Hospital Pharmacy Practice in Namibia

Hello, and Welcome to my Blog! 

My name is Mason Benjamin, and I am a doctor of pharmacy student at the University of Michigan College of Pharmacy. I began the program imagining my career as an in-patient clinical pharmacist in a hospital, but practical exposure early in my first year led me to discover a new passion for improving medication access systems. Realizing that this path would necessitate my branching out into areas that were still largely unfamiliar to me, I began taking classes at the Stephen M. Ross School of Business to complement my pharmacy education with a private sector framework. Courses in healthcare innovation, finance, commercialization of biomedicine, and entrepreneurship exposed me to case studies from around the world and I loved every minute of it. I realized then that an international career would bring me the ability to improve far more patients' lives, as well as greater personal fulfillment. I feel incredibly fortunate to have found an opportunity to begin this career transformation at the William Davidson Institute, where I am currently a 2018 Global Impact Fellow! In this blog, I will be discussing my 2018 summer internship in Namibia. In each post I will aim to describe what I'm doing in my project, share some of my favorite parts of Namibian culture, and talk about some of the more memorable experiences.

The Project, the Team, & the Location

My project is focused on pharmacy workforce development and hospital pharmacy practice. In this multi-organizational project, I will be collaborating with the William Davidson Institute (WDI), The International Pharmaceutical Federation-Hospital Pharmacy Section (FIP-HPS), and the University of Namibia (UNAM). Over the course of my project, I have been traveling all across Namibia to visit hospital pharmacies in different regions. Accompanying me on these site visits are two intern pharmacists, Moses and Olivia ('Liv), who recently graduated from UNAM's pharmacy program. I have been inspired by their drive and passion about their profession. I'm lucky to be traveling with them, talking about the future of pharmacy, and learning from them about Namibia. I'm beyond thankful for their help navigating the roads, introducing me to the culture, and for translating as needed during site visits. They're two of the best friends and colleagues I could have asked to meet!

Here I am with my project team in Namibia at the 4th Annual MURIA Conference, hosted by UNAM's School of Pharmacy. From left to right: Moses Thikukutu, Olivia Fikameni, Mason Benjamin, and Dan Kibuule. Moses and Oliva are the UNAM interns accompanying me on site visits around the country, and Dan is my project mentor here in Namibia. 

During my second week in Windhoek, I had the chance to attend the 4th annual Medication Utilization Review In Africa (MURIA) Conference with Moses, 'Liv, and one of my project mentors, Dan, pictured above. I'm thankful my time in Namibia lined up so well with this conference, because I had the chance to learn an incredible amount about pharmacy practice in Namibia (and indeed across Africa) before my site visits had even begun. I was aware of how different the healthcare system in the United States might be from anywhere else in the world, but always felt that researching other systems online had its limits. I much prefer to learn right from the source and in person, so I was grateful for the opportunity to ask questions to practicing pharmacists from over a dozen different African countries about how things worked in their setting. This, combined with three and a half days of presentations, workshops, and practice-sharing forums, was a fantastic way to develop understanding of some of my project's topics of interest. I also had the chance to present a poster on technologies used to improve medication use at this conference, which I felt was quite the honor! I will certainly look for opportunities to attend more conferences like this one in the future that present a platform to learn from other professionals and share stories, best practices, and discuss recent research.

UNAM's Health Sciences Campus, where I go to work when I am not

traveling, and where MURIA was hosted. I'm always in awe of how 

beautiful the architecture here is, and wish we had facilities as nice 

as these back home.

Here I am in front of my poster at MURIA, titled 

"Methods for Improving the Medication Use 

Process," for which I also gave a short podium

presentation. I felt honored to receive a time slot

at an international conference!

The Importance of Customs, as a Visitor

Olivia, Moses, and I at our first northern site visit in Rundu with

the chief pharmacist outside the hospital.

