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3 Ways Empathy Is Driving Successful Innovations In Health

1 hour 42 min ago

This is a repost written by Archana Sinha who leads the Health and Nutrition Initiative at Ashoka India. This post first appeared  first appeared here.

From human-centered design to the lean startup approach, methods to develop innovative products and services emphasize the importance of understanding what customers really need. Here are some lessons in innovation that social entrepreneurs have learned from empathizing with their customers:

Don’t let technology take the wheel: “I used to think that the problem lies in technology. What we realized eventually was that the problem does not merely lie in the technology, but the psychology,” says Ashoka Fellow Swapnil Chaturvedi in a recent video on his work.

Swapnil, founder of Samagra, is talking about providing adequate sanitation in India, where over 50 percent of the population defecates in the open. His statement could be true anywhere else in the world; toilets installed in low-income areas often fall into disuse or end up being used for other purposes such as vegetable peeling bins. To mitigate this, when designing community toilets in Pune slums, Swapnil introduced a LooRewards system. Based on a mapping of the community’s needs, this system linked toilet use with discounts on washing and sanitation products, water purification systems or fortified, nutritional snacks sold by local producers. This helped Samagra engage over100 first-time users of toilets.

Michael Murphy, co-founder of the MASS Design Group also realized that sophisticated technology wasn’t essential, while designing the 140-bed Butaro Hospital in Rwanda. He reveals, “A common misconception is that design interventions that combat the health worsening effects of hospitals are more expensive or require advanced equipment and machinery, but we’ve seen that’s not the case. Hospitals all over the world can be harsh environments for patients—which is shocking to consider, as we think of hospitals as places people go to get better. But labyrinthine corridors, harsh lighting, and stale air can in fact jeopardize a patient’s capacity to heal. Beyond that, hospitals are actually making people sicker. According to the CDC, about 1 in 20 patients gets a hospital-acquired infection (something they did not arrive with) per year in the U.S. (CDC, 2013). In Butaro, we designed the building without hallways, instead creating open-air, comfortable waiting spaces that would reduce the transmission of infection, but still provide opportunity for check-in and interaction. MASS also incorporated ample landscaped areas for patients to have quiet space outside, or visit with their families.”

Build the solution for the most under-served customers: Your most engaged customers often come from the edges of the market. Swapnil admits, “When I started working on community toilets, I didn’t know women would become our biggest customers. However, we have observed that in urban areas, where everyone is stretched for land and privacy, men find a solution to the lack of toilets, but women can’t. They hold their urine and bowel movements, resulting in urinary tract infections.” Thus, women are keen users of Samagra’s community toilets and as its most vocal customers, they help get their friends and families to sign up. Samagra, in turn, pays special attention to their needs, by providing dustbins in each toilet stall for disposing sanitary napkins and prioritizing water supply in the women’s toilets.

For Michael, it was important to design hospitals that served patients as well as doctors better. For instance, hospital wards usually have patient beds facing each other, with a hallway in the centre for doctors to check on patients conveniently. Instead, the Butaro hospital in Rwanda has all beds facing the window, allowing patients to view the landscape. Michael explains, “There are myriad studies that demonstrate patients with a view to nature recover faster. Moreover, patients should not have to look at other sick patients when they are recovering; this represents a ‘factory-like’ setting of health care.”


Shift how the community sees you: “Hospitals should be, first and foremost, a public resource. This includes making the hospital an approachable space, where people can come to maintain their quality of life as well as receive acute care. That is why a lot of the spaces are landscaped,” asserts Michael. While building the hospital, he sought to expand its benefit beyond healthcare. “Health infrastructure requires massive investment and construction. This mobilization of resources should be transferred to the local community, by using local labor and materials, as well as providing on-the-job training. Butaro employed over 4,000 people, and transferred a few million dollars into the local economy as well. Beyond that, several masons trained at Butaro have gone on to other skilled jobs,” he states.

