A week for review

I will be out for a week and not blogging. The last time I took a few days off, traffic to my blog increased. I’m not sure that’s a good sign, but who knows?

The good news is that this blog is borrowing a much-maligned campaign by NBC networks to justify summer reruns: “If you haven’t read it, it’s new to you.”

This is your chance to review some posts you may have missed. Read one every day if you like, and it will be almost as good as new posts:


Donations that Make a Difference

Reflections on Maimonides’ 8 levels of Charity (tzedakah)

What would Maimonides think of Kiva?


Explaining Complexity with a good Analogy

Even Fiji water can be green?

4 in the morning

Pro-poor businesses

1298 ambulances in Mumbai

The need for maternal care in the developing world

Acumen Fund breakfast discussion on energy

…and, for some reason, the single most popular post on the blog: About Sasha.

Thanks to all of you for reading and for the positive feedback. It really means a lot and it’s exciting to know you’re out there and tuning in.

The need for maternal care in the developing world

Photo by John Tucker, Acumen Fund Fellow

On a recent trip I took to India and Pakistan for Acumen Fund, I had the chance to visit LifeSpring Hospitals, which provides high-quality, low-cost maternal care. I wrote a blog post about this titled “Can a Hospital be a Breakthrough Innovation?” about my visit there on Mother’s day.

The more I’ve learned about the need for high-quality, low cost maternal care, the more I think that LifeSpring could be a blueprint for addressing an important, prevalent, but under-addressed health problem globally.

In India alone, only 43% of women are cared for by a skilled attendant during childbirth, and India’s 117,000 maternal deaths annually is the highest number in the world. The chances, over a lifetime, of an Indian woman dying due to complications in pregnancy and childbirth are 1 in 70. This makes an Indian woman 5 times more likely to die in childbirth than a Brazilian woman; 18 times as likely to die than a Chinese woman; 70 times as likely as an American woman; and 250 times as likely as a Swedish woman.

I don’t think I truly understood what poor access to maternal services means until I read this article from the Disease Control Priorities Project, which I learned about on Owen’s blog. Here’s an excerpt (be warned, it’s pretty graphic):

In developed countries, fistulas occasionally happen from surgical accidents or radiation therapy and are promptly repaired. Few in those countries have ever heard of the condition. But across much of the less developed world, fistula is an ordinary hazard of childbirth for many women and a permanent blight on countless lives. In those countries, obstetric fistula overwhelming results from obstructed labor, which occurs when the baby cannot pass through the mother’s birth canal because it either does not come head first or is too large for her pelvis. In the developed world, prompt medical intervention, often including Caesarean section, permits a delivery safe for both mother and child. But thousands of times each year in poor countries, birthing women receive no such aid and their labor is a futile agony lasting up to five days, with uterine contractions constantly forcing the baby, usually head first, against unyielding pelvic bone.

Long before the mother’s torment ends, however, the unremitting pressure kills the child. It also cuts off the blood supply to the soft tissues of her vagina and other organs trapped between the baby’s skull and her pelvis. Eventually these tissues also die, forming one or more fistulas, and the baby’s head softens sufficiently for the stillborn child to pass from her body. Should she survive, the mother soon finds urine, feces or both leaking unstoppably from her vagina. In about a fifth of cases, the woman also suffers nerve injury that can cause a condition called footdrop, which prevents normal walking. Constant contact with urine or feces irritates and infects her skin and other tissues. Her kidneys, bladder, or other nearby organs may also be damaged. Her menstrual periods may stop, rendering her infertile.

The article goes on to describe that, in addition to this physical and psychological damage, the mother often becomes a social outcast. It is stories like this that give me a real sense of urgency about the need to find, nurture and grow enterprises that are finding solutions and positioned to grow, and grow fast.

Even Fiji Water can be green?

On my commute to work, while I was digging up information for my previous post on the oil we’re burning to make bottled water, I saw this ad for Fiji water, the #2 selling premium water in the U.S. Fiji seems to be the poster child for ridiculous when it comes to bottled water and the environment. The plastic bottles are made in China, the water comes from Fiji, and I get to buy one at Balducci’s in Manhattan for $2 a bottle.

