The Girls and ICT Technology Salon was a great opportunity to get an amazing group of thinkers and do-ers in the same room to debate around a particular topic. I'm Linda Raftree, Plan International West Africa Regional Office, Advisor for New Technology and Social Media. I was honored to lead 20+ people in a conversation revolving around 5 aspects I mentioned in my blog post on Girls and ICTs:

• Tension between participation and protection
• Online behavior is an extension of, and a potential amplifier of offline behavior
• Qualifying the digital divide
• Girls' involvement in developing and designing ICT solutions for their own needs
• Research on Girls and ICTs

My impressions from the Salon on the topics are below. These points and others raised in the Salon were fed into a high level consultation for Plan's upcoming 2010 Because I am a Girl Report (in process).

Does ICT education help girls?

Tension between participation and protection.

The main point here is that ICTs offer girls (and people in general) huge opportunities for increased participation and connection. However, due to the very real problems of on-line child pornography, child trafficking, child harassment, and cyber bullying, there is a strong push by some for more control and more restricted on-line use by children and youth in the name of protecting them.

Girls, however, can participate actively in self-protection if given the opportunity to learn and practice. Teachers and adults can play a role as guides, coaches and support systems for girls to feel comfortable with ICTs and also to help them navigate and protect themselves on-line. Globally, there are differing levels of openness to girls (and children in general) going on-line. In US schools, there seems to be a stronger focus on the dangers of the internet and a bigger resistance to ICT's in education as opposed to many 'developing' countries. Adults in these particular 'developing' countries seem to be less focused on the dangers of the internet and much more aware of the opportunities for connection, advancement, broadened educational opportunities and employment that ICTs represent.

Online behavior is an extension of, and a potential amplifier of offline behavior.

ICTs are not the problem in and of themselves - they reflect existing social issues, existing human behaviors. ICTs become a concern because they can exacerbate negative behaviors, such as bullying, pornography, early sexualization of girls, trafficking, sugar daddies, sexting, etc. Girls, boys, youth shouldn't be banned from using ICT's; they should be supported to learn to navigate these spaces and use them positively. There are examples of safe platforms where children can talk to each other ( eg., a 'sand box' to learn and be safe).

Girls (and boys) who are vulnerable online are usually also vulnerable offline, and this is where any intervention should begin. Life skills and self-confidence are critical, and these need to begin at an early age, before girls and boys even go on-line. There is a need to be aware of the law enforcement agenda which, to stop pedophilia, advises children not to go online, as opposed to preparing them for a lifetime use of ICTs. This can backfire when children go around these controls and don't know how to self-protect. It can subsume the positive aspects of cyberspace and ICTs and create unnecessary fear in parents and other adults. Adult-child communication and cooperation in protection/learning to navigate is critical here and preferable to outright prohibition of Internet access.

Qualifying the digital divide.

We often think about the digital divide in terms of economics, 'developing' vs 'developed' countries, but we need to also consider the gender divide, urban-rural divide, age divide, disability divide. These divides all need to be taken into consideration when working with girls and ICTs, and ICT related programs in general and we need to be quite specific when talking about 'access.' For example, girls working as maids in urban areas vs. girls living in wealthy homes in those same areas may have quite different access levels, though they are both 'urban girls.' We need to talk about the gender divide in terms of males as partners, not just as obstacles to girls' ICT access. ICTs can also be used to positively influence the behavior of men, and men and boys can be participants and partners in programs to support girls' access to ICTs.

Young people tend to be better than their parents and teachers at learning and manipulating new technology. This can be disempowering and threatening for adults. It also means that parents and other adults may be less able to provide support to children who are using ICTs and navigating cyberspace. Institutions that provide different services may need to be retrained to deliver their services for a younger population using mobile phones and internet as their usage grows, to go where young people, where girls are. For example, in Sweden, psychologists are offering services in authorized chat rooms. Children profess to feeling safer there as it gives them anonymity.

