ICTworks

A Conversation with Liz Peloso

In this episode of the Aid, Evolved podcast about technology, poverty, and health, I speak with Liz Peloso, a seasoned global health professional best known for her work as the Global Director for the Better Immunization Data (BID) Initiative from 2014 to 2016.

Every two weeks we bring you a new episode about doing good, better and below, Liz shares examples from her career of how technology has (or hasn’t) been adopted at clinics in Rwanda and Indonesia – and what she’s learned along the way about building a culture of change.

The Hidden Reasons Technology Adoption Fails

This is an excerpt from our conversation. Listen to it all here.

Rowena: What were some of the challenges you faced with technology adoption in global health?

Liz: Oh lots! It usually comes down to “In theory, that ought to work.”

We did an implementation in Rwanda, which is a wonderful country to work in. Everybody’s really trying to make the country better.

I’m a very, very big believer that you need to understand what’s going on, on the ground. We did this whole health enterprise architecture piece – that later went on to become OpenHIE – and I was most interested in how to connect all those parts.

But how does that work on the ground? We had issues with connectivity, and you have issues with electricity, and so on and so on, but it’s those little things that are on the ground and not accounted for.

For example, I would sit in the clinic many days. And every time we’d go out to see patients, [the team from] accounting, which is the three rooms over, would come and steal our extension cords.  because they wanted it to plug their fan in. And literally that was the biggest thing

So then they’re like, okay, we got to block this off, and we’ll lock the door. Then we gotta open the door every time we’re coming and going. And after a while, it was like, oh, this isn’t working.

Rowena: Surely accounting could pay for extension cords? You’d think they’d find a way!

Liz: They could have! It’s just… it was a bit easier for them to keep stealing ours. And those are the things that make it unsuccessful on the ground

And you think, “Oh [of course] let’s just buy a bunch of extension cords.”

But then it would be something else. It would be the next thing. It would be someone used up all your data streaming music, or something else.

Rowena: Right. It’s the culture of change, the movement towards change together, rather than trying to hide and to steal from each other.

“Change is hard. People don’t always keep doing it if they don’t see that they’re part of a bigger solution.”

Liz: Yes. Not just in Rwanda, in many places, we try to make technology solutions that were not necessarily the best way to solve some of their problems. There were lots of times, things we just thought might work, [didn’t]. And for whatever reason…

Change is hard. And people don’t always keep doing it, if they don’t see a purpose in it, they don’t see that they’re part of that bigger solution.

Effective Data Use with Limited Resources

Rowena: Speaking of change, could you talk a bit about a time you saw people successfully embracing change?

Liz: I’ll give you an example of what success looks like.

I’d been asked to do an evaluation in Banda Aceh, Indonesia. After the Tsunami many aid organizations pledged lots of money to help rebuild. I was asked to do this evaluation to help GIZ determine whether or not the German government got their money’s worth.

They said, “You have to come to this one facility that we have.”

“They had no more money. In fact, they had fewer resources than everybody else in a more difficult place and they performed better than almost anybody.”

They’d actually done quite a lot at this clinic. And these clinics, they’re more like small hospitals. They might have 10 consultation rooms running at a time.

In this clinic, they would enter all of the patients they saw, what the diagnosis was, etc. So it was very electronic for the situation – this was in one of the poorest places, that was difficult to access.

What they did at the end of every day, and more so at the end of every week, is they would sit there for about 20, 30 minutes, and look at the information for the day.

[They’d say] “Huh, look at that. We saw quite a few yesterday, but we see even more cases of diarrhea today.”

You might think I just happen to get them all today or whatever. But they, they would look at the trends in the data and say, “Oh it’s concerning. And look at this! They came from these two villages. So what we’re going to do is, tomorrow, you and you are going to go to that village and you’re going to make sure that you talk to them about oral rehydration salts and washing and so on. Because we see that this is about to become a problem.”

And then we kept going a couple days and then they would say, “Okay, we’ve still been seeing more of them. So now instead of letting them mix with everybody else in our waiting room, we’re going to put in a special waiting room area outside for them to wait so that we aren’t cross contaminating.”

So they were able to make plans of things that were perfectly within their ability to do. To use that data to change the way that they deliver their services at a very local level.

That to me was a perfect example of success.

They had no money. In fact, they had fewer resources than everybody else, in a more difficult place, and they performed better than almost anybody,

Rowena: That’s awesome.

To Hear More from Liz Peloso

To listen to more from Liz, listen to the full conversation on Aid, Evolved or wherever you get your podcasts. She shares many instances of how technology has helped and hurt her work over years – as a neonatal intensive care nurse, as a private sector clinical transformation consultant, and as a global health expert.