192021

Richard Saul Wurman, prolific explainer and the creator of the TED conference, is back with a 5-year project called 19.20.21 to try and work out what makes urban environments tick. This is long overdue:  over half the world’s population lives in cities, rising to 2/3 by 2050. By analysing 19 supercities with more than 20 million inhabitants, the project:

“will lead to a common means electronically, in print and real time, to comparatively describe the demographics , economies, health data and environmental data as it relates to the urban world.” (from 192021.org)

The powerful idea at the heart of this is that whereas the world used to be thought of as power struggles between countries, it  is now “A Globe of Cities”:

“today, people think of the world as a network of cities – not a network of countries. We visit London, Paris or Rio de Janeiro, rather than England, France or Brazil. The world is now linked through mass channels of communication and transportation, managed by a patchwork of public and private interests.”

So what?

Cities grow organically and are the product of their host cultures, so it is no surprise that there is variation – in sanitation, transport, health, education, quality of life, crime etc… But how do you describe these differences? The words “crime”, “quality of life”, “public transport” may have literal translations in the languages of the world, but subtle variations in meaning are too much for a simple dictionary entry.  

To understand these factors you need to have lived in both cities long enough to have experienced the right things. Worse, even people who have been fully assimilated in several cities would mostly have experienced them in a deeply personal way. If you spent your primary school years in London, secondary school in New York and university in Mumbai, could you really comment on their respective educational systems?

And even if you could explain the differences on a completely objective level, you’d still have to consider the perspective of the other culture. The exact same meal, maths lesson or knee operation might be seen as fantastic, adequate or deeply disappointing depending on expectations.  

That’s why it’s so hard to answer the question asked by someone from a different city or country: “What it’s like where you’re from?”

19.20.21 = a common yardstick

Getting to the point where applicable lessons can be drawn from the world’s largest cities may take longer than 5-years, but the findings should be fascinating. Hopefully, the outcome will be a set of concrete design patterns which city planners can use to improve the lives of their citizens while reducing the environmental burden of urbanisation. These must do two things. 1) create an objective way to measure the success of a city’s elements, 2) make it possible to transfer these elements elsewhere.

Finding a common scoring system can kick start progress: take the introduction of the Apgar scoring of a newborn’s health, which slashed the mortality rate of babies in childbirth:

The Apgar score, as it became known universally, allowed nurses to rate the condition of babies at birth on a scale from zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and two if its heart rate was over a hundred. Ten points meant a child born in perfect condition. Four points or less meant a blue, limp baby.
The score was published in 1953, and it transformed child delivery. It turned an intangible and impressionistic clinical concept—the condition of a newly born baby—into a number that people could collect and compare. Using it required observation and documentation of the true condition of every baby. Moreover, even if only because doctors are competitive, it drove them to want to produce better scores—and therefore better outcomes—for the newborns they delivered.
Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number).

The Apgar score, as it became known universally, allowed nurses to rate the condition of babies at birth on a scale from zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and two if its heart rate was over a hundred. Ten points meant a child born in perfect condition. Four points or less meant a blue, limp baby.

The score was published in 1953, and it transformed child delivery. It turned an intangible and impressionistic clinical concept—the condition of a newly born baby—into a number that people could collect and compare. Using it required observation and documentation of the true condition of every baby. Moreover, even if only because doctors are competitive, it drove them to want to produce better scores—and therefore better outcomes—for the newborns they delivered.

Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number). (Atul Gawande in the New Yorker – also a story in his incredible book, Better)

Without a common yardstick, how can you know who has gone the farthest? 

Or what about the impact on trade and industrialisation of common standards for railway gauges, shipping containers or even the metric system itself. In The Box, former finance economics editor for The Economist Marc Levinson explains how “an iconoclastic entrepreneur, Malcom McLean, turned containerization from an impractical idea into a massive industry that slashed the cost of transporting goods around the world and made the boom in global trade possible.” From the first chapter:

Some scholars have argued that reductions in transport costs are at best marginal improvements that have had negligible effects on trade flows. This book disputes that view. In the decade after the container first came into international use, in 1966, the volume of international trade in manufactured goods grew more than twice as fast as the volume of global manufacturing production, and two and a half times as fast as global economic output. Something was accelerating the growth of trade even though the economic expansion that normall stimulates trade was weak. Something was driving a vast increase in internationl commerce in manufactured goods even though oil shocks were making the world economy sluggish. While attributing the vast changes in the world economy to a single cause would be foolhardy, we should not dismiss out of hand the possibility that the extremely sharp drop in freight costs played a major role in increasing the integration o fthe global economy.   

