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No article for today, so youll just have to bear with my voice for a little longer than normal. Instead of the article, youll find
one example of an innovation in aid that may be relevant to your project something that someone out there has already
trialed, researched, and implemented. Each person gets a different innovation (as far as possible), so I hope that you take the
time to ask around for what others got and share with them what you have.
Limitations as Opportunities
To be honest, I never really saw doing non-profit work as a veritable bed for being innovative. To me, doing charitable work
had been a dull and repetitive exercise, without much room to deviate from the norm. This changed after I attended a small
dialogue session with a Mr Chan Chun Sing.
At the time, I had been struggling to solve a massive roadblock in a project of mine, the greatest I had ever faced. Even
now, I can hardly remember the content of the session, but one line helped me get over this tremendous obstacle.
View limitations as an opportunity, not a challenge.
Mr Chan cited the example of Singapores water conundrum the
grand story of NEWater were all familiar with. Our lack of
drinking water was clearly a lifeline that was threatening our very
existence. It was a huge limitation, yet our leaders at the time saw
it as an opportunity to innovate and better the nation. As a result,
we did the unthinkable taking our own sewage and treating it to
drink. Yet the results were amazing; NEWater has become one of
our four national taps, an outstanding case study for other water-
lacking nations, and a massive source of export revenue.
Non-profit work is tough; if it werent the intended beneficiaries
wouldnt need your help in the first place. Doing non-profit work
in a foreign land with different cultures and belief systems is even
tougher. But lets start making an effort to look at these obstacles
as opportunities. Youll be amazed at what you can come up with.
Be Fluid
When people say innovation, we often think that the process involves creating something completely new the often
synonymous use of creative and innovative being a clear example of this. We imagine the Einsteins of the world
developing their theories in isolation, birthing great innovations solely from the ingenuity of their minds.
Surely that cant be true! These brilliant people managed to innovate because they learnt how to adapt contemporaneous
processes, ideas, bodies of knowledge, and technology to new methods of thinking. To me, innovation isnt so much about
creating than it is adapting.
Adaptability a term that has been used to describe Singaporeans for an extremely long time. Being adaptable means being
able to change with the times, and innovation requires you to constantly rethink, be open and accepting of failure, and
having the brevity to speak your mind even if it may sound stupid.
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Suve Tu| fcr |he B|uck & Whi|e
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"Limitations are an opportunity, not a challenge paraphrased from Chan Chun Sing
This article is Part 2 of a two-part series. The first article, Why Dont We Break the Rules Already?, was shared previously.
Hurray!
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At risk of being called out for making so many references to our government, I leave you with a final quote from Mr Lee
Hsien Loong on governance (that I believe is relevant to the principles of innovation as well). Quite a stroke of luck really, I
was watching Twilight on Channel 5 when the newsbreak came on.
Governance means having to refresh and revise policies in a changing world. New situations require new solutions. We can go with a solution we
think is best for now, but we must be prepared to rethink and calibrate again when the situation changes
Paraphrased from Lee Hsien Loong
Speak their Language
As medical students, Im sure we understand how important it is to be able to properly communicate with our patients -
speaking the right language can oftentimes be as important as the treatment you administer. Why should this be any
different when we interact with the people in villages?
When I say speak their language, I dont mean talking to them in Khmer, Thai, Burmese or whatever the native tongue. I use
it in a far broader sense: communicating with them in ways they can understand. This is a little tough for me to
communicate over typed words, so let me illustrate this with an example.
We live in an environment that is just inundated with technology. iPads, laptops, smart phones; these are the things we
understand, the things we use to interact with the world, to communicate with each other. When we think of innovation to
improve our projects, we usually think along these lines: using tablets to present educational material, using QR codes to
keep track of patients, writing booklets to give to the beneficiaries.
But if we stopped and thought for a moment, would these things truly be something our intended recipients understand?
Imagine a reverse situation where foreigners came to help you with a problem instead, and they decided to teach you how to
hunt for food by catching a pigeon and snapping its neck in front of you. How would you feel? Even worse, we hardly even
bother with the informational booklets we get right here even though we live in an environment that demands it (I never
really bothered to read my NHS booklet); what are the chances theyd read it in an environment that doesnt need it.
So innovate: find new ways to speak their language.
Our Partners Innovate Better than we do
Dont overlook the innovations that the community youre working with comes up with. They face an overwhelming
number of obstacles each day we just walk or drive down to the nearest supermarket to get rice, they may need to walk
kilometers each day just to get some water. As a result, they are much better adapted to their environment than we can ever
be, and have long created innovative ways to overcome problems that we may never think of.
