Where There is No Light

In Uganda, electrical power slinks out from a dam on the Nile River located by the town of Jinja in the east. Power lines follow the tarmac highways north and west to provide electricity for major towns across the country. Approximately 300 megawatts serves the entire country, less electricity than is used by one large data center in Silicon Valley California. Some sources estimate only 5-7% of Ugandans have access to electricity in their homes.

That's not apparent to a visitor who doesn't venture to "the village". Because power follows the highways, an outsider is unlikely to encounter the reality just a few hundred meters beyond the roadway. With the vast majority of Ugandans living in a rural setting, vital public services - schools, health clinics, and churches - are without power. And every evening, most go to bed in darkness or by the dim, sooty glow of a kerosene lamp.

Maternal health is especially impacted by the darkness. Labor pain has no respect for the time of day. When it comes, a mother is in danger if their midwife is unable to see clearly during delivery. This week I had the opportunity to partner with WE CARE Solar to administer the installation of a small solar power kit in the village of Kitswamba, near Kasese in far western Uganda. WE CARE has developed a small, portable and simple solar kit to aid health practitioners save mothers' lives. The idea is to demystify solar and let the user focus on the benefits, rather than the technology. The kit includes a mobile phone charging station, small LED lights, a AA/AAA battery charger, and portable head-lamps. These head-lamps are perhaps the most important part because they provide a large amount of light in a small area, getting the job done without using a lot of energy.


Installation
Though WE CARE provided the solar equipment, I asked the Uganda Ministry of Health to contribute to the cost of installation. The purpose was to ensure that the ministry valued what was being provided. I have been pleasantly surprised at their cooperation and enthusiasm for the project. In quick order they approved several hundred dollars worth of funds. The money covers labor and materials such as wire, light-holders, the panel roof stand and nails.

The success of the project depended in large part on the work of the senior administrative doctor, who oversees 25 health clinics in the region. He selected the clinic to receive the kit, convinced the ministry to provide funds, and was instrumental as an advocate. I would not have been able to do it without him.

At the end of the day, the clinic now has a small system to provide a place for mothers to give birth. Success is not guaranteed however due to two on-going issues. The first is cultural: the majority of Ugandan women give birth using traditional birth attendants (TBAs) in their own homes. The ministry is conducting a sensitization program to encourage women to come to health centers for their own safety. That process is ongoing and will take a long time.

The second issue is water. When I interviewed the on-site doctor, he said in the classic Ugandan way, "we have a problem of water". The clinic has a large rainwater tank, but no connection to a reliable source of water. Without it, performing births becomes much more difficult. I'm not sure how this will affect the Kitswamba health center. Some follow-up will be necessary to judge what has worked, and what is failing.

Change, change it's gonna come...

Those very words once left me numb.

I think most people's impression of Africa is of a place stuck in a rut - a place where war, poverty and corruption are the immutable facts of life. A place where children die of preventable diseases, and yet nothing can really be done because "some things never change".

All of these exist in Africa. But things are changing, and faster than most people realize. For example, I'm writing this blog post using a cellular modem from Orange on a brand new 3G network (and probably get better data rates than in NY or SF on AT&T!). This wasn't possible until just 3 months ago. Before that, I crept along on a mind-numbingly slow modem on the dominant MTN network. And even then, cellular modems weren't even available at all until just two years ago. Roads are improving too - the road to Kampala is still a complete mess, but large stretches are smooth asphalt. Each month it gets a little better. And the road to Kabale (2.5 hours away) has gotten much better since I arrived in April 2009.

Like in the developed world, consumer adoption of new products is spotty - but it's there. If something improves your life, there's a market for it. For example, the Uga Stove is an energy efficient wood or charcoal stove introduced a few years ago. I see them all over the place now, at least in shops. It appears to be a small part of the market, but there is definitely consumer demand there. And mobile phone adoption stands head and shoulders above any other consumer product - a 30% adoption rate in Uganda, a country with per capita income of $1300 (PPP, 2009 est.).

Things are changing across Africa - now is a time of opportunity. The continent's classic problems pose challenges, but are receding. Those of an adventurous sort may find their expectations far out of line with the reality they discover.

Live from Goma

Rushing home to beat the impending darkness, my Escudo was recently brought to a halt in front of a long line of Pajeros and Land Cruisers, the ubiquitous transport of Goma. My Suzuki emits a pathetic yellow halo of light in front of the car, making it barely adequate for travel after dark. I was in a hurry. The delay was exasperating and confusing, especially because this was not the normal location of a back up. We inched forward, and ten minutes later the source of the delay was found: a large power cable lay prone across the road. Now, in Congo any disruption to the normal flow of life is seen as an opportunity by enterprising individuals. This day that ingenuity was on display as young boys stood to hold the cable up on either side of the road - but only raising it up after the cars had paid a small fee, such as cigarettes. Thus, what elsewhere would be seen as a sign of municipal failure was here seen as a makeshift toll gate.