What are the equivalent costs of interaction between cities? What stops cities sharing more ideas on how to make urban environments fit both for people and for the planet?

I hope that this project will help identify the ideas which have worked best, and somehow explain them clearly enough that cities of any culture will be able to apply them. As many people as live in the entire planet today will live in cities in 2050. That’s why 19.20.21 matters, and I hope it succeeds.

kickstart21

A few weeks ago I wrote about Kickstart, the innovative company which has already helped half a million poor African people to lift themselves out of poverty. By designing products like the SuperMoneyMaker pump and selling them instead of giving them away, they make sure that 80% of them are used to start businesses, which does two thing: 1) it takes the average farmer’s income from $110 dollars to $1100 a year and 2) absolutely flies in the face of conventional wisdom. Wonderful!

After the post the great folks there got in touch and Ken Weimar, Senior Development Officer at Kickstart agreed to answer a few questions. Read on below.

The tools to end poverty.

Raphael D’Amico: What Kickstart brings to poor communities is tools which allow them to help themselves, so the design is all important.  When you and your designers were creating these tools for poor African farmers, what preconceptions (Western or otherwise) got in the way? How did you get into the minds of your future customers?

Ken Weimar: Probably the biggest hurdle to overcome was the very western idea of tools and technology to save time and labor.   Saving labor is good, right?  Well not if that “labor” is someone’s job.  We love to save time because it feels so scarce and precious.   But in the developing world, time and labor are a poor person’s greatest assets—they have them in abundance and they can be quite valuable. That’s why our designs are focused on turning time and labor into cash rather than “saving” them.

R: How did you involve locals in the design process? 

K: This was a team effort and our team is mostly  Kenyan engineers and craftsmen.    As a bunch of guys our first approach was to make the pump as powerful as possible and that meant long treadles.  But we quickly found that women did not like that.  The bigger stride required by the longer pedals is hard to do when you are wearing a skirt.  Plus the longer treadles meant the users backside was elevated to about eye level and women thought it unseemly.   So we reconfigured the treadles, stepping them down to keep the user lower to the ground, and went to work to increase the power with a more efficient valve design.

R: Was there any local design ability?

K: Yes, of course.  There is a tremendous amount of creativity born out of hardship. It is amazing to see how creatively EVERYTHING in Africa is reused.  We have a whole team of locals in our Tech Development department.   Some are trained engineers, others are skilled fabricators. In Africa we have creative craftsmen and tinkerers, and we have trained engineers.  What we are missing are the entrepreneurial inventors who can create the tool or technology that can be widely adopted.

R: What made you pick IDEO as a collaborator?

K: Martin has  known David and Tim for a long time and has a great deal of respect for the work they’ve done in creating the Design School at Stanford.  Any engineer could do the calculations we need, but I think IDEO shares our vision and loves to work around the challenges.  A lot of people would have been stumped by the limitations of the raw materials and processes available to us in East Africa.  IDEO jumped in with us and said, “OK, we know the limitations, let’s work around them.”

R: What were the characteristics of your most successful designers?

K: Tenacity, of course, is a needed in any good designer.  But you said “successful” so let’s interpret that to mean that a design gets widely adopted and used and maybe even changes the way we live.  To be successful then means thinking way beyond the design of the “thing”.  Creating a new machine is the easiest part (and this is plenty hard).  But you have to be able to understand the economics, you need to be thinking about how is my “thing” going to get from my workbench to a factory to a store and ultimately into the hands of a consumer.  And you need to be able to design these systems as you are working on the design of the thing.

R: In 2005 I had the privilege of visiting one the workshops where the MoneyMaker was being made. How many others like it were there, and what made you move production to China?

K: If you saw our factory, you saw one of the most advanced manufacturing plants in Africa.  And I am sure you recall it was pretty primitive.   You want a design challenge?  How about this:  you are trying to create a design that can be mass produced locally, but the raw materials can vary as much as 10% in dimensions from one batch to another.  Manufacturing in China opens so many more options for manufacturing that just don’t exist in Kenya.  We can also ship to anywhere in the world more easily from China.  Like everyone else, we can manufacture more cheaply in China, which means we become more self sufficient.

