 My name is Paul Kenningham, I'm delighted to be with you here today and I'd like you to welcome in an appropriate way my distinguished panellists, so I'm happy to welcome Chris Fabian who's principal advisor in innovation for the UNICEF office of innovation, Sylvia Sferego who's director of the frugal innovation hub at Santa Clara University and last but by no means least your own Sonia Sachs director of the health sector's center for sustainable development of the earth Institute of Columbia University. I'm going to start by introducing you to IEEE and the work of the Humanitarian Activities Committee. So IEEE is a global association of scientists, technologists and engineers. We have over 417,000 members in 160 countries. The diversity and breadth and depth of our technological scientific and engineering expertise I hope is illustrated by the number of technical societies and councils that we have and student membership is something extremely important to us. We have 120,000 members and I'm hoping that at the end of today we will have more members. So how do we deliver value to humanity? We organize over 1800 technical and scientific conferences a year. We publish over 4 million technical documents. We're responsible for over 200 top tier sighted periodicals and we're actively involved in standards the one of which you know best is Wi-Fi. In terms of social impact we add value in four key areas. Global public policy, sustainable development, work by volunteers, continuing education and certification and a critical area from my perspective for all of us today, ethics and technology. So the work of the Humanitarian Activities Committee which reports to the IEEE Board of Directors is to strengthen the capacity and impact of IEEE volunteers contributing in sustainable development activities around the world and we do that in a number of ways. First of all raise awareness. It's amazing the number of scientists, technologists and engineers who don't realize the contribution that they can make to the wider society by facilitating appropriate levels of education for people at different levels of experience to provide funding for relevant educational community building activities as well as projects and events that involve IEEE. We support multi-stakeholder collaboration to IEEE site or special interest group in humanitarian technology and we are building strategic partnerships around the world to facilitate impact because together we're stronger. So this just gives you a snapshot of the type of activity that HAC has supported just over the last two years. Site I hope is something that some of you will go online and join. It doesn't cost you anything and you don't even have to be an IEEE member. So the special interest group in humanitarian technology is designed specifically to facilitate collaboration between IEEE and non-IEEE members and we currently have site groups in over 40 countries in the world addressing a variety of different domains including agriculture and nutrition, education, health communication and of course energy. IEEE volunteers are supporting the realization of the sustainable development goals in a variety of different ways and because we're such a large organization the saying goes that sometimes the left hand doesn't know what the right hand is doing and to address that potential gap we're carrying out a comprehensive landscape analysis of activities in which I IEEE volunteers are involved around the world and while that work is not complete I can share some initial results and what's striking is the breadth and extent of areas in which I IEEE volunteers are making a meaningful contribution to societal impact. I think that reflects the breadth and depth of technological, scientific and engineering capacity that's available. You can see and it's probably no surprise that there's a huge amount of effort going on in areas including education, energy, sustainability, inequality, work and health but there are other areas. So my invitation to you today is that if you're not an IEEE member why not consider joining us and even if you don't want to become an IEEE member why not consider collaborating with us. Perhaps we can work with you to make life better for all of us. So it's my pleasure to now hand over for each of my panelists to give you a short introduction to themselves from the role perspective starting with Chris. Thank you so much Paul. Actually so we wanted first of all for you to introduce yourselves to us for a second. So can you raise your hand if you're in the tech space? Are you coming from technology? We all kind of come from technology today. Who's coming from academia? Okay public sector government. Everybody's too embarrassed to raise their hand there. Okay that's fine. My name is Chris. I work at UNICEF. I run a small team called UNICEF Ventures. We're going to all talk a lot about some of the projects that we find most exciting and the philosophies that we find underpin those but I just wanted to give everybody a quick two minute overview of what our team does at UNICEF. It's a bit of a unique group and you can find out more about it by using the Google and typing in UNICEF Ventures and you will see information. But I wanted to tell a story from about four years ago which was during the Ebola crisis in Liberia. When our team was there when I was in Monrovia in about this time of year but in 2014, we landed there. We had no information about where the disease was spreading. This was kind of at the peak, right after the peak of it. So it was going down a little bit but we couldn't tell that at that point. And we were working in the UNICEF office working with young people trying to figure out where this disease was moving and it was something we didn't even know a lot about as responders, as emergency responders. And our team was in Monrovia for about two months and then in Sierra Leone after and in Guinea. And one of the things that we kept finding was that this lack of information for us, for the government and for the people who are most affected was the single factor that impeded our ability to get in front of this horrible and scary epidemic. And we worked with young people in Monrovia and built up a system off of an open source platform that we built before. So we have a system called UReport in UNICEF. UReport has about five million active users, young people who send in text messages and get and receive information. And during the Ebola crisis in Liberia, we built up a version of that because it's open source. We could build it quickly. We could work with the Liberian telcos and with other UN agencies. And within about a month, we had 10,000 young people from throughout Liberia texting us in the government information about whether their school was closed, whether there were cases in their areas or what they thought was most important. And that type of system, that type of real time information gave us a fundamentally different way to approach a problem that's increasingly present, right? Pandemics are something that's now here in the world at a speed, size and velocity that we couldn't have imagined 50 years ago, as is climate change, as is job loss, as is blah, blah, blah. It's a dark world we're living in. But the idea of real time information and the idea of having systems that can provide us with that type of real time information is central to the work that we do in our team. So I think we'll talk a little bit more about that later in the discussion today, but very excited to be here and share the stage with these other distinguished guests. Thank you. Thanks, Chris. Are there slides there? You can just stand from there. Sylvia. Oh, you have the slides are here. Yeah, please. I'm the clicker on the desktop. Thank you. Hello, I'm Sylvia Figueira. I work at Santa Clara University, which is a small university in Silicon Valley in