This research was done as a part of the Alchemix Blog Series: Dispatches from the Field
We are, therefore we invent. Technology represents one of the most fundamental applications of human intelligence. Given the gift of conscious thought, human beings are constantly striving to improve, enhance and evolve their lives. Defined as the application of scientific knowledge for specific purposes, technology is the engineered end result of the conscious human thought, harnessing the potential in nature for the purposes of our convenience. Little surprise then that it is at the crux of some of mankind’s greatest achievements through time, providing solutions to many challenges, whether it is the need to land a rover on Mars, light a bulb over a surgeon’s operating table or deliver clean drinking water to massively populated urban centers.
Yet, as we achieve complex technology accomplishments, more than a billion people continue to be disenfranchised, with no direct access to economy, science or development. The critical need is for innovators and entrepreneurs who can work with existing technology and build new ideas from them, to create a range of inexpensive, accessible and effective solutions that can be adopted at large scale. In this edition of Dispatches from the Field, we looked at the work of a host of entrepreneurs who are working at the grass roots, applying technology in ways that directly impact local under served communities.
Joe Madiath’s work at Gram Vikas took biogas technology across rural Orissa providing renewable energy in a way that rural families could own and adopt it. Jaipur Foot has brought down the costs of the prosthetic foot from $2500 to lesser than $30 and customized it for Indian usage making prosthetics and aids accessible to over 1.2 million under served people. Megh Payane Abhiyan has leveraged local insights to create storage solutions for drinking water that work in the worst flood affected regions of Bihar. WOSCA uses the ubiquitous mobile phone to connect tribal communities with data that measures their access to public entitlements, significantly enhancing their access to the public distribution system. OperationAsha uses biometrics within the counseling centers and clinics in urban slums significantly reducing instances of drug resistant TB under their watch.
These are not just examples of technologies integrated into development. They are a pursuit of enabling poor communities to gain access to technologies that can be easily adopted, within their available resources – in a way that significantly impacts their economic and social security.
This raises the question of social insights that form the basis for technology adoption. Are enough entrepreneurs pursuing insights while developing new ideas or is ‘consumer insight’ relegated to the later stage of ‘market development’? Beyond the impact of these technologies, these examples raised a more deeper concern. All these models have evolved through the deep, patient perseverance of a non-profit, philanthropic approach that allowed the innovators to experiment and evolve the model with the communities in question. Does the more modern ‘impact investment capital’ have this patience? Are impact investors willing to innovate on the nature of their funds so that more such technologies can be adapted and accepted? Could we be chasing a quick solution format in the search for market-based large-scale solutions? Is technology adoption only about the technology – how do we fund the social and economic process of adoption that forms the basis for any technology innovation succeeding in impoverished communities?
The social entrepreneurs profiled here are attempting to solve the very real challenges of getting public entitlements, basic life products and services to the most under served communities. Without the luxury of resources, these organizations are using the power of insight, collaboration and continuous prototyping – connecting the ingredients through effective technology adoption. We researched their work further to understand what are the triggers for their technology exploration and adoption. From the various models we studied, we have pulled out some of the pivotal patterns that seem to be making their ideas work.
Adapt and apply. Keeping it simple and effective.
The dichotomy—between providing technologically-based tools to rural communities and searching for the most appropriate and helpful versions of them—has led to a conflict in current development paradigms,writes Joe Madiath in his paper It Takes a Faucet .
“Often we do not need any heavy R&D, just some creativity, encouragement and the courage to take risks. Basic solutions like fitting a ball bearing to a water-lifting device to draw water from a well, or designing a better bullock cart, can make changes in the way poor people live and work…” says Joe Madiath, founder of Gram Vikas  (GV), a non-profit organization that works extensively with the disenfranchised, tribal people of Orissa. Gram Vikas’ own experience in the implementation of its Biogas program makes a strong case for the importance of adapting existing technologies to suit the needs of people. More than 77 percent of Orissa’s rural households are dependent on wood as a cooking-fuel and 15 percent utilize cow dung cakes. Less than 70% of the state’s rural households have electricity connections.  
Tapping into locally available eco-friendly biomass and organic wastes such as cow dung, vegetable waste etc to generate a renewable energy source through biogas plants, GV was able to power villages and help them meet their energy demands. What began as a small 6 cubic metercommunity biogas plant that supplied electricity to 28 homes and a small communal hall in the village of Toda, rapidly extended to include over 54,000 biogas plants supporting more than 6000 villages in rural Orissa.
