Monday, January 6, 2014

Barriers to mHealth adoption in Sub-Saharan Africa

In Uganda, and Africa at large, the populace face many challenges with regard to health including but not limited to; poor facilities, poor social infrastructure, energy shortage especially electricity and limited access to education. Despite Government’s effort to improve on the health system, very few individuals, companies and organizations are tapping into the potential of mobile Technologies for health, even when the benefits are obvious to populations whose most accessible tool for communication is a phone. Below are some of the reasons that I personally think contribute to the little uptake of mhealth.
 
Photo Credit: Edward Echwalu
1.      Content
The absence of readily available mobile health related content on specific thematic areas is a big barrier. Most organizations that implement mhealth projects have to develop their own content based on the area of focus. eg HIV, Malaria, maternal health etc. There is also no central database where this content is put for future reference or to avoid duplication of already implemented mhealth issues. This leaves room for data redundancy and duplication to target groups.
 
2.     Skills
Because of the tremendous growth in phone penetration especially in sub-Saharan Africa, there is a great demand for training in mhealth education. One cannot simply rely on the assumption that because every at least many people own phones, they can ably use them for mhealth campaigns. They need to be trained on how to operate the phones, say for health related surveys or how to respond to health quizzes. This is still lacking. Unless the mhealth campaigns are inform of interactive Voice Responses (IVRs), the adoption will still remain slow with the use of interactive SMS messages especially among the elderly populations.

3.     Gender
Although this is an issue that is often under looked, it plays a key role in either the success or failure of mhelath project. It’s obvious that the biggest percentage of those who bear the burden caused by conflict ,disaster are women and children and they are the key stakeholders in promoting good health and building stable, self-reliant communities. Also most mhealth related campaigns target mainly women on issues like maternal health, child mortality, HIV/AIDs, abortions etc. but ownership of phones is predominantly male who control what kind of information comes through the phone, whose mobility is not restricted and who are better economically empowered to afford maintaining the phones especially in rural areas. Therefore, Making these projects gender sensitive and involving men right from the onset of the projects will reduce the barriers.
 
4.     Access/Affordability
This could be viewed in terms of access to the actual handset especially for the rural folks in rural Africa and affordability in terms of maintenance such as paying to have the phone charged. Many people cannot afford a 30USD handset yet most mhealth implementing organizations/companies only want to work with folks that already own phones. It’s a barrier because you reach fewer people.

5.     Infrastructure
A lot of mhelath projects in Africa depend so much on Telecom companies which are responsible for the general telephony infrastructure eg masts for access to network, distribution of short codes for those that intend to use SMS etc. In the event that an area does not have access to a mast, then it is obvious that even if there is a genuine health need to be addressed through the use of mobile phones, it does not get attention simply because there are issues of network connectivity. This is one of the biggest barriers for rural Africa. Also the issuing of short codes by the Telecoms through communications regulators is bureaucratic.

6.     Attitude
Traditionally especially in Africa, mobile phones are known for verbal communication. But with mhealth projects comes a new paradigm shift to the use and application of phones for accessing health information through SMS. Accepting this change and adjusting accordingly can be a barrier to SMS based mhealth project. IVR related mhealth campaigns could be more successful than SMS because voice messages cut across literacy levels.

7.      Language
This is a barrier because of the fact that the commonly used language for SMS is English yet sub-Saharan Africa is so diverse. However, this barrier can be solved through voice messages and using community radios along side the mobile phones.

8.     Political Will
The success of any project depends on the positive political will and government support. Often times, mhealth initiatives by NGOs are meant to compliment already existing government health services and therefore they must work closely with Government. However, many initiatives have been destroyed because the Government has not played its role. A case in point is the moratorium that was issued in Uganda from the Ministry of Health halting the implementation of all electronic and Mobile Health projects that were not approved by the Director General. While this was a great initiative to reduce on duplication of projects and to encourage wider coverage and eliminate unnecessary pilots, the Ministry did not make the vetting process smooth. It would take months to have the technical working group at the ministry meet and approve the projects. This is a source of frustration for projects that have defined timelines.