California. And I'm the director of a frugal innovation hub. And I'm going to talk a little bit about what we do and what Santa Clara engineering students do. So we're part of a school of engineering. And we have a long tradition of working on humanitarian projects. So there's students in Santa Clara, we have this idea of engineering with a mission. So we attract students that are interested in doing, you know, something good somewhere. So with that in mind, my job is basically to connect them to the need. So we have lots of partners around the world and locally actually in in California as well. And I form groups with you know, an advisor, a faculty advisor to do a project. And so I'm just going to give you some of the an idea of the projects we have just real quickly to you know, to give idea of the how broad this can actually get and how connected we are with the SDGs. So some years ago, some a couple of students went to Benning and deployed a solar microgrid. And, and okay, so people do that all the time. So what's new about that is that there was somebody in there in the field in the community that actually took over and created a business. So now there is a business that provides, you know, power to the community. And you know, they pay a little bit as they can. And now, you know, the community actually has power because of that. So this is basically, you know, the kinds of projects that do always connect with somebody in the field. Another one is a refrigerator. So again, organization contact us saying, we have a problem, you know, people don't have a lot to eat and they throw up throw away food because they don't have a fridge. We need a low cost low power fridge that people can actually afford. So this is another project in mechanical engineering where the students actually came up with a pilot for that. And it's very low cost, it's very low power, and it can work when it's really hot outside. Another example is a library system. So there is an organization called FAVL. They created several libraries in Burkina Faso in Uganda and Ghana in rural communities. But they didn't have a library system. Those are expensive. And again, a team of the students actually worked out on creating one by just using a phone and a cloud so that the libraries didn't have to invest in any equipment or scan or anything like that. The mobile device can actually, you know, help out in lots of different things like that. And this is one example. Another one is Wakabi. Again, a group of students came up with, you know, this idea of developing a Uber style kind of system for rural Ghana where people don't have access to data or Wi-Fi sometimes or GPS for that matter. So basically the whole system is SMS based and we donated the code and helped to create a social enterprise called Wakabi. You can Google Wakabi. There they are operating with a code that we donated and got basically adapted by local developers. And just to, you know, to finalize here, considering that this is like a combination of SDGs actually, last year two students went to Uganda and deployed an aquaponic system. So again, there was an organization there in the field that wanted to help some women. And the whole idea was to create, you know, this system on campus in California and then go to Uganda where they recreated with the local women so that they would learn how to do it and how to teach other women. So, and then the idea is to empower them. And this is already happening so the women learn how to do that and they are teaching, you know, other women in the same community and in another community. So just, this is just to give you an idea. We have lots of projects like that and if you actually have an organization and need the project, need engineers to work on some kind of technology or innovation, you know, you can rather talk to me after the conference. Thank you. Thank you. Sonya. If you don't mind, I'll stay put because I'm comfy cozy. I'm Sonya Ehrlich-Saxx. I'm a pediatrician and a chronologist and a public health specialist. I work here at the Earth Institute at the Center for Sustainable Development where I'm in charge of health systems for low-income setting. I was very attracted by the idea of the Earth Institute when we first came here in 2002 and the main reason I liked it is I think what fuels most of us now which is that there are serious problems in the world and it's dealt with usually by policymakers and the policymakers are not usually the ones that are the most well-informed evidence science-based people and then you have academia, wonderful universities like this one and others that have department-fulls of scientists steeply deeply steeped in knowledge and facts and findings and results but they have no way of influencing the policy and so one of the reasons my husband and I came here is because of the opportunity to have the epistemic community the university full of Chuck full of scientists and the policies such as the you policymakers like at the UN to work together on solving real-world problems. What it does for the policymakers is it avails themselves the university knowledge base what it does for academia I think is also very interesting because it focuses the mind on what I think is pretty important which is to solve the most painful or the most challenging problems so the Earth Institute here focused mainly on extreme poverty and climate change and social inequity and some other topics and what I liked what it does for the academia is that it focuses on some actionable problem and that it requires an interdisciplinary approach so for instance I am just a garden variety pediatrician and a chronologist but working in Sub-Saharan Africa if my goal was to improve child survival and child well-being I better work with and try to understand something about agriculture tropical agriculture something about infrastructure schools because to have a healthy child at the end of the day requires all of these things you need transportation ambulance clinics schools food systems a social security system caregivers etc so it forced us at the Earth Institute to work together if to to work towards common goals we took on in the beginning the millennium development goals as you all know which were the goals promulgated by the all the countries convened at the UN and it focused on low-income setting as opposed to the SDG goals which are now broader both in scope in that it involves well poor middle income and rich and also in subject it's not really just to close the economic gap but also to the SDG is also focused on social equity as you all know and climate change which is what we've been all talking about for days and years the specific project that I was involved in was something that we started in 2004 called millennium villages project which was a project to see if the millennium development goals can in fact be reached by a 10 year mile milestone which was 2015 in very war very poor and rural areas of 10 countries in sub-Saharan Africa where we addressed all of the underpinnings of poverty so we address food production health access to health access to education infrastructure and business development in really the poorest remotest areas of 10 sub-Saharan countries and what my particular focus was not only just to bring in the interventions like the bed nets or make sure that children get immunized but my focus was on systems building can you have a low-cost but high impact health systems that keeps mothers alive and children under five from dying under the age of five can you have a system that delivers the health care in these very low income setting and then the last part of our effort is scale up what I call scale apology okay so these pilots show that they're certain that these systems can be made to work but now how do you scale it up and that's what I'm working on with others of course in many instances in