Please take a look at the following bleg and offer whatever fruitful ideas you might have.
Dear Freakonomics,
My name is Michael Frank and I recently began working for a start-up NGO in Mali that strives to improve health. One of our programs is called “Action for Health,” which provides in-need families with access to free health care in exchange for doing a set number of predefined actions that benefit public health.
The logic behind this program is that studies have shown there to be an enormous jump in the percentage of citizens who choose to receive health care in Mali when it is free as opposed to just heavily subsidized. We require the actions be done so that the residents don’t take the free care for granted and because these actions improve public health either for the individual or the community.
A good action for health is something that improves health, is easily measurable, and is not so burdensome that it seriously hinders the participation of this in-need population. The action of a comprehensive hand-washing program for example, as detailed in Atul Gawande‘s new book The Checklist Manifesto, fits two of these criteria but it is not ultimately easy to monitor compliance. One recent action for health that fit our three criteria reasonably well was a recycling day, during which residents had to spend the day picking up the trash that is ubiquitous on the streets in Malian slum neighborhoods.
My bleg is: What other ideas do people have for “good actions for health” that fit our criteria? I’d also be interested for any other ideas that people had for our NGO in general. Thanks.
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Ask your clients. I am on the board of a non profit organization (www.adelantefoundation.org) and we have always learned the most by asking our clients and keeping the program client-focued. Sometimes its hard to do, to realize that the people you want to help might know more than you do, but in my experience, they do.
In addition to asking people like us, how about running a competition for the locals to suggest these actions?
I’m not sure what the state of the local education system is like where you are, but in the west at least high school kids at the top couple of years are sometimes good for this kind of thing.
Building on the previous clean water and recycling suggestions, if you are operating in an area without a public water treatment facility, you could encourage people to sanitize water using solar water disinfection.
Here’s how the technology works:
Take an old PET bottle (the type soda comes in) and fill it with water that has not been sanitized. Place it on the roof of a house during the day. The combination of sunlight and heat sanitizes the water.
Here’s how the program could work:
Provide participants with the PET bottles and the equipment to mount them. The participants will receive free healthcare in exchange for providing clean drinking water for their family and/or neighbors. This would be “free” from a monetary standpoint but would require time and effort to fill and mount the bottles on an ongoing basis.
As far as the three criteria go:
1. The health benefit would be clean water for the community.
2. The burden of participation would actually be scalable by changing the number of people each participant would provide with water. It should be possible to dial in a number that maximizes participation without being too much of a giveaway.
3. If the program requires participants to provide water to neighbors, then the compliance check is automatic. If the participants are only required to clean their own water then someone would need to periodically check to make sure the bottles are still mounted and filled regularly. But, since the bottles are mounted in plain site of the roof, it shouldn’t take too much effort to do this.
it’s not volunteering if it’s trading. trading is a good thing! call it what it is. “public health” is a non-concept, how about calling that what it is too.
i have a suggestion that affects “public health” indirectly, but gets to the roots of “public health” problems.. since a rising tide raises all boats, how about they either start a business and earn X amount, or get a job and earn X amount. or write a letter to Mali’s leadership, cc: Obama, asking for property and individual rights to be vastly improved in Mali.
Create daily exercise groups in their neighborhoods. Use the daily walks / jogs as an opportunity to learn more about their needs through casual conversation.
we have had programs to buy back guns ..why not a program to buy back cigarettes..just as deadly..
Cool approach MHOP! I currently do mHealth work in Malawi, where many organizations are trying to ensure that all pregnant mothers attend ante and post natal checkups and give birth in health facilities with trained birth attendants rather than doing so in their homes. One barrier is that women often lack moral support and/or physical assistance for transportation from their husbands, so a new program is providing incentives for couples when the father accompanies the mother to the clinic for maternity visits.
The father’s attendance is a contribution of time not money, it may (we hope!) improve clinic attendance among women as well as trust in the health system, and it’s extremely easy to measure.
cheers
“We require the actions be done so that the residents don’t take the free care for granted”
Why would you assume that they would take it for granted? Have you already tried providing free health care? Here in Canada, I don’t have to organize an exercise group every time I want to go to the doctor. I also don’t run to the doctor every time I get a paper cut. We have free health care. Its a system that has some problems, but it works.