I Left My Heart in Navrongo: Visiting the MOTECH Project in Ghana

Ellen Yiadom is Grameen Foundation’s Africa Legal Fellow. She graduated from the University of Virginia School of Law in May 2010 and is a recipient of Dewey & LeBoeuf’s Community Service Fellowship.

Last November, I visited Grameen Foundation’s Mobile Technology for Community Health project (MOTECH) in Ghana. The project covers 15 health facilities in Kassena-Nankana, a district in the Upper East Region that is only a few miles from Ghana’s northern border with Burkina Faso. I was there to observe the operations of the project and help the field staff update patient care information.

We flew into Tamale, the capital of the Northern Region of Ghana, and drove two hours to Navrongo, which became my base for this trip. As we drove from Tamale to Navrongo, I was impressed by the lushness and serenity of the natural landscape, which was a contrast to the bustle of Accra, Ghana’s capital, where I was born.

Although there was very little human activity along the road, small towns would spring up along the way and the road would quickly become populated with people on bicycles, motorbikes and even an occasional donkey. These small vehicles often included several passengers. I even saw very small children riding behind or in front of their parents seemingly without fear.

Upon arriving in Navrongo, I visited a health facility in Kurugu, a sub-district in Kassena-Nankana, to help update patient care information in the MOTECH system that provides customized health information to pregnant women through mobile phones.

One key service is Mobile Midwife, which provides weekly phone calls and text messages to women about prenatal and postnatal care.  After registering for the service, pregnant women receive information tailored to their stage of pregnancy, while women with newborns receive vital information during the baby’s first year of life. For example, if a woman is six weeks pregnant, she would receive information about what to expect during her first trimester.  Additionally, the messages encourage the women to visit the nearest health facility throughout their pregnancy and give them tips on staying healthy during their pregnancy. Because Mobile Midwife is run through an Interactive Voice Response Server, women can call in to listen to any messages they may have missed. There’s also a call center where women can ask questions about technical issues such as the alerts and messages they are receiving; staff in the field also go out to meet with women who are more comfortable speaking in person than over the phone.

Kathleen Odell Responds to “Caught in Micro Debt” Documentary

Guest author Kathleen Odell is assistant professor of economics at Dominican University’s Brennan School of Business.

Full disclosure: Last spring, I authored the Grameen Foundation report, Measuring the Impact of Microfinance: Taking Another Look, which was released in June 2010. I was asked by Alex Counts and Todd Bernhardt of Grameen Foundation to comment on Tom Heinemann’s recent documentary, “Caught in Micro Debt,” based on my understanding of the existing impact-assessment literature.

I have just read with great interest the translated transcript of the Danish documentary “Caught in Micro Debt,” which aired on Norwegian television in November 2010. (I understand that there is an English-language version that has very recently become available, but I have not had the chance to watch it.) The documentary paints an unfavorable picture of the microfinance industry, making a number of criticisms. Reading the transcript, I find this film to be deeply biased and misleading on a number of important points.

I don’t have much to add to the discussion about the transfer of Norwegian aid money from Grameen Bank to Grameen Kaylan, and this has been settled elsewhere. Similarly, the question of Grameen Bank charging usurious interest rates has been commented on at length, by David Roodman (his posts can be found here and here), by Alex Counts, and in the definitive study of the bank’s rates by MicroFinance Transparency’s Chuck Waterfield.

I’ll focus here on a claim that the film makes in its introduction: “Tonight we ask if micro loans actually are helping the poor.” Now, here is a subject on which I feel fairly well-informed. For Taking Another Look – which was a follow-up to Nathaniel Goldberg’s 2005 report, Measuring the Impact of Microfinance – I read and summarized much of the recent literature estimating the impacts of various forms of microfinance on the lives of microfinance clients. Here’s what I learned over the course of that project.

If we combine the findings of the best available research, there is modest evidence that microfinance, including microloans, has positive effects on microbusinesses. As my conclusion states, “Various studies showed increases in business ownership, investment, and profits.” With respect to microsavings (admittedly not the subject of the documentary, but surely still relevant), a 2009 study found not only positive business effects, but also positive effects on food expenditures. (Full references are included in Taking Another Look). The microfinance community awaits the release of additional studies of impact, but what we know so far is this: Though some claims of microfinance’s effects have been overly enthusiastic, the academic research, where we trust it, is either inconclusive or points to moderately positive effects. Again from my conclusion: “Based on the studies in this survey, the overall effect on the incomes and poverty rates of microfinance clients is less clear, as are the effects of microfinance on measures of social well-being, such as education, health, and women’s empowerment.”

There is an important discussion to be had here about research methodologies and the nature of program evaluation. However, the point is that if you want to prove that microfinance isn’t helping the poor, the existing impact-assessment literature won’t help you.

AppLab’s Initial Social-Impact Measurement Efforts Pay Off

Eric Cantor has led Grameen Foundation’s AppLab efforts in Uganda for the past three years, and continues to serve as an advisor on the project.

Grameen Foundation takes outcome measurement seriously.  We want to make sure that our programs and services are effective, and that we can demonstrate their benefits before implementing programs or practices on a wider scale or urging others to replicate them.

With this in mind, we recently completed one of the first randomized control trials designed to assess the impact of a mobile phone-driven health service aimed at improving the lives of the poor.  The service we sought to measure was Health Tips, part of the Google SMS suite launched throughout Uganda in 2009 with our partners Google and MTN Uganda.  Our social impact partner Innovations for Poverty Action (IPA) performed the study.

Preliminary findings from the study are substantial, supporting some of our initial hypotheses and refuting others, and informing our approach to building pro-poor, mobile phone-driven solutions going forward. In short, findings indicated that when people learn of such services, they use them. People also seem to learn from this particular text-message query-based product.  But we also found that, because of the limitations of human motivation and barriers like language and literacy, we have a lot more work to do.

The Health Tips study was conducted in Uganda over an 18-month period. Before the launch of Google SMS in June 2009, IPA conducted a baseline survey of 1,800 people in 60 rural communities, assessing demographic profiles, attitudes, and knowledge and behavior regarding sexual and reproductive health, and collecting data from local clinics.  When we launched the service, we initiated a marketing campaign that randomly targeted half of those communities (the “treatment” areas) and did not reach the other half (the “control” areas).

Our studies have shown the value of "trusted intermediaries" -- such as the Mobile Midwife counselor in the photo above -- as a way to make mobile phone-based communications to the poor more effective.

Through randomization, IPA chose two sets of communities that were uniform in every relevant respect – except that one was exposed to the product through targeted marketing campaigns, while the other was not.  Nine months later, they began a follow-up survey of 2,400 people to detect changes.  They looked at data from surrounding clinics, conducted qualitative interviews and assessed the information provided to the communities. Because the targeted marketing in treatment villages was effective – we saw more than four times as much usage in the treatment areas as in the control – we were able to assess the effect of the service on attitudes, knowledge and behavior relating to sexual and reproductive health.