basically the idea of universal health coverage thank you in terms of my own background I'm director of the ICT Africa Institute I'm also visiting fellow at Racksome and Glenmore University in Wales and a visiting professor at IUM in Namibia so the ICT Africa Institute is a strategic partnership with ministries of innovation science technology currently in 18 African member states it's supported by the African Union the European Commission was founded in 2002 and it's open to all African member states and I'll talk about some of the implementation work that we've been involved in as we continue this dialogue so maybe the easiest place to start since we're clearly looking at something that's very complex we have a panel with very complimentary expertise and I think some interesting insights to share in terms of how they go about these issues so maybe we could start and with Sylvia maybe you could do a deep dive into one specific project and maybe provide a little bit more insight in terms of how technology was leveraged to help achieve and the STGs okay I think I'd like to talk about the last one because it just happened and so the idea was that we had this organization we always work with another organization so we believe in this idea of helping the helper so we met these women that were helping these women in Uganda so that's the last project I referred to and then she this person here she's located here in the US and she told us you know I really want to help these women I know I think they you know we can empower them to create their own business to basically have their own system and basically you know plant and and fish at the same time so connect them with you know their students and a professor that that's her specialty and they work it in a whole system to basically build this aquaponics system and well the complicated parts is first of all they're in California and you know they are gonna have to be a diesel Uganda so they had to do a huge research understand the local resources that they were gonna be available and they actually went to Uganda so these are you know part of the complications they have to really understand you know the setting and the local resources that are gonna have and in the capacity that you know the people are gonna have there to do these things so they work you know for months on the system communicating all the time to understand better so that they went there they were able to actually buy the things that were available and build with the women's and so that they would learn the process and be able to replicate and teach other people so it wasn't just build and donate the whole idea was to build so that they could actually teach and teach how to how to replicate so this is you know one of the last projects we did that got deployed that we're really proud of but yeah so there's some of difficulties are understanding the local resources and understanding you know how what the capacity is and what you're gonna be have when actually go there and deploy the whole system so I suppose the key thing is not to make any assumptions in terms of you having a good idea it needs to be co-designed and needs to be locally owned that's right Sonia maybe you could talk a little about how you're leveraging technology in Ghana so in the context of building health systems in very low-income setting basically in places where there's hardly roads electricity water we have learned that you can actually have a pretty decent health system for what now would be about $80 per person per year but we did it for $40 per person per year working of course only with local people community district regional and national no expats and the biggest most interesting part for me was that the health system if you want to really have a system that is self sustaining and that can detect its own gaps and and correct them requires real time data so in our health systems we worked with a clinic for five thousand people the definition of a clinic has to be that it has to be open 24-7 it has to have a midwife and be able to do regular delivery and that there is transportation emergency transportation to a hospital the critical part was to have professionalized community health workers these community health workers were people living in their village in charge of about a hundred households and being accountable and responsible for what happens to these hundred households focusing of course on maternal child health because that was the biggest disease and death burden in Sub-Saharan Africa and countries like Nigeria Malawi etc we found that we first used make sure that each community health worker is first of all paid so that they can be held accountable rather than be a volunteer as has been traditionally done up till now paid and empowered by a cell phone first we used a regular phone because we started in 2005 but then in 2009 we switched to a smartphone which at the time was expensive but then the price went down and so since 2009 we've actually had all of our community health workers in 10 countries each site is about 35,000 people have smartphones and it's made all the difference we've learned of course from specialists like my two co-panelists these smartphones very easily very easily trained on for just second secondary school graduates and they provided both decision support in other words if you're at a household you you can there's a pregnant woman and a two-year-old you can look what you're supposed to do to the pregnant woman what you're supposed to tell her what to do what interventions etc or two year old check on the immunizations so it helps the community health worker and at the same time it gives the manager an incredible amount of rich information the cell phone of course immediately gives you a georeference and by just typing that you saw the two year old and gave oral rehydration solution or that you told the pregnant woman that she needs to go to clinic for her malaria prophylaxis whatever the manager has a rich amount of information about where how many CHW how many households at the CHWC what kind of work did he or she do and it really gives a very relatively accurate management kind of information and then at the same time of course it gives you continuous count of the disease burden because the person if the community health worker goes to the household and learns that the child died you know they can of course immediately put in the information and so you really get a very accurate real-time disease burden and death burden data and so you can number one notice when the you know when the let's say the diarrhea numbers of diarrhea incidence of diarrhea goes up you don't find that out a year later by some DHS surveys but you find it out day by day that all of a sudden instead of one case of diarrhea all of a sudden the CHWs are reporting five seven eight cases of diarrhea per week you know what's going on we should check the water source etc so it gives it gives you real-time information about that you can act on either act on the management improve the training or fire the community health worker and it gives you data about the disease burden especially if there is a an epidemic such as Chris referred to Ebola again you don't find that out you know a year later when their dead bodies piled up by the clinic you find it out by day-to-day information so community health workers responsible for a hundred households properly paid properly managed and empowered by a cell phone with an application in our case we use demagi's application called com care is hugely beneficial thanks on you Chris you're somewhat looking at this from a different perspective more of a macro perspective so would you talk us through that and also talk about why you think your model and particularly your emphasis on open source technology is so critical sure so maybe I can go back to the same