Rethinking the ‘last mile’ challenge

Sometimes I think there are misperceptions about ‘the field’ being an unfamiliar, exotic place, far, far away.  Exactly three years ago today, I was abandoning a broken down minibus for a motorcycle in rural Bangladesh, at a point where roads became merely paths. After 50 hours of flights, buses, biking and hiking, I finally arrived in a small village to interview a group of women about their microcredit loans. Sitting down on the mud floor I was surrounded by 30 pairs of waiting eyes. Bleating goats competed with the screaming humidity for airspace and my mind quickly raced. I tugged awkwardly at my collar. Why did I think I could learn to help a place I knew nothing about? Where to begin? This place felt like it was 400 years behind Boston’s 12-hour time difference.

From a sea of saris and laps cradling infants, women began to speak up: “You’ve traveled very far to see us.” “Have you called your mother, yet?” “Does she know you’re safe?” “Are you eating well?”—Classic mothers. I’ve learned that despite places lacking every infrastructural deficit imaginable, human connection is the same everywhere. And that’s where you start.

My whole last decade has been spent learning from such people that modern progress has forgotten to include: children whose access to education means carrying tattered American medical journals around the yard; families whose crop insurance is a week-long prayer before the rains come; household incomes eked sifting rubbish for value in a trash dump. These are the ingenious billions of people surviving in what is described as ‘the last mile’ of existing systems and networks; another metaphorical twist akin to the bottom of the economic pyramid (BoP).

Dimagi CEO Jon Jackson watching a Tula Salud Community Facilitator use CommCare

What I’ve learned, and what Dimagi emulates so sincerely in its model, is that it’s these people who are the real drivers of innovation; from the Kenyan developers who created the applications, mFarm and eLimu, to support farmers and schools with stronger mobile aids, to entrepreneurs like William Kamkwamba in Malawi, who responded to electricity blackouts with custom-built wind turbines for his village.

At Dimagi, we’re driven by this potential for creativity and impactful technologies. But more so, by evidence that local communities are the best designers to improve services in the ‘last mile’ homestretch of begotten markets. For example, in my second week at Dimagi, I was fortunate to visit an inspiring partner, TulaSalud, during Dimagi’s Away Month in Guatemala. Founded and staffed wholly by Guatemalans, TulaSalud is a local NGO that is committed to improving delivery of healthcare services for indigenous communities. Alongside a poverty rate of 80%, their target region, Alta Verapaz, has one of the highest burdens of maternal mortality in the world and a threateningly high prevalence of malaria.

In response, TulaSalud adopted CommCare in 2012 to support a growing network of community health workers. Uniquely, TulaSalud mobilized a mHealth team to build upon the CommCare platform to include customized reporting features and is now tracking 85,000 patient cases and disease outbreaks over simple feature phones. We were able to visit two of TulaSalud’s health workers to learn how Dimagi can help make the tools even more useful. They shared how they used the phone to track individual high-risk pregnancies, organize transportation for women in need of hospital referrals and seek decision support from doctors in urban centers. But they also highlighted the challenges ahead: the under-stocked medicine shelves, the strained capacity to care for complicated cases; that 88km trip through winding mountain trails to the nearest hospital….

Riding the long journey back to the city I watched the dirt trails turn back into highways and asked myself what ‘last mile service delivery’ means to me. I wracked my brain back to Investopedia (see self-taught MBA programs) and saw: “a phrase used in the telecommunications and technology industries to describe the technologies and processes used to connect the end customer to a communications network”.

In short: the last leg.

But in the real world, we shouldn’t be talking about delivering Grandma’s Netflix faster. The last mile really means delivering life saving, quality-of-life improving products, services and attention to underserved markets. However, I began to think about how “the last mile of a network to the user is also the first mile from the user to the world”. Thus, we can also think of it as a ‘first mile challenge’. Not just how do we connect stakeholders with rural communities, but how do we build platforms to engage the William Kamkwambas of India, Nicaragua, Harlem… with the world? Track record shows they’ll have a tremendous impact on it.