Focusing on positive outcomes for the community has prompted Swapnil to transform his rewards program from what he calls “transaction-based rewards” to “value-based rewards,” such as discounts on private tuition classes for schoolchildren. Samagra’s toilets also have bank kiosks that allow customers to deposit small amounts in their bank accounts regularly. This shift has resulted in increased revenue for Samagra, as “learning what customers care about through empathetic market research has allowed us to capture value and monetize it.” Transforming toilets into community connectors that allow slum-dwellers to access a broader range of services is powerful. Swapnil shares, “Since we installed a banking kiosk in the community toilets, rather than a place to relieve themselves, the toilet becomes a place to bank. People will never vandalise their bank; we’ve seen vandalism reduction by 85%. The toilet has become a place of business and a community centre of sorts.” Regular savings also allow customers to budget for the fees for using the toilet, and their payments have become more regular.

Innovations driven by empathy are now enabling Swapnil and Michael to expand the scope of their work. Michael’s MASS Design Group is currently completing construction on both a tuberculosis hospital and a diarrheal disease treatment center in Port-au-Prince, Haiti, as well as designing maternity waiting homes in Malawi and a Center for Global Health at Mbarara University in Uganda. Swapnil’s Samagra is evaluating options for adding more value-based rewards such as day-care centers for mothers who work in the informal sector and can’t afford to quit their jobs to take care of their children.


Redefining ‘innovation’ in the global development sector

30 September 2014 12:27 (America/New_York)

In a blog from Oxfam America, Jennifer Lentfer argues for a new interpretation of ‘innovation’ within global development and examines what we can learn from grassroots organisations.

Innovation is not a result of dictating or choosing from what is, but expanding options.” Curtis Ogden of the Interaction Institute of Social Change

Let’s face it. Some days, most days, development work is far from sexy. What’s most needed to bring about changes in ordinary people’s lives is citizens demanding fundamental services, community organising and coalition building, governments and agencies managing their budgets – i.e. the day-to-day grind of making institutions function.

So why then is the development sector so obsessed with being ‘innovative’?

It may be because we are often working in challenging, changing, and complex operating environments, within the risk-averse policies and procedures of aid agencies suffering from bureaucratic inertia. We long for a new ways of thinking and working, and new ideas are way more fun and much less political.

Nonetheless, I am often concerned that the term ‘innovation’ gets over-used and misinterpreted in the humanitarian and development sector.

Rather than the usual ‘latest and greatest idea or fad’ and ‘get-to-scale’ mentality associated with innovation, I wonder if innovation can be re-defined to identify innovation first from the ground up? In other words, can more localised, grounded means of problem-solving generate the most effective ideas, products or processes to be labelled as ‘innovative’?

This is where the DIY Toolkit can help ‘bring ideas to life’ across various sectors and settings. Throughout my experience in aid and philanthropy, I have found that local organisations are doing some of the most innovative, yet under-valued work in the development sector. Solome Lemma, Co-founder and Executive Director of Africans in the Diaspora (AiD), explains: 

“It’s often easy to forget the great amount of innovation that indigenous, grassroots organisations employ. Even more so because they often don’t frame their work within the language we understand or associate with innovation. You must listen, dig, ask questions, and reframe in your head to see that within what they describe as a regular part of their work lies ingenuity.”

Doesn’t it just make good sense to support more opportunities for ‘innovation’ closer to where the problems are occurring? Aren’t the people who intimately know a problem from the inside out more likely to see where the possibilities for innovation lie? And from small initiatives, is there not the potential to pilot and learn for application in larger programs? Ultimately, where we are looking for innovation and who defines innovation is vital.

One of the most important roles of us as development practitionersis to encourage, coach, and uphold processes of individual and collective reflection to identify and overcome obstacles, resulting in changes or adaptations in our work. If you are a development practitioner supporting community- or country-led initiatives, the DIY Toolkit is a useful tool to enhance your support of development partners to think creatively about their programs and practices at all levels. Supporting people and leaders in the developing world to enhance their own efforts with openness and confidence is what gives birth to lasting innovation.

So perhaps it’s time to re-conceptualise ‘innovation’ for global development. What if the thing really makes something innovative is not the idea itself, but the learning that made it possible?

Jennifer Lentfer is the creator of the blog, which focuses on how the international aid, philanthropy, and social enterprise sectors can be more genuinely responsive to local needs. One of Foreign Policy Magazine’s 100 women to follow on Twitter, she has worked with over 300 grassroots organisations in east and southern Africa over the past decade, as well as various international organisations in Africa and the US, including the Red Cross, UNICEF, Catholic Relief Services, and Firelight Foundation, where in her career she has focused on organisational learning.

