The Vision Thing

Having finished up my work, taken a few days R&R in Mumbai, and finally returned to the US of A, the question comes -- what next? I spent three months trying to help people build a database in a desert. What's going to happen to it? What can be done with this thing that might actually change the course of India?

To me, the key part of the vision (and the place where I might have added value by thinking of it) is getting away from the idea that REACH is "a database where we track what we're doing". Instead, I've been pitching the line that it's "networked MIS for public health" (MIS being Medical Information Systems, what we in the US call Health IT.) The second part isn't super-innovative; it's just raising the point that we should be starting to think of the possibility of a medical records system that tracks not only episodes of acute care, but the health of a community in which the individual patient is embedded. That said, the community is probably the largest determiner of health in both the developed and developing world, and in the West we don't pay enough attention to it. (Quite possibly we don't here in the East, either.)

The "networked" part, though, is where the really cool stuff might start to happen. Right now, this database sits on a server in a room, and if you want to know something, you go to the room and ask for a printout or maybe an Excel file. If you're not one of the twenty-odd people who work for this NGO in this specific village where the HQ is, you will never even know the damn thing exists. In my planning documents for the next phases (which will, if I have my way, include a major software redesign), I've repeatedly stressed that they should make the data directly available, in real-time, over the Web to any interested party[1]. When that happens, any interested government official can instantly see how much better our villages are doing than the surrounding blocks. Any deep-pocketed funder looking for proof of BCT's effectiveness can monitor directly what's happening as we spend their money.

Most importantly, as the Internet continues to rapidly pervade the Indian countryside (just as the mobile phone did in the previous decade), any person living in one of our villages can find out how his/her village is faring compared to the neighbors, and raise some hell with the old men down at the big house if the answer is "not well". There's some other interesting ramifications, such as the possibility that our field workers could update us directly via mobile phone/SMS rather than filling out paperwork, but to me, that potential for individuals to know about their own community is the biggest benefit. Social change comes about when a persnickety person finds out that something is wrong, sets out to fix it, and just won't go away until the problem does. The REACH I'm trying to design would give that person a target-rich environment, which is a worthy goal if I ever heard one.

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[1] Yes, there are privacy issues. Potentially hideous ones, since of course none of our data is de-identified. Heck, in the USA we wouldn't be able to even build the database in the first place, not without a lot of consent forms and community meetings. The lack of HIPAA is a blessing for India's health.