There is a perceived divide between the tech sector and the NGO/development sector, and also between the tech sector and the gender sector. It's important to bridge these disconnects for better work in all these sectors.

Girls involvement in developing and designing ICT solutions for their own needs.

It's important to think about whether girls are involved and engaged in voicing their needs and whether those who are designing ICT processes and solutions are listening and involving girls in them. A study in the EU found a difference in how boys and girls use technology by the level of middle school. Girls tend to then use ICTs for social purposes whereas boys think of them in terms of employment. It's suggested that girls need female mentors and role models that use technology and that work in the technology field.

Putting tech in the hands of women, for example, primary school teachers, can increase their status and strength as role models and enable them to carry out different and important roles in the community. To help girls feel more empowered, one program trains exclusively girls as ICT facilitators. The girls then train boys and the rest of the community at a big public community festival. This breaks down barriers and allows girls to take a leading role. A broad and representative range of girls should have a seat at the table to give ideas and input into research and design of technology solutions for their protection and their empowerment. This will make ICT initiatives more successful, relevant and realistic.

Specific research on girls and ICTs.

There is quite a bit of research on girls education. However, there is not a lot of specific research on girls and ICTs in "developing" countries or on the specific impact of a particular ICT or ICT-related process in reaching development objectives. Most of what is there is anecdotal. Funding for Girls and ICTs will likely be dependent on evidence gathered through monitoring and evaluation to prove certain approaches work and to discover the differentiated impact and role of ICTs in the process. It's quite difficult to unpack the impact of a particular technology given the variety of other conditions and elements in an initiative. How can ICT impact or influence be measured as something separate from reaching the broader goals in an initiative? And should it be?

There may be ways that skilled monitoring and evaluation experts can pinpoint whether a particular methodology that involves ICTs did have a greater impact on reaching goals; however, there are many other content variables eg., quality of training provided in the project, location, interest of participants, methodology, etc. that may be more important than the ICTs themselves in terms of impact.

If you'd like to lead a session of the Technology Salon, please email me today!.

In the developing world, girls need new skills and capacities for the 21st Century. They need to have the ability to be flexible, adaptive, and innovative to grow into positions of influence in their communities and countries.

Does ICT education help girls?

Yet - as we learned in the Gender Equality in ICT Education discussion - just getting girls to secondary school is a challenge, and once there, girls often shun ICT's unless they have strong mentors and female role models.

Please join us Thursday, January 28th, as Linda Raftree, Social Media and New Technology Advisor for Plan International's West Africa Regional Office, leads us in a discussion of three pertinent questions:

1. How can the technology and international development communities support the development of girls?
2. What role does ICT play in facilitating girls' growth?
3. And where are the concrete examples that prove ICT is a net positive for female progress?

We'll also try to identify case studies, partners, and further research around girls development and ICT for inclusion in Plan's Girls at the Cutting Edge of Change Report, now underway.

Improving Girls Development with ICT
January Technology Salon
Thursday, January 28, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts for a morning rush, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Addition January Technology Salon Events

I'm pleased to announce two other events supported by the Technology Salon in January. Each event is organized independently, so contact the respective event sponsors for details:

• NYC Mobile Tech Salon - January 20th
  MobileActive is organizing a conversation in New York City around how mobile phones can empower grassroots NGO's to effect change:
  
  Mobile Campaigning and Tools on a Shoestring
  Wednesday, January 20th, 6-8pm
  Digital Democracy
  109 W 27th Street, 6th floor,
  New York, NY 10001 map)


• USAID Daybreak Discovery - January 27th
  The Business Growth Initiative project of USAID is examining the impact of public-private partnerships in Asian & the Middle East:
  
  Economic Growth Alliances in Asian & the Middle East
  Wednesday, January 27th, 9-11am
  Smith School Business Suite
  Concourse Level, Room C-3
  International Trade Center
  1300 Pennsylvania Avenue, NW
  Washington, DC 20004 (map)

Competitive private companies know that just adopting the tools of ICT will not magically lead to productivity gains - it takes much change and investments in business processes to really reap the rewards that ICT can bring. But this basic tenant can be lost in the hype around specific devices or technologies.

