Voiceless faces and missed Cases – Operation ASHA bridges TB and technology

The road to recovery for a Tuberculosis (TB) patient in Cambodia can be long and arduous. For three months, 65-year old Mr. Nou Pov suffered from coughs, fatigue and night sweats, all of which are symptoms of TB, without being able to obtain an accurate diagnosis. “I became weak. I could not work, so I just sat at home,” recalled Nou. Only when an Operation ASHA staff stopped by his home while screening for TB door-to-door and recognized his symptoms was Nou brought to a local health center for testing. Upon being diagnosed with TB, he finally began his 6-month long treatment course.

Nou was lucky to ultimately obtain a diagnosis, but an estimated 36% of TB cases, or 21,060 individuals, remain undetected in Cambodia, according to the Cambodia Ministry of Health. A socioeconomically disadvantaged patient in Cambodia, like Nou, faces many barriers when it comes to TB detection, such as a lack of awareness about TB and healthcare resources, a lack of access to knowledgeable and trained staff, and a lack of means to travel to health centers.

Operation ASHA seeks to minimize the barriers that TB patients face in seeking timely TB care. In 2014, we implemented a new technological solution called eDetection, an app which would strengthen TB case finding and contact tracing. eDetection uses GPS-mapping to help Operation ASHA field staff locate areas with potential TB suspects. Operation ASHA field staff then travel door-to-door through these regions, prompting individuals to answer TB screening questionnaires that have been programmed into the app in accordance to WHO guidelines. By bringing TB care directly to the doorsteps of the underserved, Operation ASHA hoped to minimize the challenges that keep disadvantaged patients from receiving care. Based on an in-built algorithm, the app prompts the field staff to follow up on certain individuals whose responses suggest that they may have TB. Paper-based monitoring methods, the standard method of keeping track of patient screening, is often compromised by human error, thus resulting in patients being lost to follow up. With our app, when a patient is not followed up with, the system generates an alert to the field team, ensuring that each patient gets the right care at the right time.

 

With backing from ISIF Asia, Operation ASHA launched a small-scale eDetection pilot in Prey Kabas Operational District, Takeo Province, in 2014 (download report here). Although our concept was simple, bringing the app technology into rural Cambodia proved to be very difficult. “Most field staff do not begin with any previous experience with using tablet technology and require much training,” said Ms. Sinoth Lay, a Team Supervisor responsible for overseeing the activities of Operation ASHA’s field staff. “None of them had even used smartphones before”. Many rural areas also lacked reliable 3G access, resulting in inconsistent connections with the central server system that sometimes hindered the field team’s work efficiency. Additionally, the vast majority of patients lacked prior exposure to technology and many were initially hesitant to share personal health information with the field staff until they became more familiar with OpASHA’s work.

Despite the initial challenges of implementation, eDetection proved to be a valuable asset for TB screening and detection based on early pilot results. In one year, Operation ASHA managed to screen over 17,000 individuals for TB in Prey Kabas OD, of which 406 people tested positive for TB and were enrolled for treatment. Areas in which the technology was used resulted in 10% more patients being screened and 16% more patients being sent to health centers for diagnosis over areas in which paper-based monitoring systems were used. Most of the field staff also viewed the app positively, praising it for increasing data authenticity in the field. Although still in its early stages, eDetection shows great potential in being both easily scalable and financially feasible. Combined with Operation ASHA’s door-to-door TB care delivery model, it holds much promise for providing high-quality, low-cost care to TB patients across Cambodia.

The Status of ICT in Cambodia

Cambodian-computers

On June 26, 2014, Cambodia’s MPs approved the National Strategic Development Plan (NSDP) for 2014-2018. This ambitious document is the country’s blueprint for economic policy, and since it contains a full section dedicated to ICTs, this is a good opportunity to take stock of the current state of this increasingly strategic sector.

1. Why has Cambodia made the development of ICTs a priority?

Simply because ICTs can have a transformational impact and pave the way to Cambodia’s sustainable development. They can boost the economy both in the short and longer run. In 2009, the World Bank showed that using ICTs enable companies to increase their productivity but also that a 10 percent increase in the Internet penetration can contribute to 1.38 percent of GDP growth. On top of these economic benefits, ICTs can also improve the life of the most disadvantaged by granting them a better access to basic services.

