 As the sun rises over my home on Vashon Island (a ferry’s ride from Seattle), I plug in my camera and click to call colleagues in Europe, Malawi, and Ghana. As we talk, the sun sets on their day.
Before founding Kati Collective, I managed a large social change organization and worked as a consultant in large consulting firm. With this firsthand knowledge of both client needs as well as the innerworkings of the consulting business, I figured out what worked – and what didn’t – in international development consulting. Using these experiences, I created a firm with a different kind of model; one where we could stay lean, flexible, and responsive to ever-changing client needs. With Kati, I wanted to be able to move quickly and without constraints. By tapping into my global network of experts across a variety of topic areas and at different stages of their careers, I am able to strategize and take action much more swiftly than if I was still working in a larger, more formal structure. I have built a trusted team of frequent collaborators who are independent contractors and whose expertise complements my own. I can bring in the right perspective for the right project at the right time. The issues our clients face are often complex and, while connected to global issues, they are just as often specific to a region and/or a particular topic areas. When considering what a project needs, I pull in people who have the best skill set for each project and fit them together in the right balance. Some of our collaborators – who range from early to mid to seasoned professionals – are full-time consultants, others are looking for flexibility in their lives, and others are interested in applying their skills on project work during a break between longer-term leadership positions. I am always excited to find a new opportunity on which we can work together. Recently, I needed someone with a deep understanding of the gender justice landscape so I connected with Clare Winterton, the former Chief Operating Officer of Global Fund for Women. Clare has a deep knowledge of humanitarian issues facing women and girls across the globe as well as the growing network of funders, advocates, and programs that is working to support a variety of gender-related causes. She was able to plug into our project work and bring a deep and important perspective to our client. Katie Schlepp Zatorski has been working with me for nearly a year on a variety of projects. With her background managing high-level cross-sector partnership engagements, Katie keeps projects moving smoothly while quickly synthesizing vast amounts of project data, goals, and aspirations. She works with the team to create a project plan for programmatic strategies and then facilitates putting that plan into action. Katie is the management “glue” on our team; nothing slips by her. Anitha Moorthy, Ph.D. has recently joined our team to help us think creatively about designing and implementing digital health systems in LMICs. Her rigorous approach coupled with her interest in human-centered design centers the humanitarian approach while still allowing for creative exploration of new technology. When I need someone to do due diligence in the digital health landscape, I call in Ruthie Bryant. Ruthie is an MPH candidate at Johns Hopkins and was a critical part of my team at MAMA. I knew that she had a deep understanding of digital health and, as a graduate student, was adept at conducting rapid research and analysis. She is right in the thick of new discussions and innovations in the field and brings a fresh, academic perspective to the team. In order to ensure that Kati’s work is amplified to the world, I work with communication strategist Dana Van Nest and graphic designer Audrey Nezer. They ensure Kati is reaching its target audiences with strong content and clean, arresting visuals. It’s no accident that Kati collaborators tend to be women who are passionate about creating a flexible lifestyle that supports their career goals as well as meeting family and personal needs. This is important to me personally and is ingrained into the ethos of the company. When building our network, I look for content expertise, compassion, intelligence, curiosity, and a strong commitment to Kati’s three pillars: women, digital, and partnerships. All of Kati’s collaborators believe in centering women and girls to affect systemic change in LMICs and globally. By bringing in these expert, targeted perspectives for specific pieces of work, Kati Collective can offer reliable, flexible, highly skilled, and scalable resources for our clients.
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Earlier this year, I was invited to attend a gathering of minds at Wilton Park, a 16th century estate and think tank located in West Sussex with 15 acres of formal English gardens and surrounded by 6,000 acres of parkland. Of course, I said yes.
