC blog to build awareness and excitement for our upcoming Frugal Innovation Forum: Scaling Digitally.

The first looks at digital financial services and the cool ways in which people are leveraging it for development, and beyond.  In Bangladesh, mobile money (transferring money from cell phone to cell phone) is definitely picking up speed.  My friend's father (who is in his 70s) suggested that he just send him some money via bkash, since otherwise he has to wait for my friend to visit at the beginning of the next month. So much for the young adopting the technologies first!  But, a big problem in Bangladesh that others have researched in more depth is that most people, friend's father included, can't manage the whole transaction on their own.  The prompts are in English, require multiple steps, and you've got only 90 seconds to finish the whole transaction, or it resets.  So they take it to an agent instead, with introduces all sorts of new problems.  Agents are supposed to charge just 1.85% commission for a cash-out, but monitoring systems are still a bit weak.  And using one's pin code in a crowded area means there's a good chance someone else could snatch your phone and empty your e-wallet.  Is this better or worse than the problems of cash?  You tell me.

The second post (and the better one in my opinion) looks at data.  This has unfortunately better sitting in that "important but not urgent" quadrant for several years, and it's catching up with us.  There are a lot of assumptions and poorly informed decisions being made in development, at many levels, and too many hours of people's lives spent writing things down and calculating them manually.  Cool innovations are emerging at both ends of the spectrum---people are coming up with shorter survey collection tools to conduct at scale, and also figuring out ways to use data sets beyond their initial purpose, yielding cool insights.

Again, sometimes it's the older generation that gets this right--maybe they are less immune to the shiny trends.  I have a colleague here who bought an ipad to play scrabble with his nephew, who lives in London.  Through the nephew's activity, he tracks his whole schedule--when he's awake, how productive he is at work, etc. Similarly, when I forget to email my grandmama for a few weeks, she tracks me on twitter to see if I've posted.  It's her way of confirming that I'm alive and doing okay.  Pretty genius, if you think about it.

Should make you wonder, is there data you access regularly that has deeper meaning that is initially apparent?

Teasers from each article here, in case you're the kind of person that needs an extra nudge to follow a link:

2014: time to scale digitally

By the end of 2014, there will be more mobile phones than people in the world!

As if that’s not enough, there will be substantial growth in the number of people online.  Google is hoping to create access for 50 million women in India alone. Most of this won’t be through computers.  The “one laptop per child” mantra has given way to a “one affordable, probably made-in-china smart phone per child” approach.  Read more

The decidedly not flat world of data

In advanced economies, digital finance also brought about a data revolution.  Like never before, companies have been able to see how consumers were behaving and create increasingly valuable products and services.  These “big data” techniques are increasing applied to development fields–identifying epidemics, improving education, conserving energy, making buildings safer, the list goes on.  Read more

Mixed signals in Dhaka: no laughing matter

Dhaka traffic cop -- keeping things under control.

 Some years ago, a particularly innovative mayor in Bogota decided to improve pedestrian safety with what I’ll call the “playground method”.  He hired over 400 mimes to stand on street corners and mock anyone who jaywalked.  People were embarrassed by the attention and quickly began to obey the traffic signals with much more frequency.  Peer pressure at its best!

Anyone who has visited Dhaka knows that we take traffic jams to a new level.  You don’t have to spend long on the streets to realize that a major contributor to the traffic is the chaos—there are no stop signs, few drivers abide the traffic signals, and there are vehicles of all shapes and sizes in the road, not to mention the throngs of pedestrians.  Gridlock often occurs spontaneously and because space is so tight, undoing it takes time.

Having spent enough time moving from point A to B to get some good thinking time in, I casually suggested that adding some more traffic signals would go a long way to improving traffic.   Little did I know….

Willingness to pay

Recently I was talking to a donor, telling him about a learning network that my team developed over the last year.  The conversation went something like,

Me: “Now that we have a relationship with the partners, they are much more willing to talk to us.  In fact sometimes they seek us out to get guidance or ideas for how to approach something.”

Donor: “Interesting.  So, do you think that there is any impact that you can see from the project yet?”

Those of you in development probably know that impact is a word that should always be written in italics and handled with care.  Keep it on the same shelf as: “value for money” and “rigorous evaluation.” 

As soon as he asked the question, I remembered a conversation I had years ago, with another donor, ex-McKinsey.  We were talking about how much consulting McKinsey does for private foundations and government agencies.  Most of it goes unreported, because it’s a different category of engagement.  But it’s A LOT.  

Me: “Has anyone ever looked to see what the impact of McKinsey is, on firms that hire them?”  Donor: “No.”  

Me: “So then how does McKinsey know that it’s delivering any value?” 

Personalized medicine, technology optional

So a friend of mine just had a baby in London.  His first comment:  “People who complain about NHS have no idea how health care is for the rest of the world.”

One of the things that impressed him the most was the proactiveness of the health care system.  Within the first three weeks after the baby came home, a midwife came to visit five times.  Each time, she did basic check-ups on the baby (weight, etc.), and then asked the mom about any issues with sleeping, breastfeeding, and how she was doing.  An assistant from the baby’s general practitioner also called to talk about scheduling vaccinations.

I’ve never had a baby, so I don’t have any personal experience as a point of comparison.  But compared with my experiences with the U.S. health care system, his narrative includes an incredible amount of initiative on the part of the provider.  It also demonstrates a practice of public health principles.  Breastfeeding and vaccinations are two pillars of UNICEF’s “GOBI” mantra during Jim Grant’s leadership in the 1980s.  GOBI stood for:  Growth monitoring, Oral rehydration therapy (as treatment for diarrhea), Breastfeeding, and Immunizations (aside: great free book available online about James Grant that should be a “must-read” for all aspiring public health leaders).