Stockout activism

by Anjali Sastry on October 31, 2009

How to deliver more, and better, health care in resource-limited settings? At the MIT Sloan School of Management, we treat the question as an academic one, but we’re not just academic. We’re also involved in action because we work directly with organizations on the front lines of delivering health care in sub-Saharan Africa to deliver jointly-designed solutions to their pressing health delivery challenges, and a dozen teams of students will be working on site in January to do just that.

In the classroom, we’ve been looking at business models, organizational design, funding and finance, and in the weeks ahead we will learn more about various ideas for addressing the implementation gaps in global health. But it’s also clear to us from our own conversations over the past month that if the appropriate personnel, supplies, and medications don’t reach the people who need them, everything else is moot–the models and funding are means to this end.
stopstockouts.orgStockouts of essential medications are in some ways the clearest indication of the extent of the need–and the extent to which health systems fail to meet citizens’ needs. An activist view of the situation and the the extent of current needs is offered by Stop Stock-outs, a campaign bringing together a variety of organizations to advocate for changes and document the need: for more in the campaign’s goals, see its statement.  Take a look on the site at their “Pill-Check Week” effort to document stockouts (map); it’s linked to an innovative SMS-based tool and open-source software, as described in a recent  article in the technology press; here’s another story and a recent thread in ghdonline.org/tech. The stopstockouts.com site also includes country-specific news, factsheets, and resources.

This got me thinking about ACT UP, the influential AIDS activist organization. In ACT UP NEW YORK: ACTIVISM, ART, AND THE AIDS CRISIS, 1987–1993, a current Harvard Carpenter Center for the Visual Arts exhibit, you can learn more about the organization’s approach and message. ACTUP exhibit poster (partial)And at MIT Sloan we were reminded of the power of ACT UP when Dr. Jim Kim, in a 2007 Dean’s Innovative Leader Series talk, linked their activism to his telling of why the Global Health Delivery Project needs the contributions of experts in management, systems, and logistics. In many ways, this talk was the call for our current class and related work.

So, here are my questions. What’s today’s version of the AIDS Coalition To Unleash Power? What role could researchers, faculty, and students play? Where does advocacy fit in?
Check out the exhibit at Harvard, which includes gallery talks, as well as a series of linked talks at the Harvard Kennedy School of Government’s Carr Center, and  some thoughtful comments about Stop Stockouts at the Global Health Ideas blog. Then come back here and share your comments!

{ 3 comments… read them below or add one }

Andre November 3, 2009 at 7:39 am

To your question: “What’s today’s version of the AIDS Coalition to Unleash Power?”

Today Global Activism needs to do three things clearly: (1) Factually show the extent of the need, (2) Focus on what the customer actually wants, and (3) Show that it is possible to meet what the customer wants.

(1) Factually show the extend of the need:
As a native African the lived in Africa for half my life, I often see that the portrayal of Africa through activism is almost a form of propaganda. Very seldom is it fact based, and when it includes facts those facts are often not represented in context. One frequent example is the tendency to gather facts from one country and then talk about those facts as if they apply to Africa as a whole. Africa is a continent with vast differences and needs: Botswana that derives most of its wealth from diamonds, is not the same as Uganda whose main industry is agriculture, and neither is like Nigeria that has substantial oil resources. To factually show the need for Health in Africa, activists should visit the vastly disperse continent and if possible use on-the-ground customer reporting to show the unique health needs that customers in each country face. One method of gathering on-the-ground customer reports could be through cell-phones (e.g. see http://www.rapidsms.org).

(2) Focus on what the customer actually wants:
Currently most interventions in global health are donor focused – I believe that activism could be used to switch the tables and to change the focus back to the customer. It is very ineffective when a well-meaning donor thousands of miles away from an African country, identifies what they (according to their sources on the ground) see as a health need and then funds it. When you visit Africa you see many examples of these donor-funded projects that once provided some service, but that now stand empty, I would propose that many of these projects never actually met the customer need, and if they did when funding dried up their business models were not sustainable.

(3) Show that it is possible to meet what the customer wants:
In addition to factually showing the need and changing the focus to the customer, activism should also demonstrate that it is possible to meet what the customer wants. I don’t think activism can continue to focus on simply building awareness, I think activism in the future should include publicizing sustainable locally developed solutions. So that when foreign individuals hear of the need, they can also hear of local solutions. Then hopefully rather than taking the easy road of providing no strings attached aid funds, they would chose to involve themselves personally and invest in sustainable local solutions that meet what the customer wants.

Anjali Sastry November 3, 2009 at 5:49 pm

Andre, It is interesting to think of technology as a tool for better data and for voice–for both expressing needs and sharing solutions–within the community and more widely.

Two quick follow-ups: the Stop Stockouts approach uses exactly what you advocate–their tool is frontline sms. In the locations that you see on the Stop Stockouts map, it’s the community members themselves who are gathering and smsing in the data. So it’s very much locally rooted: on-the-ground consumers are a key part of the activist movement, at least from what I can tell.

Second, I really appreciate your flagging the problem of collapsing all of Africa into one monolithic entity. To this point, we’re urging everyone to take the context research, conversations with people from that country, explorations of history, literature, and culture seriously. For a searing commentary on how Africa is portrayed in the West, consider the perspective of Binyavanga Wainaina, a Kenyan writer whose piece “How To Write About Africa” is a must-read. If you don’t feel like reading it, you can even watch an actor reading it on youTube.

Andre November 9, 2009 at 8:09 pm

Hi Anjali, thanks for the links – indeed agree that Africa is often inaccurately stereotyped. For an interesting TED talk on this see a link that a friend sent me The danger of a single story by Chimamanda Adichie.

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