“We have always favored sustainability, not cutting edge technologies for which local communities had no use, and eschewed the low-quality equipment the government often provided simply because it cost the least ” says Madiath.
Innovation in plant construction was one of the key factors to overcoming the program’s challenges of scale. In fact, the concept and technology was so simple that rural community members found it hard to believe that it was a credible solution to their energy needs. “…biogas being a relatively new technology in rural areas, people did not know much about it and found it hard to believe that by just mixing dung and water in a cement and brick tank, a gas that could be used for cooking and lighting would be produced.” 
More than 90% of GV’s biogas plants were built for small scale and marginal farmers, the landless and scheduled tribes, which meant that low-cost and affordability was a key factor in scaling the program and low-maintenance models necessary to its future sustainability. When practical experience revealed that existing designs of biogas plants, such as the Janata  model, developed leaks over time and were not adequately meeting these challenges, GV set out to find solutions through innovation. Everything from lining the plants with polythene to plastering the plant wall was tried and during this experimentation phase, some 20 to 30 different biogas plant models were tested with the collaboration of various researchers and organizations. This experimentation phase, where existing technology was tested and modified to suit the local requirements that were so crucial to the large-scale implementation of the program, proved a deciding factor in its success. The Deenbandhu  model, developed in 1984, and one of the models tested at the GV campus, was found to be less complicated and considerably less expensive. Eventually, the Deenbandhu model made up for 94% of the more than 54, 000 plants installed by GV. Through the program, more than 2000 masons and 700 supervisors sustained direct employment, creating capacity within the area for further growth and sustainability of the program long after GV’s withdrawal.
This experimentation phase, where existing technology was tested and modified to suit the local requirements that were so crucial to the large-scale implementation of the program, proved a deciding factor in its success.
We may be able to manufacture the most durable water pipes on the globe through the latest research, but it will be of little use for the simple Indian farmer in a remote village who can ill-afford to customize it for his use. Like millions of the world’s most vulnerable and disenfranchised, the poor farming family will have to manage without any access to clean water or sanitation because of a lack of economically viable options.
The key to GV’s success may be found in its diligent efforts to assess the needs of the community and understand its particular challenges. This enabled the organization to find, test and modify existing technology in order that they are most relevant to meet the challenges.
Function leads design. Real life drives technology.
Constricting economic concerns, meager resources and urgent need can prove a fertile sandbox for new, groundbreaking innovation. Dr. D R Mehta is greeted by a large motley group of people as he enters the building at the Jaipur Foot campus. Stopping to speak with a young man sitting on a run down wheelchair he asks him “How much money do you have?” The young man pulls out a Ten Rupee note.
“With 10 Rupees in his pocket, this young man has come from Muzzafarpur to Jaipur, will need to stay here for 3-4 days, get himself a prosthetic and go back to his village. He has no means to pay for any of this. How can the Technology we design not take into account this young man’s real life?” asks Dr. D R Mehta.
The development of the Jaipur Limb is a great example of what is increasingly becoming a powerful driving force in technology-enabled intervention programs of social enterprises. First designed in 1968, by Mr. Ram Chander Sharma, the Jaipur Limb was a revolutionary innovation in the world of prosthetics, using simple, cost-effective technology to meet the specific challenges of amputees and physically disabled of India. Continued research, development and promotion of the technology through the initiation of Bhagwan Mahaveer Viklang Sahayata Samiti  (founded by Mr. D. R. Mehta), one of the largest social organizations in the world providing fitments to the physically handicapped, has, in many ways, brought the Jaipur Limb on par with some of its more conventional counterparts.
Unlike most other prosthetic legs that can only be worn with shoes, the Jaipur Limb enabled people to wear the prosthesis without footwear, a feature of particular cultural significance, as it allowed users to go into temples and mosques for prayer. To meet the challenge of infrequent follow-up visits by beneficiaries, the Jaipur Limb was designed to allow for quick and on-the-spot fittings. It is a known feature that many of the patients do not come back for the second visit meant for fitment.  Depending on the case, a Jaipur Limb can be custom made and fitted for each person in as little as 3 hours. This distinguishes Jaipur Limb Technology from other technology which send their teams twice to the camps, once for making assessment and taking measurements and secondly for fitment and delivery after a few weeks or months. 
The technology is not only water-proof, but allows for the same range of movements typical to a natural human foot, allowing users to squat, sit cross legged, walk on undulated terrain etc.