Lentfer is currently Senior Writer on Oxfam America’s Aid Effectiveness team and editor of the organisation’s Politics of Poverty blog. She is also a lecturer in Georgetown University’s Center for Social Impact Communication

This piece is cross-posted from Oxfam America’s Politics of Poverty blog

Getting Beyond Hype: Four Questions to Predict Real Impact

8 September 2014 12:25 (America/New_York)

By Kevin Starr, September 2, 2014

Through a kind of magic I don’t fully understand, some emerging poverty solutions—products, services, technologies—become shiny new objects that trigger something akin to a feeding frenzy. Celebration at CGI and SOCAP and TED, breathless articles in Wired and Fast Company, endorsements from celebrities, awards of all kinds—all that stuff is great if the thing has real potential for impact. Too often, though, the appetizer becomes the entrée and hyperbolic celebration displaces systematic evaluation.

That’s a shame, because we really do need to sort good ideas from bad, and it ought to happen before we stoke the fires of publicity. At Mulago, we’ve spend a lot of time trying to figure out if start-ups with a new “thing”—a product, service, or technology—are likely to create real impact in the lives of the people we’re trying to serve. Over time, we’ve evolved a set of four questions that help us make better predictions. Because we’ve been thinking a lot about cookstoves and indoor pollution lately, I’ll use improved cookstoves to illustrate how those questions work.

1. Is it needed?

Given the nature of the thing, is there a profound social impact to be had? Every thing ought to have a mission (preferably in one that’s eight words or less). If you can’t figure out a clear mission that matters, all you may have is a solution in search of problem—and some things ought to be killed while they’re young.

We might reasonably ascribe various missions to better stoves, including: improve health, prevent deforestation, save time and money, and decrease carbon emissions. Since indoor air pollution is a major killer and bad stoves are the major contributor, we think that the mission to “Prevent Respiratory Disease in Poor Families” is a compelling one and rises above all the others (especially since the evidence connecting the other potential missions is considerably more sketchy). So the answer to question one isyes, absolutely, we need better stoves.

2. Does it work?

If the thing is deployed as designed, under the conditions for which it was designed, will it have real impact? In the case of stoves, this is mostly about emissions: Does a given stove reduce pollutants enough to drive a significant improvement in health? Recent research indicates that most improved cookstoves don’t. It turns out that you have to reduce more than 85-90 percent of pollutants before you see any real reduction in respiratory illness (Burnett et al, 2014). A stove that emits 50 percent less pollution doesn’t accomplish much. To date, the only stoves that make the cut are the expensive “forced-draft” models that use a built-in fan to stoke a much more efficient burn. The answer for most stoves, however admirable the effort may be, is no. Really.

3. Will people use it as designed?

Behavior, behavior, behavior. Despite all that user-centered-design, iterative-rapid-prototyping stuff, people use and abuse things in ways that leave even the best designers scratching their heads. Too many—way too many—products have made their way into wide distribution without evidence that people use them as intended. Successful things, though, usually have these qualities in common: They fit well with local customs and culture, are easy to use right and hard to use wrong, and need little maintenance (and when they do, they’re fixable and you can get parts).

Everyone has heard about stoves that people use improperly—or not at all—but field researchers have handed the stove industry another fun surprise: Even when people do use that wonderful new stove, they often use the old one too (Ruiz-Mercado et al, 2011). It’s become known as “stove-stacking,” and you see it when you visit homes—there’s the new stove, fired up and roaring, and there’s the old three-stone fire still belching smoke in the corner. Oh no! If you want to fulfill the mission—prevent respiratory disease in poor families—not only do you have to provide an expensive stove, you might have to provide two! It kind of sucks, but that may be what it takes to get to yes.

4. Will it get to those who need it most (a lot of them)?

Nothing matters if the thing doesn’t reach the people it is intended to serve. If you don’t have a reality-based idea about distribution, you should hold off on the design process until you do. Three things matter above all else:

  1. Price. If it’s too expensive, they won’t buy it. Knowing the customer’s price point is your first order of business, and you need to design the thing to hit that number.
  2. Distribution channel. Poor people live in a world of market failure, and there are a finite number of ways to get things to them—the hardest is to set up your own network.
  3. Sales. Somebody has to make the transaction happen—who are they and how are they going to do it?

