The Asian Trends Monitoring Bulletin is a project sponsored by the Rockefeller Foundation, New York, the Centre for Strategic Futures, Singapore and the Lee Kuan Yew School of Public Policy, National University of Singapore. The Lee Kuan Yew School of Public Policy gratefully acknowledges the financial assistance of the Rockefeller Foundation and the Centre for Strategic Futures, Singapore.
The Asian Trends Monitoring Bulletin focuses on three areas of strategic concern to Asia’s well-being and future development: trade and investment facilitation; health systems; and energy security.
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Production Manager, Production & Research Dissemination Chris Koh
Editorial Trade & Investment Facilitation Darryl S.L Jarvis Johannes Loh
Health Systems Phua Kai Hong Nicola Pocock
Energy Security T S Gopi Rethinaraj Taufik Indrakesuma
Image credits, with thanks Image on page 3 is copyrighted by United Nations Photo* Image on page 6 is copyrighted by www.verdenergia.org Image on page 7 is copyrighted by cambodia4kidsorg* Image on page 12 is copyrighted by inju* Image on page 13 is copyrighted by Matthew Krueger, Mobile Money Exchange, http://mobilemoneyexchange.wordpress.com/ Image on page 15 is copyrighted by Microventures Inc. 2011 Image on page 16 is copyrighted by www.sanamobile.org *These images can be found on www.flickr.com
Contact details of the editorial team are available on the last page of this publication.
Permission is granted to use portions of this work copyrighted by the Lee Kuan Yew School of Public Policy. Please acknowledge the source and email a copy of the book, periodical or electronic document in which the material appears to chris.k@nus.edu.sg or send to
Chris Koh Lee Kuan Yew School of Public Policy 469C Bukit Timah Toad Singapore 259772
CONTENTS 1
At a glance
2
iNNOVATIONS AGAINST INEQUALITY
3
Innovating for Access to basic Infrastructure
7
Maternal and child health interventions
13
UNBANKED AND UNCONNECTED: Interventions that make a difference
18
cONCLUSIONS
19
references
21
editorial team
1
The World Bank has upgraded the income categorisation of Thailand and Laos. Thailand moved from a lower-middle income economy to an upper-middle income economy, and it now has a gross national income per capita of US$4,210. Laos just surpassed the lower mark of US$1,006 to become a lower-middle income economy. Indonesia, with a population of 240 million, is on track to surpass Thailand as the region's biggest car market. An official at the Indonesian Automotive Manufacturers Association, Jongkie Sugiarto, said it would take only two years for Indonesia to overtake Thailand not only in terms of sales but also in production. The demand for micro‐credit in the rural segment of the Myanmar economy is estimated at around US$470 million, but estimates revealed only 10% of this demand is met. The UNDP Microfinance Project is presently providing about 80% of microcredit through PACT Myanmar, a non-profit organisation. The rural poor rely on relatives, money lenders as well as pawn shops for small loans. The postal department of Bangladesh has introduced an innovative mobile financial service, which allows users to transfer money or pay for goods by simply swiping or tapping their mobile phones against a special reader, though both parties have to register first at a postal outlet. The "mobile wallet", a banking service that enables people to transact money or buy anything across Bangladesh with a mobile phone has been rolling out since September 2011. The so-called "super-rice", a rice breed with the name DH2525, has set a new world record for rice yields in China. In the first of two trial years required to be officially deemed a success, this breed yielded about 13.9 tons per hectare. The strain was developed by China's "father of hybrid rice" Yuan Longping who hopes to reach 15 tons per hectare before he turns 90 (in about nine years).
Follow Johannes loh for latest trends in trade & investment facilitation across Southeast Asia, critical dialogue and implications for pro-poor policy and policy development. @seASIAtrade
Contrary to popular perception, rural areas may contribute at least as much to the spread of dengue fever as cities, according to a new PLOS medicine study using data from Vietnam. Researchers analysed the interaction between human population density and lack of tap water as a cause of dengue fever outbreaks to identify geographic areas most at risk. Rural and semi-urban areas with population densities between 3,000–7,000 people per km2 without access to piped water, were most at risk. The United Nations high-level meeting on chronic, or non-communicable disease, was convened in New York. Chronic diseases kill around 36 million people a year, mostly in low- and middle-income countries where they disproportionately affect people under 60. Governments pledged to work with the United Nations to adopt targets to combat heart disease, cancers, diabetes and lung disease and to devise voluntary policies to cut smoking and the high salt, sugar and fat content in foods, by the end of 2012. Thailand’s Ministry of Public Health is keeping a close eye on outbreaks of avian flu (H5N1) in humans and hand, foot and mouth disease among children. Total patients with hand, foot and mouth disease between January and August stood at 8,842 with four fatalities. Public Health minister Dr Paijit Warachit has set up a “war room” at the Department of Disease Control to monitor the re-emerging epidemics within Thailand and outside the country so that preventive actions can be taken in time. A lack of official blood donations has led to a rise in freelance "blood sellers", in Cambodia. The sellers are mostly street children, who sell their blood outside hospitals. According to reports, doctors are encouraging relatives of patients to purchase the blood, where donors can make around US$5 to US$10 per donation. Prime Minister Hun Sen recently appealed to students to donate blood, noting that just three in 1,000 people were donors.
Follow Nicola Pocock for health & health systems trends monitoring & futures scanning across South and East Asia with a pro-poor lens.
@healthSEAsia
The province of East Kalimantan, Indonesia, is installing a set of two Independent Power Plants using aeroderivative gas turbine technology developed by General Electric. These power plants will generate a total of 82MW of power, which hopes to increase the number of Indonesian households connected to the grid. Over 30% of Indonesians, mostly in eastern Indonesia, do not have access to grid electricity. Vietnam recently approved its national power development plan for 2010–2020: the “Power Master Plan VII”. The plan includes a specific target of 98.6% rural electrification by 2015 and 100% by 2020. The master plan also introduces nuclear power into the national energy mix, with the first plant expected to be operational by 2020. The Second Forum on Children in the Urban Environment was held in the Philippines. The forum, organised by the Department of Interior and Local Governments, the Institute of Philippine Culture and UNICEF, discussed the plight of millions of poor children who are at risk of disease and subnormal development due to lack of food, health services, potable water, sanitation and decent housing in urban areas. Topics discussed included health, child protection, urban planning and even climate change, with an emphasis on the role of local governance. The World Bank’s Water and Sanitation Programme recently launched a series of reports that highlight the costs and benefits of investing in sanitation systems. The reports, a part of the Economics of Sanitation Initiative study, use case studies from Indonesia, Cambodia, the Philippines and Vietnam to show that poor sanitation systems create massive economic losses and investments in sanitation are needed to recover those losses. The reports recommend that countries develop viable sanitation markets and disseminate information on household sanitation options to promote behavioural changes.