The week of Thanksgiving, I joined colleagues from around the globe to discuss the promise of digital health to address noncommunicable diseases (NCDs) in low- and middle-income countries. The idea behind dialogues held at Wilton Park is to bring together diverse stakeholders from government, healthcare, private foundations, corporations, and the social benefit sector to bring their unique experiences, education, and perspectives to the table to not just further the conversation, but to spark innovative paths and solutions. We spent three days discussing how to employ digital health strategies and tools to prevent and control NCDs. As we have discussed in these pages before, however, applying a digital solution in LMICs requires digital tools that are culturally relevant, in the language of the user, and in a method that they have the skills and time to actually use. The digital world converged on LMICs in the last decade. Many countries in sub-Saharan Africa had limited landline phones. Instead, they went straight to cellphones. These countries did not have the opportunity to catch up with technology methodically or in bite-sized increments, but rather experienced technology leapfrogging over their current systems and demanding adherence to a new reality. This can cause a serious disconnect for a country and its inhabitants. As we address the issue of prevention of NCDs, we have to ask who we are designing for and how digital can augment, not hinder, current or longstanding systems that may not be technologically advanced but do work. It is also important to be very clear: which part of LMICs are we talking about? Though we refer to low-income and middle-income countries under the same banner, the two can require different outreach strategies. What is the population of a particular country? What is realistic and viable given the different socioeconomic levels in each country? AI apps that offer healthcare advice and guidance can be the right step forward for middle-income countries, but people in low-income countries (where they earn less than $5/day) often do not have the functional literacy to properly access and use digital health tools. At Kati Collective, our lens is on the people that are hardest to reach. How much can and do countries spend on healthcare per month? For many countries, the true cost to provide thorough healthcare is not viable. And for individuals, being sick – and the ramifications on their families and ability to work – can lower their socioeconomic status. Treatment is expensive. Our global conversation is about prevention, but in these countries, healthcare workers are focused on diagnosing and treating. We need a different kind of healthcare system: one in which national digital health care strategies and systems are implemented by knowledgeable healthcare ministries who understand their populations and allocate proper funding to educate healthcare workers and the general public about how to prevent NCDs. I was honored to be invited to participate in this conversation. My own perspective was expanded, and I was able to share my knowledge and experience to expand that of others. As we end this year, I am grateful for all the colleagues and thought partners with whom we have listen, debated, learned, and worked with in 2019. Together we are identifying and working to solve the major healthcare and humanitarian issues of our age. Thank you. Images: The Wilton Park grounds and meeting room. Photos by Kirsten Gagnaire.  Two weeks ago, Jennifer Schlecht, a leader in the field of family planning and the mother of a five-year-old, was brutally murdered by her estranged husband. He also murdered their daughter before hanging himself. Jennifer was like many of my global development colleagues: smart, passionate, and dedicated to humanitarian causes. She devoted her career to women and girls in crisis situations. And she was experiencing ongoing intimate partner abuse. She was afraid to stay and afraid to leave.