It's scenes like this that make Goma such a fascinating and exasperating place. One can only admire the ingenuity required to survive while at the same deploring the reasons such ingenuity is needed. But some people here are doing more than just surviving off of opportunity, they are creating hope for others. For example, my friends Pascal and Christine run a center for young people called Camme, which aims to build community and provide useful skills for children who otherwise have no chance to learn. The organization is completely home-grown and locally operated, with growing, enthusiastic support from the United States. Heal Africa, which I've mentioned numerous times before, is another example of a home-grown and operated institution that is working to bring healing and transformation to Goma and North Kivu.

Goma is a place in rapid transition, with a long way to go towards "normality". But it's clear, even over just the one year I've been able to observe, that things are changing for the better. It is a place on the fragile road to recovery, and a lot can still go wrong (and very much is still going wrong in the districts surrounding the city). But with hopeful, passionate people working to make their home a better place, things maybe can get better (as long as governments don't screw it up, but that's a tale for another day).

Integrated Design vs. the Constant Crisis

Back home I worked (and come April will continue to work) for a small mechanical engineering firm specializing in energy efficient design. Our guiding philosophy was the concept of integrated design, which means coordinating our work with the architect at every phase of design. It requires a lot of talking, coordinating, and patience because the process is iterative. For example, if I increase the size of an air cooling unit, I need to inform the structural engineer (to make sure the ceiling beams are strong enough) and the electrical engineer, who needs to know about the increased power demand. Changes can therefore have cascading, unpredicted effects. The process is hard, but the benefit is great - a well functioning, energy efficient building. And by eliminating potential conflicts before construction, it should also reduce the building's cost.

The alternative, traditional design process is top-down and sequential. The architect creates his building, then passes the plans on to the structural engineer. He then passes his plans to the mechanical engineer, and so forth. The process is simpler but doesn't allow for changes very well. Mistakes are also more likely to go unnoticed.

What does this have to do with water, Africa or development? I think it points to the problem of crisis-driven management, which seems to be endemic here. With few resources, there are a thousand fires to fight at once, to the detriment of long-term planning. What resources are available are short-lived and dedicated to specific purposes, which usually have more to do with the donor's priorities than the recipient's. Crisis-driven management precludes the forethought inherent in integrated design, resulting in a confused decision-making process. Many of the buildings and campuses I've seen in Uganda and DR Congo are the result - ad-hoc and confused places. Places that cannot use their limited resources efficiently because they are squandered fighting real (and imaginary) crises.

The solution is the implementation of "soft" improvements, such as a reliable revenue stream, master-planning, and improved personnel management. Only then can the wonderful physical donations (such as buildings and medical equipment) be put to full use. Until then they sit under-utilized, waiting to be integrated into the whole.

Developing Local Talent

There seems to be a Catch-22 in the development world: creating great programs often requires bringing in outside talent. But the very act of using outsiders inhibits the central process one is trying to nurture, namely the ability of a country to sustainably raise living standards. Outsiders take up jobs that might otherwise go to a local, thereby preventing current seekers from obtaining the position. They also inhibit investment in the education necessary to create the skills needed for the position.

So why are outsiders needed in the first place? An organization might have a few reasons for doing so. Firstly, the skills needed just might not be available in-country. One often will find this true in management positions or in positions requiring a very narrow skill-set. Secondly, using outsiders might be built into the way the organization functions. Some country-specific funding organizations (such as USAID, CIDA or KFW) require the organizations to which they’re contributing to place nationals in internship or paid positions.

But there’s another reason an organization might prefer outsiders. Frankly, it’s just easier to “get things done” when everyone in the organization understands each other, in all the small cultural details. Communication can break down in surprising ways when people think they understand one another but actually have no idea what’s going on. But this is the easy and ultimately self-defeating path for an organization to take. Most organizations focused on development should be focusing on creating skills that translate into high-value jobs, thereby creating the talent to let locals determine their own path.

Now for a confession – I’ve been thinking about this as I’ve worked as a volunteer in Uganda. The work I do does require some relatively advanced skills, but not skills completely unknown in Uganda. There are engineers here that could be doing the work I am doing. But as I described above, I work with an organization that places a large number of young people as interns. The funding has a two-fold purpose: to increase living standards in sub-Saharan Africa, but also to develop talent amongst its own nationals. There’s some self-interest tied to the altruism.

As a relative novice to the development world when I arrived in Uganda 10 months ago, I’ve gained invaluable experience during my time here. Experience that will inform a lifetime of decision-making. I’ve also contributed much to work here that might otherwise have been difficult to finish. But ultimately, a country will show the mark of progress when people like myself become redundant.

Innovation vs. the Boring Stuff

Over the last year or so, I’ve encountered a tremendous push for innovation in the fields of development and disaster relief. Organizations big and small are looking for the ideas that will catapult millions of people out of poverty. The next clever gadgets that will cheaply and quickly filter water, prevent malaria, and stop the spread of HIV/AIDS. These ideas are almost by definition just over the horizon – because once an idea has been around for a few months, it’s not that innovative anymore.