Follow Taufik Ramadhan indrakesuma for poverty alleviation and policy trends around ASEAN, specialising in infrastructure, energy, natural resources and sustainability. @SEAsiaEnergy
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2
innovations against inequality In the Asian Trends Monitoring (ATM) Bulletin 12: Rising Asia, Growing Inequalities, we highlighted some inequalities that still persist throughout ASEAN, despite rapid economic growth. This issue now seeks to highlight several interventions that have been developed by organisations to close these gaps. Moreover, the examples are meant to bring life to the numbers and illustrate a range of successful approaches in tackling the inequities highlighted. The interventions we have chosen vary greatly in size and scope. This allows us not only to provide a clearer picture of the wide array of currently existing innovations and interventions, but also touch on the strengths and weaknesses that differentiate the efforts of national governments from those of grassroots organisations. Our first section discusses interventions in providing basic infrastructure. We showcase three examples of small-scale, market-driven interventions in the provision of water, rural electrification and clean cooking methods, as well as a broad overview of national-level approaches in rural electrification. We discuss why these small start-ups have enjoyed much success in filling the gaps that governments cannot reach, in addition to why these projects may or may not succeed when replicated on a larger scale. We also touch on the different ways in which governments can better approach interventions that aim to provide basic necessities, such as electricity, water and sanitation, on a nation-wide scale. The Millennium Development Goals gave prominence to global inequalities in health indicators like maternal and child deaths, galvanising countries to take action to reduce preventable mortality from causes such as birth complications (mothers) and childhood diseases like diarrhoea. With some way to go to reach 2015 targets in both maternal and child health, we
draw attention to three innovations at both the macro- and micro-levels in selected ASEAN countries that are helping mothers and children to live healthier and productive lives in our second section. For chronic disease, we showcase examples of two city-level interventions that are helping to create enabling environments for residents to live actively and healthily. In the third section we present four innovative projects, all based on sustainable business models which improve the livelihood of the poor. In two cases, these are innovative services provided via mobile phones: M-PESA, a mobile banking service developed in Kenya, and Sana Mobile Health, an application that allows health workers to collect data in a structured way and then receive a doctor’s diagnosis from hundreds of miles away. Hapinoy is a social enterprise that combines small storeowners into one branded network in which they enjoy bulk discounts and entrepreneurial training to enhance their income. The last case is a microfinance product offered by Safesave which enables even the extreme poor to save up starting from amounts as small as 2¢. We hope that the cases presented in this issue can provide you with a clearer understanding of why certain interventions did or did not work, in order to better inform future policy designs and decisions. We invite you to share the ATM Bulletin with colleagues or friends who are interested in poverty alleviation in Southeast Asia. The ATM Bulletin is available for download online at http://www.asiantrendsmonitoring.com/category/downloads, where you can also subscribe to future issues. Additional content and videos are hosted on the website, where you can share your thoughts with us on this issue. Thank you again for supporting the ATM Bulletin, and as always, your comments and feedback are welcome. Johannes Loh Nicola Pocock Taufik Indrakesuma
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iNNOvaTiNg FOR aCCESS TO BaSiC iNFRaSTRuCTuRE The solution comes in the form of a large barrel shaped vessel that can be rolled on the ground with the help of a long metal handle. This allows people to transport large quantities of water (around 24 gallons, or one day’s supply of water for a family of four) in a single trip, without having to exert as much physical effort as when using more traditional methods such as carrying jugs or buckets atop their heads.
bringing water home with ease.
Rolling water into rural communities Deciding the appropriate intervention to improve access to clean water is a complex policy choice, because there are many different types of water access problems. There are two broad categories of water access intervention: water supply and water quality1, each with a wide range of options for specific interventions. These interventions also differ on factors such as scale and cost. One example of a successful small-scale water supply intervention is the creation of the water roller. The water roller was first initiated by the Hippo Water Roller project in 1991 in South Africa. Since then, the design has been imitated and improved by Wello, the organisation behind the WaterWheel that is sold in India. The water roller was designed to address the problem of transporting water from its source to the home. One of the parameters of “access to improved water sources” defined by the WHO is that water sources must be within a radius of one kilometre from dwellings. For many people in ASEAN, especially in places such as rural Laos and rural Cambodia, the sources are typically much farther away. The unfortunate consequence is the need to make multiple time-consuming trips in order to fulfill the daily water needs of a family.
The main advantage of interventions such as the water roller is that they are small-scale and do not require capitalintensive infrastructure investments such as drilling wells or building networks of pipes that lead to household water connections. Thus, is it easier not only for charities or other organisations to donate these products rather than build infrastructure, but also for households and communities to purchase these products via micro-loans or other financing methods. Furthermore, even if individual households cannot afford to buy their own roller (the Hippo Water Roller is priced at around US$70–100, while the WaterWheel will be available for around US$20–30)2, the product can give rise to water jockeys, an occupation which is made theoretically feasible due to the increased efficiency of small-scale water transport. To date, it is reported that over 32,000 Hippo Rollers have been sold throughout Africa.3 Currently, the availability of these rollers is limited to Southern Africa and India, where the projects originated. However, there is significant potential to replicate these projects or ship the rollers to ASEAN countries. The Hippo Roller, for example, has a “local manufacturing” programme, where the company ships the manufacturing machine and an on-going supply of raw materials abroad instead of shipping the completed product, with the rationale that shipping completed products will drive up the costs by too much. Entrepreneurs in ASEAN could take advantage of this programme and bring not only the products into the market, but also generate local employment opportunities.
4
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Assuming that water rollers can carry 350% more water than traditional methods, an adult with a walking speed of 5km/h and who lives 2km away from water sources can save nearly 20 hours per week that can now be used for other productive activities such as paid work.
However revolutionary these products seem, it is important to remember that they are, ultimately, one-dimensional, micro-level solutions to macro-level problems in water supply infrastructure. Water rollers may lead to time savings for water collection and a reduced risk of injury to water carriers, but they do not address core issues such as water quality and the stability of the water supply. Thus, when considering these kinds of projects for replication, it is also important to consider the limitations of the intervention, as well as other kinds of interventions that can be used to fill the remaining gaps. For more information about the two types of water rollers, visit: http://www.hipporoller.org/ (Hippo Water Roller) and http://wellowater.org/ (WaterWheel). Sustainably connecting off-grid consumers There have been a number of large-scale rural electrification projects around the world based on just extending the reach of large centralised power grids. One of the problems with this approach is that the projects are very expensive. For example, one rural electrification project, carried out in Indonesia in 1994–1996, consisted mainly of extending distribution lines to 851 villages at a cost equivalent to US$130 million in 2010. Another problem, as the Alliance for Rural Electrification explains, is that rural areas “are often too sparsely populated or have a too low potential electricity demand to justify the extension of the grid�4, which means that these projects, if carried out at all, cannot penetrate all rural areas. However, several projects recognise the need for a different solution, and have instead sought to provide electricity access through local means of electricity generation, usually
utilising renewable energy technology. This allows electricity access to penetrate remote areas more easily, without requiring massive investments in extending the centralised distribution grids. The Global Sustainable Electricity Partnership has initiated a number of these projects, including one project in Indonesia and one in the Philippines. The project in Indonesia was a multi-pronged approach in the island of Sulawesi, involving the installation of three micro-hydro power systems which covered roughly 2,500 people, 175 solar home systems in three villages, and a photovoltaic/wind hybrid system on Rote Island that provides coverage to roughly 600 people.5 The project also entailed setting up and training a number of village-run electricity cooperatives to manage and maintain these systems. In the Philippines, the organisation built a 200kW hydropower plant in Ifugao province in order to aid efforts to preserve the Ifugao Rice Terraces World Heritage Site and to provide electricity access to the local agricultural community around it. Another fast-growing technology is the use of various forms of waste to power electricity generators. Previous issues of this bulletin have discussed the potential of electricity generation using agricultural waste such as rice husks in Thailand. These waste-powered electricity technologies have also popped up in farms in Malaysia in the form of biogas plants that utilise animal manure, as well as in some urban areas like Jakarta and Ho Chi Minh City that are also trying to solve the problem of urban waste management. Although the projects highlighted above were mostly implemented by non-government actors, there are also some governments that have decided to follow the same route of using renewable energy to provide off-grid electrification. China launched very ambitious rural electrification programmes using renewable energy in the past decade. It started with the Township Electrification Programme in 2001, which installed a total of 20MW of solar photovoltaic capacity, 200MW of small hydroelectric capacity, and 840kW of wind power to over 1,000 townships.6 After the completion of this programme in 2005, it continued to expand its rural electrification programme with the Village Electrification Programme, which aims to provide renewable electricity to 10,000 villages.7 India has recently followed suit, setting up a solar energy plan that aims to provide solar lighting to 20 million rural households by 2022.8
5
The main barrier to the interventions above is that, although these projects are more efficient and have a wider reach than the “traditional” grid expansion method, the generators still require sizeable investments. For example, China’s Township Electrification Programme cost a total of RMB 1.6 billion9 in total, or about US$250,000 per township (assuming an equal distribution of resources). Thus, there will still be difficulties in funding the replication of these projects throughout the parts of ASEAN that need them most. Thinking even smaller: the case of ToughStuff The previous section showed the limitations of large-scale projects in energy provision. Some projects, however, are so small-scale that they do not require any amount of infrastructure investment. One interesting example of this type originates from a company called ToughStuff, the winner of the 2011 Ashden Award for Sustainable Energy. ToughStuff was set up in 2008 with the goal of “providing affordable solar-powered products for low-income people”. The products they sell include rechargeable battery packs, small solar panels with connectors to mobile phones and radios as well as LED lamps. These products, as mentioned in their website, “fulfill the three main energy needs of offgrid consumers: lighting, connectivity, and information”. Currently, this company sells its products primarily in Africa, although it has expanded into 11 African countries in the last two years, and sometimes gets involved in disaster relief efforts outside of the continent. In addition to their core business of selling solar-powered products, ToughStuff also engages local communities using their "Business in a Box" programme, where they recruit and train a number of locals to become distributors of their products (they refer to distributors as Solar Village Entrepreneurs), which both increases the penetration of their products to remote areas and provides an additional US$500–1,000 of income for the worker. This type of business is by no means unique. There are many other companies within the energy sector as well as other sectors that operate much like ToughStuff, with a mix of low-cost products and employing local people as distributors. Nokero, for example, is a USA-based company that has almost exactly the same products as ToughStuff, with even the same Business in a Box concept. It, too, is finding some amount of success in selling solar lanterns and mobile phone chargers to countries in Africa and South Asia.