Reflecting on the preparatory work I did before traveling to Namibia, I'm the most thankful for the time I spent learning about Namibian history and present-day culture. This was probably more necessary even than my understanding of pharmacy practice or business was. There were customs I needed to understand to be well-received at these sites to avoid offending the people there, including the etiquette surrounding introductions, the proper way to shake hands, and especially the Namibian perception of schedules and time. For instance, the people I have met here have very relaxed, warm, and friendly attitudes, so long as you don't try and rush things. Pleasantries and affiliations are extremely important, and not to be taken for granted. Developing this understanding was especially important given my role as someone who was representing multiple affiliations including WDI, FIP-HPS, and UNAM for this project, as well as the University of Michigan in a broader sense. It was also very helpful on these site visits to be accompanied by Namibians, especially two who were affiliated with UNAM. Thankfully, we received a warm welcome everywhere we went.

Traveling Around Namibia

My first view of Namibia, upon waking from some much-needed

sleep in-flight. I always love the first glimpse of a new place, 

and this time it was especially exciting since I knew I'd be going

around to each of the places I was seeing from the plane.

Because traveling all around the country was a large part of my project, I thought in this first post that I should share a bit about the different areas in Namibia and my journey here so far. 

At the start of this trip, I had never before been so excited to board a plane. After a red-eye bus ride, 3 connecting flights, and 48 hours of continuous travel, I had also never been so excited to land! It wasn't as tiresome as it sounds though. I had the chance to get a Chicago Dog in the O'Hare airport after my flight to Chicago from Detroit, and also several hours to walk around Amsterdam during my layover there. That was a nice chance to stretch my legs and wake up a bit. I also got to visit the tulip museum, cheese museum, and walked around the network of canals. While the journey was long, I was glad that I arrived safely and that everything went according to plan with my connections.

Mountains south of Windhoek on the way to Mariental. I'm

originally from the foothills of the Rocky Mountains in Colorado,

and used to seeing a carpet of evergreen trees on those hills. It

was fascinating seeing a familiar sight with a new twist! 

Thankfully, my travels in Namibia wouldn't end when I arrived in Windhoek, due to the nature of my project. Namibia is home to several fascinating geographical regions, which I have been fortunate enough to see over the course of this summer. While it is named after the Namib desert and receives the least annual rainfall of any Sub-Saharan African country, Namibia is also home to beaches, jungle, and some of the most sought-out Safari parks in the world filled with unique grasslands, savannah, and an incredible diversity of flora and fauna. Namibia actually has a small population of 2.5 million for such a big country, and many areas are not inhabited. This resulted in some very long drives, and we were advised to fill our tank every time we saw a petrol station. They also don't stop filling when the pump shuts off. Instead, they'll shake your car a bit to settle the petrol, and over-fill it all the way to the brim since they know you may need more than a full tank to make it to the next town.

   

The coast in Swakopmund, where the desert meets the ocean, and the sand dunes

between Swakopmund and Walvis Bay. It was incredible on the drive between the

two being able to look one direction out the car out to the ocean, and then turn my
head the other way to see a vast desert and towering dunes.

One of Namibia's special claims to fame is being "the land where the desert meets the ocean." The vast landscape of desert sand sinks into the Atlantic Ocean along the west coast of Namibia, and this is quite the sight to behold! I would love to return some day when I had the time to enjoy the area and explore a bit, but our travel schedule only had us there one evening.

The long hours in the car gave me a good opportunity to study the variations in this landscape in detail, and spending time in over 20 cities for my site visits gave me an up-close look at some very diverse sections of Namibia. 

Basically all of Namibia is covered in palm

trees, as they grow well in hot, low-

moisture conditions. Many areas looked 

almost tropical because of all these trees!

This shot was taken leaving Oshakati.

In Rundu, looking out over the river

that forms Namibia's natural border

with Angola to the north. We had to

pull over for some stubborn goats, so I

had the chance to take a couple photos.

While I have traveled internationally a few times before, each time I would visit only one or two major cities. This project has given me a unique chance to truly get to know an entire country, and I can confidently say that I've never seen anything quite like Namibia. You also never knew when you were going to see animals crossing the road. That was exciting in two ways; first, you had to make sure you avoided a crash (especially in the north where there are commonly cattle, donkeys, and goats hanging out on the pavement), but second, you might see something really cool. We were extremely lucky to see this elephant!