2. How is the Cambodian ICT sector doing?

There is a paradox. Traditional information and communication services are of poor quality. Public postal services are unreliable; mass media do not reach 15 percent of the Cambodians; and only 3.96 percent have a fixed phone line. When you look closer, though, the picture is different. It turns out that Cambodia has been closing its technological gap by moving straight to mobile and Internet. In 2008, 3.8 million people had a cell phone; in 2014, there are 20.2 million SIM cards in circulation, which is a 130 percent penetration rate (regional average rate reaching 89 percent).

The Internet sector is also doing well. Six years ago, fewer than 10,000 Cambodians had a web connection, and it was extremely slow. Today 2.5 million people have Internet access at home, and an additional two million Cambodians go online daily using their smartphones.

3. How to explain this leapfrogging development?

There are two main reasons. First, the coverage is good in most regions, and this is because both the public and private players have invested in the telecom infrastructures — up to $209 million by 2015. Moreover, in the past decade, Cambodia has experienced a 7-8 percent economic growth per year. As a consequence, standards of living have risen, and the emergence of a middle class has attracted many operators. With the competition being fierce, both mobile and Internet subscription prices have been reduced.

4. To which extent have ICTs impacted the Cambodian society?

It took only a few years, but ICTs have already transformed the Cambodian society. On the economic level, they have boosted entrepreneurship: 2011 census showed that the tech industry was among the fastest growing in Cambodia. Moreover, ICTs have had a positive impact on other economic sectors, such as agriculture. In central Cambodia, for instance, Oxfam has been implementing an “e-agriculture” program. By providing rural women with a mobile phone, they have given them a tool to plan when to harvest, integrate with the national market and eventually increase their revenues.

On the social level, ICTs have proven they can be impactful as well, in particular by expanding the access to basic services. In 2014, for example, Women’s Media Center of Cambodia launched a radio show in order to promote maternal care in the countryside. To make sure they reach everyone, they decided to develop an Interactive Voice Response system. And it has worked: in only three months 4,500 people called to get information.

However, the most striking impact has been political as ICTs have helped further strengthen the Cambodian democracy. During the 2013 elections, many voters would check Facebook and YouTube to get not-censored reports. Despite some irregularities, the opposition party obtained 44 percent of the votes. Eventually, Cambodia’s Prime Minister who has been incumbent since 1985 had to agree to share some of its power.

5. Which challenges will the Cambodian ICT sector be facing in the coming years?

Among the many challenges, two stand out in the short run. First there is no consistent legal framework, which affects the industry as a whole. In September 2012, the government established the Telecom Regulator of Cambodia. However, since the Telecom Law has not been passed yet, the rules rely on a collection of somehow volatile and often flouted decrees. The second challenge lies in the current market saturation. In a country of only 15 million people, there are seven mobile companies and 24 Internet operators. Since Cambodians have no brand loyalty, experts believe the market will have to restructure soon, and this may cause some business turbulence in the coming years.

How Mobile Phones Can Illuminate Rural Cambodia

kamworks

Have you ever been to Cambodia? If so, have you noticed that everyone there has a mobile phone? Whether you are in Phnom Penh, Siem Reap or even in the countryside, you’ll find people talking on their cell phone all the time.

Mobile Technology for Development

As in other developing countries, mobile penetration is very high in Cambodia. More than two-thirds of the populationuses a cell phone on a regular basis, and there is a pretty good GSM coverage in most regions.

For the country, which is one of the poorest in Southeast Asia, this is very good news, as it may contribute to a sustainable development momentum. Mobile phones have proven to be a great technology to empower the Base of the Pyramid in other countries, and there are benefits that you may not even imagine. For instance, did you know that cell phones can help people have a better access to electricity, even in the most remote rural areas?

In India, Simpa Networks has developed a Pay-As-You-Go model to enable 60,000 off-grid households to buy solar home systems by 2015. In Cambodia, a project using mobile technology has recently been started by Kamworks, a social startup whose objective is to bring innovative solar energy solutions to the rural poor.

Electricity Situation in Rural Cambodia

The need for affordable and accessible energy is huge. Today, 10.5 million Cambodians live without grid electrical power. Experts say the situation is particularly critical in rural areas where nearly 70 percent of the households have no access to electricity. Why is it so?

In many regions, there is no grid power at all; and, where people could be connected, they often cannot afford it. Most villagers have no choice but use kerosene lamps or car battery-powered lights. In the longer run, unfortunately, these products are not only expensive, but they are also inefficient, dangerous, unhealthy, and polluting.

