At IMAGO, we strive to contribute to the changing practices and thinking in international development. In this newsletter, we share some of our most recent ideas and work, including commentary on the interaction between technology and development, field experiences from 2018 IMAGO Fellows, and our latest news.
In this issue:
Articles: Technology and Development
A.The Necessity of Human Tech
B. The Digital Economy: Promise and Challenges for Development
C. The Power Behind Technology: The Human Brain
Blog: A Review of Our Summer
D.Technological Tools to Benefit Underserved Communities
The Necessity of Human Tech
Will future technological change exclude or involve the poor? Will it enhance or restrict their agency?
A utopian view sees digital technological change and artificial intelligence as tools for transformation of the lives of the poor. The genius of Silicon Valley will come to the rescue—bringing tech innovation to solve problems at the grassroots. Tablets, new data systems, open information, and machine learning will finally solve the market and government failures that have held the poor back.
A dystopian view considers the new technologies as mechanisms for deepening disadvantage. The poor will always lag in the infrastructure, hardware, software design, and adapted algorithms needed to join this technological revolution. Worse, livelihoods will be hit as new technologies take over labor-based work. If wealth can be taxed to finance more for pro-poor transfers, or a Universal Basic Income—popular in Silicon Valley—this may moderate material hardship, but is no substitute for the disempowerment from lack of dignified work.
Both views suffer from a top-down perspective—of taking technological change to the grassroots as if from above. What is needed is to take seriously what we call “Human Tech”, both in terms of what shapes change, and in its adaptation and use.
Human Tech is the intricate interplay between human interaction and technology integration. This can be agency enhancing, augmenting the capabilities of the poor and the organizations that work with them. We have witnessed this in our work in IMAGO at the grassroots. This has so far been in early phases of digital engagement, but it easy to imagine future uses of AI in these contexts.
But getting the processes right is fundamental to avoid three risks: of massive exclusion—as in the dystopian vision; of adverse inclusion, with data-driven processes maximizing what can be extracted in profits from the poor; and of paternalistic inclusion, with government using sophisticated data to better “target” and “deliver” to the poor, backed by comprehensive surveillance.
Let’s illustrate with four examples of how we have seen Human Tech working in the field.
First, at IMAGO we use electronic polling, or “clickers”, to explore strategic tensions in organizations owned by, or working with, the poor. This digital platform allows participants to quickly and anonymously respond to questions related to living and organizational dilemmas. They see the collective survey results at the click of the mouse. We have used this in groups ranging from illiterate Indian women to medical professionals working with homeless populations in Houston. In each instance, irrespective of context, technology provided a springboard for the human part of our interventions, allowing for facilitated dialogue on the revealed results. Alignments, tensions, and trends are then openly explored as the group makes sense of their own revealed views. In this example, Human Tech brings equity to conversations whereby each person has “voice” through their vote. Dominance of the managers or supervisors is diminished as each member of the organization grapples with the analysis of what they are saying rather than positioning or posturing.
Second, the Self-Employed Women’s Association’s (SEWA) IT team developed software for smartphones employing visual imagery to allow self-employed female sales workers to manage the accounts of their food processing social enterprise. Once the resistance is overcome, teams embrace the importance of digital literacy. Tackling the resistance crucially involves treating technological adoption as an adaptive challenge, through use of interactive workshops (now run by SEWA’s own management training arm). This again takes the Human to the Tech.
Third, another partner, the Fundación Paraguaya, developed the Poverty Stoplight that uses technology to implement a participatory, multi-dimensional poverty assessment tool that uses highly visual software, deployed in a tablet, to support self-diagnosis of living conditions as the basis for developing goals and action. The process converts a typically extractive relationship in data-gathering to one that is both reciprocal and agency-expanding for the participant.
Fourth, the Houston-based social enterprise—the Patient Care Intervention Center—seeks to transform the care of vulnerable intensive users of the health system, including the homeless and other socially disadvantaged groups, through bringing sophisticated data analytics to bear on the interactions with the health and social system and the management of case plans. They are now developing using technology to incorporate client feedback and participatory goal-setting into this process
These four examples of Human Tech have common features: (i) the personalization and greater precision of interactions; (ii) use in the context of reciprocal human interaction and (iii) helping individuals expand their own agency, rather than restricting agency. While they are specific cases, they show how incorporating the Human into Tech can move us away from the dystopian trajectory toward a world in which technology opens possibilities for the poor. The potential is exciting.