However, it is more important to note the business model’s success rather than its novelty. The ToughStuff model succeeds because, much like the water rollers mentioned in previous sections, it identifies specific problems that can be solved using low-cost products. In this case, ToughStuff correctly identified the primary uses for electricity in these off-grid rural communities. Thus, it is able to streamline their product to provide solar-powered electricity for those specific purposes: LED lamps, mobile phone chargers and radio chargers. It means that production costs are low and the appeal of purchasing those products is high for people in rural communities. It is unfortunate that no independent studies have been conducted to show the real impact of these products to off-grid rural communities, thus judgment is still reserved on whether this is an effective method to provide access to electricity. However, assuming that ToughStuff sales figures are reliable, its products are currently bringing benefits to over 140,000 families, mostly in Madagascar and Kenya.10 This information, however, should be taken with a grain of salt. Although the merits of these businesses deserve applause, they have their limitations. In the case of ToughStuff, their successful business model is also what limits the utility of the interventions in the long run. By focusing on providing for the current demands for power in the form of mobile phone and radio chargers and LED lamps, the ToughStuff model does not allow for improvements in rural electricity access beyond those three services. The batteries are too small to power larger electrical appliances such as refrigerators or electric stoves, which are equally impactful to the improvement of rural lives. Whether these products count as providing “access to electricity” is still debatable. The International Energy Agency, for example, only considers households with access to central or local power grids as “having electricity”, due to the limited uses of these smaller-scale products. Thus, it must be noted that the much improved reach of this kind of model comes with the trade-off of a more limited range of possible improvements. For more information about the product, please go online: http://www.toughstuffonline.com/ Cleaner ways to cook: the Protos stove Another vital energy necessity that is still lacking in several parts of ASEAN is the availability of clean-burning stoves that
use non-solid fuels. As highlighted in the previous issue, nearly 50% of ASEAN’s population still relies on solid fuels for cooking their meals and heating their homes. The regular use of solid fuels, such as firewood, charcoal and biomass, has several negative health impacts (indoor air pollution from solid fuel use causes increased risks in respiratory tract infections and chronic obstructive pulmonary disease)11, as well as negative impacts on the environment (solid fuel use emits a high amount of carbon and other air pollutants).
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Men with regular exposure to indoor air pollution from solid fuel use are 1.8 times more likely to contract Chronic Obstructive Pulmonary Disease, while women face even greater risks of about 3.2 times. Thus, providing clean cooking methods can have massive health implications.
oils. These oils are usually easier for poor rural communities to produce or to access than kerosene and LPG. This means that there is a lower risk of interventions that fail in the long run, as is the case with kerosene or LPG cookers that may end up being re-sold or abandoned because of the inability to afford or access fuel. Additionally, the company claims that the product was designed to enable local manufacture, which creates potential for employment. The Protos stove in action.
Factors such as high prices and limited distribution of nonsolid fuels such as kerosene or liquefied petroleum gas (LPG), as well as the inability to afford cook stoves, are the main constraints that the poor face in improving their cooking methods. Thus, effective interventions to provide cleaner cooking methods must not only provide affordable stoves, but also sources of fuel that are clean, abundant, and affordable. The Protos stove is one such intervention. The Protos stove is a plant-oil cooker stove that was developed by the BSH (Bosch und Siemens Hausgeräte GmbH) Group, a home appliances manufacturer, specifically to address the prevalence of solid fuel use in cooking. To date, the product has been field tested and distributed in countries such as Guatemala, India, Indonesia, and the Philippines. The stove has received much international media coverage for being the first of its kind. The main strength of the Protos stove is the wide range of fuels that can be used to power it. The stove can run on a number of different plant oils, such as coconut oil, jatropha, and rapeseed oil, as well as biodiesels and even used cooking
There are, of course, several other cook stove designs that can improve the current conditions faced by the poor. For example, there are stove designs by Envirofit, an organisation whose stoves still use charcoal or biomass as fuel, but do so in a cleaner and more efficient way. Of all the small-scale interventions in this sector, the Protos stove seems to be the first holistic, market-driven solution that tackles both the health and sustainability aspects.
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MaTERNal aNd CHild HEalTH iNTERvENTiONS laos: piloting free facility-based births Giving birth in a health facility is an evidence-based strategy that reduces the risk of maternal death, should a mother face complications during birth.12 In 2008, statistics reveal that for every 172 childbirths in Laos, one mother would die. Reasons for this are both economic and practical – a high rate of home deliveries without medical assistance in rural areas (where just 11% of births are attended by skilled health personnel), poor transport and communication links to birth facilities during the rainy season and a lack of health information. Traditions and beliefs are also a barrier to safer births – World Bank assessments note that some communities believe that a woman must give birth in the forest by herself. The government managed Health Services Improvement Project is piloting free facility-based maternal deliveries and pre- and postnatal care in Nong and Thapanthong districts, supported by World Bank grants totaling US$27.4 million. This significantly reduces the economic burden for families, where 75% of the population lives on less than US$2 a day. Preliminary results from the pilot suggest a significant increase in childbirths at health facilities since they became free for service. For more information, please see: http://bit.ly/qP6bCj intervening to immunise Immunising one’s child against diseases is standard protocol in higher income countries with universal coverage. In some ASEAN countries, immunisation coverage against the four key diseases13 in the first year of life is still patchy, particularly in island archipelagos Indonesia (87%) and the Philippines (88%). It is a particular challenge to provide immunisation services in remote and rural communities and in conflict-ridden areas. Child immunisation is linked to cognitive ability in later life; using data from Cebu, Philippines, Harvard School of Public Health researchers found that full vaccination against measles, polio, tuberculosis and DPT in a child’s first two years significantly increases cognitive test scores relative to children who receive no vaccinations.14 Organisations
children in cambodia receiving immunisation shots.
