What’s APPening in Malawi? An overview of the National mHealth Landscape Analysis

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What’s APPening in Malawi? An overview of the National mHealth Landscape Analysis

By Andrea Fletcher, Lead Data Strategist

Chances are if you aren’t reading this on your mobile phone, you at least have one within reach. Mobile phones have become ubiquitous and are changing the way we do everything from banking to healthcare. This is true globally and even more pronounced in countries such as Malawi, where the uptake of smart phones skyrocketed in the past few years and now 85% of households have access to a mobile phone. It’s therefore not surprising that the Malawian healthcare industry is seeing a large influx of mobile projects as a means of reaching the population for healthcare delivery, data collection, and supervision.

Over the past few months, Cooper/Smith worked with Malawi’s Ministry of Health and Population to register the numerous mHealth projects deployed in the country by various development partners. The analysis kicked off with a memo from the Secretary for Health requiring all projects to register, which allowed us to identify and gather information on 31 mHealth projects. The 2018 mHealth Landscape Analysis provides aggregate information regarding the scale of projects, health domains, alignment with national strategies, and budgetary information.

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mHealth projects in Malawi have existed since at least 2007, with an average of 2 new projects coming online each year. The average lifespan of a mHealth project is 5 years. 2016 was the most active year for new projects with 7 new projects coming online. As of March of 2018, there were 22 live mHealth projects.

With so many active projects, the report provides a foundation for decision-makers to better understand the role of mHealth in the National Health Information System and coordinate the efforts of partners. It is already being used to provide recommendations for the development of the new National eHealth Strategy and is a valuable tool for communicating with stakeholders on the successes and challenges with mHealth deployments. Some key questions we’ve been asking based on the results of the landscape analysis include:

  • How do we do a better job of coordinating mHealth in Malawi?
  • How do we minimize duplication of efforts among partners?
  • Where should we invest mHealth resources to see the most impact?
  • What standards are necessary to achieve integrated service delivery at community level with mHealth?

Enjoy reading! And stay tuned for the results of the technical deep dive report from the Kuunika Project, where we go under the hood of several mHealth projects!

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What we’re learning about using technology to enhance teamwork, improve productivity, and communicate more efficiently

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What we’re learning about using technology to enhance teamwork, improve productivity, and communicate more efficiently

Authored by Michelle Jenn, Administrative Director

Figuring out the best way to communicate with co-workers, peers, clients, and vendors has become a major issue even for the most established business.  Start with a myriad of options to choose from that continually evolve (email, phone, text, chat apps, collaboration tools, social media, task-oriented apps, etc), add varying preferences among participants, and you end up with an ever-changing toolbox full of halfheartedly used apps and software tools. 

But maybe our trials and tribulations can help you avoid this. Whether you are a start-up yourself, have lots of staff that work remotely, or just want to use technologically to be more productive across teams, we hope our experience is useful.

We took advantage of a small core staff, knowing we could adjust or change tools altogether with little effort, and explored freely tools we stumbled upon or that were recommended.   Now that we are 2+ years into this journey, let’s look inside our toolbox to see what made the cut:

·         Email & Calendar

Google Suite

We started with Outlook, but quickly realized Suite was more powerful and provides better integration with Apple products/software. About half of our staff use Mac and half PCs. We noticed strange quirks in mail exchange between our Outlook account and all other providers. Given more and more orgs are switching to Google, this just made sense. Plus, the search function in Outlook is maddening and absolutely can’t compete with Google. (If you’re smart, you’ve stopped sorting emails into folders and now archive everything for search later). Also, some of our staff prefer to use local email/calendar clients on their computers. This is especially valuable if you travel extensively to places with limited connectivity, as we routinely do. Google works so much better across a range of people’s preferences for local clients.

 ·         Chat

WhatsApp

Great encryption, indicates when a comment has been seen, can create different groups, searchable, wi-fi calling, pdf sharing, and best of all...free. We do participate in other chat groups that are administered through Slack or some of the task tracking apps (Asana, Trello, etc.), but seem to always default to WA. We’ve noticed there is a different platform for different ways of speaking to each other. For example, we try never to use email for internal communications; we try to not task someone in a chat group; and we try not to have conversations in Asana. It really takes some trial and error to get this right, and standard operating procedures to make expectations clear, but ultimately everyone knows where to look for each type of information, increasing our ability to communicate with speed and accuracy.