And, of course, if the thing costs more than about 20 bucks, you’d better think about financing, too…

This is where stoves have always struggled: The affordable ones are inadequate, and the good ones are unaffordable. Even with the (unreliable) assistance of carbon credit subsidies, stoves that can fulfill our health mission are still too expensive. Emerging technologies will almost certainly lower the price of forced-draft stoves, but for the time being, they’re mostly out of reach for those who need them most. Financing can help, but poor people often have more urgent things to do with available credit.

One organization working on the stove problem that gets to “yes” to all four questions is Inyenyeri, a Rwandan company that leases ultra-low emission, forced-draft cookstoves to households at a nominal cost (about $7 per year), and sells customers the fuel pellets to burn in them. The pellets cost less than charcoal, and people who can’t afford to buy them can trade biomass for pellets. Inyenyeri leases families two or even three stoves to account for stacking. It’s still early days and there are a lot of moving parts, but it’s headed in the right direction.

The four questions are unforgiving; getting a no on any one of them means you won’t pass go on your way to impact. That doesn’t mean that a no answer should lead you to abandon the whole effort, but it should refocus your efforts on getting to yes. Stick with R&D, and avoid the big splash until you’re pretty sure you’re there—it’s the least we owe the people we serve.

The Ethics of Innovation

30 August 2014 12:23 (America/New_York)

By Chris Fabian & Robert Fabricant, Aug 5, 2014

Technology is all about making new stuff, agility and adaptability, and knowing what’s next. It’s fast. It’s cool. It wears a hoodie.

International development deals in systems and measurements to help shift government policies. It’s slow. It’s big. It wears cufflinks.

Each field has its own language and ethics. How do you work with beneficiaries (or users)? How do you conduct monitoring and evaluation (or A/B tests)? What does it mean to implement (or deploy)? These lexicons don’t always connect—and when they don’t, we see wasted effort and the potential to lose real global change.

An ethical framework—“a way of structuring your deliberation about ethical questions”—can help to bridge disparate worlds and discourses and help them work well together. Ethical questions might include: “Is this platform / product actually providing a social good?” or “Am I harming/including the user in the creation of this new solution?” or even “Do I have a right to be taking claim of this space at all?” This helps us form value-based collaborations—and allows us to better assess and monitor our work.

Here, we propose an ethical framework—very much a strategy or structure—based on nine principles (operational tactics and measurements) that UNICEF and other development sector actors developed and adopted. Building on their work, our framework includes a set of four cross-cutting values and statements that innovators can use to negotiate between the competing priorities and objectives of startup business and international development.

Innovation in International Development

In the dominant model of international development, targets such as the United Nation’s Millennium Development Goals are created and managed centrally, and measured globally. International development professionals try to agree on these goals, and then work to coordinate the big systems needed to make progress against them.

In recent years, many people in international development (inside and outside of the United Nations) have added a powerful new word to their discourse: innovation. The term carries many meanings, all of which seem far from the realm of three-year project plans, SWOT analyses, monitoring and evaluation, and logical frameworks (log frames).

In development, innovation most often means:

  • Working fast and flexibly like a Silicon Valley startup (process)
  • Incorporating the latest technologies to transform the way we engage populations and measure everything (technology)
  • Taking user needs into account, make sure that solutions reflect real user needs (design)
  • New models of shared value partnership, thinking more like an ‘incubator’ than a serial-process driven system (investing)

We’ve used these appealing words and concepts extensively in pushing for new design and development models in our own organizations. But while Silicon Valley has proven that “creating multi-disciplinary teams” and “failing quickly” add value to Facebook and Google, have we been able to prove that “agility” (for example) adds real value to large-scale human development?

“Invention Saves Lives”

As the international development community draws on the technology community’s language of innovation, private sector technology community itself is starting to approach the world of life-saving innovations.

The designers and technologists that created the personal gadgets, connectivity platforms, and Internet-enabled culture of sharing we use today are creating another portfolio of inventions that have largely charitable or humanitarian aims. A significant portion of these inventions target the most basic human technologies: toilets, water filters, smokeless indoor stoves. These efforts, though new, often 1) don’t see user growth, 2) are focused on advances in engineering and manufacturing rather than systemic change, and 3) start and end as ideas or prototypes.