and partnerships geared toward scaling up immunisation services are abundant in Southeast Asia. We spotlight those most interesting to us below: Expanding immunisation in Luang Prabang, Laos “Public-private partnership” is a generic term that can produce vanguard initiatives. One such example hails from Laos, where immunisation coverage was just 63% across key diseases in 2009, with expected lower coverage rates among ethnic minorities. A 16-month pilot programme in Luang Prabang province, rolled out between 2006–7 by the Asian Development Bank, GlaxoSmithKline, UNICEF and the Laos Ministry of Health, tested strategies to increase community demand for childhood immunisation coverage. Following assessments in communities to understand motivations for immunisation delivery among health workers and parents, the project engaged the Laos Women’s Union and other non-governmental organisations to mobilise communities to immunise their children. In addition to peer education efforts, strategies that were particularly effective in low-coverage communities included:
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• Frangipani flower immunisation cards with five petals, stamped with the programme’s signature elephant stamp for each immunisation visit so that parents could easily keep track; • Certificates of completion publicly awarded to parents who completed the vaccination sequence by a prominent individual in the village; • Target household flags, a pocket of which contained info about the communities next immunisation outreach visit. These were placed outside households one to two weeks before each visit; • Seasonally calendared outreach visits, so that health worker visits did not conflict with peak periods in the agriculture cycle; • Ethnic language radio programmes, which were contracted to run dramas, jingles and knowledge spots about immunisation; and • Inexpensive gifts to incentivise parents whose children were not fully immunised. Results show that immunisation rates in pilot districts doubled and in some cases nearly tripled over the duration of the project. One key success factor was building on and mobilising additional national political support to increase immunisation rates across the country, which helped to ensure appropriate synergies between national and community efforts.15,16 Challenges: the short duration of the project (16 months) hampered its ability to generate behaviour change (recognised to take years), develop systems of operation and build capacity in a health system that already struggles to respond to consumer demand. Plans to ensure continuation of project activities with religious groups and the private sector were not fully explored. The project was also affected by a lack of vaccines for three months in 2007. Bearing these barriers in mind, it is important to have a continuation plan in behaviour change interventions, contingent on programme evaluations to determine whether it is cost effective, equitable and sustainable. A continuation plan could be operationalised by streamlining project activities within a health ministry's programmes or by engaging non-governmental organisations and private sector partners. Generation of new social norms takes time and requires sustained institutional efforts.
Engaging both health and education ministries in Aceh, Indonesia Following the tsunami, privately-funded Project Hope entered Aceh in 2005 to initiate a five year project aimed at improving the health behaviour of mothers and children in Nagan Raya district, supporting the Ministry of Health’s integrated management of childhood illnesses strategy. Before the project was implemented, immunisation was not a social norm in Nagan Raya. Preliminary assessments showed that health workers were not trained to deliver vaccinations, and demand from communities was low due to cultural prejudices against injections and a lack of knowledge about immunisation benefits. The project trained health workers to deliver vaccines, upgraded and built posyandus (local health centres), as well as established a health education programme in partnership with the Ministry of Education. Innovative features included: • Children educating mothers: the child-to-child health education programme has been instrumental to reaching out to mothers. Elementary school teachers engage fifth grade students to promote the importance and benefits of immunisation and other health services to mothers of children below three years old. Students are taught about nutrition, immunisation, diarrhoeal disease control, acute respiratory infections, malaria and personal and environmental hygiene. Their weekly homework is rather innovative as well: a young child has to share information he just learned with his mother. During the programme, teachers assign a mini-survey to students to identify two priority mothers with children under three to encourage or remind them to visit the posyandu each month. The day before the monthly posyandu session, students visit mothers to remind them to visit the posyandu the following day; and • Feedback loop to posyandus: using project reporting forms, teachers collected information from students and shared this with health centre staff. By 2008, immunisation rates had more than doubled. Deliveries attended by a healthcare provider rose from 44% to 68% between 2005 and 2008. To date, Project Hope has upgraded or established 247 posyandus where there were previously only 56 functional health posts, and trained 1,200 local health workers and 40 midwives in basic birth delivery. This has been accompanied with maternal and newborn care training, and the training of 25 community health volunteers as breastfeeding support leaders.
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Table 1: Project results Baseline 2005
November 2008
Percentage of women who had four or more antenatal visits during their last pregnancy
14%
56%
Percentage of mothers and newborns who received postpartum visits
36%
45.7%
Percentage of children who received oral rehydration solution during recent bouts of diarrhoea
23%
40%
Percentage of children 6–59 months old who received vitamin A
59%
69%
Percentage of mother with children under 23 months who were breastfeeding their newborn within one hour of delivery
15%
38.3%
Percentage of newborns who received postnatal care
36%
45.7%
Percentage of deliveries attended by a healthcare provider
44%
68%
15.1%
79.5%
DPT3 vaccinations
32.3%
70.9%
Measles vaccinations
19.8%
66.4%
Indicators
Verifiable maternal tetanus toxoid immunisation BCG vaccinations
Source: ADB: Maternal, child and newborn health interventions – immunisation. Asia NGO workshop, studying innovations from Asia’s NGO’s. 24–26 February 2009
Promisingly, project activities are now integrated into regular health and education ministry procedures. But a key takeaway for implementers was that to stimulate demand, the health system had to first raise its quality of care. Interventions aimed at specific groups are generally more successful within the context of broad health system improvement.
within 1–3 years of dietary changes… Policy interventions which achieve population-wide changes (such as smoke-free legislation or reductions in dietary salt, transfats, or saturated fat) can be effective and cost saving. Although such policies are politically challenging, they could achieve substantial and surprisingly rapid reductions in disease.”18
For more, please see: http://www.projecthope.org/wherewe-work/southeast-asia-middle-east/indonesia.html
To reach the most number of people, population-wide changes have to go beyond targeted behavioural interventions, which decades of research have shown to be unsustainable beyond programme duration.19,20 A comprehensive, social ecological framework of health promotion and disease prevention can be found in the Community Intervention for Health (CIH) programme, a pilot intervention run by the Oxford Health Alliance. CIH is a dual research and intervention project with a significant evaluation component. The four interventions used include community coalition building, structural change, health education and social marketing. Authors of a recent assessment note that the CIH is the “first comprehensive community intervention programme of its kind, addressing chronic disease risk factor reduction and prevention”, with a 3-year pilot study running in China, India, Mexico and the United Kingdom. CIH programme evaluation involves three components: individual assessment (surveys);
Chronic disease interventions Chronic disease risk and prevalence is complex and not attributable to health interventions alone – built environments must facilitate and encourage physical activity and healthy foods should be accessible in the food supply. Chronic disease interventions span the spectrum from prevention (e.g. programmes to increase physical activity, adoption of healthy lifestyles) to management (e.g. patient management of chronic conditions like diabetes). As epidemiologists Simon Capewell and Martin O’Flaherty wrote recently in a letter to the Lancet, the need for interventions with already at-risk populations is pressing: “Extensive empirical and trial evidence shows that substantial reductions in mortality can occur within months of (individual or population-wide) decreases in smoking, and
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Table 2: Store assessment tool Name of assessment tool
Component
Response categories Mega supermarket Small chain grocery Small non-chain grocery Chain convenience store
What kind of store is this?
Non-chain convenience store Local store Market Kiosk/fixed stall/mobile stall Bakery Fresh fruits and/or vegetables
Store assessment
High-fat/salt/sugar options (such as sweets, chips and sugar-sweetened drinks Low-fat/salt/sugar options What does this store mostly sell? Variety of high-fat/salt/sugar, low-fat/sugar items, fresh fruits and/or fresh vegetables Tobacco products Staple food Does this store sell fresh fruit and/or vegetables
Yes/No
Does this store sell tobacco products?
Yes/No
Is there a 'No sale to minors' sign?
Yes/No
Are there healthy food options at the register?