I met a nice man who heads a government innovation center in China who shared with me a story of the time he visited a
rural village. As he was walking along the path from the outlying farms back to the village center, it began raining very
heavily and the levee along the path broke, inundating the mud ground. He had been an innovator all his life, doing it
professionally, yet he had no idea how to solve this sudden issue. His local guide solved the problem easily: he transferred
the radishes out of his rattan baskets and jammed it into the break. He even got nice catch of fish from it.
So dont write off that random toothbrush jammed into the ceiling rafters as them being unhygienic. Ask them why its
there; you may learn a lil something something.
Concerns when Innovating Trialing and Experimenting
No one likes being a lab rat. When possible, try it out on yourselves first and seek feedback from neutral parties. Ask your
beneficiaries what they think thats the most important step. Kevin Starr, director of the Mulago Foundation recommends
asking four questions before introducing new things: 1) Is the product needed? 2) Does it work like its supposed to? 3) Will
it get to those who need it? 4) Will they use it right when they get it?
Collaboration and Innovation The Worlds most beautiful relationship
Just to round up the materials for today, we innovate better when working together. Humans have been so
successful as a race because of our ability to share information and knowledge, allowing others to innovate better
than they could alone. Start looking up ideas that are already available and share yours. Start by exploring the web
sources provided to you in the innovation case study.
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Methods to Encourage Innovation
After all this talk about how important innovation is, I thought it might be good if I shared some methods I enjoy using to
encourage innovation. Now, again, Im no expert at innovation (else I wouldnt be studying medicine), so take my advice
with a pinch of salt.
The first step to good team innovation is to ensure that the environment is right for innovation. Everyone is clear on the
principles of brainstorming never turn down an idea. Make sure that everyone understands this, and team leaders should
make an effort to ensure this culture carries on beyond the first brainstorm session.
People innovate best when multiple learning styles are engaged (visual, auditory, kinetic). When brainstorming, put aside
your notions of a conventional meeting and have fun with it. Write down the ideas on a large sheet of paper or on the
board, and encourage everyone to draw. Have many different coloured markers. Play upbeat music before starting.
Encourage everyone to move about as they think. Make sure the environment is comfortable as well, with proper ventilation
and comfortable seats when people get tired from walking around.
Another great tactic is to encourage everyone to break their habits one day before to get the brain working in different ways.
If you wear a watch on your left hand, switch it to the right. If you keep your wallet in your right pocket, switch it to the
left. Swap your fork and spoon hands for the day. Small things go a long way in engaging both sides of your brain.
Finally, heres an exercise you can try to substitute your regular brainstorming session. Its called the Running Ball Game, but
you can call it anything you want. Get a ball (it can be as small as a ping pong ball if space is limited, or you could get a
basketball) and have everyone sit/stand in a circle. Have one person as the moderator, who starts off holding the ball and
sets the topic for the session (e.g. coming up with new ways to teach the children first aid). The moderator throws the ball to
a random person (Person A), and Person A has three seconds to come up with a random noun (e.g. bananas). Person A
passes the ball to Person B, who has three seconds to come up with a verb (e.g. throwing). The third person the ball is
passed to (Ball C) then has five seconds to find a way to link the verb and noun together to answer the topic (i.e. a possible
way to teach children first aid toss bananas imprinted with the 4 Bs of first aid to help them learn better). Keep going till
your team has a good set of avenues before you start discussing. Even better, play this with your intended beneficiaries and
get their brain juices flowing on ways to solve issues they face when youre gone. The best part is, they will give words and
ideas that are relevant to their context.
Lets Discuss!
In the spirit of innovation, there are no questions today. Make your own!
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Case Study 1 - School Based Deworming
Source: http://www.poverty-action.org/deworming
Parasitic worms damage the health of children, limiting their access to education and thwarting their overall
development. They exist in tropical and impoverished areas, characterized by inadequate sanitization, limited
access to safe water, and overcrowding.
Deworming is not a new concept. Im certain some of our very own NUS projects implement deworming to
some extent as well, considering its relatively low cost.
What then is there to innovate with the concept of deworming? The tool itself had proven to be effective in
achieving its goal, but it took some rethinking of how the tool was used before it reached its full potential.
School-based deworming has been a concept that has been bounced around quite a bit in recent years, with
project teams bringing the deworming medication along with them and providing training to the local teachers.
For deworming medication to be effective, it has to be administered to the child once every six months an issue
that was easily solved once the teachers were trained how to administer the relatively safe drug.
It took some innovation to apply the concept of deworming to the school network, which proved to have
tremendous results. Schools already collect children in one place, with existing distributing and training networks.
They are often more commonplace than health clinics, so treatment within the school system is much cheaper.