According to Pablo Päster at Triple Pundit, it takes 7 times the amount of water in the Fiji water bottle to bring you the bottle, along with .9 liters of petroleum. Yet Fiji’s advertising is asking you to go to www.fijigreen.com to learn how environmentally conscious they are. Hmmm.

(If you’re interested in hearing Fiji’s side of the story, here’s an interview in U.S. news & World Report with Fiji’s Thomas Mooney, Sr Vice President for Sustainable Growth. His arguments about water replacing soda and their positive impact on the Fijian economy are both interesting, but a little beside the point on the environmental questions).

When I switched from the train to the subway, I found myself face-to-face with an Allstate ad that boasted about an Allstate employee who volunteers in schools. It just so happens that I’m an Allstate customer in the midst of filing a claim for a small flood in my kitchen, and what I care about is how and whether they will pay my claim; the fact that I have to dial “1” four times and then dial an extension to speak to a human being; and the fact that the person who cheerfully sold me my claim and wants to keep me as a customer has no formal role in deciding how I’m being treated. The point is that the Allstate employees’ volunteerism is irrelevant to me as a customer, and presumably irrelevant to someone choosing an insurance provider.

Yet this kind of “greenwashing” and publicizing a company’s good deeds is amazingly prevalent. I used to work in corporate citizenship at two Fortune 100 companies and got to interact with lots of other companies, and my experience is that some progress is being made but that the messaging is really getting ahead of changes in practices.

What amazes me most is that someone at Allstate (or Fiji) convinced someone to run these ads (I’m sure it had something to do with ‘brand attributes’). I guess any story will capture the imagination of a few customers, but when the story you’re telling is either opposed to (Fiji) or unrelated to (Allstate) what you do, it’s hard to imagine that this story is going to have much of an impact on anybody.

Forget the Olympics: another barometer of China’s rise

I just came across this great post in Chris Blattman’s blog. Chris and I overlapped in graduate school, and he’s now a rogue Assistant Professor of Political Science at Yale.

Apparently, across certain parts of Africa, the ubiquitous greeting of foreigners as “mzungu” (“white person”) have begun to be replaced by “mchina!” (“Chinese person”), regardless of the foreigner’s country or origin.

It is amazing to see the increased investment by China into Africa, which no doubt has both positive and negative effects. The flood of cheap goods is good for consumers but may be undermining the nascent manufacturing sector. This is significant since manufacturing has such significant job creation potential, and it is hard to move large numbers of people out of poverty without following the path from agriculture to manufacturing to services.

I could never get over, when I was in Indonesia, being called an “orang blanda” (Dutchman), which has stuck as the catch-all term for foreigners regardless of provenance (despite the Aussies in their midst), thanks to Indonesia’s colonial history. This also serves as a reminder that in many places in the world, globalization is still nascent, foreigners are still a novelty, and the divide between “us” and “them” is wide and clear.

Would you like some petroleum with that Evian?

I’ve been running around with a factoid in my head, wondering if it’s true before I start repeating it. The factoid is that it takes a third of a bottle of petroleum to make and deliver a bottle of water.

I was told this about six months ago and hadn’t been able to check the facts until now. As far as I can tell, it is at most a small exaggeration. If you take manufacturing and delivery together, the number seems to be a quarter of a bottle according to Peter Gleick, president of the Pacific Institute.

This is shocking, especially for a product that barely existed 10 years ago. Consumption of bottled water in the U.S. has increased fivefold in the last 10 years – from under 4 billion to more than 30 billion. Put another way, the average American has gone from having about a bottle of water once a month in 1997 to twice a week in 2007. That’s a seven-fold increase in a decade.

What’s crazy, of course, is that there’s a good substitute (tap water) out there, one with a huge infrastructure in place to distribute it right into our homes and places of work. This has all the makings of a habit we could all unlearn as quickly as we have learned, if the right message gets out.