·         Time tracker 

Toggl: 

The free version provides all the functionality we need for consultants.  We can create various projects and tags for each client and can have unlimited workspaces of up to 5 users each.  The “reports” options allow for meaningful analysis or can simply serve as a time sheet.  However, it works best when the user tracks in real time because manual entry is cumbersome to say the least.

·         Collaboration

Google Sheets, Google Docs, and Dropbox:  

We primarily use Dropbox as internal file storage for collaboration.  But it creates conflict copies if 2 people are editing at the same time.  So, for those times when we are up against a deadline and all hands are on deck, and often for external collaborations regardless, we use Google Sheets/Docs.  It’s a bit less intuitive and Sheets does not have full functionality of Excel, but we can all work on the same document at once without issue. The other challenge with Google Suite is its surprising lack of intuitive file storage. If I create a doc, it lives in my individual drive storage (even with a company account). I must share this document with others to have them work on it. We haven’t been able to create a company space where files can be stored and everyone with permission access them. This is a bit frustrating and often leads to unnecessary back and forth. (Please fix it Google!)

·         Expense reports

Expensify:

We started with this from the beginning and it serves its purpose well.  Some highlights: a photo of a receipt automatically creates a report, admin role can create different work groups with unique clients/projects/tags and rules, ACH direct deposit to employee/contractor’s bank for next-day reimbursement, automatic approval workflows with custom rules, and you can sync to your accounting software.  Basically, for only $9/user/month, they live up to their tagline “Expense reports that don’t suck.”  Our staff that travel all the time swear by Expensify. It really is a game changer.

·         Notes

Microsoft Office OneNote: This is basically a digital notebook where we can all view, add, and/or edit at the same time.  There is no forced structure or page layout.  We use it to keep meeting minutes, notes from phone calls, etc.  It is organized similar as a 3-ring binder with pages organized into sections within notebooks.  Many note-taking options exist today (Evernote, Dropbox Paper, etc.), but there’s a couple reasons why we chose this OneNote. First, we already pay for Office 365 (see below). Second, OneNote offers an offline client.  We are often taking notes in the field, so a web-only interface is just not an option.

·         Documents and Spreadsheets

Office 365, Piktochart, LucidPro:

The reality is that most of the world still relies on Microsoft products (Word, Excel, and PowerPoint), and this is true of our clients and partners. As such, we maintain an Office 365 membership for all our staff so we have access to the latest versions of each software. The big limitations of these products are they are heavy, consume lots of memory and space, and don’t work well on Mac. The Excel for Mac is so limited that our Technical Director runs 2 hard drives on his Apple computer, one with OSX and one with Windows—only for the Excel version. This definitely is not ideal and we hope Microsoft can get it together one day.

For fancier documents and charts (basic) we’ve been relying more on Piktochart and LucidPro. Both are web-based products that allow for much more visually appealing formats and graphics. Both require a subscription for downloading final products, but we tend to turn them on and off based on our needs each month.

·         Project management, Tasks

Asana: 

Where would we be without Asana?  This tool is super powerful as a project manager and task master and is certain to improve productivity.  But the possibilities don’t end there and are limited only by your imagination.   It can be used to keep meetings organized, for event management/planning, to keep pipelines (think recruiting or blog or biz dev), marketing launches, HR onboarding, tracking interviews, etc.  Seriously, I am in love.

Ultimately, we’ve learned that most offerings have one or two things they are really good at, but none are master of all.  Luckily, many of these products interact with one another without requiring an understanding of “APIs” and other scary integrations.  We therefore can use common nomenclature and tags for clients and projects across Expensify, Toggl, and Asana.  We’ve found this to be incredibly useful, and it results in a cohesive communications platform.

Work Smarter, Not Harder

The nature of our business requires team members to travel often and work remotely.  This work also necessitates coordination with many different partners and consultants around the world. 

We’ve discovered some powerful tools available to bridge these geographical gaps, and they are certainly worth the effort needed to get past their learning curves.  Without such a strong communications platform, we’d likely waste a lot of valuable time trying to perform even basic daily activities necessary to run a business (such as time tracking and expense reports) not to mention coordinating work efforts around the globe. 

We may have to navigate several tools to get the job done, but even speaking as a Gen-Xer, reluctant to take this plunge in the beginning, I can see the net positive.   With all this technology at our fingertips, business communication has the potential to be both more effective and more efficient than ever before.  And that’s speaking our language.