So how can donor-funded projects that aim to increase enterprise competitiveness using ICT, make sure companies can take advantage of technological advances to create a sustainable advantage? Or even a strategic advantage.

In the November Technology Salon, we'll get an exclusive sneak peak at "How Information and Communication Technology (ICT) can Catalyze Enterprise Competitiveness", a brief from the Business Growth Initiative (BGI), that's not yet released.

In our forum, we'll be able to review and give our opinion on the brief's ability to inform those who design and implement donor-led ICT projects through its four sections:

1. A framework for supporting ICT as a tool to improve enterprise competitiveness for donor projects
2. Examples of framework operation in agriculture/agribusiness, tourism, and manufacturing sectors.
3. Lessons from donor-initiated ICT projects with greater impacts, more sustainability, and larger scale
4. Recommendations to donors on creating better ICT-enabled business and competitive environments.

Please join us Thursday, November 19, for what will be a lively discussion around enterprise competitiveness and donor funding at the intersection of technology and development. We'll be led by Michael Ducker, an ICT development specialist focused on supporting ICT, entrepreneurs and innovation.

Can Donors Improve Enterprise Competitiveness with ICT?
November Technology Salon
Thursday, November 19, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts for a morning rush, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Whew, I think this was one of the most intense and contentious Technology Salons yet! After an hour of lively discussion around what "sustainability" and "scale" means to information and communication technology programs, we were just starting to pull back the layers around the topics.

(Want to attend the next Technology Salon? Then subscribe to our meeting announcements to be invited.)

Sustainability Means Many Things

We quickly found that there were many definitions of sustainability and scale. Maybe too many, as these terms differed wildly across implementers and donors. It was even suggested that in the realm of ICT, development has an unbroken string of failures since none of the projects have scaled to the extent of mobile phones.

Before we cast out the entire body of work to date, much of ICT4D is done as experimentation - there is an expectation of failure while we figure out models that would work. At least we have mobile phones to show that there are ICT models that can scale, sustainably.

Government supported project sustainability

Donor Funding is a Sustainable Model

Mobile phones also show that beneficiaries must pay for at least a portion of ICT services. This both validates the service and makes it responsive to the beneficiaries. But they do not need to pay for all of it. In many cases, long-term external funding from donors, government, foundations, etc, can be the cornerstone of a sustainable program.

Great examples of this are in the education and health field. Universal primary education is a public good in many countries - paid in full by government entities which themselves can be funded indirectly by beneficiaries (taxes) or external funders (multi-lateral donors).

In the health field, health information is often created and supplied via free-to-beneficiary models supported by donors. And before anyone thinks donor funding isn't sustainable, there are multiple countries that are in their third or fourth decade of multi-billion dollar multi-lateral donor agreements.

Different Time Horizons for Sustainability

Which brings us to time horizons. In development, we are often looking at projects with a three-year funding commitment, while in domestic private industry, three years is considered the initial start-up phase, with five years the usual time horizon for profitability. In the developing world, even successful organizations like Kick Start, consider 10 years a more reasonable break even benchmark.

So there is a gap between this pilot/start up phase, and a self-sustaining business model, that isn't bridged by current financing. Donors are reluctant to fund "on-going operating costs", yet venture capitol sees development investments as too risky, and development financing organizations rarely see above microfinance or below multi-million dollar financing.

Add to that gap, the reality that donor project requests don't give much guidance around what they consider sustainability to be in their given time horizon, nor do many donor staff have the training to evaluate what models would be sustainable anyway, and implementers are often left to create fantasy sustainability plans and financing.