Of course everyone asks about creating jobs.   Well, we’ve created maybe 50-75  jobs in the manufacturing of our pumps, and over 100,000 jobs through the use of our pumps.  Helps put that decision in perspective.

R: The most impressive thing about Kickstart is the way you’ve flipped the traditional view of aid – instead of seeing the poor as a burden to carry, you’ve realised that they can help themselves, why is why you charge for the MoneyMaker pump and created a supply chain where everyone benefits.

K: Thank you, yes! It is about sustainability.  Everyone uses that term differently and often to mean “when are you going to stop asking me for money”.   It’s a valid question but not the most important.  The most important measure of sustainability is “will the people who are helped, stay helped?”  The next is “can additional people avail themselves of this solution without additional cost to the donor?”  That is the beauty of and the importance of the supply chain.  As long as there is demand, and each player makes a profit, our pumps (or anything distributed this way) will be available to everyone who wants one.

R: How did you develop this approach? Did you try any others before this one?

K: Oh yes indeed.  Nick Moon and Martin worked on every kind of development/aid programme you could imagine.  They were both were idealistic young guys and went to Africa wanting to make things better.  They built schools and ran training programs and built factories and installed huge water systems and not a single one of their projects lasted more than a few years past the end of our involvement.

Perhaps the first lesson they learned what that giveaways don’t work—not because the recipients are ungrateful, but because we tend to give away what we want to give rather than what is actually needed.

R: How did you go about creating this sustainable system? What were the challenges?

K: It wasn’t easy.  We wanted our pumps in Agro-Vet stores that sell other ag inputs.  Makes sense right?  Well not many were interested at first.  These were new and so much more expensive than anything they ever sold.  Our first retailers were butchers and hairdressers.  But the bigger challenge is getting funders to understand what we are trying to do and how building this supply chain means real sustainability.

R: Was there any cultural resistance as you went up against traditional methods?

K: God yes!  There still is!  There may have been some farmers who thought “if I wait around long enough they’ll just give it to me,” but the bigger cultural resistance was (and to a large degree still is) from the traditional aid organizations.    They think we are unfair to make people invest in themselves.  They think we are simplistic for insisting that the cause of poverty, the very definition of poverty, is not having enough money.

There is always the challenge of dealing with silos.  We get grouped with a bunch of different organizations but don’t really fit neatly in these categories.  For instance, we work with farmers and within the AG sector, but for us , Ag is an economic engine for income generation.  We get grouped with the water sector because we make pumps but for us pumps are  a means to an end.  And we get grouped with the new technology for the developing world group, and we have a lot of friends here, but again our technology has the very specific purpose of generating income, where most other technologies are about reducing a burden of some sort.   The upside is that we have a lot of friends in a lot of sectors, and even if we can’t collaborate, it’s exciting and energizing to talk with other social entrepreneurs.

The downside is that we always seem to be about ten degrees off plumb with major funders.  That is the challenge of being the innovator, the first mover, the leading edge…it takes a while for the world to catch up with you!

R: Where do you see Kickstart going next? 

K: We have just scratched the surface on what is possible with our pumps.  There is a worldwide potential for over 40 million pumps and we’ve sold 125,000.  There is a lot of room for growth.  We’ve got some allied technology, like a pretty effective well-drilling technology that we’d love to get out on the market, and I’ve got a few other ideas I’d love to pursue, but for the foreseeable future, KickStart will continue to be about irrigation.

R: Finally, I wonder if there are other situations which are waiting for this kind of turnaround. Crudely speaking, your products act as a catalyst which allow a community to use the same resources they had before to reach a higher standard of living, which would could otherwise only achieve by pumping money and aid from outside. Everybody wins when this happens – the community get better off and the resources which would previously have been diverted to helping them can go to help another. In business you would crudely call this turning a cost center into a revenue center. 

K: We changed our name from ApproTEC (appropriate technology for enterprise creation) to KickStart because KickStart really captures what we are trying to do—to stimulate economic growth.  A lot of people think that these farmers climb up to some plateau and stay there.  In reality, these people continue on this upwards spiral of prosperity—growing their businesses, diversifying, creating jobs and hiring.  So yes, there is a ripple effect.