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Discrete Choice Experiment for Data Use Incentives in Malawi

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Discrete Choice Experiment for Data Use Incentives in Malawi

Our Lead Data Strategist Andrea Fletcher presented at the Global Digital Health Forum 2017 in Washington, DC as part of a panel on exploring methodologies.

Cooper/Smith conducted a Discrete Choice Experiment in Malawi to better understand data use incentives and how to prioritize investments in incentive programs for healthcare workers. This approach allows researchers to quantitatively measure perceived value and trade-offs between options provided to participants in simple survey form, which in turn allows policymakers to choose those factors that will most affect the desired outcome.

Click through the slides below to see her full presentation and learn more about Discrete Choice Experiments!

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Taking the Next Step to Implement Data4Development in Malawi — DIAL

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Taking the Next Step to Implement Data4Development in Malawi — DIAL

Malawi is a country of more than 17 million people stretching over 118,000 sq km in Southern Africa. The country is called the warm heart of Africa for the friendliness and compassion of its people and the beautiful warm waters of Lake Malawi. However, there are multiple challenges facing Malawi’s economy and public health sector. These challenges range from fragmented health data systems to insufficient data on population demographics, characteristics, behaviors and trends. These challenges act as a barrier for policy makers and health service providers from deploying targeted resources more effectively and efficiently for improved health outcomes.

The potential that mobile (and other types of data, including geospatial and digital) holds to generate insights for improved health outcomes is immense. Despite the advent of Big Data for social good, scale and sustainability continue to be a challenge for initiatives that lie at the intersection of data-driven insights and health outcomes. DIAL, in partnership, with Cooper/Smith intend to demonstrate the value of analyzing and mapping data from Mobile Network Operators (MNOs), population census, settlements mapping and geospatial data to routine patient or aggregate data collected through the Malawi health system.

The ultimate user and consumer of such insights is the Ministry of Health. DIAL will provide capital investments and technical resources, such as analytics, through its partners Infosys. Cooper/Smith will work with the Ministry of Health to verify data from health facility systems, establish new ways to seek and utilize data. In the long term, Cooper/Smith will support the Government to set the stage for long term programmatic use of MNO data in order to answer key questions on Malawi’s disease burden.

 


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The Malawi Network for AIDS Service Organizations (MANASO) meeting with the Malawi Data Use Partnership (DIAL, Cooper/Smith and Infosys)


In October 2017, teams from DIAL, Cooper/Smith and Infosys went to Malawi to engage with various stakeholders that are key in making this 6-month study and demonstration of data for public health outcomes a success. The team started off by meeting with the Secretary for Health in the Ministry of Health; Dr. Dan Namarika. As the ultimate consumer and client of this study, the Secretary reiterated the value of such data insights in improving health outcomes. He intimated, that while equity is sought in distribution of resources across health facilities and diseases units, there is also need for this D4D demonstration to likewise consider cross sectorial use cases in the health domain.

An interesting use case of mapping and analyzing MNO data for health outcomes was raised when the team met with the Community Health Services Section which is within the Department of Preventive Health Services. Through the Health Sector Strategic Plan’s Capital Investment Plan the Ministry of Health plans to deploy over 900 health posts over the next 5 years across the country. Use of MNO data would shed light on the relevant migration patterns of communities, ultimately providing insights on where best to deploy new health posts and resources. This is a typical example of a use case where analytics from telco data can directly improve health outcomes.

The team also met with the Director of Policy and Planning, Deputy Director of the Central Monitoring & Evaluation Division (CMED), Director of HIV and AIDS, and the Malaria Program Manager in the Ministry to discuss modalities of deploying this data for development study. A recurring theme in discussion with all these departments was the inability to track migration of patients and how to differentiate between drug defaulters and compliant migrants. A typical example of such a case is when communities migrate to urban areas in search for seasonal jobs such as within the Tobacco industry which is Malawi’s largest forex earner. How does the Health System adequately target resources based on movement patterns of people? Our goal is to explore how Telco and geospatial data may be the answer. It was also eminent that there is need to integrate the multiple health systems available in the country to enhance efficient data use. Cooper/Smith, is also working on supporting the Ministry of Health to enhance integration and interoperability of the health systems through the Kuunika Project, that our joint investigations will support.