Are 400,000 Uruguyan XO's sustainable?

Sustainability Changes Over Time

In sustainability plans, there is also often the expectation that sustainable business models do not change, or if they do, they should always go from a donor or publicly supported program to one privately funded. In education, its often the opposite.

Educational innovations, like computers in classrooms, start with private schools which are funded through parental school fees. Then, once the benefit of that innovation is considered a basic necessity for a quality education, the government is expected to scale it up to all public schools.

It was suggested that while education and healthcare could be public goods, industries like finance or telecoms didn't need public support. Then we were reminded of the recent troubles in the financial sector, and its billions in bailout funds handled by Central Banks around the world. In addition, Universal Service Funds helped spur innovation in rural telecoms that have come back to benefit all users.

How Do We Scale, Sustainably?

While we didn't answer this question today, we did agree that the market works in the developing world. Mobile phones prove that if there is beer money, there is money for information and communication technologies. People will find a way to pay for what they consider necessities. Our challenge is to keep innovating, and nurturing that innovation, until we find another model that scales - lest ICT become a one-hit mobile wonder.

At least we can celebrate one small step towards scale - the Technology Salon is now replicated with Mobile Active's the NYC Mobile Tech Salon. And like any good model, we've adapted to the local conditions - they're meeting in the evenings, over beer, instead of the morning over donuts. Next, a San Franciscan conversation.

What do you think is the single most important issue at the intersection of technology and development? Recently, the twin issues of sustainability and scale have come to the forefront in many conversations, with both peaking in October in several forums:

• Sustainability: Besides being the buzz word de jour, this month's Educational Technology Debate is focusing on ICT4E sustainability and at an IADB meeting, one discussant suggested that virtually everything that USAID does was unsustainable.
• Scale: Both Joel Selanikio of Data Dyne and incoming mHealth Alliance Executive Director David Aylward recently reminded us that while there is an incredibly vibrant mobile phone industry, after 15 years of PDA and mobile phone pilots there are few, if any, scaled mobile technology development projects - most are small, non-sustainable proofs of concept.

But what do we mean by "sustainability" and "scale" in ICT4D?

Is it only about private income streams?

Now here's the real issue. What might be our shared definition of both "sustainability" and "scale" with information and communication technology programs in international development?

Is sustainability when projects are self-funding, like a for-profit business, and is scale reaching an entire country? Or can sustainability be reached by a dedicated funder, like government, and can scale be just a community large enough to support sustainability?

Also, is sustainability and scale different for different sectors in the developing world? Could donor support be a valid business model in education or health - two sectors dominated by government support in developed countries - while finance and agriculture are required to source private sector income streams?

Please join us Thursday, October 22, for what will be a lively discussion around sustainability and scale at the intersection of technology and development, lead by Kerry McNamara, a Scholar-in-Residence at American University and a noted expert on technology and development.

"Sustainability" and "Scale": What's that really mean for ICT4D?
October Technology Salon
Thursday, October 22, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts for a morning rush, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

In our September Technology Salon, we took on James BonTempo's pertinent question of What Does the "m" in mHealth Really Mean? in a spirited debate with technology and development practitioners.

We were seeking a better definition of mHealth than the current focus on devices, and specifically the hype around mobile phones. As one participant bemoaned, it seems that every health project with a mobile phone or PDA, no matter their usage, is now an mHealth project.

(Want to attend the next Technology Salon? Then subscribe to our meeting announcements.)

Is this mHealthcare? (photo: Data Dyne)

So we sought to put parameters on what could be called an mHealth project, and through that, come up with a new definition for mHealth. After an hour of vibrant debate, we developed these four aspects for mHealth projects:

As we looked at the four requirements listed above, we realized there needed to be one more change to the concept of mHealth, and that's the limitation of the word "health". We're really talking about a holistic approach to improving health outcomes, with an end-to-end communications infrastructure, so we're really talking about mHealthcare, not mHealth.