Even better, school-based deworming proved to be the most cost effective way in improving attendance at school,
costing less than 50 US cents per child per year.
Does your team have a deworming programme? Are there any local partners or schools you could use as a means
of entry for your deworming programme?
Find out more at:
- www.dewormtheworld.org/for-implementers/for-implementers
- http://www.economics.harvard.edu/faculty/kremer/files/Worms_I_Econometrica_2003.pdf
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Case Study 2 - Chlorine Dispensers
Source: http://www.poverty-action.org/safewater
In seeking to solve health related problems, there are two main
categories to classify solutions: upstream solutions and
downstream solutions. Upstream solutions seek to solve the
problem right at its source (e.g. using insecticides to kill
mosquitos), while downstream solutions try to mitigate or
minimise damage caused by the problem (e.g. providing bed nets
to keep mosquitos out). As we all know from the countless
Medicine and Society lectures weve attended, prevention is better
than cure; yet upstream solutions for foreign problems often cost
way more than an individual small project team can manage.
Lets take a look at the example of providing clean water. The go-
to solution is to build taps and wells for the community an
upstream solution that is relatively low cost. But this isnt
something that small project teams (particularly those in medicine)
can undertake, since we lack the expertise to reliably construct
such things. But if clean water access is an underlying cause for
many of the issues you face in your partner community, how can we bear to leave it unattended?
Start by looking at downstream solutions already available out there. I just threw up a Google search and got five
different, cheap technologies that help to filter water. Weve all heard about the clunky water filters (or hydro-filters
if the team is set on sounding absolutely sophisticated) small project teams bring over, but what about chlorine
dispensers placed at wells, or the LifeStraw? Take some time to find out what options there are out there if your
team is planning to tackle the water problem makes sense to get the most cost-effective doesnt it?

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Case Study 3 - Free Bed Nets
Source: http://www.poverty-action.org/provenimpact/bednets/challenge
Innovations in aid work should always be supported by rigorous research with the results to prove that this change
in product or process is more effective in achieving its goal than older methods.
Take the example of bed net distribution to limit the incidence of malaria. The conventional manner in which aid
organisations did this was by charging people a minimal sum for the nets to ensure that they wouldnt take the nets
for granted (since they now had a stake in it, and was more likely to use it).
Yet other organisations began experimenting with giving out the bed nets for free, and no one was really sure if
this ensured better penetration of the market. This sparked off a massive aid debate that got around to nowhere,
since everything was backed off anecdotes and armchair reasoning.
With the aid of organisations focused on research, randomized control trials (RCTs) were carried out to
provide hard evidence. Ill leave you to research that showed to be more effective, but the point is that your
innovations should always (where possible) be backed up with sound research results. Our entire profession is
based upon evidence; why should we compromise just because were overseas?
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Case Study 4 - Incentives for Vaccination
Source: http://www.poverty-action.org/provenimpact/vaccines/challenge
I love the idea of using incentives to nudge people to make changes that benefit them in the long-term, yet isnt
something intuitive for them to do. Think about things like going for health screenings, or even doing community
work. We all started with some form of incentivized volunteerism before (hopefully) moving on to volunteer
without incentives, with the Community Involvement Programme having been the gateway of entry to the world
of aid.
Incentives, or the carrot as it is more derisively known, is an every day part of our lives, yet people never really
seem to want to admit its effectiveness. There is some kind of primal discomfort with the idea of paying someone
to do something that is ultimately good. Whether or not you choose to use incentives to bolster the effectiveness
and use of your programmes/services, I leave it to your discretion, but heres an example of one that did use
incentives in a rather innovative manner.
The aim was to increase of use of vaccination services, and to ensure that the vaccination programme was
followed to increase effectiveness. What this particularly organisation found was that the reason behind the poor
use of vaccination services was due to 1) distance from the village, and 2) the opportunity cost the recipients
incurred (i.e. not working for a day) for something which did not seem to have much immediate benefit to them.
To solve this problem, they developed mobile immunization camps that rewarded the people for getting
vaccinated. These rewards were equivalent to opportunity cost of time (roughly of a typical days wages), albeit
non-monetary to avoid complications with donors. They provided goods such as a bag of lentils which the
villagers immediately saw the value in. Furthermore, they rewarded them with a set of plates for completing their
immunization schedule. Through the use of incentives, they associated the benefit of free food with that of the
less well-understood benefits of immunisations.
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Case Study 5 - Skoolbo and Fitbit
Source: http://skoolbo.com
You guys all know about Fitbit, so Ill tell you guys a little more about Skoolbo and the lessons I learnt from the
product.