The Ministry of Health also works closely with key stakeholders such as the National AIDS Commission (NAC) and the Malawi Network for AIDS Service Organizations (MANASO), organizations that are critical in coordinating HIV/AIDS programming across the country. As such, the team also paid courtesy calls on these two entities. Once again, the issues of migration patterns of people as relates to health outcomes and deep insights in understanding certain demographic segments to manage HIV/AIDS were key. For example, adolescent girls and young women are at a higher risk of contracting HIV/AIDS than their male counterparts, yet there is limited understanding of their behavioral patterns and trends that can help deployment of interventions and resources. MNO data has the potential to help unlock insights into this group and allow better targeting for HIV prevention and treatment services.

Finally, the team met with the Malawi Communications and Regulatory Authority (MACRA), the Department of E-Government, the National Commission for Science & Technology, and the two leading Mobile Network Operators in Malawi, Airtel and TNM. The conversations with both Airtel and TNM highlighted the shared value in using telco data to identify trends and patterns in population density, migration, lifestyle and movement that can be triangulated with site level health program data to predict health outcomes or provide insight on health interventions and deployment of resources. Data privacy and protection remain key themes in the deployment of this study in ensuring anonymity of user data sets.

Within the next few months, together with the Ministry of Health and mobile network operators, we are hoping to demonstrate the value in mapping and analyzing telco data alongside health systems data to inform health outcomes. With valuable lessons learned from this study, DIAL will advance the impact made possible by unlocking mobile, digital and geospatial data for social good, ultimately acting as a springboard for entities in other geographies to replicate, customize and scale digital health data solutions. Consequentially, we anticipate that these solutions can enable policy makers in the health sector to make efficient and informed decisions to improve health outcomes. Our expectation is that Malawi may become one of the model countries in demonstrating tangible use of big data for social good and truly drive data-driven societal transformation.

Rachel Sibande joined DIAL in September 2017 as Programme Director, supporting DIAL program partners in selected countries. She works to demonstrate sector wide collaboration between D4D players in deploying initiatives that enhance data use for evidence based decision making. Prior to joining DIAL, Rachel established Malawi’s first technology hub; mHub. She has over 11 years industry experience spanning academia, development and social enterprise domains.

Hannah Cooper is the Co-Founder and Managing Director of Cooper/Smith, a technical assistance organization that uses hard data to improve the efficiency and effectiveness of health and development programs. Throughout her career, she has helped governments and organizations plan development projects and achieve lasting results. Prior to founding Cooper/Smith, she served as Team Lead for Monitoring, Evaluation, and Quality at the Office of the U.S. Global AIDS Coordinator, President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Department of State. Hannah was also a Results Specialist at the World Bank and led an online community of practice for African civil servants on Managing for Results. Hannah also was responsible for strategic planning and performance at Canada’s Department of Foreign Affairs — where she developed metrics to measure Canada’s diplomatic work.

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Your accountant would face palm (Expenditure Analysis 101)

How old were you when you got your first bank account? Some of us started with a checkbook, maybe an ATM card to go with it. Do you remember that annoying ledger at the beginning of the book? You were supposed to carefully record each transaction you made, whether it was a deposit, or a check written, or money withdrawn — along with a little note about what prompted the transaction. You felt proud when you remembered to balance your check book, and conversely a little ashamed when you forgot.

Learning to manage personal finances takes some getting used to. Of course, some of us can now log into our bank’s online portal (or app) and see comprehensively, all in one place, our financial flows in real time. Neatly recorded for you is the starting balance at some date, all your transactions with a date and merchant, and the ending balance. (Pause for a minute at this point to thank technology for alleviating our collective guilt for poorly balanced check books!)

Of course, I recognize that a large portion of the world lacks access to basic financial services — a point not to be forgotten, but also not as relevant for this analogy, so stay with me please!

What about the age when you realized you needed personal financial goals? It was no longer enough to know how much money was in your account, but you needed to know how those bucks were being spent. Keeping track of it in your head wasn’t enough, you had to make financial goals — budgets for groceries, rent/mortgage, utilities, fun stuff, savings, etc. — and stick to them. By doing so you ensured you had food, shelter, and a cushion for the unexpected (hopefully). You ensured you and your family remained solvent and you could live your best life with the money you had.

Even those with extremely low wages and no access to formal financial services do this kind of calculus on a daily basis. Despite how much cash you have at your disposal, how you choose to spend it determines — at least partially — your fulfillment in life. As Charles Dickens’ Mr. Micawber said:

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“Annual income twenty pounds, annual expenditure nineteen [pounds] nineteen [shillings] and six [pence], result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery”.  