Yes/No
Source: Wong F, Stevens D, O’Connor-Duffany K, Siegel K, Gao Y (2011) Community Health Environment Scan Survey (CHESS): a novel tool that captures the impact of the built environment on lifestyle factors. Global Health Action 4 (5276)
community assessment profile; and assessment of the process required to implement activities.21 We spotlight the Community Health Environment Scan Survey (CHESS), part of the environmental scan in component 2, as a tool to help policymakers assess how the built environment interacts with health behaviours and chronic disease risk. The Community Health Environment Scan Survey: a tool to assess the impact of the built environment on lifestyle factors CHESS aims to help stakeholders to understand the link between population health behaviours and resultant health outcomes. It systematically documents and maps data (using
Global Positioning System) to assess the environments in which people shop, live, work and play as they relate to diet, physical activity and tobacco use. Eight items are assessed – streets, stores, restaurants, street vendors, recreational facilities, parks or gardens, vending machines and the information environment. An advantage of the CHESS is that it measures community attributes in “real time”, making it suitable in developing country contexts where data on the built environment (stores, parks, etc) may not be available. A recent assessment of schools in the Mexico site revealed extensive interaction between health behaviours and the
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Figure 1: Neighbourhood environmental scan involves walking a 400m radius around each school to identify and / or survey stores, vending machines etc
Source: Safaricam Ltd (2011, May 18). FY 2011 Results Announcement
environment, as one might anticipate. Using baseline data from a survey of 4,608 young people between 12–14 yearsold and scans of intervention and control sites (n=16), results showed a significant association between the percentage of fast food restaurants in the surrounding area and eating fast food within the last week (over 50%). The relationship between smoking prevalence and the availability of tobacco showed similar attributes, with the odds of being a current tobacco
user in closer proximity to stores selling tobacco. A greater proportion of stores with a “no sales to minors� sign was associated with greater use of smokeless tobacco products. Limitations of the CHESS include that it uses cross-sectional data, which may be limited in highlighting the dynamic nature of communities. Researchers also note that the ability to measure affordability of food options was hampered
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Excercise events for the public held on the ground floor of the national library in Singapore.
by the variability of units in how fruits and vegetables were sold. However, the CHESS as a diagnostic tool has substantial potential to guide urban planning and design community interventions that prevent chronic disease.
halls for badminton, basketball & netball, nine tennis centres, four squash centres, two netball centres, five fields for soccer & other team sports, 75 school fields and 15 gyms. That’s one sports facility per 2.6 miles (or per 6.9km2).22
For more information, please see reference 21 on page 19 and http://www.3four50.com/cih/
The HPB uses simple healthy lifestyle rules of thumb (heuristics) in its advertising, including: “Aim for 150 minutes of physical activity every week!” and “Eat 2 fruit + 2 veggies every day for good health!" These simple messages help consumers to remember what they should do to improve their overall health. The HPB website features interactive tools like “monitor and manage your diabetes” and a mobile diet tracker that can downloaded on a smartphone.
Healthy lifestyles campaign in Singapore Singapore’s Health Promotion Board (HPB) has recently stepped up marketing and outreach efforts in its healthy lifestyles campaign. It is not uncommon to see posters advertising a minimum intake of fruits and vegetable at bus stands or in the underground mass transit system. Additionally, the city-state’s focus on public housing and providing outdoor exercise equipment in those areas helps to mobilise citizens to do regular exercise, as has the sustained focus on building sports infrastructure. The Singapore Sports Council records more than 11 million users of their facilities annually, operating 24 swimming complexes, 19 stadiums, 16 sports
As shopping is a popular national pastime in Singapore, the HPB organised the "Walk the Mall to better health" programme, whereby walks in shopping malls (at a brisk pace) take place on Sundays, which is particularly suitable for the elderly. For more information, please see: http://www.hpb.gov.sg
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uNBaNKEd aNd uNCONNECTEd: iNTERvENTiONS THaT MaKE a diFFERENCE The most notable example is the mobile money service M-PESA offered by Safaricom in Kenya. M-PESA is a mobile phone-based service for sending and storing money. Customers can sign up at any of the 26,948 merchants who act as “agents” for account opening, handling of deposits and withdrawals into the customer’s virtual “wallet”.25 The mobile application allows users to check their balance, directly send money to other users per SMS, pay bills, and top up their phone airtime.
M-PESA sales agent interacting with customers.
Cheaper and easier financial access for the “unbanked” In many countries we can observe some progress in financial inclusion, but it is usually the result of the slowly expanding conventional banking infrastructure.23 The potential for rapidly reaching a large number of people lies within mobile banking solutions. Estimates put the number of unbanked people around the globe who have access to a mobile phone at about one billion.24 The market potential for providing financial services to the unbanked is enormous. In recent years, many commercial initiatives have been launched, but only some have caught on successfully.
The most common barriers to banking outreach, which exclude the poor from accessing financial services, are minimum balance for checking accounts, account fees, and required documentation.26 Mobile banking has less restrictive sign-up procedures, cheaper rates and no minimum balances, all reasons why M-PESA has witnessed the spectacular growth from inception in 2007 to 13.8 million users in 2011. Every day the company records US$19 million of person-toperson transfers. Since its inception, cumulative transactions via M-PESA have reached US$10 billion.
M-PESA quick facts Person-to-person money transfers
US$19 million a day
Registered users, as of March 2011
13.8 million
Agent network countrywide
26,948 agents
Annual growth 2010 in total users
45%
Annual growth 2010 in revenue
56%
Annual revenue, FY 2011
US$142 million
Cumulative transactions since inception
US$9.98 billion
Source: Safaricam Ltd (2011, May 18). FY 2011 Results Announcement
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The definition of “unbanked” People who have no access to financial services (including savings, credit, money transfer, insurance, or pensions) through any type of financial sector organisation such as banks, non-bank financial institutions, financial cooperatives and credit unions, finance companies, and NGOs are considered “unbanked’. Implicit in this definition is that financial services are usually available only to those individuals termed "economically active" or "bankable". – UN Capital Development Fund: International Year of Microcredit 2005
M-PESA lessens, and in some cases eliminates, many of the spatial and temporal barriers to money transfer.27 Customers save enormous amounts of time previously spent to reach the nearest bank branch for withdrawals or deposits which they can now do at any M-PESA agent. Moreover, M-PESA has helped to facilitate the urban-to-rural cash flow as well as enhance the financial autonomy of women. About 70% of Kenyan adults use M-PESA, despite less than a quarter of Kenyans having bank accounts.
A chain of small retail stores across the country: Hapinoy There are approximately 800,000 “sari-sari” stores (Filipino word for various kinds) in the Philippines. They are small shops, often extensions of the owner’s home, which offer basic goods for daily needs.31 These stores account for 40% of
An example from seasonal workers in an informal urban settlement in Kibera illustrates how affordable mobile banking can improve the lives of the poor. There are no banks near their settlement, but 40 M-PESA agents allow workers to deposit their daily wages of about US$1.30. They save these small sums until they have accumulated enough to make lump-sum transfers to their rural homes. Others just use it to save up money for emergencies.28 It is not even necessary
Founded in 2007 by Microventures Incorporated, the Hapinoy Store Programme originally was intended to aggregate the small storeowners and provide them with bulk product discounts in order to increase their income. Today, it has evolved into a “full-service micro-entrepreneur enhancement” programme which encompasses micro-loans for store owners, the Hapinoy store branding, bulk discounts for goods and services as well as entrepreneurship training. Hapinoy’s concept attracted the interest of SMART, the largest telecommunications operator in the country, Unilab, one of the leading pharmaceutical companies in the Philippines, and a number of companies for consumer goods. While SMART assists Hapinoy with technical equipment for its community stores and offers its mobile services in each Hapinoy store, the other partners have varying agreements for bulk supplies, marketing efforts and projects through their corporate social responsibility divisions. Microventures Inc. takes a small cut before passing on the discounts to the Hapinoy stores as well as charges companies for activities done with and through the network. This is the business principle behind the idea, which makes the social enterprise profitable.32
to possess a mobile phone. Having a SIM card, which can be placed into a neighbour’s or friend's phone, is sufficient to take advantage of M-PESA money transfers. In the Philippines, two mobile phone operators Smart and Globe have been offering mobile banking since 2004. However, the uptake of the service was much slower than in the Kenyan example. There were about 3.6 million users in 2009, with about 50% of them otherwise “unbanked”.29 Recent innovations of the service such as linking up with microfinance providers and signing up pawnshops and small retail shops, such as Hapinoy, have contributed to higher adoption rates.30 Certainly, much room remains for growth of mobile banking in the Philippines, as more than two-thirds of the population remain unbanked and are forced to rely on informal saving instruments such as hiding the money, giving to a friend or family, or using a savings club.
total retail sales in the Philippines for fast-moving consumer goods. The Hapinoy Store Programme covers a network of over 10,000 sari-sari stores clustered along 150 bigger Hapinoy Community Stores.