Thursday, September 19, 2013

Citizen Journalism: A paradigm shift in reporting on Agriculture

“Reporting on Agriculture is not sexy” has become a new cliché these days.

Many young journalists have been made to believe that the area of agriculture lacks the right stories that can draw attention and increase readership, viewership or listenership to their journalistic work. Unless, of course, these are stories about agricultural related disasters like floods, famine, hunger and or the negative effects of climate change.
A lot of print media (New papers, magazines etc) and broadcast media (TV, radios etc) are braced with headlines and feature stories on Celebrities, political scandals, riots, finances and many more but very few look at all these from an Agricultural point of view, simply because they think it is not catchy and therefore will not attract the attention of many.

While we are all aware about the role of journalism in reporting agriculture, we know that many times, these journalists have downplayed crucial stories on agriculture and consistently use excuses such as, “Agricultural Lingo is too technical for their audience”. Other have blamed it on their editors who never approve agricultural related work pieces.

Taking the bull by the horn

These excuses have always existed and the blame game in the newsrooms is not about to end, however something can be done by another kind of journalists, Citizen Journalists.
Gone are the days when publishing news globally was an act that had been the exclusive domain of established journalists and media companies.  Today, people like you and I without professional journalism training can use the tools of modern technology and the global distribution of the Internet to create, augment or fact-check media.
This means that anyone with access to the Internet or even a cell phone can report, start a blog, chat and or tweet. As a result, it is becoming cheaper and easier for individuals and organizations with the right skills to publish their own newsletters, produce both audio and video materials in addition to hosting public chats. However, it is vital to not that while the media scene is changing globally, mainstream media still carries weight and has influence in setting the public agenda.

Great initiatives in using technology for agricultural reporting

According to the Farm Radio International 2011 report , radio is the most widely used medium for disseminating information to rural audiences across Africa.
Radio can reach communities at the end of the development road – people who live in areas without phones or electricity. Radio reaches people who cannot read or write. Even in very poor communities, radio penetration is vast. It is estimated there are over 800 million radios in sub-Saharan Africa.
Just like many other ICTs, radio has one major limitation. It has been a one-way medium that reaches farmers in their homes and or fields and on its own, radio has had limited means of interacting with listeners because of the one way flow of information.  And even if it’s true that radio is the most widely used medium, its ownership, control and greatest percentage of listenership is limited to mainly the men despite the fact that majority of those involved in agricultural production are women.

It’s because of such limitations that we see the rise in the use of mobile technology for agriculture by organizations like Grameen Foundation through APPlab that thrives to avail farmers with relevant and timely information regarding their products. We also continue to see mobile innovation such as M-Farm an integrated and customizable ICT platform designed to help stakeholder in agricultural value chain communicate with each other efficiently, establish and maintain business relationships and manage the flow of goods and services among them.
Because of the power of these simple initiatives, many organizations have begun motivating youth to develop applications that support Agriculture. A case in point is CTA which is organizing a hackathon in partnership with East African ICT hubs and labs with an aim is to highlight the potential of ICT applications in agriculture and to support the development of ICT innovation and entrepreneurship in agriculture especially by young people.
Such practical initiatives and many more are what will change the paradigm of how agriculture is reported about.

As we continue to advocate for more coverage of agricultural stories especially among the youth, we must note that this advocacy must be holistic and look at all categories of youth from farmers, activists, techpreneurs, business, students, young professionals and most important young journalists because they are the ones who will tell the story.

Sunday, August 11, 2013

Civil liberties under threat on the streets and online in Uganda

Since 2011, Uganda has been the scene of protests against corruption, poor health care, education, unemployment and alleged nepotism in the current ruling National Resistance Movement (NRM) Government. As a result, opposition parties and civic groups have since 2011 planned rallies that have been actively blocked by the police under what they call the "preventive arrest" of protest leaders. Several activist groups have however continued to demonstrate in the capital Kampala and have often been faced with obstacles including beatings, harassment, arrests, use of live ammunition and tear gas canisters among others.