Solar Energy Solutions

When Kamworks was started in 2006, the idea was to offer sustainable alternatives to the rural people; and this is why the company’s founders opted for solar solutions. With an average of five hours of full sun each day, Cambodia is a perfect place for solar lanterns and home systems. In addition, since fuel price has increased over the years, solar technology has become more and more competitive as its price has fallen. Then economic benefits of solar have proven to be real and short-term as well as long-term.

Difficulties usually arise, though, when it’s time to pay for a solar system. While many villagers are willing to buy solar products, the majority cannot afford the high up-front investment. To solve this issue and enable its customers to have access to solar power, Kamworks has had to be creative over the years and develop various business models. In 2007, it started renting products, and this has turned out to be among the most effective solutions. Yet there is still a major problem: higher collection costs for the company, and sustaining such a model was difficult in the long run.

Today, the answer will come from cell phones and mobile payment technology. Customers renting Kamworks’ solar home systems will soon be able to pay for the rental fees through their mobiles. For the company, this will be easier to manage; and for the customers, as they won’t have to pay upfront for the product any longer. So they will be more likely to make the leap, and go solar for their electrical needs.

Access to Energy is the First Step to Development

Of course, you could wonder, “Why is it so important to have power?” Specialists agree that access to electricity is actually a key to sustainable development. To put it clearly – where there is no light, both economic and human development goals are harder to achieve.

In Cambodia, night falls at around 6 pm. Keeping the light on until late weighs on villagers’ financial resources, and ultimately it can have an impact on livelihood, education and even quality of life.

But imagine – if the Base of the Pyramid had an easy access to affordable electricity, it could transform their lives. Children would be able to study in better conditions after dark; businesses would operate longer hours; and farmers could even have access to modern tools to produce more. Last but not least – they would stop poisoning themselves with kerosene-induced indoor pollution.

No wonder the United Nations placed the question of sustainable energies on the global agenda for the coming decade and we should celebrate innovations like mobile payments for Kamworks solar systems.

Scaling Operation ASHA to Fight Tuberculosis in Cambodia

ecompliance

According to the WHO, tuberculosis is the biggest infectious-disease killer, taking more lives than AIDS, cholera and other pandemics combined. There are 8 million new cases in the world each year and 1.8 million deaths, even though it is a fully curable disease with the right treatment.

In response, Dr. Shelly Batra and Sandeep Ahuja founded Operation ASHA in 2005 with a compelling vision: a tuberculosis-free India. Operation ASHA has grown to become the exclusive provider of tuberculosis (TB) treatment to nearly five million Indian citizens.

Operation ASHA uses eCompliance, a comprehensive low-cost technology solution for tracking and monitoring TB patients that is constantly being upgraded to suit the needs of the people.

Recently, their technology team launched a text free version of eCompliance to be used in zero literacy areas such as the tribal areas of Madhya Pradesh and Jharkhand in India, and transitioned eCompliance from netbooks to tablets for improved efficacy and cost-efficiency.

Cambodia Expansion

Thanks to a grant from Information Society Innovation Fund Asia (ISIF), Operation ASHA is replicating eCompliance in two provinces in Cambodia. The pilot has begun, and more than 140 patients are registered. But numbers do not tell the whole story. Watch this video to see the impact of technology on TB as told by a Operation ASHA patient in Cambodia:

In recognition of her success in scaling treatment of TB in India and Cambodia, Dr. Shelly Batra, President & Co-Founder of Operation ASHA, was selected by Schwab Foundation as Social Entrepreneur of the Year 2014.

Congratulations Dr. Batra, and keep up the good work!

People with Disabilities Realize Their Dreams with Digital Divide Data in Cambodia

treng

When Treng Kuy Chheng looks back at her past, she wonders what she would be doing, had she not met Digital Divide Data (DDD), a non-profit organization whose goal is to empower Cambodia’s youth through digital training and employment.

Being Disabled in Cambodia

Chheng was born into poverty, and to make things worse she had polio when she was two. She survived but her illness left her with physical impairment and bleak prospects for the future.

Being disabled in Cambodia is often perceived as a tragedy and, among the estimated 700,000 Cambodians who are afflicted with disabilities, it is true that the majority do not fully enjoy their fundamental rights, and they often do not have equal opportunities for education or employment.

Chheng was rather lucky as her parents did not treat her differently from her siblings. In the morning she would sell vegetables at the family’s food stall; and in the afternoon she would go to school. However hard it may have been, it made Chheng believe in herself and her abilities. And the more the neighbors would stigmatize, pity or even discourage her, the more determined she was to succeed in life and not be a burden to her relatives.