This is the economic concept of utility. We derive utility — or satisfaction — from trading our hard-earned resources for goods or services we can’t produce ourselves. Which goods and services we choose to buy reflects our preferences and what will ultimately maximize our personal utility. At the societal level, these principles are no different.

Hopefully, you are fortunate enough to be governed by a democratically elected authority. You have entrusted (at least tacitly) this government to raise revenue and provide certain goods and services that make more sense to be managed collectively — e.g., military and police protection, clean water, healthcare (sometimes), education (sometimes), etc. You allow your government to make decisions about what should be regulated, to ensure people are protected from undue harm, and you allow them broad authority to decide how to spend money in the collective coffers. Maybe government resources come from you directly (in the form of taxes) or maybe from benevolent sources (external donors). Either way, they partially belong to you and your community as the intended beneficiary.

If you’re with me so far, then you may agree the goal of public expenditure should be to maximize the collective utility of the people. Plain and simple.

If you think that’s reductionist — you’re right. The true picture is super convoluted. Assuming the government has the best interest of the people in mind, how does it know what they really want? How do the people know their interests are being served equitably? What about when the government is negligent or corrupt? When external donors are involved, whose utility should be included in the equation — the recipients, the donors, or both?

These are all very complicated questions with entire volumes already written to explore them. The reason I bring it up here is simple: without the right data we can’t begin to find answers to these questions or even have a productive discussion.

Let’s bring it back to the personal finances analogy. When trying to achieve your financial goals you need some key data. You need to know how much money you have now in all locations (accounts, coin jars, mattresses). You need to know what future obligations you are likely to incur for basic needs (e.g., rent) and how much discretionary funds are left over. You need targets (i.e., budgets) for how much you intend to spend in certain categories going forward (e.g., groceries). What else?

You need to know how you actually spend your resources against those budget categories in the future!! Was it more or less than intended? Did you struggle to meet the budget in a specific area? Do you need to shop for lower prices in some categories? Do you need to rethink your budgets or your goals?

For most of us, this is a no brainer. Let me be clear though: most national governments struggle to know how many resources they have on hand, rarely budget based on intended goals, and do not track actual expenditures against those goals! This is true for domestic programs and overseas assistance (looking at you OECD).

Your accountant would face palm.

Confront any government agency about this and the answer will be the same: “We meticulously track our finances in standard accounting categories.” And…this may be true. But standard accounting categories and project level accounting is archaic and not enough. If you want to achieve big goals, you need better data.

Consider, for example, the sustainable development goals (SDGs). Almost every country is signed on to targets across 17 stated goals. We know achieving the targets requires money, we know the amount of money will be different in different places, yet ask any government official to tell you how much they spent last year (on average) to test a pregnant woman for HIV or deliver a unit of clean drinking water and they will look at you perplexed.

In our above analogy, this would be the same thing as trying to set a budget for food without having been in a grocery store in 10 years to check out prices!

The next defense from officials might be, “We budgeted X, spent all the money, and achieved Y. So, we clearly know the impact of our investment.” No, no, no, no, no.

This concept will be a recurring theme of this Expenditure Analysis blog series, so please repeat it with me at your computer terminal: BUDGET DOES NOT EQUAL EXPENDITURE.

Assume you budgeted $2 per meal last month, thinking you would eat 90 meals (3 per day). You have no money left over from your paycheck at the end of the month. Can you confidently say you (1) ate 90 meals, (2) you spent $180 on food (2 x 90), and (3) that every meal was about $2? No, you can’t. Nor would you want to. All you can say with this level of information is that you spent all your money.

For example, maybe you exceeded your food budget and had to draw from other categories. Maybe in reality, the average meal was $5 because you ate out too often. Maybe the average cost per meal when cooking was $1 and when eating out was $7. Does this information matter? Of course it does, because it will correct your budget assumptions, shed light on the financial implications of different behavior, and determine how you choose to spend your money next month. Maybe you cook at home more, or decide you really like eating out and will increase your budget for food by reducing the number of taxis you take.

The point is, the trade-off is explicit because you have the right data and you are able to continually squeeze out more satisfaction from your income while remaining solvent.

Substitute “solvent” for “sustainable” in the last sentence and it could not be any more relevant to public spending. Budget does not equal expenditure, and we don’t have the right expenditure data at current to maximize the benefits of public and donor services.