Most of the vitriol that I’ve seen explaining why we shouldn’t drink bottled water centers on cost. It explains that bottled water can be 10,000 times more expensive than tap water to drink, and that bottled water costs more that gas (even at today’s high prices). I think these facts are interesting, but also “ho hum.” The mistake is that the anti-bottled water advocates are fighting a story with facts alone.

What’s missing from this approach is that a bottle of Evian (or Poland Spring, or Desani) is not the same thing as water from your tap. True, the quality of the water from a health perspective is essentially the same. But when you buy Evian, you’re buying the story of purity, the alps, clean mountain air, a story whose ultimate punchline is that at the most luxurious resorts, the poolboys come by and cool off the guests by spritzing them with spray bottles of…Evian. Add to that refrigeration, convenience, and habit and you understand why water and its offshoots are a big piece of Coca-Cola’s growth story these days (never mind that Dasani’s source is tap water).

So instead of dry facts that appeal to the head, why not fight a story with a story that hits people in the gut? How about taking something that’s on everyone’s mind these days – oil – and putting that at the center of the debate?

Making plastic bottles is oil-intensive: it took 17 million barrels of oil to make the 29 billion liters of bottled water Americans drank in 2006. That’s almost a full day’s worth of our nation’s annual oil consumption.

But I’m pretty sure even that idea won’t stick. So here’s my idea (and if anyone knows how I could get some donated billboard space near I-95 or Route 101 let me know):

Make a billboard with two bottles of water on a white background. The first bottle is filled with water, the second is one-quarter full of oil. Put an equals sign in between the bottles. Done.

(OK, it probably needs some snappy slogan like “Bring back the tap.” and a sentence saying, “This is how much oil it takes to bring you bottled water,” but I think all of that is incidental. The point is the powerful, simple, memorable image, one that’s worth talking about.)

If we want our advocacy to be as effective as the marketing that gets us to adopt bad habits, we have to be better at using marketers’ tools more effectively. Start with storytelling. I’m picking on bottled water but I’m sure you could come up with 10 other good examples. If you have some ideas, let me know.

Better yet, if you’re good with Photoshop, or know someone who is, ask them to make the image and send it to me, and I’ll use that to pitch the idea to Clear Channel Outdoor (who own all the billboards).

Notes for the skeptics:

1. According to the Earth Policy Institute, it takes 17 million barrels of oil to produce bottles for U.S. consumption. (Oddly, a recent NY Times article cited the Earth Policy Institute but quoted the number 1.5 million.)

2. If you are interested in this topic, check out the American Museum of Natural History water exhibit.

3. I was curious if I could get even close to Peter Gleick’s (of the Policy Institute) numbers using the information that’s being kicked around in the mainstream press. The bottom line is I could get to 10% as an oil:water ratio just for production of the bottles. I couldn’t get good information on transportation. Here’s the math for those who are interested:

a. 1 barrel of oil = 42 gallons = 158.987295 liters/barrel of oil

b. 17 million barrels of oil to produce water bottles = 2.7 billion liters of oil to produce 29 billion liters of water.

c. So just the production of the bottles means you could fill the bottle 10% with oil

1298 Ambulance in India

[Editor’s note: this post was originally published on the Acumen Fund blog]

I recently received Dial 1298 for Ambulance’s first newsletter. 1298 is an ambulance service in Mumbai. In 2007, Acumen Fund invested a $1.5 million for an equity stake in 1298, to fund expansion of their service. Since then, 1298 (the number you call when you need an ambulance) has grown faster than expected in Mumbai and is already expanding their service to two new districts in Kerala. The company has captured a lot of press attention, with coverage from the Economic Times, DNA, the Hindustan Times, and others. 1298 currently has 51 ambulances which have taken more than 50,000 trips since inception. The service is world-class, modeled on the London Ambulance Service (down to the forms the paramedics fill out on the ambulance).

Before 1298 launched its service, Mumbai had only about 12 working ambulances that fitted with intensive care equipment (which were primarily linked to specific hospitals); 9 out of 10 trips were to transport dead bodies. These weren’t ambulances; they were hearses.