Gender-based violence knows no societal boundaries. It affects women (cis-gendered, trans, and genderqueer) in all socio-economic levels, all ages, all sexual preferences, and in every country. And gender-based violence isn’t just about physical abuse – it’s sexual and psychological abuse, financial coercion, and withholding a woman or girl’s ability to go to work or school. This is not a female problem – it is a human problem. It’s rooted in the attitudes, cultural norms, and behaviors of men worldwide. When men and boys are educated about ingrained sexist and systemic biases, they begin to see how they can stop these behaviors and practices from harming the next generation. The LGBTQ community is also affected. Rates of intimate partner violence is actually higher than in heterosexual relationships and often underreported due to fears of discrimination and bias. We have made progress towards SDG 5 and SDG 10, but we have an immense amount of education and work to do to meet our 2030 goals. It’s not only about helping survivors; it’s about changing the entire paradigm. SDG 5 not only sets the goal to end all forms of discrimination against all women and girls everywhere but also to eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation. Last week at the Global Washington conference, I moderated a panel of experts on gender justice and gender-based violence. Joining me were Puja Dhawan, Director, Initiative to End Violence Against Girls and Women at the NoVo Foundation; Rebecca Hope, Founder and Executive Director at YLabs; and Zainab Ali Khan, Founding Working Group Member of Every Women Treaty. The discussion was engaging, honest and informative, and, it helped me to understand that while women are inherently powerful and leaders for the solutions to this issue, at its core this is a human issue, and everyone needs to be involved in understanding and stopping gender-based violence. The Every Woman Treaty mandates that nations enact interventions that have been proven to reduce rates of violence. There are five points of action: legal, training and accountability, violence prevention education, services for survivors, and funding. New data from the Women, Peace, and Security Index shows that in some countries, women still report up rates of intimate partner violence in the 40th percentile. One rapidly growing of harassment is tech-based – mobile phones and social media, in particular. Almost three quarters (73%) of women have endured some form of online violence. While there are challenges and ethical issues in putting a dollar amount on such a complex issue, several studies have calculated the financial burden of GBV. The United Nations Population Fund estimates that the annual cost of intimate partner violence against women in the US exceeds $8 billion in medical and mental health care and lost productivity. A study of the cost of GBV in Bangladesh amounted to 2.05% of national GDP with majority of this cost borne by survivors and their families. Gender-based violence only stops when women speak out and are treated as equals, not commodities. We need to establish violence prevention education to teach boys and men how to build and navigate healthy relationships. On a local, national, and global scale, we improve lives and outcomes when we believe and protect the survivors as well as insisting on transparency, domestic violence laws, education, and funding. Whether you are in the U.S. or elsewhere, if you see a woman who is experiencing gender-based violence, ask her what is happening. Use your voice so she can find and use hers. If you are experiencing gender-based or intimate partner violence in the U.S., please call the National Domestic Violence Hotline at 1-800-799-7233. They are experienced, resourceful, and will help you right now. Image: Habiba Osman carries a placard denouncing violence against women during a march in Lilongwe, Malawi, Sept. 14, 2017. (L. Masina/VOA)  In global digital health, the focus is on outcomes and having accurate data that both proves and informs those outcomes. Testing a new digital health intervention can take years of effort and funding, readying the system to be implemented. Positive outcomes are proof-of-concept and can be lifechanging both for the service recipients and the innovator. When a new tool is ready or a country wants to think about a more digitally focused approach to their healthcare system, there’s a push to implement and start measuring results. The implementation team may be ready, but is the country? This is a question we recently asked ourselves after observing one too many great theories falter in practice because the country, while enthusiastic about the possibilities opened by the services, were not actually ready to receive them – and funders weren’t always sure how to fund them in a strategic and coordinated way. Vital infrastructures often were not in place. How do you assess if a country is ready to implement a new system? What are the identifiers and how do we measure them? How can the country ensure it is clearly articulating its needs to funders and aligning those funders around its most critical needs? We’ve got a tool for that. With support from the Bill & Melinda Gates Foundation, Kati Collective has developed the Early Stage Digital Health Assessment to facilitate a discussion between a country and its stakeholders around the building blocks that need to be in place before designing a digital health solution. The Assessment focuses on countries who are in the early stages of developing a more coordinated strategic approach to digital health or are in the early stages of assessing their readiness to develop a plan. The tool identifies a set of critical indicators the country should meet prior to planning and implementing a new digital health intervention. From there, the tool digs more deeply into a set of essential building blocks: human capacity, investments and funding, data capture and use, infrastructure, standards and interoperability, and governance and policy. The Assessment employs a simple scale of one to five. If a country scores lower than a three in a certain area, the results are used to guide conversations between countries and stakeholders to develop a roadmap that can be taken to improve readiness, therefore increasing the chances of positive future