But for this type of changes to go to scale radical shifts are required in technological design and implementation—and this is in addition to the investments in infrastructure and regulatory designs that are needed. The first concerns adapting technological development to the needs, aspirations and desires of the poor. The second involves a process of adaptive engagement in implementation. Neither will occur automatically. If the digital economy is left to the “invisible hand” of current market and power structures and it will only lead to more inequality. That is the subject of a future blog.
The Digital Economy: Promise and Challenges for Development
As part of the UN High Level Panel on Digital Cooperation, I have been reading and listening to the amazing work so many people are doing around this topic. The digital world is very complex, permeating so many aspects of our lives, and we are all trying to keep up with the break-neck speed of new technologies. We are also starting to understand the many implications for our daily lives and the way innovations are disrupting our world, both good or ill.
So how is technology impacting economic development? Immensely. The digital revolution is disrupting development pathways in so many exciting ways. After working for over thirty years in development it is wonderful to see how so many innovations are solving problems that seemed to be intractable only a few years ago.
The attainment of SDGs could be dramatically accelerated by new technologies that consolidate value chains and reduce the need for intermediaries. Farmers, for example, can now have localized data on the weather at the tip of their fingers and even anticipate droughts or floods. This can help them plan ahead and also help with more localized insurance calculations. Affordable clean energy is also much more available thanks to the spectacular development of solar panels and nano technology.
These innovations are also lowering the cost of reaching the last mile, are diffusing faster than ever before, and can be personalized for local needs. By digitizing physical assets like doctors and teacher trainers, the cost of reaching the last mile can dramatically decrease. In health, for example, virtual consultations can bring specialized doctors to remote locations. Malaria can now be diagnosed with the help of a smart phone. Women in self-help groups can use low cost tablets to track members, savings, and livelihood activities. In education, children can become proficient in numeracy and literacy by using tablets for teachers in remote areas at lower costs and massive reach.
All these developments are super exciting, but they also pose new challenges that require attention. Some of the risks come about because a few large firms can expand at virtually no marginal cost. So new monopolies are emerging from data control and network effects. Moreover, the direction of technological change will cater to the needs of richer groups, increasing global and national inequalities. And both individuals and governments are ill-equipped to adapt and respond to these rapidly changing realities.
Only if we tackle these challenges as a development community will we be able to see the benefits of the digital economy in the attainment of the SDG goals. If we don’t, we will end with a more unequal and divided word that will have failed to use this amazing opportunity to become a better world.
Technology is Amazing, but Still Far Behind the Power of the Human Brain
The rapid evolution of artificial intelligence (AI) continues to amaze the world. It is fascinating to see how things that were unthinkable, such as humanoid robots or restaurants and hotels served by robots, are now a reality. Endless discussions have taken place to estimate to what extent robots will replace humans. The progress of AI is admirable and sometimes even intimidating. Yet, the human brain is so much more complex and adaptive to learning and social environments than a robot will ever be.
Jack Shonkoff, Director of the Center on the Developing Child at Harvard University, explains that early experiences literally shape the architecture of the developing brain. Before a baby is born, human brains have the highest number of neurons that it will ever have; but few connections, or “circuits”, as they are known in neurology. Genes provide a blueprint of when the brain’s circuits are developed (i.e. the timing); but how these circuits are formed depends on the experiences a child has and the environment in which a child grows up.
According to the Center for Developing Child, “Brains are built over time, from the bottom up”. In the first years of life more than 1 million new neural connections are formed every second. It is hard to imagine a machine with this level of complexity. Furthermore, in the case of humans the conditions in which a child grows and the interactions with her surrounding adults will be a key determinant of the process of circuit formation and will have an irreversible impact on her development. This period of life creates the foundation for future learning, health, and behavior. Just like building a house, everything is connected. The first neural connections are simple but provide the foundation to build complex circuits later.
Let’s use a specific example; how a child learns her literacy skills. The first words will be learned from her parents and surrounding adults. At this early age, without any additional intervention, the family’s education will be a determinant of the child’s vocabulary. By age three, children whose parents completed college have two to three times broader vocabulary than those kids whose parents did not complete high school. Evidence shows that children gain from having access to high-quality early childhood education and care, but this is particularly important for disadvantaged children.
