4 Technology Lessons Learned Fighting a Health Crisis in Africa

Over half the population of Ghana uses public or shared latrines. This means more than 12 million people have to get up and leave their homes to do their business. Sometimes, they have to pay money for the privilege. Take a moment and think: What would that mean to your daily routine? In Ghana, this inconvenience, coupled with a lack of proper health education, leads to an ongoing problem of open defecation in streets, near waterways and within communities. It’s a public health hazard for all – and one that technology can help solve.

To help solve open defecation in Ghana, CauseLabs worked with Water and Sanitation for the Urban Poor (WSUP) and IDEO.org to innovate new technologies to address the problem. We started with a decidedly offline process called Community Led Total Sanitation, which included community education and empowerment on the open defecation issue. We also evaluated how we could provide the community with technology tools to report open defecation sites, knowing that a successful solution would also raise awareness of the problem and its serious health implications.

Here’s how we built technology to help address this problem – and the broader lessons we learned about building technology as a result of this project.

Building Technology for a Specific Environment

As soon as we dove into the practicalities of collecting and disseminating information about this practice within urban communities in Ghana, we hit a technology roadblock. Even though feature phones are ubiquitous and the community is comfortable using SMS, the SMS cost structure has caused the community to adopt a practice called "flashing" instead of texting. Flashing is calling a number so that it rings only one or two times and then hanging up. The idea is that the recipient’s phone rings, but they won’t have time to answer and will thus be charged for the call. This serves to notify the recipient of the call that they want to talk, and perhaps the person can pay for the call back. Sending and paying for the sending of SMS messages is not a part of the Ghanan technology culture. So, even though the community members we worked with weren’t comfortable sending SMS messages to services or other people, they were completely comfortable "flashing" a number.

As a way to deeply integrate our data collection technology within the community, we decided to build a system that took advantage of these cultural norms and allowed people to report open defecation within their community by flashing our service. We built this service using a combination of technologies. To handle the receipt of calls from the community, we had an Android-based smartphone running TeleRivet with a local Ghana number. Physical signs were placed at frequent open defecation sites directing community members to report when they saw open defecation occurring by flashing the number on the sign. The Android smartphone running TeleRivet would then detect that flash and call server-side code we built to kick off the next part of the process.

From there, we integrated Twilio to call that number back as soon as we detected a flash. Twillio allowed us to call Ghana numbers and collect data from the community member via a localized interactive voice response (IVR) system. With this system, we recorded locals asking the community member for the location they were reporting and then collected that information via touch tones. We also took the opportunity to provide snippets of education about healthy hygiene habits and to inform and coordinate participants around local community action meetings on eliminating open defecation.

Lessons We Took Home

During CauseLabs’ 10 years of developing innovative and culturally sensitive technology solutions across the world, we’ve learned many valuable lessons about how to drive real impact using technology. Here are a few:

Let constraints fuel your work
As we work with each community and group, we encounter new technology problems to solve and constraints to work within. We’ve learned to use constraints to focus our process around rapid innovations that work and deliver impact in the communities we work within.
Technology alone isn’t a solution
One lesson from Ghana and other projects is that although technology is a powerful tool, it is not a solution by itself. We always strive to understand the bigger picture and the larger environment into which technology fits. We want to understand how technology plays a role in users’ lives and adapt our solutions to meet those needs.
Don’t expect adoption of your technology solution in other places
The single biggest problem we see in using technology to solve big social issues is the expectation that our technology methods will be adopted and integrated into a wide range of communities across cultural boundaries. We work hard to inform our solutions with real-world feedback through rapid prototypes, user interviews and diligent field work. These efforts help ensure we have the support of real community members and stakeholders. This isn’t just a great strategy in the social sector either. If we are not deeply engaged with the people using our technology, we are going to miss the mark.
Immerse yourself in your user’s world
We have also learned through our process of innovation that people learn by doing. The best feedback we get about the effectiveness of our technology solutions comes from users. In addition to our work in Ghana, we have worked with East Meets West and Blue Planet Network to design a mobile latrine verification process. The technology solution streamlined the data collection process used to determine how newly built and funded latrines actually impacted the communities they served. In working directly with these community members doing the verifications, we were able to carefully study their existing verification process from beginning to end. We noticed we could add the most value by actually combining a larger subset of their workflow into a digital platform. Had we not immersed ourselves in their world, we might not have seen the best solution.

One thing is clear no matter where you are in the world: Technology is an amazing enabler to drive immense impact. To go the full distance, however, we need to share our stories and lessons from the road so others can be not only tap into the knowledge but also be inspired to use technology to change the world for the better.