At the centre of the intervention are women micro-entrepreneurs, so-called “Nanays” (Filipino for mother). The Nanays, who previously were individual sari-sari store owners,
A "nanay" in front of her Hapinoy store.
become part of the Hapinoy network. They are usually able to significantly increase their profits by learning how to run their store more efficiently, gaining access to bulk discounts (5%–15%), and offering special products of interest to their communities. These products include solar lanterns, basic medicine and mobile banking services. In each community the programme establishes one community store, run by one or several Nanays, to serve as a hub for around 50 to 100 smaller stores in the area. The community store orders the products in bulk and supplies stocks for the individual Hapinoy Stores; in some areas, it also serves as a SMART Money Centre providing mobile financial services.
!
What Hapinoy offers • Access to additional loans • Store makeover including painting and signage • Product discounts and promotions from Hapinoy partners • Entreprenuership training Before joining Hapinoy, a typical store would make sales of US$10 a day. After a successful Hapinoy store makeover, it can make US$300 a day.
After initial problems in developing cost-efficient models to serve their network, Hapinoy has fine-tuned its business operations, standardised many of its procedures in setting up community stores and reached impressive scales. Their 5-year plan foresees an expansion to more than 100,000 sari-sari stores. This business model targets those at the Bottom of the Pyramid (largest, but poorest socio-economic group) and it has generated interest beyond the country’s borders. “We are a new model, the first to blaze this trail and there are many outside the Philippines who want to know more about it,” says founder Bam Aquino.33 He continues, “We want our organisation to be an example of a model which is sustainable, scaleable and has a true impact on communities, where change is ongoing but at the same time can operate on its own in terms of expenses and create value not only for its owners but also their partners.” With millions of small corner shops all over Southeast Asia, a social enterprise modeled after Hapinoy’s approach could benefit store owners and their Bottom of the Pyramid customers across Indonesia, Vietnam, Cambodia and Laos. Supporting health services in remote areas: m-Health Providing healthcare access to populations in remote rural areas is a tremendous challenge. Often, poor rural communities will receive only rudimentary health services provided by less trained village doctors or nurses. In consequence, more complex disease patterns are not recognised, resulting in misdiagnosis.
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A new generation of mobile health applications can help bridge this rural-urban access gap in a simple and cost-efficient way, so long as their implementation is intuitive to the target group. Sana Mobile Health was developed by students and alumni from the Massachusetts Institute of Technology and Harvard University with the aim not only to improve clinical outcomes, but also to streamline the health delivery process.34 It is a mobile phone application that guides and assists Community Health Workers in treating patients by providing interactive step-bystep instructions on questions to be asked. Moreover, it can be used to solicit advice from medical experts in urban centres by uploading the collected data to a web-based medical health record system for the doctor to review. The application can be customised to meet the specific needs of a community. Physicians can create their own medical procedures and then upload them to the health workers’ smartphones in the field. The pre-programmed procedure can integrate pictures and videos to be displayed as prompted.35 Beyond this key feature, Sana Mobile Health can also be implemented to provide built-in training for local health workers and nurses. Once downloaded, the software operates oine so that the medical guidance is available even in areas without mobile connectivity.36 Data uploads are reliable even in poor coverage areas due to algorithmically controlled data transfer. Improving health outcomes for post-surgical follow-ups Patients from rural areas often have difficulties to complete follow-up routines after undergoing surgery in the city. Distance and costs are two factors that prevent patients to travel to the city for post-surgical checks. As a result, post-surgical complications or infected wounds are mistreated or recognised too late. A specific Sana Mobile programme designed to guide health workers through wound inspections can significantly lower the cost burden for the patient and prevent long-term damage. Pilot studies with Sana Mobile show promising results In partnership with eHealth-point Services India (EHP) and the Public Health Foundation of India, Sana developed an intervention to undertake a cardiovascular disease (CVD) risk assessment. Rural community health workers from Pujab were equipped with phones with the customised Sana software and trained to conduct door-to-door CVD risk assessments.37 Due to the efficiency of the data collection process, EHP has plans to offer this service in all rural clinics of its global chain.
The interface of Sana Mobile Health on Android smartphones.
In Bangalore, Sana has partnered with the Narayana Hrudayalaya Hospitals and Mazumdar Shaw Centre to launch an early cancer and cardiovascular disease detection programme across the state of Karnataka. As of July 2011, 30,000 people had been screened for oral cancer in Bangalore. The plan is to scale it to 1.5 million people over the next year in the province. In the Philippines, plans are under way to launch Sana in conflict regions where severe shortages of doctors leave the population without adequate health services. Remote diagnosis with Sana’s software will help to alleviate the situation. Moreover, the Philippines team is designing a Sana system which will improve the identification, management, and treatment of hypertension, one of the most prevalent disorders striking populations in both the developed and developing world.38 Initial barriers to adoption The introduction of mobile health applications is not without problems. Sana had to overcome language barriers by tweaking its interface to include symbols and voice prompts for taking pictures or videos in order to make the software more
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user-friendly for semi-literate health workers. At the other end of the work flow, convincing physicians to accommodate these new diagnostic methods and getting them to take ownership of this new technology is hard work. Financial services for slum dwellers: SafeSave The poor often struggle with their day-to-day money management. In absence of savings instruments they find themselves unable to save up for the future. There are too many essential expenses that eat up their daily or weekly earnings. With small and irregular incomes, managing their financial affairs takes is a major concern for the poor. Thus, there is strong demand for a convenient cash-flow management facility on a daily basis.39 Ideally, the facility should allow for small-scale savings of any value at any time with the right to withdraw on demand, combined with the possibility of taking small loans to smoothen unexpected cash expenditures. These are services that people in developed countries can utilise at any automated teller machines or via online banking. Conventional microfinance products do not offer this kind of facility and commit borrowers to regular repayments. They also rarely include a flexible savings instrument. SafeSave, providing financial instruments in slums in Dhaka, Bangladesh, offers a service that fills this gap. SafeSave provides financial services to very poor clients without the usual requirements. There are no group meetings, joint liability, guarantors, or even fixed weekly loan repayments.40 Originally, it started out as an experiment and turned out both, extremely popular and sustainable. Despite flexible loan repayments, the repayment rate stands at 97%. Operating from nine branches, Safesave sends out 66 collectors, all women from low-income neighbourhoods in the same area, who visit clients' homes or workplaces every day. With a small handheld device they process deposits and withdrawals and document loan repayments. Clients only have to visit the branches for loan disbursements or large savings withdrawals.41 The innovation of giving clients the choice of how much to save or how much to repay on a daily basis, matches the irregular nature of the slum dwellers’ income flows. In consequence, there are no fixed loan terms. To ensure proper accounting and prevent human error, all collectors are equipped with handheld devices to electronically record each transaction into SafeSave’s database.