Driven by the needs of the people themselves, such innovation often draws from the cultural and traditional practices of a region, combining modern scientific knowledge with existing practices. This is often a participatory endeavor that galvanizes communities to meet the challenges of their region with the collaboration of external agencies such as non-profits, government organizations and the people themselves, a process that in itself strengthens future sustainability of any intervention program that may be implemented. Enabled by innovation but strengthened by the people, these technologies are addressing broader social issues such as gender gaps, hygienic living conditions, proper management of natural resources among many others, to create paradigm shifts in a community’s approach to meeting its challenges.
Megh Pyne Abhiyan  (MPA) is using this strategy to meet its campaign goal of a behavioral change amongst the rural communities to effectively revive, innovate and institutionalize water and sanitation management practices and mainstream issues concerning floods through collective accountability and action. When participatory research revealed that lack of clean drinking water during floods created many problems for the communities, a simple innovation in rainwater harvesting and water storage techniques provided a workable solution. 
An estimated 77% of north Bihar is vulnerable to flood ,a phenomenon that is so common in the region that it forms an additional season to the calendar year, known locally as Barh. During floods the flood and river water are used for multiple purposes such as – defecation, drinking (if the hand pumps are submerged), immersing the dead persons and animals. Perforce people drink unclean stagnant water or flowing flood water’ .
To enable access to clean drinking water throughout the year MPA began a series of efforts that drew from the experimentation and feedback of local communities for a scalable solution. The Jal Kothi  was the result of this collaborative effort. Designed from traditional grain storage earthenware, the Jal Kothi has enhanced storage capacity, allowing community members to store water during the 3 months of the rainy season when they are most vulnerable.
MPA’s Phaydemand Shauchalay  and Matka Filters (eco-sanitation and household filter initiative) is another result of these efforts. These toilets address several concerns at once: they are designed to account for seasonal floods in the area, they prevent contamination of the environment, particularly drinking water sources and they allow for privacy, which is particularly important for women and girls. In the Matka filters there are three local typologies of filters that address existence of iron, microbiological and arsenic contamination in groundwater.
The ‘community receptiveness’ of MPA has created a critical mass- that is both ‘willing and able’ to take forward innovations that emerged during MPA’s alternative safe drinking water and sanitation initiative. These innovations are in the form of structures that collect, filter and store water, and provide safe and hygienic space for defecation, especially for women and adolescent girls – all built using local materials.
People driven strategies in this high-risk environment were derived from the resource- specificities of the region. Adapting simple innovative systems of resource utilization based entirely on local perceptions, knowledge, creativity and skill sets have enabled the adoption. The strong “local” component in the technology has facilitated the process of cost and model construction, in such a way that the design and unit price are derived based on availability, access, quality and remoteness to required resources, skill sets, need and location of the affected habitation. Thereby, making the technology thoroughly decentralized in terms of construction, costing and use. Eklavya Prasad, Managing Trustee of MPA strongly believes that weaving the drinking water and sanitation mandate into the social, health and economic fabric of the target areas, will help in developing a scalable model. It has been very important to leverage these innovations and integrate local innovators, to enable a critical mass of adoption within the community.
Facilitating visibility and access, technology makes data easy.
Economically poor communities lack access to public entitlements. But more importantly they lack the ability to visibilize the extent of the gaps and large discrepancies that keep them poor and under served. This seems to create a regressive cycle of dependency and further poverty. But easy to use technology seems to be playing the role of a rapid catalyst in bringing about change in this scenario. Is the ability to create empowered transparency a trigger for adoption of technology?
The Women’s Organization for Socio-Cultural Awareness (WOSCA), implements a very interesting project titled: Tracking Livelihood Entitlements of Rural Communities in Orissa Using Mobile Phone and Information Technology. This project aims to use technology to increase transparency in order to empower disenfranchised tribal communities in Orissa so that they may be sufficiently equipped to claim their entitlements as outlined in various government schemes and programs.
WOSCA’s project uses MERComs , a modular, expandable and localized (English, Hindi, Oriya) Management Information System (MIS) that generates regular reports using data extracted and summarized from a database of 46,000 households. These households are connected via a group of volunteers and community members who are responsible for collecting data at the point of disbursement of a service/entitlement. The data is collected diligently from each household and sent to the main server via SMS using a mobile phone. This is done regularly to ensure that the entitlements are reaching those who need them most. The data that is generated allows WOSCA to create a report indicating which households in the database have received their entitlements and shows any discrepancies that may be present, such as families not receiving what is their due.