outcomes. We recently used the Assessment for the first time in Malawi which allowed us both the opportunity to use the tool in a familiar setting and to finetune the instrument. This is not a lengthy process – the Assessment can be done in less than a week which is ideal for the principal users of the tool: health ministries and donors who have little time and want results for the health of their citizens now. Starting with an understanding of current tools available, we identified the gaps in those tools (see diagram below) and used this information to develop the Assessment. In Malawi, we interviewed key stakeholders, reviewed relevant policy, strategy, and assessment documents, and identified strengths and areas for improvement. We also took recommendations from previous assessments into account. By codifying existing data, we are able to identify gaps and create a more defined picture of how the country aligns within the ecosystem. We then identified, scored, and prioritized the key strengths and gaps in each building block, and made recommendations in each area. The Assessment is flexible and can be adapted to work across the digital health ecosystem. Our next step is to test the Assessment in other countries. Once we have more results (we love outcomes as much as anyone!), we will work with the global digital health ecosystem to determine how to best ensure that the Assessment becomes a tool for the global good, ensuring it is available to anyone in the ecosystem to use. For those who want professional guidance, we offer both remote support and in-country facilitation. We believe the Early Stage Digital Health Assessment could be a gamechanger for LMICs. We’ve posted an overview of the assessment and analysis. Tell us what you think!   Nearly every morning, I am at my desk before the sun rises, talking via video conference with my clients across the world from my home base on an island near Seattle. This service is usually clear and reliable, allowing me to see my clients face-to-face. It’s efficient and pleasant for both of us as we have immediate access to our files and ledgers, and once the meeting is over, it’s a quick disconnect and we’re on to the next meeting.
But what is not there, is a real sense of place. When you are working with an international client or partnership, there is a limit to what you can do from afar, and the connections you can make. I have to rely on the person on the other screen to relay stories and data. I hear about experiences, but I don’t have them. Because of my decades of experience, I can understand and extrapolate, but I’m not there to share the experience myself. It is important to leverage travel to see clients and partners, build relationships, and understand the context. When we arrive in a client or partner’s home country, we feel the air, we see the town, we meet the local folks running the clinic, and we laugh with the kids checking us out. A few weeks ago, I traveled to Malawi. Travel is nearly always an exercise in patience and this four-leg trip of Seattle – Paris – Nairobi – Lilongwe was a one for the books. Thanks to flight delays and missed connections, I stood in line after line after line, showing my visa, paying fees, and trying to keep myself upright and lucid after nearly 48 hours of travel. Finally, I arrived and was able to rest before meeting with my Malawian colleagues. For those of us who do global work, this is just one of many relatable stories of how un-glamorous travel can be. And nearly all of us know how important it is to make the trip. On this most recent trip, I was in-country to work with a colleague to populate and test a tool Kati Collective has developed to help Ministry of Health officials assess what is needed to advance digital health. We were able to sit together in the same room, go over questions, look at the same files, and have a true back-and-forth dialogue regarding what they need in their environment. When we are in the places we are working to support, we are forced to examine our assumptions and biases. It’s easy—and normal—to create an image or idea based on conversation and what you think you know. When I am in a health clinic and see the multiple single-use digital devices handed out by siloed projects, the six or eight (or sometimes more) patient registers that require repeated entering of patient names, hash marks, and notes, I can better understand the ramifications of adding another indicator on an M&E framework or recommending another digital tool. We see the pleased looks and hear the frustrated sighs of those on the front lines of the work. We see where our theories play out in unexpected ways when put into actual practice. It’s not that the local community isn’t being upfront when we talk via email or video chat, it’s that they have a different take on their everyday life and processes, than you, as an outsider and sector expert, would have. You can’t get the full picture of the ecosystem until you sit in it with the service providers and recipients. And whatever country you are in, you chase after busy government health officials who scurry from meeting to meeting with UN agencies and global funders, hoping to secure an hour to tell them about your work. But every minute is worth it. Each relationship is important to the overall goals and every assumption that is challenged makes the work better. Our goal at Kati Collective is to get to know the actual people whom our strategies, organizational plans, and tools are affecting. We are always asking whether our ideas and assumed outcomes match up with their actual use and needs and whether our recommendations are adding value, not just workload. If the people we work with trust us and we truly understand them and their needs, we can continue to grow our relationship by digital means and together, as partners, reach the goals we’ve set out to accomplish for their community and for our world. Image: Kirsten Gagnaire, Kati CEO, with Maganizo Manawe, a digital health expert at the Malawi Ministery of Health.  Last month, I joined 8,000 people from 165 countries in Vancouver, BC to participate in the Women Deliver 2019 Conference. Held only every three years, this four-day gathering is the world’s largest conference on gender equality, and the health, rights, and wellbeing of girls and women.