Surprisingly, 44% of account holders do not take loans and prefer only to save. For accounts with balances above US$15 the organisation pays 6% p.a. interest to account holders, while the interest rate for loans is 3% monthly. Regular and fast repayment is incentivised by making an increase of the credit limit conditional on how fast the existing loan is repaid. In 2010, the product range was expanded to include a longterm savings product for three, five, seven or ten years with 7%, 8%, 9% and 10% interest per year. Recently, the organisation has started a trial, called P9, in rural areas following the same model of daily doorstep collection but with the possibility of offering liquidity in the form of interest-free loans. Immediately, one third of the loan is placed in a savings account. By sequencing loans to grow each time, clients soon have more cash deposited than they borrow.42 While some people prefer the rigid repayment discipline required by traditional microfinance providers such as Grameen, the service has filled a gap for all those with more irregular, unpredictable cash-flows. SafeSave has found a profitable business model that at the same time pushes the boundaries of financial inclusion to the extreme poor. Accepting deposits of tiny sums as small as US$0.02 allows even those living on less than US$1.25 a day the opportunity to save for a better future. It would be great to see this innovation replicated by major microfinance providers and brought to scale in more countries in Asia.
SafeSave quick facts Clients, as of January 2011
15,750
Service branches
9
Collectors
66
Monthly small transactions
120,000
Minimum deposit amount
US$0.02
Average savings balance
US$45
Average outstanding loan balance
US$71
Loan recovery rate
97%
Source: SafeSave (2011). SafeSave Performance
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Conclusions The case studies highlighted in this issue are just a few examples of the emerging countertrend to pervasive inequalities in ASEAN: a persistent stream of innovation. Although these interventions emerged from specific contexts and may not be fully replicable in other situations, the purpose of this issue is not to recommend specific projects or products to replicate, but to extract valuable lessons from the successful practices of micro-level organisations. However, micro-level interventions cannot act as a replacement for large-scale macro-investments in infrastructure, health systems and internet connectivity. The danger is that governments and major corporate players take a back seat in community development efforts – with non-government organisations and micro-level organisations doing the heavy lifting at the frontline. Clearly, political commitment to addressing inequalities and investment in doing so is required for broad improvements in access to basic services for Southeast Asia’s 250 million poor, living on less than US$2 a day. Notably, this issue highlights many infrastructural interventions – such as in water, electricity and information and communications technology – that were initiated in Africa or South Asia. Not many of these innovative organisations have started to sell or launch their products or programmes in ASEAN. This shows that not only are inequalities and access deprivation problems in ASEAN not as well-documented or profiled as they are in Africa or South Asia, but also significant potential exists for innovative entrepreneurs to make a difference in the market for Bottom of the Pyramid customers. Finally, most of the innovations spotlighted were only able to come about after a thorough identification and understanding of the problem. Tools such as Participatory Rural Appraisal that involve communities in the identification of problems and solutions are a prerequisite in generating locally relevant, and ultimately successful, interventions. We are actively soliciting feedback on our work. If you have any comments on the profiled interventions in this issue or the data posters in Asian Trends Monitoring Bulletin 12: Rising Asia, Growing Inequalities, please drop us an email (our contact details are listed on page 21). We also invite you to post comments on http://www.asiantrendsmonitoring.com, where additional materials are posted online as and when. Once again, we thank you for supporting the Asian Trends Monitoring Bulletin.
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References 1. Fewtrell, L. and Colford, J.M. 2004. Water, Sanitation and Hygiene: Interventions and Diarrhoea. Washington, DC: IBRD/World Bank.
– immunisation. Asia NGO workshop, studying innovations from Asia’s NGO’s. 24 – 26 February 2009.
2. Rahman, Maseeh, 2011. Can India’s women cast off the burden of water carrying?. The Guardian, [online]. Available at:<http://www.guardian.co.uk/ world/2011/sep/02/india-women-burden-water-carrying>
16. Dacanay MR, 2008. Strengthening demand for immunisation in Lao People's. Democratic Republic. NPRS-PRF June 2008. Available at: http://www. adb.org/Documents/PRF/knowledge-products/LAO-4787-Immunisation.pdf [Accessed on September 8, 2011]
3. Joseph, Natasha, 2011. This is how we roll… to an easier way of life. Cape Argus, [online]. Available at: <http://www.iol.co.za/scitech/science/news/ this-is-how-we-roll-1.1130876> 4. Alliance for Rural Electrification, 2011. Why renewable energy sources for rural electrification? [online]. Available at: <http://www.ruralelec.org> (Accessed 12 September 2011) 5. Global Sustainable Electricity Partnership, 2000. Contributing to sustainable rural electrification in Indonesia. [online]. Available at: <http://www. globalelectricity.org/en/index.jsp?numPage=121&numFiche=120> (Accessed 10 September 2011) 6. National Renewable Energy Laboratory, 2004. Renewable Energy in China: Township Electrification Programme. Colorado: NREL [online]. Available at: <www.nrel.gov/international> (Accessed 9 September 2011) 7. Wikipedia. China Village Electrification Programme. [online]. Available at: <http://en.wikipedia.org/wiki/China_Village_Electrification_Program> (Accessed 10 September 2011)
17. See reference 15. 18. Capewell S, O’Flaherty M, 2011. Rapid mortality falls after risk-factor changes in populations. Lancet 2011; 378 (9793): 752-753. 19. Sha E, Smith GD, 2001. Exporting failures? Coronary heart disease and stroke in developing countries. International Journal of Epidemiology (30), pp. 201 – 25. Sourced from reference 25. 20. Katan MB, 2009. Weight-loss diets for the prevention and treatment of obesity. New England Journal of Medicine (360), pp. 935 – 5. Sourced from reference 25. 21. Wong F, Stevens D, O’Connor-Duffany K, Siegel K, Gao Y, 2011. Community Health Environment Scan Survey (CHESS): a novel tool that captures the impact of the built environment on lifestyle factors. Global Health Action 4 (5276) 22. Singapore Sports Council. Available at: http://www.ssc.gov.sg/publish/ Corporate/en/participation/hotspot.html [Accessed on September 8, 2011]
8. 2011. India to produce 20,000MW of solar power by 2022. Asian News International [online] Available at: < http://www.thefreelibrary.com/ India+to+produce+20,000+MW+of+solar+power+by+2022.-a0246922121>
23. CGAP, 2009. Scenarios for Branchless Banking in 2020. Focus Note No. 57.
9. National Renewable Energy Laboratory, 2004.
24. CGAP, 2009. Mobile Banking: From Concept to Reality. Available at: <http://www.cgap.org/p/site/c/template.rc/1.26.10806/>. [Accessed on September 8, 2011]
10. 2011 Ashden International Award. Case Study Summary: ToughStuff International UK and Africa. [online]. Available at: < http://www.toughstuffonline.com/news/2011/jun/ toughstuff-wins-2011-international-ashden-award> 11. World Health Organisation. 2006. Fuel for Life: Household Energy and Health. Geneva: WHO Press. 12. World Vision / The Nossal Institute for Global Health, 2008. Reducing maternal, newborn and child deaths in Asia-Pacific: strategies that work. World Vision policy brief. 13. Measles (MCV), Polio (Pol3), Diptheria tetanus toxoid and pertussis (DTP3) and Tuberculosis (BCG). Data from World Health Organisation, Global Health Observatory, 2009. http://apps.who.int/ghodata/ [Accessed on September 8, 2011]
25. See reference 24. 26. Beck, T., Demirguc-Kunt, A. and Peria, A. S. M., 2008. Banking Services for Everyone? Barriers to Bank Acess and Use around the World. World Bank Economic Review, 22(3), pp.397-430. 27. Morawczynski, O. and Pickes, M., 2009. Poor People Using Mobile Financial Services: Observations on Customer Usage and Impact from M-PESA. CGAP Brief. Washington, DC. 28. Morawczynski, O. and Pickes, M., 2009. Poor People Using Mobile Financial Services: Observations on Customer Usage and Impact from M-PESA. CGAP Brief. Washington, DC. 29. See reference 23.