The reports are shared with community members and SHGs once a month in order to empower them to continually claim their entitlements. This report forms a strong starting point for beneficiaries and community members to open up a dialogue with concerned government officials at the appropriate administrative levels and claim their entitlements. It acts as a form of evidence that, when presented to concerned authorities, holds them accountable and compels them to ensure transparency within the system.
While the mobile phone is ubiquitous across rural India as a communication device, its very interesting to see that the relevant MIS system, linked to the mobile phone and a community demand for transparency can be transformative within the sleepy tribal village communities of Keonjhar District, Orissa.
A similar prototype has been implemented by Operation Asha  (OpAsha) within its Tuberculosis (TB) program. OpAsha uses technology to measure the effectiveness of its Tuberculosis Management.
‘Our low-cost biometric technology has not only ‘turned the tap off’ on MDR (Multi Drug resistant) TB, it also reduces the cost of treatment per patient, improves productivity of staff, prevents ‘gaming’ of the system, and ensures total transparency. It also streamlines our reporting system by electronically generating monthly reports, thus proving environmentally friendly and time saving,’9 writes Dr. Shelly Batra.
As the Co-founder and President of OpAsha, Dr. Batra has long been aware of the particular challenges that the poverty stricken of India face, especially in the health sector.
Established in 2005 with a vision to make India Tuberculosis-free, OpAsha tackles the high incidence of TB in South Asia through its 200 treatment centers present between India and Cambodia. The organization uses the Directly Observed Therapy Short Course  (DOTS) treatment method as outlined by the World Health Organization. In DOTS, medication is administered by trained healthcare workers, who must diligently ensure that every patient swallows each dose of the 6 to 7 month course in their presence. DOTS was developed after it was observed that many TB patients never completed their course, leading to multiple drug resistant TB (MDR-TB).
Though it has proved effective, the DOTS method has some drawbacks. One of the biggest criticisms leveled against it is that it depends solely on the honesty of healthcare workers’ inputs to ascertain if a patient has in fact taken the medication. Further, if a patient has missed a dose, the existing process was very slow to respond effectively. For OpAsha, effective impact measurement on a daily basis was an essential need to succeed with the TB program.
Faced with these challenges, OpAsha turned to technology application. ‘Under the eCompliance initiative, each treatment center is equipped with an eCompliance terminal, consisting of a fingerprint reader and a low-cost SMS modem. When a TB patient visits the treatment center, they verify their visit by scanning their finger on the reader before taking their medicines. The terminal keeps a real-time attendance log. This gives health workers the option of quickly viewing which patients have visited the center, which patients still need to take their medicines and which patients missed their doses the previous day. With use of the fingerprint reader, the system provides unmistakable evidence that a patient was physically present for the treatment’ 10
What characterizes these examples are their simplicity and the use of the core challenge as the trigger to seek and adopt technology (rather than a technology that seeks a market). Complementing the technology is a nurtured involvement of people in the community to use and deploy the solutions. These examples and cases are not singular in their simplicity and contextual use of technology. Hints of several such examples can be seen in the work of grass roots innovators and social entrepreneurs building new products for the underserved market.
For any technology to work it seems that the innovator, entrepreneur must find answers to key questions in their context:
- What is the impact of NOT having an appropriate technology solution right now, in your context?
- Can your user/ consumer procure the solution given their available resources?
- Does the user/ consumer have to change behavior and old habits to adopt your idea – or have you found ways to extend current behavior forward?
- Does your solution tangibly improve the economic and/ or life security for your user/ consumer in a way that the user/ consumer herself can measure it?
Are enough entrepreneurs paying attention to the social behaviors and social science that is associated with the adoption of new ideas and technologies? Or are social insights relegated to ‘market development’ – much after the technology or idea has already been crafted and invested in? Are impact investors willing to learn from philanthropic behavior to build new and enhanced ways of supporting the social process of technology adoption? And finally who in the ecosystem must facilitate this journey of ideas and technology to large scale adoption?
Series Author: Parvathi Menon
Research and Content Development: Anupama Kalgudi
Blog Series inspired by discussions with Arvind Gupta, previously the Program Lead for the World Bank’s Development Marketplace Program.
This research and learning is the basis for the 6th Alchemix ™ Session to be hosted by Innovation Alchemy in Bangalore on 21st November 2012. This Session will be brought to you by Mahindra Rise . Join the discussion in person or through a Live Stream. Register Now. 
This article was originally published on: http://www.innovationalchemy.com/