story this this idea and I think we've all touched on it of being able to get real-time information in ways that we might not expect and you know a minister of health might not have expected ten fifteen years ago to be able to get real-time data from not only doctors and health workers but also from patients and that's a possibility now but I think that I would add in addition to the academic and the political maybe one more dimension to this which is the financial and I like finance I don't like the crude this caustic capitalism that we're all locked into today I think that's a little bit off as a model and we can see that tearing at the world around us but but finance in general is a pretty reasonable thing and it's countable and it has numbers and it works sort of but I think that this dimension of finance is very important in the development of these types of solutions the and by finance I mean finding businesses that work supporting them and helping local entrepreneurs build these types of solutions because they're always better when they're built locally and when somebody comes up with them in New York our team has like a ninety eight percent ninety nine percent failure rate for building anything in New York for the rest of the world which is fine we just stopped doing that a while ago and platforms like rapid pro the platform that powers you report the system that lets young people engage us and governments in real-time decision-making that platform was built locally by engineers in Uganda first in Ethiopia then in Uganda and Malawi and eventually we saw a bunch of these companies at the time that John was starting to Maggie John Jackson at about the time we saw a bunch of companies all working in various countries mostly in Sub-Saharan mostly in East in East Africa on the same idea of like real-time information and we thought well here's a premonition maybe if all of our stuff breaks all the time in New York why don't we invest in these companies who are building this stuff locally and let's invest in open-source versions of this software if we if we invest in a proprietary version we spend a bunch of UNICEF's money we get locked into one solution maybe it works really well in that context but we know it won't work in the next country over and what works really well in Kitgum doesn't even work in Kampala much less in Kenya so the ability to localize and to adapt things and that's going from northern Uganda to capital of Uganda to the next country over but right the ability to adapt things regionally or super regionally is really limited if you if you aren't open-source about your code which doesn't mean you can't still make money you can't have businesses that are that work well if they're open source but it means that you have to think a little differently about how you go in so about three years ago we started a venture fund in UNICEF it's the first VC vehicle in the UN it allows us to do exactly the same thing a venture fund does anywhere in the world it allows us to find great entrepreneurs in emerging markets and put a little bit of capital into them often in low liquidity markets like Malawi where we may be one of the larger capital investors in open-source at where the largest capital investor open-source tech in Malawi we find good companies we help them build products that can have these amazing ripple effects and we help them scale them globally and in fact the platform that we used in Liberia four or five years ago was the end result of a set of those investments where we bought accelerated capitalized a company that was a Rwandan company and they built this open-source platform stack which is now being used by businesses around the world so I think that adding the financial aspect in as we look at how do we accelerate these these kind of critical solutions is really important and and our venture fund is looking at applications of machine learning and AI and using UNICEF's backup like all of this power of a 12,000 person organization to provide the data sets and the access to government a lot of these startups need to scale and that's quite a new model for investing in development because it takes the language of capital which has its own value and it takes the language of need and it finds a middle point where you can create global value out of local inspiration and I think that that's just a slightly different riff on maybe where we started where we were trying to do everything ourselves and failing pretty miserably at that I think and two things that jumped out of me there were in terms of context the need for adaptation and one of the frightening things about Africa is that how arbitrary the borders were and far be it from an Irish person to criticize cartographers despite their nationality I do think it's something that people need to think about in terms of consequence so one of the areas that the ISD African Institute is focused on is in terms of strengthening policy capacity but also in terms of strengthening the research culture in universities and the partner countries you work in so over the last 10 years we've helped bring in over 165 million euro of research funding from the European Commission framework program to provide the resources to support masters and PhD students who would traditionally have gone to the states or to Sweden you know all the Scandinavian countries have been enormously generous to Africa in terms of scholarships but provide them with an opportunity to work in local societal challenges and one of the projects and that we're currently involved in is a project called M Health for Africa we provided evidence the European Commission a few years ago to justify the first ever technology call there were two calls and focused on African societal challenges and those of you who work with NIH and the National Science Foundation here in the states or the European Commission would know that the research challenges are driven by the funder in this case and these two calls were designed that the African participants would design what the call should be about to make sure that they're relevant to their environment so one of the projects and that was funded under that call is called M Health for Africa where we're working with ministries of health district health offices clinic managers and clinicians in Ethiopia Kenya Malawi in South Africa to co-design a platform designed to work on a cross-border basis because illness does not respect a passport or visa you know the fact that you have these challenges these silos between what happens on one side of our border what happens another side of our border seems assalined to us so and over the last three years we've co-designed that open source platform that's currently being used in resource constrained environments in those three in those four countries and what jumped out of me in terms of what Chris was talking about was that very key importance of having an approach that can be adaptable the importance of rapid prototyping you know working with local partners in those countries having the ministry of health co-design what they need to solve their needs at a policy level the district health offices what they need an implementation level and then the clinicians and the clinic managers in terms of what they need to do their job so we need to be thinking about this from a kind of a multi-dimensional point of view and I think taking that kind of interdisciplinary approach of bringing together stakeholders with complementary experiences and perspectives is I think enormously important which brings us nightly on to our second topic which is how do socio-economic and socio-cultural factors impact on selecting appropriate technology so can we start with the hand grenade and who would like to describe what they would regard as appropriate technology Chris I've got a different hand grenade it's about