The energy at this conference was palpable and illustrates the power of uniting across women’s issues. Inviting strategists, practitioners, and supporters into one space to coordinate efforts and create synergy among leaders and organizations reduces silos and increases opportunity for collaboration. Rather than separating out reproductive rights, maternal health, and gender equity – to name a few major areas of concern – these issues were all brought together at WD 2019 and examined. Women are complex, multi-faceted humans who face a confluence of issues. Our response to these issues must address this complexity and be holistic in nature. Infant mortality, access to women’s healthcare, and the agency of adolescent girls are not discrete problems to solve. WD 2019 not only acknowledged and highlighted some of our most pressing collective issues, it pushed all of us to mobilize for change. There is great power in engaging with a spectrum of women – all ages, orientations, cultural backgrounds – coming together to address systemic issues. At WD 2019, the voices of girls were amplified. Today’s young women are ready to serve and to lead their communities, and they accept no excuses for inaction. With advocates such as Natasha Wang Mwansa, Girls Be Heard, and the Young Leaders Program, this generation, backed by the experience and wisdom of the women who came before, will be agents of positive social and economic change for women. And now, the conference has ended. The conversation continues in boardrooms, in health clinics, on email, and via social media. It’s time for the data and the conversation to lead to action. Following the Women Deliver conference, I spent a week in Lilongwe, Malawi, where Kati Collective is working with the Global Financing Facility to provide support to the countries in their portfolio. The GFF, whose portfolio of countries has grown to 36, is a tangible way that funding is being targeted to the many health priorities for women and girls. As funders, such as Canada, make ever deeper investments in this work, definite and defined actions to effect change are becoming more and more possible. Additionally, I’m impressed by the White Ribbon Alliance’s promise to not just listen to women’s needs and demands for quality reproductive and maternal health care (read their report What Women Want), but they have pledged to act upon them. Let’s all join them in that pledge. We talked, we studied, we collected, we determined. Now, we deliver. And we improve the world for women and girls. Together. Image: WD 2019 delegates from Deliver for Good, a global campaign that applies a gender lens to the Sustainable Development Goals and promotes 12 critical investments in girls and women to power progress for all. Photo: Suzanne Rushton.  Implementing digital solutions to human problems seems like a no-brainer in our connected age. Technology is powerful; it connects people worldwide, it offers innovative solutions to age-old issues, it simplifies situations. On the other side of every digital platform, however, is a human being who needs to relate to and operate it.