What happens during the first three years of a baby’s life will have a long-lasting impact on her health, education, income, and well-being. Experts talk about this time as a window of opportunity. Numerous studies have shown evidence of the benefits of early-childhood interventions, not only for individual children, but also for the country’s economy. James Heckman, Nobel Laureate economist, has shown that financial returns to early years’ investments are higher in the first three years of life; after that age the returns diminish rapidly.
Given the huge impact these early years will have on outcomes well into adulthood, adequate early childhood interventions will be more effective and less costly that interventions in later stages of life. This is particularly true for children from vulnerable families. However, actual expenditure is the inverse of what the evidence suggests. According to the World Bank data for education, for countries with available data, the average expenditure on pre-primary education as a percentage of government expenditure in education is barely 5%, compared with an average 32% for primary education, 34% of secondary education and 21% of tertiary education.
If the evidence on returns to early years interventions is so compelling, why is it not happening? One hypothesis is that a shift towards early childhood would imply either an increase in expenditures, or a reallocation of resources from existing programs. Either of those options are difficult for governments to assume, especially when their time frame is biased toward actions with short-term effect. Technology could offer an opportunity to facilitate access to cheaper services and to give alternatives to traditional interventions that could reach a higher number of people. However, this will only occur if the power of technology is delivered in a way that poorer groups can also take advantage of its benefits.
Challenges imposed by new technologies only make early childhood interventions more relevant. The speed at which technology is evolving will require new and more sophisticated skills. The demand for inherently human attributes, like creativity or care for others, will be higher. The way we learn will also evolve towards a journey of permanent learning and adaptation throughout our lives. Technological change magnifies the need for early childhood interventions and makes a more urgent case, on equity and efficiency grounds, for policy to assure effective access for all.
We cannot forget that behind the wonders of artificial intelligence there are human brains creating this technology. Just imagine how things could be different if all children had access to environments that were optimal for their development, allowing them to reach all their potential.
 Video: https://developingchild.harvard.edu/science/key-concepts/brain-architecture/
Technological Tools to Benefit Underserved Communities
By Homa Koohi, 2018 IMAGO Fellow
Over the summer I worked at “Patient Care Intervention Center” (PCIC), a non-profit advocating for health care for underserved communities through use of technological tools.
PCIC started its work in 2014 with a focus on providing health care for the homeless using web-based electronic medical records. This database is called “Street EMR” because this data was originally gathered by going to streets, reaching out to the homeless, and recording their medical conditions. In subsequent visits, other volunteers could check medical backgrounds and update them with relevant changes. Consequently, PCIC developed a platform called “Unified Care Continuum Platform”(UCCP) through which different stakeholders, including care providers, payers, and social institutions share their data. Based on these datasets, PCIC today identifies “super utilizers” of health care and then provides a customized plan for the individuals over a six-month period to improve their situation.
PCIC is different to other programs because it integrates social data and medical data. This allows for consideration of social determinants of health as a centerpiece of their program. This perspective impacts: (1) from which organizations they collect data (i.e. social as well as health organizations), (2) how they analyze data to identify super users (i.e. considering social determinants of health factors), and (3) what kind of interventions they consider. Specifically, they are considering improving social aspects of life for their clients with the hope that these aspects will also lead to improvements in their health.
PCIC integrates a tech team and a medical/social team in their organization. This helps PCIC have real-time feedback on how their product/services, specifically UCCP, works and how to develop it further.
Overall, my internship was one of the best experiences of my graduate studies. I learned a great deal about the challenges of health care provision and real questions a non-profit like PCIC faces when navigating their way to scale up. Although using data and technological products and practices is an efficient, powerful way to improve health care, there is a lot more that should happen to make this possible. Some of the important challenges/questions are as follows: How can different organizations be brought together to share data and beneficial information? How can huge and rigid systems that are relying on traditional ways of health care provision and are reluctant to change be penetrated? How can brilliant innovations be scaled up in different places with different cultures? These are some of the questions that I’m taking with me and will think about in my second year at HKS. I cannot express how grateful I am to IMAGO for providing me with such a great, fruitful opportunity.
By Erika Caballero Montoya, 2018 IMAGO Fellow
GITA is a middle-aged hardworking Indian woman. She is a member of a self-help group (SHG), a mother, and a wife. Her life is at the center of Transform Rural India’s (TRI) efforts to transform rural villages in India into places of equal opportunity. GITA was the starting point of the systems-mapping created during the brainstorming session held last July with TRI and EkStep – two of our partner organizations in India. However, what GITA symbolizes for IMAGO goes beyond. GITA translates to “song” in Sanskrit; and, as such, it personifies how IMAGO partners’ individual essences come together as part of a whole.