Tuesday 6th August saw the passing of a very contentious bill by the Ugandan 9th Parliament, the Public Order Management Bill. The bill was passed despite criticism from opposition members of Parliament, religious leaders, activists, human rights groups and some members of the public.
According to clause 8 of the bill, police have discretionary powers to reject or grant permission to a gathering, including the use of force to break up gatherings held without prior authorization. This clearly infringes on civil liberties and the sanctity of the constitution which guarantees these rights.

The Public Order Bill was initially proposed and tabled in 2009 and just like today, it sought to regulate public gatherings and empower the inspector general of police to regulate the conduct of meetings. Despite the heated debate in and outside Parliament it was finally passed on Tuesday. Prior to its passing, one of the young opposition lawmakers Hon. Odongo Otto, in an apparent bid to delay voting on the bill, tore up a roster of lawmakerswho were for the bill as the deputy speaker Hon. Jacob Olanyah looked on. For many, this was an act of courage and he was praised for representing and fighting for the rights of the people he serves.

As a youth activist, together with other young people in Uganda, I have on several occasions organized tweetups (physical meetings of people who tweet) at public coffee shops to discuss some of the issues affecting our country and what role we can play. These issues range from politics to governance, fundraising and youth unemployment. With the passing of this bill, we might never be able to discuss issues that affect us directly as young people.  Many have resorted to using the Internet to share, question, engage, blog and tweet their thoughts because they are afraid of what may befall them should they take to the streets after the passing of the bill. These virtual meetings are also under threat as the government’s communications regulator is planning to monitor and regulate the use of social networking sites like Facebook and Twitter.

This poses a threat to Uganda, a country with the youngest population in the world and the highest rate of youth unemployment in sub-Saharan Africa. It is thus extremely important that youth activists seek to promote responsible and effective youth leadership to build positive attitudes towards education, knowledge sharing and entrepreneurship, human rights and tolerance Uganda, to contribute towards lowering the number of youth involved in criminal activity and increasing youth resilience in the face of violence and poverty. Such a bill only hinders our progress.

Uganda’s President Museveni, took over power undemocratically in 1986, when many of the current youth population were not yet born. (Museveni was later elected in 1996).  While Museveni may be a villain for many Ugandans today, he is still praised as a hero by the older generation in Uganda for ushering in peace in 1986 after the said tyrannical rules of former presidents Idi Amin Dada and Milton Obote. I cannot ignore the fact that there are mixed reactions towards the bill because the real cause of this action is to manage public order in the country. Many of the critics do not say much about that. There are many ‘non-players’ in these gatherings including school children, business people and youth who are constantly victims of uncouth police action. The manner in which the bill was passed and the fact that so much power is given to the police to regulate the conduct of meetings is bizarre. Perhaps what Uganda needs is proper dialogue and not imposed bills that infringe on the rights of her citizens.

The cause(s) of these political riots, demonstrations and gatherings must be addressed by the Ugandan Government if positive change is to be achieved and the youth must be at the forefront of these dialogues.


Follow what Ugandans on Twitter are writing about the bill using the hashtag #POMB
Read Same article here on One Young World Website

Tuesday, May 28, 2013

Freedom of expression crackdown in Uganda, why Social Media is not helpful.



Over the past one week, I have closely followed the story about the recent media crackdown of one of Uganda's leading independent newspapers TheDaily Monitor , RedPepper a tabloid and a couple of radio stations. I have, on daily basis streamed local news via NTV Uganda , followed the social media buzz and read blogs from some of Uganda Journalist like Charles Onyango Obbo and Angelo Izama regarding the media besiege of 20th May 2013 in Kampala Uganda.
With many personalized African regimes, where you easily get thrown in jail for publishing news that holds the government accountable, there is no doubt that good journalists become an endangered species. Main stream Journalist have become an easily target and have been victims of media crackdowns with so many being thrown in jail and threatened or have their licenses withdrawn by the communications regulator Like Rosebell Kagumire a Journalist and blogger shares.
 
