20 (deceptively) low cost ideas for development

Alertnet recently issued a piece “AlertNet’s top 20 big ideas that don’t cost the earth” which highlights a number of proven, low-cost, mostly low tech or easily replicable tech development solutions. This includes traditional items such as  bednets, breastfeeding and handwashing to some more recent development innovations such as mobile health or solar power.

On reading this I had three reactions, in this order:

1. Wow isn’t this a great list. Imagine what the potential could be if these simple approaches could be widely adopted.

2. Wait, if these are so good how come they are not used more widely already. Some are new, but some of these have been known about for a long time already – why are they not being used more?

3. Are they really as effective, simple and low cost as they are being presented in this list?

For some of the examples given, dissemination might well be a problem – as of yet they are not widely known by developing country governments and aid agencies, or perhaps even if they are known, there is still need for greater technical documentation on how exactly they work. And here both communication, and knowledge management have a role to play in order to raise general awareness and interest in the approaches and then share the technical details needed to make them work.

In quite a number of the examples given, the ideas are not new, and the technical side is well known (e.g. manufacturing specs for TB detecting paper), but nevertheless they are still not as simple as they first appear.

Let’s take the well documented and well discussed example of bednets. On the one hand there is general agreement that  sleeping under an insecticide treated bed net is an effective means to help combat malaria. Check. On the other hand getting this to happen is a little bit more complicated than it appears on the surface. Let’as take a (very simplistic) look at how bednets get there and get used to illustrate this.

Step 1: Manufacture – where should we do this? Do we buy in bulk from overseas to ensure quality, regular supply and good price (assuming we can persuade the government not to charge import taxes)? Or do we foster local manufacturing to better stimulate local markets, employment and possibly demand?

Step 2: Delivery/distribution – how do we get the bednets to the people? First challenge might be logistics, how to get the bednets transported to the most remote areas. especially in conditions of insecurity? Second – how about distributing them – where/how should this be done? Should they be distributed in healthcentres, or should they be distributed door to door, or sold in the market, given out at schools?

Step 3: Use – how do you persuade people to use bednets, especially if they are not familiar with them, don’t believe they work, don’t like sleeping under them, or perhaps believe it makes more sense to sell them, or use them for something else. Bednets also have a limited lifespan and need to be replaced every 4 to 5 years – less well documented is how best to get people to consistently replace them when they are no longer effective.

Bonus step – Money. Although cheap, bednets still cost around $5 each (and I’m not sure if that includes all the costs of distribution and marketing) which makes them unaffordable to the poorest (or at least perhaps not on their top priorities for a highly constrained household budget). So who should pay for them? should the money come from governments, from donors, NGOs, should the bednets be distributed free of charge or should some part of the cost be paid by the user? How does the cost effectiveness of this compare with other interventions for malaria, or for that matter in health or development more generally.

And just to say of course that in fact these four steps are not in reality distinct but they all influence each other, sometimes in unknown ways.

So while a good idea such as bednets may in of itself be relatively cheap, and proven to be effective, making it happen in practice is rarely simple or easy. Many of the challenges in doing this are not in the technology itself, but lie in developing systems (wouldn’t it be much easier to distribute bednets if you have a well functioned, adequately financed  health system) and in changing human behaviour.

While “awareness raising” about the potential of these approaches is valuable – I’m not sure that giving the impression that they are easy technological fixes is quite so helpful. And from the perspective of a knowledge manager – the innovations and knowledge that seem most valuable to share are not the technologies themselves, but rather what did it take in terms of policy, politics, systems, procedures, behaviour change and participation that enabled these technologies to be adopted and used successfully, and whether or how can these be adapted to work in different contexts.