borders so maybe I'll start with that please not a big fan personally because if you look at borders a lot who it doesn't go like mountaineering or hiking nobody there no politicians and no hikers well if you do decide to go in the mountains someday and it's really cold and you're out there and you're lost and about to die the way to figure out how to survive is you don't find a straight line look first I'm giving you a tip I'm saving your life right now in Columbia University find a straight line and go towards that because only humans build straight lines there's no straight line in nature so if you find a straight thing go towards it you know some human made structure you're welcome look at a map of any country in the world you'll find an awful lot of those straight lines that's because those are not real things sorry political science students and they're not real because they were drawn by a bunch of white people in Europe a long time ago on a piece of paper the I come from my family comes from Poland what was Poland what's now Ukraine and there are parts of my family on one side parts of the other parts in the US parts in Australia but the borders that have been drawn on maps certainly don't find people they don't define how diseases move and they can't define how we do whatever this financing of innovation stuff that we're talking about is and i'll give you a very specific and concrete example of why that is right now there are about 60 million kids who are on the move because of war and violence 60 million kids around the world and you see a lot of it now because like suddenly they're in Europe on the doorstep of Europe but in fact the brunt of the refugee crisis is born by Central Africa and South Asia and these are countries that have quietly and the countries in the Middle East like Lebanon for quietly for years and with great humility taken on huge numbers of refugee populations from their neighboring countries and supported these populations to help young people have access to opportunity and choice but suddenly they're on the doorstep of Europe look out the world is unfair anyway we're living in a world with 60 million young people around the move because of violence and UNICEF as a construct was built to deal with sovereign states that's how the United Nations it's United Nations right so we're built to deal with states and it's very hard for us in a world which is on the move to start to understand how to deal with these populations because if it's a state of its Kenya we know how to deal with the minister of health minister of I don't know education minister of whatever that's what the organization was built to do but if we need to provide the type of services that Sonia was talking about to a population which doesn't have that interlocutor we also need to think about how to reframe our own organization our own financing structures and the type of data that we collect and this again points to why the proprietary solution whether it's on the side of data or the IP that we create or how we invest or how we think about those financial flows is really dangerous because if the world keeps going towards this sort of sovereign plus thing that we're all looking at we need to be much more agile and much more adaptable in how we invest in and find problem solvers because what we certainly know is that the great solutions for the world's biggest problems don't come from New York Silicon Valley Geneva they don't they come from places where those problems are best described but what those well resourced environments do have if not the solution makers themselves is the networks that can allow those solution makers to scale and that's really what we've seen in the investments that our fund has made so we've got a brilliant drone manufacturer in Kenya we've got somebody who's doing amazing AI in Cameroon but they may not have access to the type of networks that we in New York have so close at hand because you can walk out of here and hit a financier not physically but like emotionally or maybe on the subway brush up against her or him and those are things that are at hand in well connected parts of the world and so I think that speaks to a slightly different method or methodology when we're looking at how we find solutions and solution makers and how we connect them to the kind of global strata that we can we can really use to be adaptable in these tumultuous times so appropriate for you is fit for purpose I'd say locally created and globally scalable okay very very open so yeah yes I deal with technology and idea my main area have two hats is I advise the projects that are mobile and yes it's true everybody has a phone if a smartphone almost and if not if they don't have one they have access to one in their house or in the community and you're taking advantage of that so it you know probably everybody thinks such very easy right you write an app donate the app and it's all good but it's not so when you're asking about you know how to use select the technology to use there's a lot involved in that so first of all people are gonna have phones but they are not gonna have actually sometimes even the place to charge the phone every night so the phone is not always on also you know they may not have access to data or Wi-Fi for that matter so which makes things way more complicated also here when you're developing especially you know I come from Silicon Valley when you're developing in Silicon Valley my students grew up you know with technology all the time so they assume you know the cloud is there in access to the cloud is free or easy so we learn you know that it's not like that so whenever we are developing for other places you have to adapt so this is why we you know when I mentioned the Uber style system that we did for for Rural Uganda that was the idea we started using you know what we had and we didn't know much about their specific place we are going and eventually when we finish and donated the code local people local developers actually you know took over and you know changed to the services that made sense for them and to the cloud system that was less you know less expensive for them so picking the right technology to use even if it's always smartphone even if it's you know Wi-Fi you have to deal with you know different countries are going to have different services and they're going to cost different amounts so maybe you're going to have to adapt to that another example that I had that I have with that is we did a project for for an organization that deals with farmers in Africa and they help them to communicate information and the cost for them to send an SMS was super expensive and you're like in Silicon Valley we don't even care about that people send all kinds of things to the SMS all the time they don't even think about that that's actually may cost somebody you know some money some more money and then you know this person want us to compress SMS so that they would spend large money so as you deal with different countries and different realities you learn how to pick the right technology to use how to adapt the technology that we are building to you know the different realities of different countries and different situations Sonny so the cultural socioeconomic and cultural and ethical sensitivity of the kind of work that we do and the technology that we work with is obviously very important it is by the way one of the reason not the only reason why in the Millennium Villages Project that ended three years ago we deployed it in 10 countries in Sub-Saharan Africa four in West Africa six in East Africa because we chose they were chosen to represent completely different agroecological zones some were pastoral some were you know some were farming communities so it was to represent different agroecological zones but also different sociological culture religious communities