Strong partnerships and flexible thinking — lessons in innovation from Afghanistan

Surrounded by snow-capped mountains, Mehterlam lies in the valley formed by the Alishing and Alingar Rivers of Laghman Province

Have you heard of the saying: any problem can be solved when people unite? Shifo experienced this firsthand while working in Afghanistan.

In August 2017, we invited our partners at the Ministry of Public Health of Afghanistan (MoPH) and The Swedish Committee for Afghanistan (SCA) for our first Health Innovator Programme workshop held in our Stockholm office. The three day meeting was an outcome enabled by years of committment and collaboration between the partners and gave us a chance to discuss and reflect on what was accomplished during our project in Mehterlam district. A project which resulted as something completely different than what was the original intention.

When we first started working together in Afghanistan, we planned to implement an electronic immunisation registry based on a digital device, the MyChild App, which was to be installed at health clinics. Everyone was excited and we began adjusting the system to the national requirements. After several months of hard work on the development, when the finalisation of the MyChild App was almost complete, we received some information that nearly made us fall out of our seats.

Health workers in Afghanistan had raised concerns that their lives would be endangered if they took expensive gadgets with them while providing immunisation services in the rural and hard to reach areas. Shifo’s team immediately gathered and started figuring out a way forward. No matter what, we could not put the lives of health workers in danger.

Shifo’s solutions must make health workers stronger, not weaker.

With our experience of working in Uganda, and the challenges of implementing electricity-reliant interventions there, we had begun working on an alternative solution using Smart Paper Technology (SPT), which at the time was only meant to be tested and piloted in Uganda. The SPT solution was an idea that grew out of several issues we had experienced while developing the MyChild App. For instance, in Uganda the majority of health clinics did not have reliable electricity, and there were concerns with how local governments would be able to sustain an expensive eHealth solution.

After learning about the concerns of the health workers, we started considering if the SPT solution could also be a more appropriate solution for Afghanistan; and after long discussions with the team, it became evident for us that using SPT instead of the app would eliminate the security concerns for health workers in Afghanistan.

Internally, we were convinced that going with the SPT solution instead of the app would be the right thing to do. But we also knew that in making this transition we were putting a lot at risk. The project plan, allocation of resources and relationships and commitments made with SCA, MoPH and IKEA Foundation were all based on the app.

We set up a Skype meeting with the SCA leadership team to discuss our concerns. We discussed the risks and concerns raised by the health workers and that we could not jeopardise their safety. All we had at hand at the time, was an early stage prototype of the SPT solution. We presented it, unsure if the presentation had been clear and awaited a response.

After few seconds pause, Dr. Humayon Safi, SCA’s Health Programme Manager said, “because of SPT, I like this project even more. It is now becoming very interesting and I believe more in the sustainability of this solution for Afghanistan. This solution is far better than what we envisioned with MyChild App”.

There was no talk about SPT being too low-tech compared to the MyChild App or that we had to stick to the original plan. The team at SCA understood that SPT was the right and timely solution for Afghanistan, and that changing the approach was the right thing to do.

We discussed the changes this could bring to the project plan, and that we had to put aside finalisation of the MyChild App to focus all our efforts on fully developing the SPT solution. When SCA had a meeting with the Afghan MoPH, their leadership team had the same willingness to implement the SPT solution. We informed IKEA Foundation and given that their organisation is committed to long-term success and for every project to gain roots in communities, they were supportive of the radical change in the approach.

With all our partners on board, Shifo decided to park any further development of the MyChild App, and fully dedicate all energy on building the SPT solution for Afghanistan. After several months of hard work and determination, we were able to develop and pilot SPT in the first clinic in Mehterlam District. This was truly a triumph in uniting partners, health workers and other key stakeholders in Afghanistan, and joining together to build the SPT solution which is in use today.

Although, due to security reasons, Shifo’s team could not always travel to Mehterlam District, thanks to our partners and the roots established in local communities, we see how our solution is being used, and how SPT is able to replace the paper forms that were previously used by health workers.

Because of the strong partnerships established in Afghanistan, we have been able to innovate not only on the products and services, but also in the way local capacity is built and how we share knowledge with each other. Several new innovations were discussed during our Stockholm Health Innovator Programme workshop, as well as lessons learned which we carry with us in our future work together. We are glad that SCA, IKEA Foundation and Afghanistan’s MoPH share our goal in bringing solutions that have a good chance to make a systemic change in Afghanistan, and focus on long-term success.

We act as one team

When we are united towards the same goal, we can solve any challenges that come our way.