1298 is one of a number of Acumen Fund investments that defies easy classification. The operating ˜special purpose vehicle” organization is structured as a for-profit business. This business uses cross-subsidies (the rich customers pay more for ambulance rides; the poor pay less or nothing) to achieve a social mission. And the supervising umbrella organization “Ambulance Access for All Foundation” is a non-profit. (Got it?)

The cross subsidy model is simple and ingenious. Patients who want to go to a private hospital in a full-service ambulance – staffed with a doctor – pay 1,500 rupees (about US$35). Those who go to public hospitals pay either half price or nothing. This way, it’s not up to 1298 to decide who can and cannot afford to pay. 1298 is committed to a social mission of having 15-20% of the company’s calls be free or reduced cost.

Why all this complexity? Mumbai is a giant, teeming city with unbelievable wealth and extreme poverty. 1298’s structure and social mission allow it to offer ambulance service for all in a financially sustainable manner. So now, anyone in Mumbai who needs an ambulance can dial 1298 and, thanks to the magic of GPS and Google Maps, one of 51 world-class ambulances arrives in about 15 minutes to provide care and transport. Wow.

So what is 1298? Classifying it as a “social enterprise” seems to sell it short, since 1298 is becoming the provider of ambulance service for all of Mumbai, a city of 22 million people. However, because of its social mission, 1298 now finds itself the recipient of donated ambulances from non-profit ambulance services that were not financially viable. By combining world-class operational skills with a social mission, 1298 can take on private invested capital (from the likes of Acumen Fund) as well as donations in kind from individuals and NGOs. Their social mission allows them to partner in ways a profit-maximizing business venture never could.

It is easy, seeing 1298’s success so to date, to underestimate what 1298’s founders, Shaffi Mather, Sweta Mangal, Ravi Krishna, Naresh Jain and Manish Sancheti, have accomplished. As co-founder Ravi Krishna described when we met a few months back, “Doctors told us we were insane to try this. Others said it was impossible. When I heard this, I knew we couldn’t go wrong. What’s wrong with an insane man trying to do the impossible? You have to succeed more than people say you will. And now everyone wants to copy us.”

Replication in other cities is now front and center for 1298; hopefully, their success will serve as a model to others interested in creating a new mold of what enterprises can accomplish to bring service to all.

Explaining complexity with a good analogy

I would bet that most people not in finance (or with formal financial training) have glossed over countless news articles that explain the current credit crisis without understanding much of anything. If so, this one’s for you.

I got a heads up from an Acumen Fund Partner about a great article in Harper’s titled The Next Bubble: Priming the markets for tomorrow’s big crash. The article is about financial bubbles, and it eloquently explains why the next financial bubble might be in alternative energy. (It also shows with deft simplicity why those of us who bought our homes after 1996 were buying after the bubble started — and that it may take until 2012 for this to play out.)

While all of that made the article worth reading, what I liked most was a wonderful analogy that explains CDOs (collateralized debt obligations) and the financial contagion they caused. It is powerful because it takes a very complex concept and paints a concrete picture that gets the core principle across:

Consider the chemical industry of forty years ago, back when such pollutants as PCBs were dumped into the air and water with little or no regulation. For years, the mantra of the industry was “the solution to pollution is dilution.” Mixing toxins with vast quantities of air and water was supposed to neutralize them. Many decades later, with our plagues of hermaphrodite frogs, poisoned ground water, and mysterious cancers, the mistake in that logic is plain. Modern bankers, however, have carried this mistake into the world of finance. As more and more loans with a high risk of default were made from the late 1990s to the summer of 2007, the shared level of credit risk increased throughout the global financial system.

Comparing CDOs to effluents, and the inability of “cleaning” this toxin (read: loans that weren’t credit worthy) captures the essence of the financial contagion — and yes, that makes modern bankers the bad guy corporate fat cats of old. As a bonus, the “hermaphrodite frog” leaves the reader with a memorable image as a mental point of reference.

For those of you who have a complex message to communicate, find a powerful analogy as your starting point. The analogy is packed with meaning, and it does most of your heavy lifting for you.