and so that way we learned what are the core things that are true everywhere you know such a you know some things are immutable regardless of what religion you are and yet some things obviously are conditioned by these different characteristics of a community so what worked in Eastern Kenya let's say did not work in Northern Nigeria so we actually this question is very interesting to me because we that's what we were learning is how do you deliver the same actual service but in a different circumstances I have also learned though that what might be considered cultural inappropriate is conditional on what's going on in the in the surrounding so for instance when we were doing vital statistics in other words the CHWs as they go from house to house they are supposed to also notify a birth and a death because we're all in the business of trying to get accurate birth and death data for the continent of sub-saharan Africa and the continent of Africa because it's sorely lacking and so we have the community health workers of course note births and deaths and that in and of itself is very complicated and sensitive in that some mothers don't want to admit that it was actually a newborn that died and so they the mother might tell you that it's a stillbirth or they don't want to even tell you that there was a death because you know you may have to pay for the burial culturally necessitated burial and so you know there are reasons for over reporting under reporting etc when we started in 2008 to do what we call verbal and social autopsies which were not actual autopsies but they were it was an application on the smartphone where the community health worker would go to the house of the bereaved family and being trained to be culturally well they were locals but to be sensitive to the situation they asked a certain list of questions so that we could determine roughly without a doctor without a nurse roughly what that person died of so that you could at least have broad categories injury you know some sort of car accident or malaria childbirth newborn death so the verbal autopsy was a very interesting tool for us because it again allowed was another part of the feedback loops that we were trying to learn to do and to have a system so that you would be able to correct adapt adjust interventions and implementations in real time so you learn a lot from what caused the death not only what caused it but what was the social autopsy you know was it because that the child was sick and the mother didn't have the money to take a cab or car to the clinic or was it that she went to the clinic and the clinic was closed for the last three months or what was the gap in the system where was the delay so it was very informative but we found that in certain communities like in Malawi people would not speak to even their local community health worker because in in some parts of Malawi anyway the there was a lot of superstition and you don't talk about dead relatives it brings you bad luck they burn everything of the dead relative including the health card clothes and everything but once the chief of the village that we were starting the verbal and social autopsy tool once the chief explained to the family that this is a way to decrease the chances that the families will lose a child or a mother during delivery it really took very short amount of time for it to turn around and people actually not only welcoming the community health worker coming in to try to determine what was the cause of death but they actually we actually came to the point where they were clamoring for it we only did it for children under five and maternal deaths and people you know actually got so used to what they before thought was culturally unacceptable that they said hey my 80 year old grandfather died and nobody came to do a verbal autopsy you know what does that mean so my point being that when you develop these tools they can be extremely helpful but if you just dump them as Chris said without the acculturation process that takes time because you have to educate explain all of us also you know if you ask me to switch to something I will rebel and resent unless it's explained and unless I start to understand why it's good for me or good for people around me so it's like any tool introduction in any setting I'd like to pick up on the issue of essentially change management that Sonya has picked up in this case sociocultural change management one of the design features call us what you will that we took with them Health for Africa was that rather than design the data sets around what is currently captured in the big tomes that you have in the clinics is that we created a meta set in other words we would capture all of the unique all the common elements but all the unique elements and then that meant that when we were going and showing the system to someone in Kenya or in somebody in Ethiopia or somebody in Malawi or South Africa they would see fields that they're not familiar with because they're not things that they typically would capture and one of the interesting things we found was that initially it was a bit like well you know this can't be for us because there's something here that we're not familiar with but when we explained why in Ethiopia they capture a certain type of data the immediate response from the nurse in Kenya was that's clever yes really we would be interested don't make it mandatory but we would be interested in that because that makes sense and I think this kind of way of building trust where you respect the sociocultural norms but you expose people to the context of why if they buy into it if they decide to take that decision themselves by changing the way in which they approach these things you can end up with a better result for everyone could we maybe for a moment talk about ethical concerns because you know a number of us have talked about health but I mean I think ethics in technology is something that is underestimated in terms of both the sociocultural but other the other consequences of introducing innovative ways that may affect the culture in a very very fundamental way so who would like to start that football Chris this morning oh yeah why not because there's so much arrogance in a lot of this work that we've I mean my own arrogance and our teams and the way that we go forward the biggest fight that I got in in the last five years was with Paul Allen about something that happened during Ebola you can Google that I don't feel like getting into it now actually sure so um so Paul wanted to send 10,000 smartphones to Liberia during the height of the Ebola crisis prepackaged with a bunch of stuff that he'd built it was all very well meaning and from being in like you're in Monerovia and you're sitting there and you're watching like Paul's gonna send a bunch of phones there's a there's a whole like the people who were still doing business in October of 2014 in Monerovia who had little shops selling smartphones and repairing them the last thing they want are Paul Allen's 10,000 smartphones to be dumped for free on the market like absolutely 100% guarantee you the shop owner does not want that right because that's gonna put him or her out of business the network operators who are like most of the people running the networks for the three network operators or most of the engineers had left most of them were either from China or Sweden and as soon as the Ebola outbreak they've gone so those networks were like tied together by a thread and the last thing the network operators wanted was 10,000 phones guzzling but the little amount of bandwidth they had left which was being used to send SMSs and that's the kind of thing that seems like a really good idea from one part of this whole spectrum and actually isn't very good if you ask somebody who is an actual human being on the other side of it and so I think that