The ripple effect we talk about though is better governance.  A fundamental problem in Africa is bad governance.  To be fair, think about where the US was 40 or 60 years post independence—we were heading into a horrible civil war that nearly destroyed our country, so we need to keep post-colonial Africa in perspective.  But in these nominal democracies, you can buy a vote for a handful of rice because people are starving.  But when I have enough money to feed my family you can buy my support for dollar.  When I’m not worried about basic survival, I can start demanding things like roads and schools and electricity and you, as a politician had better deliver or get voted out.  That’s how an entrepreneurial middle class brings better governance.  Not the other way around.

R: I’m sure this could be done elsewhere. For example, schools often see controlling kids as a necessity, hence costly investment in attendance tracking software and reporting of discipline. Maybe there is a product out there that would cast this in another light.

Have you seen any other areas ripe for this kind of shift? 

K: Absolutely.  There are so many goods and services that we want to give away for free that could be provided far more sustainably through the marketplace.  We’ve long championed the idea of franchised, for-profit schools in Africa and our friend Jay Kimmelman is doing just that.  Bridge International Academies will provide a higher quality education for less than what parents might pay to send their kids to public schools.

Medical care is another.  In Kenya (and in most of Africa) the “free” public clinics are so underfunded that you have to bribe doctors and nurses to get care.  Or people pay witchdoctors or charlatans for ineffective or dangerous care.  Imagine if that for less what you would pay for a bribe, you could buy decent care and real medicines.   Our friends at SHEF in Kenya had done some of this and work and others are taking the idea to the next level.

I know, some people recoil in horror to think about asking poor people to pay for things like medical care or education.  But without a tax base these will always be dependent on external donor funding and is that really the model we want to continue?  And think for just one moment about how it would feel if everything in your life was provided by some donor—your food, your clothing, your house, your church, your medicine.  Is there anything “empowering” about that? 

R: What lessons from solving poverty would you apply back to the first world?

K: We’ve always said that solving poverty is Africa is so much easier than solving poverty in America or the UK or Europe.   In the developed world, maybe 10% of the population is a permanent underclass.  These are the people with serious mental health and substance abuse issues who need a lot of “wrap around” services to get to a basic functional level.

 In Africa, 80% of the people are poor.    Within that 80% are all of the people who would have been solidly middle class had they been born elsewhere.  More importantly, within that 80% are the people who would have been doctors and lawyers and entrepreneurs.  These people still have the same basic intelligence and the same drive and determination.  They just happen to live in a place where there are few opportunities.

No matter where in the world you live, poverty is about money and income (specifically the lack thereof)

Thanks for the great interview and I wish the best of luck to Kickstart getting a pump into the hands of the 40 million farmers and families who need them! 

Philanthropic judo

February 23, 2009

0012345-R6-049-23

In Tanzania, five out of every six hectares of potential arable land goes unused through lack of irrigation (sources 1, 2). I met this woman back in 2005 at her farm in Arusha, at the base of Mount of Kilimanjaro, and even though the land around was parched, she was surrounded by greenery.

There is a fascinating story behind this, with design at its very heart.

Teach someone to fish…

0012345-R6-045-21Her water was drawn from a groundwell 20 feet deep, efficiently pumped up by her husband using this treadle pump: the Super MoneyMaker.

The pump is the brainchild of Martin Fisher and Nick Moon, the former an engineer and the latter a craftsman and entrepreneur, who together founded Kickstart in 1991 (formerly ApproTEC). Their aim was to create products which allow poor people in the developing world to start successful businesses.

The logic is working; by investing $35 to $100 in a pump, the average farmer can increase his income from $110 to $1,100 a year.

The result?

So far, 80,000 business have been started in Kenya, Tanzania and Mali. That means over 400,000 people lifted out of poverty. Astonishing, and based on a simple insight:

The Number One Need of the Poor is a Way to Make Money

“The Poor are Not Victims”

“To define people by their conditions rather than their qualities is dehumanizing. When you look past the poverty, you see abilities, resources, and desires. The poor are extremely hard-working and entrepreneurial–they must be just to survive. They don’t want or need to be rescued. They want an opportunity to create a better life for their families.”

From the Kickstart website’s lessons learned.

Right on. Often, the best way to help is to realise that the person in trouble has the will and the capacity to help themselves if given the right tools. The Kickstart website is very clear, concise and full of insights (particularly in explaining what they do), so I won’t go into too much detail here. I have nevertheless picked out three clues on how to make a lasting difference:

1 – Make sure everyone can get stuck in

Aid is commonly seen as a one way street, but it can be provided by creating a supply chain in which everyone involved benefits. On top of increasing the farmer’s income tenfold, the Super MoneyMaker pump (and replacement parts) also provides revenue to the factories that make them the distributors who transport them and the local traders who sell them. Everybody wins.