 Snap shot of tweets about the Besiege on 20/5/13
Because of such risks, the advent of social media has shaped and continues to shape the experience of news because, it not only enables real time reporting but also creates millions of witnesses to hold Governments accountable. We all witnessed its impact during the Arab spring and how the narrative about Kenya is Changing though an online movement on Twitter dubbed #KOT [Kenyans on twitter] who will not waste any chance to correct  international media like CNN for wrongly broadcasting news about the various situations in Kenya. All these have been very successful but the same approach has failed to yield anything tangible in Uganda yet a reasonable number of Ugandan use social media.
The obvious reasons will be attributed to issues of numbers; how many people use social media in Uganda,what social media platforms are used, if any, what they are used for, if there are rules governing usage? Etc. While I personally agree that big numbers are essential for advocacy, they do not always guarantee positive impact. But for those who use social media (which is quite a reasonable number) how is their online activism and advocacy shaping and or impacting on the media freedom debate in Uganda? 

This is why I think social media is/has not been helpful in Uganda

  1. For many of us, action has become what we think. We have chosen to use social media as platforms to express our grievances and only stop at that, and then leave it for few ‘brave’ ones to act. And unfortunately, only few brave people have acted. This is why I think that, social media has not been an effective tool in advocating for positive social change or creating positive impact in instances where the government has silenced citizens who question its mandate, those who express their opinion freely and those who threaten its existence in one way or another through freedom of expression. 
  1. We advocate for connectivity without pushing for freedom yet at the back of our minds, we know that this cannot work. In many places worldwide, ordinary people have been tortured and continue to be toured because of censorship. Without freedom, many Ugandans are hesitant to participate in sensitive issues that jeopardize their existence, so they choose to follow the “bandwagon” effect and share information randomly without good coordination such that at the end of it all, no one is responsible for the online buzz and therefore one is to blame or held accountable because somehow everyone is responsible.
  1. When you look at a list of Ugandans on twitter you will notice that these are elite and mainly urban dwellers that have jobs to protect and fear to get on the wrong side of government. You will hardly find members of parliament, the police, ministers and other legislators with personal accounts that they manage and use to engage. For online campaigns to be successful in real life, there must be a leader, someone to guide the discussion and move it forward, someone to keep the interest strong right from the start to the end, to keep the online communities of practice focused and not easily swayed away by other "breaking news" a common trend on social media platform and above all someone ready to take up the biggest part of responsibility and willing to be accountable. We do not have many of such people in Uganda when it comes to sensitive issues that that are linked to or involve the government.
  1. The communication regulator, Uganda communication Commission (UCC) claims to recognize the fundamental importance of ICTs in all policies for development and says that it creates the conditions for the fullest participation by all sections of the population, yet the same regulator is quick to shut down radio stations and threaten to block social media websites when citizens use the internet to question issues of governance like it currently is with freedom of expression. In 2011, UCC, through Internet service providers attempted to block social media websites twitter and face book during the presidential elections and Walk to work riots. Major telecoms in Uganda were also accused of violating customer privacy because they were censoring SMS messages with key words like Egypt, Mubarak during the Arab spring. These actions by the country's communications regulator raise suspicion among online internet users making them worry about their privacy thereby hindering online activism that could later on become physical activism.
    Aljazeera's Malcom Webb (R) runs away from a teargas Canister during the journalist demo in Kampala, Uganda on 28/5/13: Photo by Isaac Kisamani 
    Like Chris Obore an investigative Journalist with the Daily Monitor recently said during the 2013 Internet freedom Forum in Sweden , that "Until internet begins to determine politics in my Government, it will still remain useless for so many”. It is true that very little advantage can be taken of the opportunities social media provides if the policies needed to provide citizens with meaning and purpose are not conducive. And because we still have a small online community in Uganda, the newspapers and radio stations are effective ways of accessing relevant and timely information by the populace. We need our journalists to be protected because they are society watch dogs. Threatening them and beating them affects us all. We need to be informed so that we can question and hold our government accountable because we are all stakeholders. Journalists surely deserve better.