And so what happens to those innovative ideas? What happens when the clever creator has received his fellowship grant and begins to work out the tricky details? From what I’ve seen, the funding organizations have moved on to the next ‘innovation’ and left the creator to work out the Boring Stuff on their own. My experience in Africa has pointed to the Boring Truth – 90% of what’s needed is not innovation but ‘capacity building’ – training, logistics, and equipment purchases. Building systems that can scale up to help thousands more people.

Take for example the work my fiancée does in health care. She is deploying an innovative new computer and mobile phone-based system to track and process health claim forms. It promises to reduce overhead and errors, increasing the rate at which health providers are reimbursed by funding agencies such as KFW (the German development bank). And yet the health providers she partners with, while supportive of her new claims system, are more excited by the equipment and training she is giving as part of the research. They’re excited about the opportunity to purchase laptops, check email, and learn how to track patients on Excel. And they want to do it on laptops, not smart-phones, as are being so heavily touted in development circles. They want to do things like we do in developed countries. Given the option, they’re taking the boring stuff before the innovative.

To a large extent I’ve found the same to be true in the work I do with water. The basic work – building gravity flow systems – has been done since the Romans! It’s not exactly cutting-edge technology. But the great improvements are coming from the Boring Stuff – GPS devices to mark pipe and tank locations. Creating a database to manage the hunt for new sources of water. These behind the scenes changes are making it much easier to build and manage a water system.

But unfortunately the Boring Stuff isn’t sexy enough to get funding. The truth is, nobody wants to fund it because they can’t put their names on it. The funding organizations can’t brag to their peers and donors about the Boring Stuff - “look we gave $10,000 to train X health practitioners on how to enter and process data!” But when they put out $10,000 to fund the Next Big Thing, out come the press, book agents, and dollars.

This trend points to a glaring fact – we in the developed world are more interested in creating a system that makes us feel good rather than creating a system that provides the resources people in the developing world need to succeed. And I will be the first to confess of this – I want to feel good about myself just as much as anyone else.

Now, all this is not to say that innovation is inherently bad – far from it. It is only to say that innovation should not be the absolute focus, or even the primary focus. We need to support the Boring Stuff, the physical and educational infrastructure that will be the foundation on which the vast majority of people are lifted out of poverty.


Elsewhere, Blood & Milk has argued along the same lines…

Don't these people want clean water? (Part 2)

This morning I met with the head water engineer at the Millennium Villages Project in Ruhiira, Uganda. The MVP in Ruhiira is within a few kilometers of a previous ACTS project. In 2009 the community protected a spring that we are now considering for use in a new project. I dropped by the offices to introduce myself and see if we might collaborate with MVP.

The meeting was very encouraging; the engineer was excited to partner with a local NGO given our long history in the area and our existing relationship with the communities. And I was excited to find a talented Ugandan engineer with some new ideas about how to implement a GFS project. In my last post I lamented how difficult it is to make a project sustainable. This engineer suggested a different method gaining popularity in Uganda: private operators.

Over the years, GFS implementers have tried different ways to maintain the system after construction. In the past little thought was given to maintenance, the assumption being that the users would naturally have an interest in maintaining the system themselves, and would find the money and skill to do so. The number of broken systems littering Uganda speaks otherwise. More recently, implementers have created "tap stand" committees to perform operation and maintenance (O&M). These committees are formed of elected individuals from the community, and their function is to collect fees and perform maintenance. The engineer I spoke to today made a good point, one that I am now discovering: these committees often fade away after the construction is finished. Now, this is less of an issue for ACTS because it maintains a presence in the area for years - it's not going anywhere, and is therefore able to return to communities and encourage them to continue their commitment. However, this is not done without difficulty. But for most implementers, the system breaks down within a few years of completion. Therefore, some are now willing to license management of the system to a private operator. There are several advantages to this approach:

• Uptime is in the operator's interest: every inoperative tap means lost revenue. The operator therefore has an interest in a high level of maintenance.
• Smaller individual payments: instead of having a committee come door-to-door looking for 1,000 UGX every month, the operator can put locks on each tap, and then charge for every jerry can of water. The charge might be 40-50 UGX. The smaller payment makes a huge difference because of the short-term mentality people have here. It's difficult to save money for any period of time, even a month. Paying 50 UGX a time would likely be much preferable than a 1,000 UGX lump sum.

What are the drawbacks? I can think of a few:

• Who do you license? Choosing an operator would likely be a very political decision. What qualifications should they have? What criteria would disqualify them? How do you keep the selection process transparent and fair?
• Land issues: in ACTS projects, we ask the community to donate all land for tanks, pipes, and tap-stands. We do this because the system is for the community's benefit. But if now someone stands to make money, I don't think landowners would simply give away their land. And if they don't, then the construction costs could be much higher. Where would this extra money come from? Would funding agencies foot the extra cost, or would it be passed along to the community in the form of user fees? (user fees typically only cover operation costs, with the construction costs coming from a funding agency such as CIDA).
• Community consent: would communities agree to pay a private operator? Would they trust them? Tap-stand committees have the advantage of being composed of people from the community, whom users presumably know and trust.

Personally, I think the advantage to using a private operator could be great. Any task that can be reasonably performed by the private sector likely has a greater chance for long-term sustainability because it is in the operator's financial interest.