What happens when the preeminent tech investors and inventors of our age take on this mantle and design directly for the global poor? What are the dangers of “disruption” when dealing with vulnerable populations’ lives? Should we use the same metrics to evaluate new releases of technological platforms as we do for social change?

Bridging Two Worlds

Here is a summary of the ethical framework we propose for guiding and evaluating innovation projects:

  • Innovation is humanistic: solving big problems through human ingenuity, imagination and entrepreneurialism that can come from anywhere
  • Innovation is non-hierarchical: drawing ideas from many different sources and incubating small, agile teams to test and iterate on them with user feedback
  • Innovation is participatory: designing with (not for) real people.
  • Innovation is sustainable: building skills even if most individual endeavors will ultimately fail in their societal goals

This basic framework is helpful when it is used to spur questions about specfic initiatives, which cross the spaces of technology, business, and development—questions such as:

  • How do we take advantage of global knowledge, technology and expertise to solve enormous problems without imposing a paternalistic model on the solution or those who benefit from it?
  • How do we design in an inclusive and participatory manner, when resource and power dynamics are so unequal?
  • How do we address persistent problems that defy a single clever invention and require sustained engagement, learning, iteration, and adaptation? (Imagine if Google left its original Spreadsheets application alone, thrown up its hands, and said, “Well, people either use it or not.”)
  • How do we take advantage of capital markets as paths to scale, while recognizing that they are not inherently humanistic or ethical?
  • How do we account for the potentially destructive results of innovations five or ten years from now without completely shutting down the sort of risk-taking that is essential to the creative process?
The Journey to a Set of Values

UNICEF’s Innovation Labs provide a good example of a values-based approach to problem-solving that effectively bridges technology and development. The labs fit into a growing constellation of tech hubs in the developing world and share the space with private-sector labs. (Many technology corporations are setting up their own labs—fueled by investments from technology giants, and modeled on Bay Area startup incubators—in the belief that having a footprint in the developing world innovation space is enough to inspire network growth or turn up new opportunities for core business.)

One of the reasons that UNICEF set up labs was to create a way to engage problem solvers in a space where problems are not just about a better product or single-pointed solution, but also about systemic changes that run from individual to community to national government and beyond.

UNICEF’s labs create a translation layer between startup thinking (“If I could make this one thing better, then people would use my product”) and development thinking (“If we can create a systems-level argument and fully monitor all aspects of our change, that change will become institutionalized over time”). These are simplifications of both systems, but the dichotomy is clear.

Without pathways to scale or market, many great ideas get lost. As Steve Davis of PATH puts it, “The ‘iPods’ of poverty alleviation and literacy have likely been invented and put to use by small organizations in some corner of the globe, but there is no market for identifying these breakthrough ideas and ensuring widespread adoption.” UNICEF intends its labs to work as APIs between small local innovators, and global systems of policy-making and scale.

These labs represent an important new physical layer in the innovation ecosystem by combining private-sector entrepreneurialism with broader societal needs. Structures like this can be effective in building a community with the skills and capacity to innovate, regardless of whether individual technologies or product ideas deliver on their promise.

However, they still constitute only one layer, and the strata around them needs to be balanced to ensure that innovations from within the network are authentic, fair, and useful. Set up correctly, labs move away from hierarchical structures for solving big problems and toward more-participatory engagements with potential consumers of those solutions (inspired by our close partnership with the global product strategy and design firm frog). In many ways, they are a physical metaphor for (and instantiation of) this ethical framework.

Shifting the Paradigm

In-country innovation teams, labs, localization, and research units represent a fundamental shift in the paradigm of innovation in development by dismantling the often modern, often Western distinction between business activity and social good.

Local (but global) labs also represent a fundamental shift toward a more human-centric approach to problem solving grounded in human needs, insights, and ingenuity. People’s needs are not neatly packaged up into commerce and social good. Similarly, they are not neatly divided between saving money and getting medicine for a sick kid or transport to a job site. Building one class of products for “consumers” and another for “those in need” creates false divides, as well as products that are neither sustainable nor scalable.