the ethical considerations in the space of technology and innovation innovation is like a terrible word because it doesn't mean anything and it means everything and whatever but if you so there's a company here that a lot of us have used that rhymes with smuber that you can use to get a car and this company that rhymes with smuber started an experiment recently and I think it's all documented so recently in Florida Uber started to pass off a lot of it sorry the government of Florida decided to pass off a lot of it civil services for buses in a few cities to Uber so you could take out your phone if you're living in one of these cities and you could hail an Uber come and pick you up you guys heard about this this was about a year ago great so you can get an Uber you get it for free cost the same amount of this bus the city pays for the rest of it so city saves a lot of money because they're not hiring these bus drivers they're riding stupid bus there it's very targeted Uber has a great thing this is a fantastic innovation it's crushing it right yeah technology making everything more efficient unless you don't have a smartphone in which case your bus ride is just gone or if you've got a smartphone and the screens cracked and you're too poor to pay for it or if you don't have that data plan and a lot of technology is designed that way and I think that there's a real question that we have to wrestle with on information poverty and algorithmic equity in a lot of these pursuits when we're building big data science models that can help governments make decisions those models are built on data sets that are sourced from the top two quintiles of people maybe you get down to quintile three but then they've come really poor and it's hard to get data from them so we'll just kind of point a finger there and that means that data set isn't fair that's not a good training set it doesn't create a good model it means that when you build a platform like for privatizing bus services or something you suddenly lock out a whole quintile of people or two and I think that's something like if you're Facebook we can talk about Facebook now if you're Facebook you're all of your algorithms are about distributing content to the thickest nodes in your network right that's how you make money and that's it there's nothing secret about that's how Facebook's algorithms work it's like get your Kardashians out to the most other Kardashians and you're making money but nowhere in that algorithm is there a question of how do you get a piece of vital information to a girl who's disconnected on the borders of Kitgoom Town because she actually needs that information more than anybody else and so I think the ethical well in the ethical encumbrance upon all of us the thing that we should be most aware of is that as we're building these tools and we're so privileged to be building them in thickly connected environments we have to look at that bottom quintile of people economically their access and whether or not the algorithms can see them whether or not the data comes from them and how we can actually build these systems with them and that's why again that's why our fund is so pointed at investing in companies that are working with people who probably don't show up on a lot of data streams that that Facebook looks at when it's gearing it's it's ads to be as trafficked as possible so I do think that there's a big ethical question and I think that the world of fast-paced tech development has gotten it totally wrong I think the language is pretty horrible in in terms of how a lot of the sort of Silicon Valley verbiage goes and I think that also the world of development has gotten it pretty wrong in not being able to access some of that speed and agility and so there is a big middle ground there's a space of translation that we need to be in to make sure that the the great benefits of technology can reach people who might not be accessed by that kind of language and and and economic push in the traditional kind of frameworks that we've been working in Sylvie? Yeah, I have a little different perspective on I agree with everything he said they just have a different perspective it's just that yeah this is the reason why most of our projects are with somebody in the field who actually asked for something instead of hours going there and saying you need that I'm gonna build it for you on the other hand we do projects abroad but we also do projects for homeless people in in the Bay Area and and this is started so that's a totally different setting and that brings up you know the whole ethics and how to deal with a different population it's local live they live actually around the corner from us my universe is very close to the airport in San Jose for people who have been in Silicon Valley and homelessness is becoming a big problem as you know housing in Silicon Valley is extremely expensive and you know going up as we speak so we have a lot of people living on the streets and it's not like that usually you think homeless people a mentally disabled person pushing a cart that's not what I'm talking about I'm talking about families living in cars kids go to school sometimes the person has he has a job and the mom has a job they just don't have enough to pay for a house so we have families living like that and you know our organization in San Jose researched and interviewed people and realized that 70% of them have a phone and they hold on to that phone like crazy because in you know if you have a phone you are able to talk to your family and friends and you know we don't get depressed because depression is a big problem among homeless people the other important thing if you don't have a phone how do you get a job how do you get housing how do you get out of the streets so people realize that cellular phones is a super important tool for homeless people and you know Google and other companies donated a thousand phones and that was a good thing so donated a thousand phones for homeless people and we are part of the group that actually developed applications to go onto these phones that got distributed and interesting enough is we okay it's the U.S. it's Silicon Valley we all live there but there's a bunch of things we didn't know when we are building these tools for homeless people first thing is whenever you complete a form for anything whenever you register for a service the first thing that you know you ask is the name right I mean it's the obvious question what's your name then what's your address homeless people don't have an address second homeless people don't like to give their name they don't want to be remembered as a homeless person when they are not homeless anymore and so we had to learn how to build these interfaces so the whole development for homeless people is totally different than what we were used to or their students are used to you know whenever they build a system for anybody for that matter so it's a learning experience and you have to you know ethics play like plays a big part here because you have to respect and you have to build a specific tool that will help them find resources that will help them find housing that will help them communicate with each other find help whenever they need because you know they they are there they are at risk and we have to basically help out but we have to understand the needs and actually do the right thing and my mother always said Paul there's a reason why you have two of these and one of these Sonya I obviously believe that ethical underpinning is critical for everything that you do if you go to any project especially if you go to somebody else's house or community or country it's incumbent upon you to be first and foremost respectful courteous ethical especially once you start talking about actual recommendation of interventions and so for me it's you know obviously no question