This determination gave her the strength to look for employment after she graduated from high school. At the time, the economy was beginning to recover slowly, and landing the first job was very hard for everyone. For a disabled girl like Chheng, it was even more difficult, and, while she was searching for a professional opportunity, she experienced stigma, rejection, and discrimination. Before she started losing hope, she had the chance to meet with Digital Divide Data, which had been co-founded two years earlier by Jeremy Hockenstein.

Impact Sourcing

In 2000, this young American traveled to Cambodia as a tourist. During his stay, he was not only struck by the level of poverty in the country; he was also impressed by the eagerness of the youth to learn and struggle to build up a better life. They would take computer and English lessons but in the end there was no job for them and they kept being trapped in an endless cycle of poverty.

In the meanwhile, the world was going global, and international companies started outsourcing low-skilled IT jobs to India. Hockenstein was a business consultant at McKinsey, and it did not take him long to figure out that he could replicate this model in Cambodia and use it to promote employment and empowerment for the disadvantaged youth.

A Study-Work Program

DDD

When she joined Digital Divide Data in 2003, Chheng had hardly seen a computer in her life. She had to learn everything from scratch, but she worked hard and soon she knew how to turn a computer on, enter data and master fast typing. She was also trained in English and soft skills (e.g., team work, self-confidence, management). After six months, she was fully operational and became one of DDD’s data operators.

For four years, she worked six hours a day to transform physical documents into searchable and digitalized archives for publishers, libraries, and companies all around the world. For her work she was paid a fair wage but she was also granted a scholarship to study at Pannasastra University, one of Phnom Penh’s best universities.

A Stepping Stone to a Brighter Future

With 400 employees, Digital Divide Data is today the largest technology employer in Cambodia, and in the past 13 years its impact sourcing model has had a transformative effect on nearly 2,000 underprivileged young adults, 10 percent of them being disabled.

Working at DDD is always a stepping stone to a brighter future. After they complete the program, graduates are either hired by the organization or they move on to other companies, where they earn more than four times Cambodian average salary. With this money, they can support their parents and enable their youngest siblings to get a proper education. In the long run they break the cycle of poverty that has trapped their family for generations.

As for Chheng, she has managed to make all her dreams come true. She wanted to study; she now holds a Bachelor’s degree in accounting and an executive MBA. She wanted to have a job; she started as an accountant at DDD and for the past year she has served as the finance and administration manager of a large electronic company. She wanted to see the world; in 2013, she went to Canada to participate in the Global Change Leaders program.

At 29, this highly successful woman keeps having new dreams! Today she wants to change the public’s attitude towards persons with disabilities and create real job opportunities for them. She believes they have the ability; they just do it in a different way. Just like her.

Daniele Adler is a consultant in communications strategy in Cambodia

RSVP now: Tech for Good Fast Pitch by USAID Cambodia

USAID

Want to know how you can get involved in using technology to impact Cambodia?

USAID’s Cambodia Development Innovations invites you to the first pitch presentation event. The concept is simple – presenters get 4 minutes to talk and “pitch” their idea. After pitching their idea, presenters and participants network with each other to find areas of collaboration.

In this first event, up to 10 speakers will present their ideas on how to use technology for social good. Presenters will outline their idea and what they need to progress their idea. Perhaps you have something they need – a product, a service, or even a similar idea?

Presenters include:

  • Marie Stopes International Cambodia, Nicky Jurgens, Head of Team Programme Development to pitch about “Improving uptake of long-term family planning methods”.
  • Fourth Sector Innovations CEO, Byungho Lee to pitch about using mobile devices to improve math education in Cambodia.
  • FHI360, Sophat Phal, Innovation Prevention Advisor to pitch about “Application for MARPs”
  • Learning Institute, Eileen McCormick, M&E and Resource Mobilization Officer to pitch about “Develop Research Forum App”
  • CEDAC, Lak Youssey, Project Monitoring and Eveluation Officer to pitch about “Improve Information Access among Farmers”
  • World Education Cambodia, Run Ul, Project Manager to pitch about “Khmer Automated Assessment”

Be sure to RSVP today to join your peers in celebrating great new ideas in using technology for good.

Tech for Good Fast Pitch
Himawari Hotel
Sisowath Quay Khan Doun Penh
Phnom Penh, Cambodia
Cambodia
Monday, February 24, 2014 from 3:30 PM to 5:30 PM (ICT)