Why You Can’t Create a Great Proposal From Behind Your Desk

Dr. Musaed Abrahams on a clinic visit.

Luke Shankland, Interim New Business Lead, recently returned to Zimbabwe with his team for a field visit. He was joined by Marcha Bekker, Head of New Business, and a new member of the team, Dr. Musaed Abraham, a medical doctor with public health experience.

After a preliminary visit to Zimbabwe earlier this year, our team had returned to better understand the local context in order to “right-size” a solution that can create maximum value. In our experience, this simply cannot be done well if you don’t get out of the office and see for yourself. We consider it vital to engage with many different stakeholders prior to contracting, in order to make sure that we are able to scope appropriate solutions that can then be refined and iterated on by our service design and engineering teams.

Our visit involved meetings with many key players. For example, the Organization for Public Health Interventions and Development (OPHID) is a potential key implementing partner. OPHID has been working in Zimbabwe for many years, primarily in HIV, and has excellent support systems throughout clinics across the country. They were aware of the success that the South African National Department of Health’s maternal health program, MomConnect, was having and thought that this would be an excellent way to improve maternal health locally. OPHID provided us with invaluable knowledge on how programs are implemented and successfully integrated into health systems in Zimbabwe.

Department of Health meetings are also critical in understanding the ambitions and budgetary constraints involved in providing the best healthcare possible. We were really struck by the Ministry of Health’s commitment to embrace technology as a way to extend and deepen the impact of their activities and budgets. Government officials were very impressed with the MomConnect Helpdesk and support, especially the possibility of real-time tracking and improvement of the quality of systems.

During these visits, we also meet with funders and donors who are looking to create as much impact as they can with each dollar spent, while also trying to open up avenues for innovations that may have bigger pay-offs down the road. Ideally, we also meet with Mobile Network Operators, as they provide the channels through which our services flow. Finally, and critically, we visit the end users — for this trip it was nurses and the moms in the clinics — as that helps us to really understand the ideal scope for the solutions that we propose.

There are many things we learn in visiting a country that we can’t learn from a Google search. What helps us “right-size” a solution?

For one, we can ascertain quickly what systems (digital or otherwise) already exist and how embedded they are. This is critical to starting to formulate some ideas on how we can integrate in a way that is simple for the end user and has a high chance of getting traction. For example, all the nurses in this clinic had at least a simple feature phone in their pockets, and all pregnancies were systematically captured in paper registries. This means that we can have confidence that a registration module that captures information about the pregnancies digitally (for tracking, messaging the users and getting their feedback) can be used by these nurses as long as it is on a USSD platform. At the same time, we noted that there was no wifi in the clinics, so we also know that we have to find a way to work with the MNOs, government and donors to make access to the registration menus cost nothing to end users, or we will still have a big hurdle for uptake.

Being in-country also allows us to get a very different view into patients and their needs than stats in a database will show. In this case, we can see right away that the current sources and channels of information between patients and their health providers are rudimentary at best, not updated very often, and not particularly engaging.

Speaking with the nurses and patients also helps confirm and nuance what we know from the national statistics. In Zimbabwe, almost all women are comfortable reading and texting in English. If we can reach most people in English, we can save on translation fees, reducing implementation costs that potentially free up resources to help support other new features that can maximize the platform’s impact.

Over the course of these visits, our teams are able to work with partners to make some high-level decisions about the roll-out that enable us to fund a project and get started. From here there are hundreds of decisions that need to be made ranging from technology features that impact the platform’s stability to word choices that will help improve the acceptance rate of the tool.

What is critical is that from the very first point of contact we are careful to include real empirical evidence, gathered in the field with partners and seen through a prism of user-first thinking. This gives us confidence that we are making a proposal that can create real value. And, once we get going, as long as we stay humble and nimble enough to react and change as we learn more, we know that we will create that value.