that is the highest first and highest standard my problem with the ethical component is more on the international scene which is I think it's unethical that we have tools and institutions and collaborations and internationally agreed on agreed on partnerships such as the Global Fund for HCB and malaria GAVI the Global Fund for Vaccine and Immunization UNICEF and others and they're woefully underfunded and we don't talk about it very much or we celebrate you know when we give X amount of dollars to the Global Fund without saying that that's only 2% of what it really needs so we celebrate the small increments rather than expose the big gaps I find that the biggest gap of ethics internationally so how do we deal with those kind of issues I mean if I take the environment I work in I spend most of my time in Africa you're talking even if we look at the 18 countries that we work with what's ethical in one country may not be socially acceptable another and do people argue that ethics is context specific you know based on race religion geography who decides what's ethical I mean this is something I'd like us all to think about maybe as we kind of come to a close I'd like us maybe to talk a little about how can technology and innovation be used to better effect and in the context of achieving the sustainable development goals so Sylvia maybe you'd like to start us off well I from what I we have been doing lately I really believe that you we can use technology to empower people so we decided that charity doesn't go a long way but empowering people goes a long way so we have been working really hard to always you know go meet somebody in the field that you know can be empowered a social enterprise that's a big movement that actually is making a big impact or just a person who would create a business like we did for the solar grid the microgrid and in Benning so empowering I think using technology to empower people I think it goes a longer way so I think if you can actually do more of that and and get people to actually you know help themselves that may have like a good impact Chris last week the Secretary General came out with his new technology strategy I would encourage every I don't usually encourage people to read you and documents but since I bled sweated and cried for seven months helping to work on this one please take a look at it there are five principles in it there are four that I think answer this question and there's a lot behind it as well but it speaks to what the SG sees as the next few years the first one is the principle of values having values in building your technology the second one is around inclusion and transparency and really being inclusive as you build these technologies the third is around partnerships and building partnerships that and building on existing mandates and these kind of groups but the most important one is the last one and the Secretary General actually explicitly calls out being humble and humility as his fifth principle in his new technology strategy and I think that's noteworthy for a variety of reasons it speaks to the ethical and the global discussions that we've been having and I think it was a really nice signal light that he's put up for all of us who are working in this space Sonya I think that's very well said and I will read it and recommend it to others in reverse order I would like to be very concrete about the technology as I have learned to use it which is that since I'm basically live and breathe for universal health coverage meaning that everybody that it's a basic human right for families and all the members of any community to have access to basic core health care I really do appreciate the technologies that sort of frog leap or short circuit some of the problems that are experienced in low income settings so for instance so of course as we've discussed the fact that a community health worker not a highly trained person who has gone to undergraduate and then medical school and then fellowship but a secondary degree secondary school graduate can actually do life saving activities at the household level because they can actually consult by telephony text or algorithm can consult higher level of knowledge by the same token one of the interventions that we done in the millennial villages that has then scaled to the district region and then has been now nationally deployed is telemedicine I just wanted to put a plug for an intervention that's extremely helpful it doesn't violate as a matter of fact it depends on local culture and local mores and local systems but it all it does is connect the activity and what can happen in the periphery for instance what a midwife or a nurse or community health worker can do at the household by being able to consult a consultant specialist or a doctor in a distant hospital so basically I really like the fact that this relatively simple technologies like a cell phone or telemedicine can bridge the gap places where there aren't enough higher level of technicians by the way it's not that Africa doesn't educate a lot of nurses and doctors and specialists it's that they do them so well that they brain drain out and take care of us here in the US so these technologies really do can short-circuit some of these short-term supply problems or topographical problems distance problems transportation problems I think one of the problems is it's so easy to fall in love with technology because it's convenient and when I talk to people about the work that Sonny and I are both doing in the area of of health for example everyone talks about clouds and the importance of clouds and I say yes clouds are very important but unfortunately that's water vapor that's not falling where it's needed so I think we need to think carefully about what assumptions we make you know if I look at Ethiopia for example it's such a large country there is no local cloud available it is not legal to have data about personal individuals not located in Ethiopia therefore by definition until there is a cloud that is resident in Ethiopia cloud is water vapor that's passing by three things I'd like this maybe to think about in conclusion we have a proponent of the importance of open source principles and I'm sure he'd be very happy to talk to you afterwards but from my own perspective leaving aside the importance of open source principles I think there are two other things that I'd like us to take away from today and those are the importance of interoperability and the importance of standards because if you have standards then it makes it easy that irrespective of what hardware it'll work irrespective whether it's 2G 4G 5G whatever G it'll work and in terms of interoperability you know Chris said at the very beginning you know part of the whole premise behind the work that they do is to avoid lock out you know to don't get locked into a situation where you've got a solution that may no longer be fit for purpose so we need to think about the importance of these things I suppose in the end that I philosophically this means that if we want to leverage technology effectively to achieve the STGs we need to work in true partnership and that requires an ethical approach or at least commonality of ethics it requires an openness to the transparency issues that Chris also mentioned and the interoperability issues and not getting locked into a mindset of I have a hammer there for everything looks like a nail and we are organizing a couple of colleagues and I are organizing a participatory workshop tomorrow it's all day that we'll be looking at these issues of what's appropriate and how can we work together to solve societal needs and how can technology play a role and I hope some of you will be able to join us in the meantime I'd like to thank Sylvia Chris and Sonia and I'd like to thank you Gurav Mela Mahagath and I hope you'll talk to us soon thank you