Yet even mHelathcare is still a subset of the more holistic eHealthcare, where these field-focused solutions tie into national electronic healthcare systems that can empower changes in people and policy at the country level.

Back down at the Technology Salon level, we concluded with a simple hope for our discussion. That this exercise would help each of us better discuss and explain what the "m" in mHealth means in our respective professions and promote a more inclusive and pragmatic concept of mHealthcare to the larger development and technology communities.

In a recent Twitter exchange, James BonTempo asked a very pertinent question about the current mHealth buzz:

The only mHealth definition? (Img: DataDyne)

Should definition of #mHealth include devices (wondering specifically about netbooks) or simply the concept of mobility?

He followed up his initial query with a simple poll that asked if mHealth should include a list of specific platforms or just the concept of mobility. So far, Twitterers agree, the "m" in mHealth should represent mobility, regardless of form factor.

But that's different from the general notion of mHelth, represented by the mHealth Wikipedia entry, which focuses on equipment "mHealth is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices"

In our next Technology Salon, we'll explore what the "m" in mHealth means for those who actually practice mHelath, with these field-experienced experts:

• James BonTempo who says, "Ask someone about #mHealth they'll mention (smart)phones and PDAs. But who's counting users with laptops? After all, they are "mobile" devices."
• Josh Nesbit who says, "I tend to frame everything in reference to end users, so the "m" describes the mobility of healthcare workers, facilitated by devices."
• David Isaak who says, "I am definitely in the "m" in mHealth being everything mobile. I usually use the acronym "mICT" for a broader view."
• Wayan Vota who says, "Ask those in #mHealth hype and they say (smart)phones. Ask those who DO #mHealth and they talk about holistic ICT ecosystems."

But enough about what the four of us think. Come out Thursday morning to give your own voice to the conversation. Our goal: a shared definition of mHealth from an implementer's perspective, and a better understanding of mHealth for everyone involved.

What Does the "m" in mHealth Really Mean?
September Technology Salon
Thursday, September 10 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts to wake you up, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

In last month's Technology Salon, we looked at Health Information Systems that improved reporting systems for governments. But what about improving patient care? Giving clinicians support and feedback at the point of care can bring about immediate changes in diagnosis and treatment, and start the reporting process with high-quality data.

Baobab Health Partnership is using innovations like touchscreen clinical workstations and unique power systems to guide low-skilled healthcare workers through the diagnosis and treatment of patients according to national protocols. They've even developed a HIV eVCT System - a locally designed and implemented solution to advance medical care in real time for Malawians in resource-poor settings.

Here is a video of their electronic records system in action registering new patients:

We'll have Mike McKay, former country director, lead us through their technology choices and into a larger discussion around improving feedback loops inside the clinic, not just above it. We'll also have a hardware show and tell to get acquainted with the technology.

Improving Patient Care with ICT: A Malawian Example
July Technology Salon
Thursday, July 23 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts to wake you up, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

In this month's Technology Salon, National Health Information Systems: Who Uses What, Where?, we discussed a recently-completed study by Vital Wave Consulting that surveyed the global landscape of national HIS ecosystems in the developing world. The overall outcome may surprise some development practitioners, but its well known to IT experts: basic change management matters more than fancy technology.

(Want to attend the next Technology Salon? Then subscribe to our meeting announcements.)

Brendan Smith started the Salon with a great overview of the challenges faced by contemporary paper-based national Health Information Systems (HIS), from delayed initial reporting, to transcription errors, to the massive time commitment required to analyze the data. In fact, Jamaica clinicians have over 500 forms to record their activities, and Indian clinicians typically spend every Saturday recording the events of their week.