A key part of IMAGO’s work is to bring organizations together to build partnerships, co-develop new solutions, and catalyze individual and collective impact. Along this journey, the team gets to experience how the individual voices of each organization harmonize to form a melody. Each organization maintains their own attributes, enriching their interactions with the rest of the stakeholders, yet, the common ideals and core values ensure that the melody stays in tune.
The goal of the session was to explore how digital infrastructure could help TRI advance their goal of bringing lasting change to the 100,000 poorest villages in India. As a result, the central focus was to understand EkStep’s proposition of Societal Platform as a way forward to resolve complex societal challenges.
And soon, the learning began. What stands behind the idea of a Societal Platform? Starting from its name, Societal covers the interaction between different stakeholders – Government, Private Sector, and Civil Society. Platform is the set of mechanisms that will enable us to establish interactions across stakeholders to achieve a specific mission. This is built upon three concepts:
- Amplification Networks catalyze innovations happening at the grassroots organization level
- Co-creation Environments – build capabilities and provide services to build viable, robust and more effective solutions
- Digital Infrastructure – creates an environment that leverages from networks and is conducive to co-creation environments in order to amplify innovation
This means that in order to amplify the impact of societal innovations, their solutions are not centered around digital services exclusively. In fact, their approach is based upon a continuous process through which they analyze the innovations, unbundle the component of the problem that is context independent and build a digital infrastructure. By choosing a minimalistic design, different stakeholders are allowed to adapt the infrastructure to meet context-specific needs, while retaining the flexibility to add as many new layers of capabilities as necessary.
As the concept kept unfolding, it became evident that EkStep’s principles wereclosely related with TRI’s and IMAGO’s theory of change. On one side, TRI and EkStep share the idea of societal change as a collective approach from a diverse range of stakeholders. Altogether, the three organizations share the commitment to develop spaces for co-creation. And finally, both EkStep and IMAGO recognize the importance and complexity of scaling up. In this sense, EkStep differentiates the concept of scaling up from growth. In their definition the process of scaling up should be divided in the following stages: Pilot/Prototype, Relevance, Significance, Standardization, and Attainment. Any organization that chooses to talk about scale, should have reaching approximately 10 million people in mind. And this is exactly the path that TRI is undertaking to attain a large-scale impact.
Through these examples we can see how, even when looking at the same problem from different perspectives, the motivation behind each of the organizations comes from a common place. In this way, different elements that by themselves will look incomplete, come together to form a complete song.
Who Deserves the Best Care?
By Homa Koohi, 2018 IMAGO Fellow
*Names have been changed to protect the privacy of individuals
It is my second visit to the city and my first visit to Dr. Davis and the clinic:
I was in the pedestrian seat, looking around the city, recalling some of the places we saw yesterday, when my attention was caught by the long line of people in front of a building. Among the crowd one man was laying on the ground.
After a minute or two, I realized that we have arrived at the clinic, where I was supposed to meet Matt. It was a small clinic with a very tight and narrow entrance. I told the nurse that I am visiting Dr. Davis and that I am a Fellow. It was right around 8 am when the clinic started working and a few men sitting there were waiting to be called. I go in and meet Matt for the first time and he recalls my face and gives me the warm welcome I was expecting.
He gives me a quick tour of the clinic. Few rooms, amazing people, a very small lab, a class D pharmacy, and a relatively large open Hall, with two guards sitting behind a small desk, and several scattered tables where the crowd, which was waiting outside, is now settled down. Most of them have received a simple breakfast. They are waiting for their turns to talk to case managers, who are separated from the rest of the space by a sectional curtain. Possibly one or two case managers are talking one by one to the patients trying to have as much privacy as possible. I ask Matt if they are all first-time visitors and he replies that lots of them have come before.
We go back to room one, where we left off, and Matt starts seeing patients. The first man is middle aged, African American, and wearing a red hat. Matt tells him about me and the other student/intern and asks whether he is fine with us being there. Matt persists that he should let him know if he prefers us to be out at any time:
- “At the end whose visit is this?” the man replies “Me”
- “And who deserves the best care?” the man replies “Me” with a little bit of uncertainty, not used to such a conversation!
Then Matt starts checking his history on a website including patients electronic record and checks which drugs he is taking. The man says that he ran out of drugs so he had not had his over the past three days. He mentions that it has been difficult to get an appointment. Matt makes sure that he has been told that he will get an appointment the day after he tries and fails.