0012345-R7-034-15A0012345-R7-032-14A0012345-R7-046-21A

This takes care. When I visited in 2005 we were shown around a factory where half a dozen workers were assembling pumps using comparatively rudimentary equipment. Production has mostly moved to China now that Kickstart have improved the design and employed higher tech materials and techniques, but I am struck by the simplicity of a design which could be manufactured in a workshop like the one below. 
 0012345-R7-036-16A

Just an aside; in this case the economics pointed towards lower cost, higher tech China, but what other designs could enrich a local economy by letting it produce them?

2 – Sell, don’t give

Kilimanjaro 160

By making the Super MoneyMaker a commercial product which costs up to a year’s salary, Kickstart provided a strong incentive to use it properly.

There is strong evidence that the price of a product affects how we perceive its quality (apparently, expensive wine tastes better). The purchase also acts as a form of commitment to the idea that the farmer will use this pump.

Kickstart say that “less than one-third of pumps given away are used to create a new enterprise.”

It is not easy to start a successful business. The cost of the pumps selects farmers with the entrepreneurial will to actually use them to lift them and their families out of poverty.

3 – Measure!

According to Kickstart, every buck invested leads to $15 of profits and wages on the ground. How do they know this?

“Every product comes with a one-year guarantee and every buyer fills out a guarantee form when they buy the product. The guarantee reduces the perceived risk of buying the product, and the forms give KickStart a database of all pump owners.”

“From this database, we select a statistically valid sample of recent purchasers. These customers are visited within a month of purchasing the products, before any impacts have been realized, then again at eighteen months, and again three-years after purchase.”

 

They then send teams of two (a man and a woman) to track down these customers. This is difficult as most farmers don’t even have addresses.

I can’t stress enough how crucial these measurements are.

In my last post I mentioned a story from Atul Gawande’s great book, Better: A Surgeon’s Notes on Performance. There is another remarkable story, about measurement. My brief paraphrase:

Cystic fibrosis is a genetic disease. It affects only a fraction of the population but is devastating if untreated, as it screws up the body’s ability to manage chloride; those affected cannot properly digest food and their lungs are slowly made useless by a thick, hardening mucosal sludge. Fifty years ago the average life expectancy for a child with this disease was a paltry 36 months – patients now live into their 40s (and perhaps longer).

The change was catalysed in the 1960s by a young pediatrician from Cleveland, called LeRoy Matthews, who claimed an annual mortality rate ten times lower than his peers. In response, the Cystic Fibrosis Foundation commissionned a survey of every patient in the 31 treatment centers active in 1964. This confirmed the difference, and pushed other centers to follow his methods and eventually set up strict, national standards, leading to the dramatic improvement described above.

The monitoring has continued ever since, and in 2006 the field of cystic fibrosis became the first in medicine to fully open up the results of the 100+ centers who treat the disease in the US. Disclosing the top centers has allowed the others to improve yet another notch.

Designing careful measurements of success is one of the most easily overlooked aspects of the design process. It should not be as it forces you to ask the question: what does success look like?

The fundamental tenet of design is iteration, which is impossible unless you measure outcomes.

A bigger thought: problems can be their own solution

Kickstart should be studied for many reasons, but the main one is this: they transformed a system, charitable aid, which is draining and unsustainable for most involved, into one which feeds off itself. They saw the poor not as a black hole of necessity but as an engine for growth.

What other areas could benefit from this counterintuitive approach? Where else are we pouring energy into a system which could fuel itself?

  • Instead of seeing kids as antagonists to the teacher’s attempts at engagement, can schools find tools which make them the drivers of their own education?
  • How can communities harness the entrepreneurial abilities of their criminals to reduce crime?
  • How can we use people’s tendency to waste energy to solve our impending energy crisis?

Sometimes all you need is a great design to allow people to make the difference themselves.

P.S.

We can all help – I didn’t know this until recently, but the MoneyMaker pump was originally designed by IDEO was involved in their original deep lift pump and is helping design the next generation MoneyMaker. Check out this TED talk by David Kelley from back in 2002 for more.

Another point: Kickstart is one of many great businesses in this space. Read about some of the others in the Design for the Other 90% exhibition site.

Designers should also check out Design Can Change, which looks at a few ways graphic designers in particular can make a difference.