Disrupting the system is a popular catchphrase these days; implying that the system needs to be interrupted and upset in order to resettle into an improved form. Perhaps the system really could use a serious disruption, but on the receiving end, have we disrupted a person’s life in order to prove a tech point? On June 10, the UN High-level Panel on Digital Cooperation released “The Age of Interdependence,” a report which advocates for improved digital cooperation and stability while concurrently developing human capacity and mitigating the risks. It’s encouraging to see that more than 2,000 people were met with to discuss inclusive development, data, human rights, and digital trust and security. We must have empathy and understand the context in which the person on the ground will use the tool. No matter how elegant, helpful, or potentially life-changing, a tool will only work if a human being can use it without too much fuss and if it makes sense, given their particular context. Questions to ask yourself before disrupting:
Here’s an example for you: As is typical in low-and middle-income country healthcare settings, staff at a local health clinic kept huge registry books of all patients to record what services and commodities were provided. There can easily by five to eight registers (or more) in just one clinic, each delineated by programs, such as ante- and post-natal care, HIV/AIDS, family planning, and immunization. Last year, during a data use assessment in Eastern Africa, I observed staff carefully entering each person’s details and treatment by hand although a new digital patient registration system had recently been implemented in this and a few other facilities. This system was supposed to eradicate the need for the manual registry as patients could be entered directly into a new digital platform and their records pulled up quickly. However, the interface was in English, a language in which most community health workers were not fluent at the level required to navigate an interface requesting medical information, and many were not well trained in how to operate the new technology. It’s an all-too-common scenario where digital solutions that are not fully contextualized and/or don’t have a reasonable plan for scale and elimination of the paper entry system actually causes dual data entry. This does not ease the clinicians’ workload—it makes it more burdensome. Digital systems and human implementation have to be coordinated, both on individual and larger community levels with a localized understanding of how the system interacts with other systems at play in the environment. And, there needs to be a clear, realistic, and funded plan for rolling out the digital system so it can replace—not duplicate—manual systems. Fragmented solutions are not enduring solutions; they do harm rather than help. At Kati, we work with you to think through these issues before program implementation so that the chance of success and satisfaction is increased. We help our clients leverage digital to meet humanitarian needs. We are excited to see how the UN High-Level Panel works with partners to implement its recommendations. With every innovation, real people and communities are affected. Let’s work together to ensure that disruption isn’t disruptive, but instead leads to coordinated community action and improved outcomes for all. Image: Healthcare workers at a clinic in Tanzania. Courtesy of Kirsten Gagnaire. Giving birth is normal, natural, and, if you live in a low- and-middle- income country, potentially life-threatening. Day by day, woman by woman, Kati Collective works to improve this outcome.
In 2015, the global maternal mortality ratio stood at 216 maternal deaths per 100,000 live births. By 2030, Goal #3 of the UN’s Sustainable Development Goals includes reducing this mortality rate by two-thirds. The Maternity Foundation is one of the leading organizations working to reduce maternal and newborn mortality in LMICs by empowering skilled birth attendants (SBAs) to provide a safer birth for mothers and newborns everywhere. Their main digital focus has been the creation and dissemination of the Safe Delivery App, a smartphone app that provides SBAs with instant access to up-to-date clinical guidelines on emergency obstetric and neonatal care via easy-to-understand animated instruction videos, action cards, and drug lists. Kati Collective spent six months working with the Maternity Foundation to facilitate their transition into becoming a scaled and sustainable capacity-building program to help their innovative approach to SBA training to exponentially more frontline health care workers in LMICs. This included partnering with MF staff and leadership to facilitate the identification of their value proposition, key audiences and costing model in a way that helped them feel connected and committed to the results. The resulting sustainability plan will help the Maternity Foundation grow and create a more robust program to support more women in more countries. On May 22 at 3 pm, we will continue the conversation about this important work at Global Washington for a panel on “Mother, Baby, Provider: Completing the Triangle.” CEO Kirsten Gagnaire will moderate a panel of experts including Heidi Breeze-Harris, Executive Director, PRONTO International; Kathleen Davis, MD, Board of Directors, Worldwide Fistula Fund; and Susan Thompson, Director of Timor-Leste Programs, Health Alliance International. We will be talking about creating safer birth environments and how improving the skills, training, and resources available to SBAs—who are often poorly paid and unappreciated—lowers maternal mortality rates in developing countries. If we are meet UN Sustainability Goal #3 by 2030, we need to keep talking, keep listening to women in LMICs, and create innovative methods, like the Safe Delivery App, to leverage digital technology for human benefit. Register here if you would like to join us. |
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