This piece is from PopTech Editions III—Made to Measure: The new science of impact, which explores the evolving techniques to accurately gauge the real impact of initiatives and programs designed to do social good. Visit PopTech for more interviews, essays, and videos with leading thinkers on this subject.
The Kakuma Refugee Camp sits in a hot, dusty, and remote region in the far northwest of Kenya. Over the past 20 years this camp has been a semi-permanent home to refugees from Somalia, Sudan, and Ethiopia. With recent waves of arrivals and few refugees leaving, the camp population has swelled to 100,000. There are now more inhabitants per square kilometer in Kakuma than in Bangkok or Mexico City. Micronutrient deficiencies and anemia are a major public health concern at Kakuma, particularly among young children, pregnant women, and nursing mothers. Worldwide, iron deficiency contributes to 20% of all maternal deaths.
To tackle the micronutrient deficiencies at the Kakuma Refugee Camp, the World Food Programme in partnership with the Swiss company DSM launched a program in 2008 that aimed to provide all individuals six months or older with daily access to a micronutrient powder called MixMe.
MixMe is one of several micronutrient powders available on the international market, generically called "sprinkles" after the trade name of a leading product. Sprinkles is a powdered mix of vitamins and minerals packaged in a sachet, like the single-use shampoo packets popularized in India in the 1980s. The idea is for people to sprinkle this powder into food. Sprinkles are usually designed to have minimal effect on the taste, color, and smell of food. The MixMe sachet contained iron and 15 other vitamins and minerals.
This little sachet should save lives. At first, it seemed like it would. Initially, data showed that 99% of adults collecting food at distribution points also picked up MixMe boxes. But within five months, this number had dropped to 30%.
World Food Programme officials watched that trend with dismay, and launched a concerted social marketing effort that helped the program recover some ground. But the percent of people picking up MixMe never exceeded 50% in the final seven months of the program. More troubling were anecdotal reports showing that many of the families that obtained sprinkles discarded the sachets without using them.
This was mysterious. Why would people not use potentially life-saving nutrients?
The answer, surprisingly, was in the packaging. People thought the aluminum foil sachets resembled condom packages. Some people thought that the product was in fact, a condom, while others talked about the embarrassment associated with the product being mistaken for one.
Sadly, the sprinkles program at Kakuma Refugee Camp is just one of many similar tales. Other large-scale programs and evaluations focused on products to improve life for people around the world have stumbled because of poor understanding of culture. There are examples from water purification, anti-malarial bed nets, and improved cookstoves, among others.
All too often, these lessons are learned too late. In the best cases, the cultural gaps have become apparent through qualitative post-mortems to explain the results of the study, like with the sprinkles example. But that also means we are wasting too much of our evaluation effort on explaining why programs didn’t pan out as expected. Couldn’t we avoid this? Shouldn’t we?
It turns out that we can, and we should. A better understanding of culture helps us avoid these failures.
The tools we need are available in the innovation-design process. This process can provide specific tools to understand culture and to translate this understanding into products and services with a high likelihood of success.
This type of innovation process goes by many names: human-centered design, community-based participatory research, design thinking, and participatory design to mention a few. All these approaches share a focus on understanding people in context and from their own perspectives, testing various solutions on a small scale, and continuously iterating through this process.
In general these approaches use qualitative and quantitative research methods to explore the "how" and "why" of problems, not just the "what" and "how much." This is as much a type of measurement as program evaluation, but done before implementation, not after. Instead of a peer-reviewed publication, the endpoint of this measurement is demand creation: a product that people will want to use. This includes all the elements that go into supporting that: branding, packaging, distribution, pricing, and marketing. But it also includes determining whether the product is the right one. We can use the innovation process to maximize the chance that people will adopt a product or service and that they will stick with it over time.
The people behind the MixMe program wanted it to work. The sprinkles that were distributed in Kakuma were tailored to this environment. MSM developed a micronutrient formulation that was based on the specific physiological needs of the Kakuma population. For example, they lowered the Vitamin A content in the sprinkles because the camp food ration basket already included Vitamin A supplements in fortified cooking oil. Still, something didn’t work.
Design is a powerful process, but it’s easy to get wrong because it is as much about the specific tools and techniques as it is about a philosophy: Put people first. As smart as we might think we are, there are things we do not know, especially when it comes to what people want and need. The elegance of the design process is that we don’t need to know all the answers, or even the questions upfront. We have to go out and spend time with the Kakuma refugees, or whoever we are trying to help, and let them show us the path forward. That forces us to challenge our assumptions and almost always makes us look at our problem differently.
This all seems obvious in hindsight. What does it look like at the beginning of the process?
Let’s take a look at Juabar (pronounced joo-a-BAR) as an example. Juabar has effectively applied this process to their core service in the Tanzanian mobile phone recharging market.
Mobile phones are ubiquitous in Tanzania, but only one in seven Tanzanians has access to electricity and almost none of the poorest 40% have access, even in urban areas. Plenty of businesses offer a mobile phone recharging service in off-grid communities in Tanzania, but Juabar is unique in several respects. Their business model relies on local entrepreneurs to enter into franchisee arrangements with the organization. They use a strongly branded, mobile platform for these entrepreneurs who deliver the charging station via a tricycle or a cart. And the stations run on solar power.
Juabar systematically developed this model by engaging in the three types of measurement that define this kind of effective innovation process: 1) understand your customer, 2) study your competition, and 3) prototype your product.
Juabar traces its roots to 2011, when a team of three graduate business school students from the United States was on a consulting engagement exploring solar opportunities in Tanzania. They visited homes, interviewed and shadowed customers in context, spoke to a half-dozen energy companies, and interviewed local entrepreneurs. They recognized an opportunity to sell a franchise business for recharging phones to "Juapreneurs," rather than selling the service themselves.
Juabar studied their competition in and around Dar es Salaam by directly observing customer transactions and interviewing competitors. They discovered limited customer loyalty among existing recharging businesses. This led to the concept of a strongly branded, mobile platform: a cart and a tricycle.
Working with their institutional partner in Tanzania, Appropriate Rural Technology Institute (ARTI), Juabar developed a prototype for each type of platform, and they released these prototypes into the market. For several months they have been tracking the number of phones charged, the adapters used, and the overall revenue. They are now using this data to compare the two platforms and refine and rethink their business model.