What is the right expenditure data and how do you use it? Follow this blog series to find out. Next time we will explore what efforts have happened to better account for money in global health.

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"America First" & Foreign Aid

At the end of a long, dusty red dirt road bordered by fields of maize sit several huts owned by Luzi Orphan Care. This community organization in rural Malawi receives around $500 a year to care for children orphaned by AIDS. Five hundred dollars go a long way here. We know this because we saw the organization’s meticulously kept records: Binders of crisp white pages, filed neatly in boxes, recording how those $500 were spent and how many orphans received care.

We asked the group if they needed anything. They didn’t request more money. Instead, they asked: “How are we doing? How does our work compare to others? Are there things we could do better?”

 Luzi Orphan Care Community Organization with Tyler Smith (Cooper/Smith Co-Founder)

Luzi Orphan Care Community Organization with Tyler Smith (Cooper/Smith Co-Founder)

Their questions were instructive. For too long, foreign aid programs measured their worth based on the size of their budget, not on the results achieved. Fortunately, that is beginning to change.  Instead of using last year’s funding amounts to justify budget requests, organizations as large as the U.S. government and as small as Luzi Orphan Care are looking to accomplish more with existing resources. 

This interest in effectiveness and efficiency is being demonstrated across the foreign aid world. Increasingly, organizations are focusing on using data, evaluations (such as randomized control trials) and advanced analytics to measure results and demonstrate value for money.  And they are deploying the power of technology to pinpoint where development interventions are needed.

This revolution arrives just in time.  With the Trump Administration’s proposed budget portending fewer resources for foreign assistance, providers must accomplish as much as possible with available resources.  In addition, better data about what well-run programs can accomplish, will help persuade the public that foreign assistance is a wise investment.

Donor governments and aid organizations should take three basic steps to generate that data:

First, every aid program should be accompanied by a rigorous framework to assess whether it achieves its goals. Backward-looking evaluations after a project’s conclusion are not enough; at that point, the donor has a powerful vested interest in ensuring that the project is deemed a success. Under those circumstances, without a pre-determined baseline against which to measure the results, a passing grade is virtually guaranteed.  That kind of evaluation tells us little about whether the project achieved its intended goals or delivered good value for money.

There is a better way.  Instead, before the project begins, donors and implementers should agree on the metrics, or “indicators,” they will use to measure the project’s effects.  The next step is to gather baseline data for those indicators and set clear targets for project success.  With baseline data and pre-determined indicators and targets, donors and implementers can rigorously measure what a project achieved.  

Second, development professionals need to collect the right data—and sometimes that means collecting fewer indicators. One of the downsides of the drive to show aid effectiveness is that both donors and implementers have become overwhelmed with indicators.

For example, in a recent study in Malawi, we found that health workers collect more than 3,500 different HIV-related data elements. This means that staff at already-overburdened health facilities spend, on average, several days each month filling out reports. This takes time away from patient care and leaves little time to use the data to improve the clinic’s services.

 Data collection at a health facility in Malawi

Data collection at a health facility in Malawi

One way to reduce this burden is for donors to better coordinate the indicators they ask governments and organizations to collect.  An African health system supported by five separate donors should not have to collect five slightly different datasets to respond to each donor’s requirements.

Third, donors must analyze and use these data to better tie resources to results. Some implementing partners provide great value for money; others do not.  For example, in countries receiving support from the President’s Emergency Plan for AIDS Relief (PEPFAR), we found that the unit expenditure to deliver HIV treatment varied substantially.  Fortunately, a relatively new technique called Expenditure Analysis allows PEPFAR to explore why it costs more or less for different organizations to deliver similar results. Sometimes there is a straightforward reason for the higher cost: the work takes place in a remote area, labor costs are higher, and so forth. Sometimes it is a warning sign that something is amiss. This information allows planners to identify best practices that can be replicated elsewhere.

Today, the political winds are blowing against foreign aid.  In this challenging climate, donors, implementers, and advocates should continue to mount a principled defense of foreign assistance. But pushing back against budget cuts is not enough: Like Luzi Orphan Care, we should strive to do better with the resources we already have.

Hannah Cooper and Tyler Smith are co-founders of Cooper/Smith, a DC-based startup that uses data to increase the effectiveness and efficiency of development programs.  They previously served in the State Department’s Office of the Global AIDS Coordinator.

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