Health information system in practice

With the obvious drawbacks to paper systems and the allure of massive efficiencies expected with automated ICT-based systems, many countries are looking at or actively moving to electronic national Health Information Systems. Vital Wave Consulting identified 5 levels of sophistication that countries go through in their HIS automation progress:

1. District Routine Health System Data Reporting
   Manual tallies from activity registers using redundant paper forms reviewed only at higher Ministerial levels
2. Optimized District Health Data
   Still paper-based, but indicators rationalized and simplified to reduce collection burden and increase data quality
3. Electronic Storage & Reporting of District Health Data
   Manual data entry from log books to electronic forms for stronger analytics, requires basic computer literacy and continuous tech support
4. Incorporation of Operational IT Systems
   Automatic data capture in routine transactions where indicators are automatically generated with access to information from all levels
5. Fully Integrated National Health Information Systems
   Data from all key sources (public & private), governed by explicit national policies, creating a strong data-driven culture with sense of ownership at all levels

They also categorized the studied countries into each level, with one notable exception. Not a single country made it to Category 5 - Fully Integrated HIS. In discussions with Technology Salon attendees, it was our opinion that no country - developing or developed - is in that category either. And skipping ahead to Vital Wave's report conclusions, shows us why.

In their analysis of national HIS efforts, Vital Wave found five key metrics to success, which should look familiar to anyone involved in change management for large organizations:

• Integrate an HIS in conjunction with broader health system reforms
• Streamline data collection and reporting as a first step
• Plan for hidden costs and staff resistance
• Cultivate a data-driven management culture
• Create change management and incentive structures

To bring home the point about change management vs. technology, let's walk through the India HIS example Vital Wave gave from their own field research.

India's National Rural Health Mission is rolling out a health information system to gather data from the block level - an administration point, usually a hospital-type community health center, that has local and rural clinics beneath it. These clinics will still use a paper system, but 3,000 data points have been reduced to 200. These paper forms will be entered by dedicated data entry staff at the block level, and eventually block level clinicians and higher will enter their own data directly.

Category 3 advance

While this system will greatly increase accuracy, timelines, and efficiency overall, Ministry staff were the most proud of the data point reduction. It was seen as the greatest challenge and accomplishment of the HIS - more than even the computerization of the process. In fact, that single act alone took the personal intervention by India's Health Secretary as there was huge resistance to giving up indicators.

Each indicator was seen by the person tracking it as integral to their work, maybe even to their continued employment, so reducing the number of indicators, while creating benefit for the whole, also created intense fear and uncertainty in the Ministry rank and file. In addition, the reduction of errors also posed its own problems. With more accurate information, long-held assumptions, some of which careers were tied to, were revealed to be false. Salon participants reported instances of Ministry staff, even Ministers themselves being fired when the new HIS data reflected a different reality than previous systems.

So deploying a national health information system successfully does not require the high-end technology resources available to richer countries. The major hurtles to successful national health information systems are human, not high-tech. Having a clear goal of improving data quality, and a solid change management approach to achieve is the critical success factor. And this can be accomplished in countries as varied in resources as Belize, India, and Sierra Leone.

It often seems that there are as many health information systems (HIS) as there are governments - from custom legacy systems to new web-based applications. But which governments are using a HIS, what system do they employ, how has it helped them, and and what can we all learn from their experiences?

Health information system in practice

For the next Technology Salon, we'll focus on a recently-completed study by Vital Wave Consulting that surveyed the global landscape of national HIS ecosystems in the developing world. This study was sponsored by the Bill & Melinda Gates Foundation to:

1. analyze the landscape of national HIS ecosystems
2. review prominent examples of HIS implementations
3. identify critical success factors to strengthen health outcomes

We'll have Brendan Smith of Vital Wave Consulting lead us through the report highlights, India case study, and an accompanying online HIS forum with an engaged discussion around the various health information systems, fueled by a hot coffee and Krispe Kreme donuts sugar rush.

National Health Information Systems: Who Uses What, Where?
June Technology Salon
Friday, June 26, 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that this Salon is on Friday morning, instead of Thursday, seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.