After confirming what pills he needs, we go to the pharmacy, which is very narrow and small, and we locate the pills, which are all in zip locks with very detailed tags on them. We go back to the room. Matt continues, “We have to do better on this. And we have to do it together” And the patient is referred to another room for some additional tests.
A PCIC Patient
Pride in Agency and Community Support
By Emily Hsaio, 2018 IMAGO Fellow
One of IMAGO’s partners, Poverty Stoplight, works in familial poverty eradication. The Poverty Stoplight is a multidimensional poverty self-assessment tool that allows families to identify their own situation, take control of it, and feel able to improve their quality of life. What is essential to the Poverty Stoplight is that it positions the families as the protagonists of their own story, and exemplifies the values that IMAGO espouses: their tool “unlocks the latent agency” of families.
The Poverty Stoplight distributes its tool in a few different channels in order to reach a significant number of families –250,000 worldwide–: microfinance organizations, non-profit organizations, governments and communities, and businesses.
In communities, it is common to see the Poverty Stoplight at work. In the Qom community in Cerrito, Paraguay, women had utilized the Poverty Stoplight and begun to sell crafts. They sell weaved baskets and scarves, and with the income, many go to school. They are proud of what they have been able to achieve—one woman had the Poverty Stoplight survey printed out and posted on the wall next to a portrait of Jesus—and they are proud of each other: women sell side by side and encourage each other.
I had the privilege of working with the Poverty Stoplight for Businesses, where the community and pride aspects may not seem as salient to the outside observer. The Poverty Stoplight for Businesses line sells the tool to employers as an “employee wellness tool”; the businesses then conduct the assessments with their employees. The employer will then take this data into account when designing HR policy (e.g. compensation), benefits, events / trainings, etc. The impact is designed to be two-fold: to improve the lives of the employees, and, by doing so, indirectly improving the productivity, retention, and recruitment of employees—and thereby, the profitability of the firm.
In order to understand the customer satisfaction of the businesses, I interviewed 8 of the companies in Asuncion, Paraguay, that had been utilizing the Poverty Stoplight with their employees the longest. While we asked questions regarding their satisfaction with the product and service, it was clear that the businesses were proud of utilizing the Poverty Stoplight with their employees: 75% of the employers we interviewed said they would recommend the Poverty Stoplight to another HR colleague or friend. One company mentioned that she shares the Poverty Stoplight concept with her group of colleagues: “It is a point of pride to be able to show the Poverty Stoplight”
Reasons for this pride, however, do not lie in the number of surveys taken, or the productivity increase in each of the firms. They are proud of the community they have been able to build among their employees with the Poverty Stoplight, and the agency they have thereby unlocked for each of their employees.
What they mean by community is the support that their employees give each other to improve upon each other’s life situations given the results of the assessment. As one company mentioned, “There is no tool like the Poverty Stoplight. It is an important tool to know the employees that you are working with.” Another company added, “There is the information that each employee needs to fill out when starting at the company, but with the Poverty Stoplight, you can better understand the foundation of each employee”.
This community-building is not insignificant. Many companies reported that their employees had helped each other build bathrooms and start saving. In Summer 2018, the Poverty Stoplight ran a campaign across all of the companies that were their customers which was called “My Bathroom, My Kitchen, My Pride”. Many of the bathrooms or kitchens that were built were built cooperatively across employees. One of the companies we were at was specifically proud that there was a community event happening that day: employees were selling hot dogs at the office every day in order to raise money for the bathroom of one of their coworkers, which they planned to build together.
They wanted to help unlock their coworkers’ latent potential. And they were proud.
Homa Koohi, 2018 IMAGO Fellow, was featured on one of our client’s websites for the work she did this summer modeling systems to inform strategic decision making. Read more
IMAGO Executive Director, Isabel Guerrero at the UN General Assembly as part of the UN High Level Panel on Digital Cooperation. The panel is co-chaired by Jack Ma and Melinda Gates and includes academics, civil society representatives and senior government officials. Read more
When is comes to shifting behaviors, locally-driven efforts have the tools. Listen to IMAGO Executive Director, Isabel Guerrero featured on Episode 2 of societal platform podcast, “Sea Change”. Listen here
IMAGO is excited to announce the addition of two new members to our team: Greta Sloan and Johanan Rivera Fuentes.
“Just when the caterpillar thought the world was over, it became a butterfly. . . ” -proverb