Skoolbo is an educational game developed by a social entrepreneur by the name of Shane Hill and his team, and I
had the amazing privilege of speaking to him once. In case you guys werent aware (as I wasnt at that time), being
a social entrepreneur is vastly different from being a non-profit worker or volunteer; these social entrepreneurs
innovate to create products or services that not only has to Do Good, but also must have an element of Do Well
(earning a profit each year, scalability). Because of this additional dimension, social entrepreneurs are exposed to
more rigorous criteria when getting their ideas supported financially and non-financially, often at the same level as
start-ups are.
That aside, Shane had a vision of helping every child in the world literate not just minimally literate, but
operationally literate. He starts off his pitches by saying it takes less than 2 cents a year to make a child
operationally literate (if youve already read my Metrics article, youll know how powerful a pitch this can be and
how you can use it for your project). In order to do this, he did his best to gamify education to make it more
appealing to children. If you remember, thats what Fitbit does for fitness too it seeks to make a non-intuitive
behavioural change fun.
So I decided to borrow a page from these new concepts (once being an avid gamer myself), and tried to transform
youth volunteering behavior by making the process integrated into a game. My team and I were very confident
with what we had, after pouring in more than a months effort just to come up with a draft. We got quoted $30
million to develop our plans (what a way for a dream to be crushed, eh?), but more importantly, we got a
wonderful piece of advice that Skoolbo and Fitbit developers understood perfectly.
First, innovations built around technology always seem alluring to us. Have a problem? Solve it with a website, a
one-stop portal, a mobile app, the list goes on. But because of our obsession with technology, we forgot the
fundamental element of innovation PEOPLE. You can pour in millions into a glitzy application with wonderful
features, but it will still be a failure if its something people dont want to do. Skoolbos team tested their concepts
out much earlier programmes built around similar concepts to gauge the response. It proved to be the most-used
e-learning site after a few years, and they had all the evidence they needed.
Second, innovation must be in the language of the target audience. We were developing a product for youths our
age, and so we assumed that technology was a common language that our audience was comfortable with. My
once preponderant addiction to World of Warcraft betrayed itself in the naming of the different features of the
site terms like blacksmith and inn popped up all over the place. I certainly loved the terms because of how
anglo-fied (is that even a word?) my friends and I are, but we never considered that our target audience might not
have the same affinity towards the words. Bam, massive failure on our part. I hope this illustrates how important
learning the language of your audience is when innovating (or even just developing programmes).
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Case Study 6 - Pumpkin Regatta
Source: http://www.vermont.org/pumpkin/
Have you heard seen a Pumpkin Regatta before? In this sporting event that Sports Illustrated featured in its
Craziest Competitions list, competitors carve out giant pumpkins and race across the Burlington Waterfront.
The regatta was added on as an extra event to the annual pumpkin growing competition held at Vermont just a
few years back, and it proved to be a huge success. The pumpkin growers now had something to do with their
gargantuan pumpkins, carving out the flesh and using it for food, and using the usually useless shell as a boat for
the race. Because of someones wild innovation (imagine how silly it must have sounded when someone first said
Lets put the hollowed shell of engorged vegetables as the only thing between glory and a watery grave!) the
usual cookie cutter festival became a hit.
Dont ever turn down an idea or concepts when brainstorming, because you may never know when youll need it.
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Case Study 7 - Bookmobiles and Donkeys
Source: http://www.nytimes.com/2008/10/20/world/americas/20burro.html?_r=0
One thing common to most OCIPs is the element of education be it formal, content-heavy education or
training in life skills. As products of the educational system in Singapore, Im sure were all perfectly clear about
how ineffective 3 days of education by rag-tag students can be in ensuring long-term retention of knowledge.
Bookmobiles were innovations born out of the growing awareness that students needed more than just basic
literacy in order for the education to be useful in improving their lives. Theyre essentially modified buses that
serve as mobile libraries, travelling to rural areas to provide book-lending services to the children who find it
difficult to travel to a fixed library. Its also a far cheaper way of providing a constant stream of literary material
for the children than building a whole new library in the village.
Luis Soriano from Colombia wanted to bring books to village children as well, knowing how difficult and
dangerous it was for the unprotected children to travel across the war-torn hinterlands just to get a book. He
didnt have the kind of money to purchase a bus, so he did the next best thing. He simply grabbed his two family
donkeys and strapped on pouches filled with books. Because of this simple innovation and courage to make it
reality, the children in La Gloria get a constant stream of books to supplement their education.
So dont write off some ideas just because you dont appear to have the means to achieve it (e.g. the roads are too
narrow for buses!). There will be a way, and sometimes that way can be right in front of you.