14. Bloom DE, Canning D, Seiguer E, 2011. The effect of vaccination on children’s physical and cognitive development in the Philippines. Harvard School of Public Health, PGDA working paper 69. http://www.hsph.harvard. edu/pgda/WorkingPapers/2011/PGDA_WP_69.pdf [Accessed on September 8, 2011]
30. The Economist, 19 January 2011. Smart, Globe see surge in mobile money payments.
15. ADB, 2009. Maternal, child and newborn health interventions
32. Dietrich, M., 2009. Achieving Scale and Sustainability in a Social Enterprise
31. Microventures Inc., 2011. The Hapinoy Store Programme. Hapinoy Store Programme Brief 2011.
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at the Base of the Pyramid – Case of Hapinoy, Philippines. School of Community Economic Development Southern New Hampshire University: Unpublished Master Thesis. 33. Sunday Magazine, 14 August, 2011. Bam Aquino’s hapinoy. Available at: <http://www.manilatimes.net/index.php/sunday-times/sundaymagazine/4536-bam-aquinos-hapinoy> [Accessed on September 3, 2011] 34. Sana Mobile, 2011. About. Available at: <http://www.sanamobile.org/ about.html>. [Accessed on 12 September 2011] 35. MobileActive.org, 2010. Sana Mobile: Connecting Big-City Care to Patients in Remote Villages. Available at: < http://mobileactive.org/case-studies/sanamobile>. [Accessed on 11 September 2011] 36. Sana Mobile, 2011. The Sana Technology Overview. Available at: <http:// www.sanamobile.org/tech.html>. [Accessed on 12 September 2011] 37. Legatum Centre for Development & Entrepreneurship, 2011. Seed Grant Voices: Sana Mobile Health. Available at: <http://legatum.mit.edu/newsletter/ summer2010/sana> [Accessed on 13 September 2011] 38. Sana Mobile, 2011. Partnership with dotPH in the Philippines. Available at: <http://sanamobile.wordpress.com/ 2011/02/17/partnership-with-dotph-inthe-philippines/>. [Accessed on 13 September 2011] 39. Murali, D., 9 June 2010. Three opportunities for Microfinance providers. The Hindu. Available at: <http://www.thehindu.com/business/Economy/ article450818.ece>. [Accessed on 10 September 2011] 40. Bauchet, J., 15 July 2010. Report from the field: SafeSave, a different kind of microfinance methodology. Available at: <http://financialaccess.org/ node/3509>. [Accessed on 10 September 2011] 41. SafeSave (2011). SafeSave Performance. Available at: <http://safesave.org/ performance.html>. [Accessed on 9 September2011] 42. Shohoz Shonchoy, 2011. P9 Rules. Available at: <https://sites.google.com/ site/thepoorandtheirmoney/p9-rules>. [Accessed on 10 September2011]
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Trade & investment FACILITATION Darryl Jarvis is an Associate Professor at the LKY School of Public Policy. He specialises in risk analysis and the study of political and economic risk in Asia, including investment, regulatory and institutional risk analysis. He is an author and editor of several books and has contributed articles to leading international journals. He has been a consultant to various government bodies and business organisations and for two years was a member of the investigating team and then chief researcher on the Building Institutional Capacity in Asia project commissioned by the Ministry of Finance, Japan. His current research is a large cross-national study of risk causality in four of Asia’s most dynamic industry sectors. He teaches courses on risk analysis, markets and international governance and international political economy. His email is darryl.jarvis@nus.edu.sg
Johannes Loh is working as a Research Associate at the Lee Kuan Yew School of Public Policy. He holds a Master’s degree in Public Policy from the Hertie School of Governance in Berlin. His previous research experience includes international student mobility, visual political communication, aid governance and public sector reform in developing countries. Recently, he completed a research project on Success Factors for Police Reform in Post-conflict Situations with the German Technical Cooperation. Prior to joining the Lee Kuan Yew School of Public Policy he has also worked for the United Nations Environment Programme in Geneva, Transparency International Nepal and the Centre on Asia and Globalisation in Singapore. His email is johannes.loh@nus.edu.sg and you can follow his updates on trends in pro-poor policies in the region on Twitter, @seasiatrade.
HEALTH SYSTEMS Phua Kai Hong is a tenured professor at the LKY School of Public Policy and formerly held a joint appointment as Associate Professor and Head, Health Services Research Unit in the Faculty of Medicine. He is frequently consulted by governments within the region and international organisations, including the Red Cross, UNESCAP, WHO and World Bank. He has lectured and published widely on policy issues of population aging, healthcare management and comparative health systems in the emerging economies of Asia. He is the current Chair of the Asia-Pacific Health Economics Network (APHEN), founder member of the Asian Health Systems Reform Network (DRAGONET), Editorial Advisory Board Member of Research in Healthcare Financial Management and an Associate Editor of the Singapore Economic Review. His email address is spppkh@nus.edu.sg
Nicola Pocock is a research associate at the LKY School of Public Policy. She is also the research manager at aidha, a non profit financial education and entrepreneurship training school for migrant women, especially domestic workers, in Singapore. She holds a BA from Warwick University and an MSc from Kings College London. Prior to joining the LKY School of Public Policy, she interned as a Fast stream trainee in the UK civil service at the Home Office and as a research volunteer at Amnesty International. Nicola has also carried out social work in Marseille, France as a European Union sponsored youth volunteer. Her research interests span health and social policy, health systems financing, social impact assessment, gender, migration and financial behaviours. Her email is sppnp@nus.edu.sg and you can follow her work on health systems on Twitter @healthSEAsia.
ENERGY SECURITY T S Gopi Rethinaraj joined the Lee Kuan Yew School of Public Policy as Assistant Professor in July 2005. He received his PhD in nuclear engineering from the University of Illinois at Urbana-Champaign. Before coming to Singapore, he was involved in research and teaching activities at the Programme in Arms Control, Disarmament and International Security, a multi-disciplinary teaching and research programme at Illinois devoted to military and non-military security policy issues. His doctoral dissertation, “Modeling Global and Regional Energy Futures,” explored the intersection between energy econometrics, climate policy and nuclear energy futures. He also worked as a science reporter for the Mumbai edition of The Indian Express from 1995 to 1999, and has written on science, technology, and security issues for various Indian and British publications. In 1999, he received a visiting fellowship from the Bulletin of the Atomic Scientists, Chicago, for the investigative reporting on South Asian nuclear security. His current teaching and research interests include energy security, climate policy, energy technology assessment, nuclear fuel cycle policies and international security. He is completing a major research monograph "Historical Energy Statistics: Global, Regional, and National Trends since Industrialisation" to be published in Summer 2012. His email address is spptsgr@nus.edu.sg
Taufik Indrakesuma is a research associate at the Lee Kuan Yew School of Public Policy. He is a recent graduate of the Master in Public Policy programme at the Lee Kuan Yew School of Public Policy. He also holds a Bachelor in Economics degree from the University of Indonesia, specialising in environmental economics. Taufik has previously worked as a Programme Manager at the Association for Critical Thinking, an NGO dedicated to proliferating critical thinking and human rights awareness in the Indonesian education system. His research interests include behavioural economics, energy policy, climate change mitigation and adaptation as well as urban development policy. His email is spptri@nus.edu.sg and you can follow his work on energy security on Twitter @SEAsiaEnergy.
The Lee Kuan Yew School of Public Policy is an autonomous, professional graduate school of the National University of Singapore. Its mission is to help educate and train the next generation of Asian policymakers and leaders, with the objective of raising the standards of governance throughout the region, improving the lives of its people and, in so doing, contribute to the transformation of Asia. For more details on the LKY School, please visit www.lkyspp.nus.edu.sg