Some Background: Nine Principles

The thinking in this article and the ethical framework itself stems from a set of operational principles and specific thesis statements that a group of development, design, and technology experts have been building over the past two years. They include:

  1. Design with the user.
  2. Understand the existing ecosystem.
  3. Design for scale.
  4. Build for sustainability.
  5. Be data driven.
  6. Use open standards, open data, open source, and open innovation.
  7. Reuse and improve.
  8. Do no harm.
  9. Be collaborative.
In Practice

UNICEF’s deployment of RapidPro—a flagship, open-source platform for moving information quickly using simple mobile phones—offers another example of putting these principles to work. As the organization developed RapidPro, it faced a choice: traditional development or tech-driven innovation. In an attempt to bridge the two, (and through its Innovation Labs), RapidPro is basing development on non-hierarchical, participatory, sustainable, and humanistic design:

  1. Non-hierarchical: RapidPro has a management structure that looks like a tech startup (business development, operations, sales, engineering, and design), but each part of that structure sits in a different innovation lab.
  2. Participatory: Teams develop features and applications in the field, at the point of use, with people who will eventually use the system.
  3. Sustainable: The code and platform are entirely open source (AGPL), and vendors across five continents and a dedicated open-source community will support it.
  4. Humanistic: A real-time information platform is important to the private sector (where are my shipments? customers?) and public sector (where are services? those in need?), and the problems it solves are applicable to every country in the world.

By aligning the purpose and processes behind building RapidPro, UNICEF is creating platform that seems to fit this emerging model of global development, but more importantly, it has created ecosystems around the platform (and its services) in more than 30 countries. This would not have been possible using either of the traditional approaches, or without innovation, technology, and business partners such as frog.

This is only one example of such an approach. There is a rising tide of interest from organizations such as to move beyond individual product innovations, and plug into broader platforms and systems that can have a massive impact on poverty and health.


All collaboration is difficult, because the languages and principles behind these fields have been developed independently and over time. But by working together, the fields of technology, business, and development can create bigger change than by working separately.

A framework for discourse and collaboration, and a shared ethics around approach, are necessary to make certain that there is a common vision and that great innovations can have the best impact on the world’s most marginalized populations.

UNESCO-IHE – Smart eSOS toilet for emergencies

29 July 2014 14:17 (America/New_York)

UNESCO-IHE – Smart eSOS toilet for emergencies | SOURCE: UNESCO-IHE, July 2014 |

The emergency Sanitation Operation System (eSOS) concept provides a sustainable, holistic and affordable sanitation solution during the aftermath of a disaster. The eSOS reinvents (emergency) toilet and treatment facilities, and uses ICT to bring cost savings to the entire sanitation management chain. The toilet will improve the quality of life of people in need during emergency situations – from natural to anthropological disasters – and minimizes the threat to public health of the most vulnerable members of society.  

The eSOS concept was developed by UNESCO-IHE Institute for Water Education. The experimental prototype of the smart toilet was developed in collaboration with FLEX/The INNOVATIONLAB and SYSTECH and is funded by the Bill and Melinda Gates Foundation-funded project SaniUP – Stimulating local innovation on sanitation for the urban poor in Sub-Saharan Africa and South East Asia.

Smart features
The eSOS emergency toilets are easily deployable in disaster areas because of their robust and light-weight specifications. The smart eSOS toilet includes some unique features in the prototype that will shed new light on how the toilets are used in emergencies. This includes remote-sensing monitoring, an energy supply unit, GSM/GPS sensor/card, occupancy sensors, urine/faeces accumulation sensor, an S.O.S. button, and a communication system that allows for data collection by remote sensing and their transfer to an on or off-site emergency coordination center. The data resulting from the use of the toilets will allow the toilets as well as the entire sanitation management chain to be improved.

Field testing
The eSOS toilet will be tested further in a refugee camp in the Philippines in September with support of the Bill and Melinda Gates Foundation and the Asian Development Bank. UNESCO-IHE PhD fellow Fiona Zakaria from Indonesia will carry out further experimental testing in cooperation with relief agencies on the ground. The eSOS smart toilet design prototype will be manufactured based on the results and feedback obtained from the experimental application.

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