One of my favorite moments of the summer was seeing this "little" guy cross the road. On the side of the highway, I had quite a list of animal sightings, including: ostriches, baboons, oryx, termite mounds taller than houses, springbach, flamingos, sheep, cattle, goats, warthogs, giraffes, wild horses, hippos, and crocodiles. 

Tagua Nuts: A Piece of the Culture

Carved tagua nuts purchased from a

craft market in Windhoek, early after

my arrival to Namibia. Namibians will

usually carve "The Big Five" into these

nuts, including lions, leopards, rhinos,

elephants, and buffalo. It was also not

uncommon to see zebra and oryx.

As an artist, one of my favorite things about Namibia is the tradition of carving animals into tagua nuts, sometimes called "ivory nuts" based on how closely the nut's color and texture resemble ivory. These nuts come from palm trees in the northern part of the country, and you will find craftsmen selling them all over the place. Commonly they leave a blank rectangle, which they use to personalize the piece by carving a name or desired message. After buying a handful for family and friends back home, I became fascinated by how beautiful they were, and decided that during my stay I would learn how to carve them. 

This is a tagua nut, which had an outer, furry husk that had been removed. 

Carving away the bark-like covering that remains reveals a slick, alabaster-

colored nut. It was a bit tricky to get the hang of it, but after twenty minutes

or so it becomes second nature. These things are sturdy, and nearly as hard

as stone. Apparently elephants will eat them, but human teeth would break!

My offer to purchase fresh, un-carved nuts from a local artist named Alfons started quite the conversation. He was curious why I wanted to buy the unfinished ones, and it turned out that in 30 years he had never had any visitor express interest in learning how to carve the nuts themselves! We chatted for 45 minutes about carving techniques, the preparation steps beforehand, the source of the nuts, how he began his career, and also what materials I would need. Because I hadn't seen any animals yet, I decided to carve the landscape I snapped a picture of on the way from the airport. 

I thought that since these nuts come

from palm trees, and since I had seen

so many of them, it was only right that
I include one of the makalani palms.

As instructed by Alfons, I included an

elephant I had seen in this carving. It

was both in-line with tradition, and
authentic to a memory that I'd made.

When I returned the next week to buy more, he was happy that I'd given it a go, and generous enough to give me five more nuts, along with the leather, beads, and wire to finish them for free in exchange for the promise that I return to show him what I carve. He had no doubt I would see animals during my travels, and so tasked me with inscribing the ones I saw. Nut carving ended up being one of my favorite hobbies during the weekends, and has resulted in some souvenirs that will last a lifetime! I decided I would try to commemorate this internship by carving the outline of Namibia, the names of the organizations I worked with, a makalani palm tree (where the nuts come from), and of course the elephant I saw crossing the road.

It was tricky to get in one shot, but I also carved the silhouette of Namibia, the year, and the initials for WDI, UNAM, and FIP into this nut to commemorate the purpose of my visit for this internship.

Until Next Time!

Thanks for reading this far! Hopefully now you've gained an understanding of the nature of the work I'm doing this summer, and can picture what I'm referring to when I talk about the country. In the next post, I'll share an update on the activities I'm involved in and highlight additional parts of Namibian culture!

Namibia has remarkably beautiful sunsets, and I thought it was only appropriate to end this first post with a shot of one :)

Project Update - Jacaranda Maternity

Andrea Arathoon – University of Michigan School of Public Health

Tuesday was a very exciting day because I reached a milestone in my summer project! After 8 weeks of work, we started testing the new outpatient care checklists for prenatal visits.

During the past few weeks we’ve been working on developing this checklist to improve patient flow within the outpatient clinic. Currently, waiting times can be longer than expected due to certain inefficiencies in patient flow,  and we anticipate that the new care checklists will address these issues. We are also making sure that Jacaranda Maternity follows WHO and Kenyan Ministry of Health guidelines on prenatal care. After designing the new outpatient checklist, we consulted with physicians, nurses, patient care assistants and the administrative staff to ensure that the document was complete and easy to understand, and that it served its purpose of being a decision-support tool for clinicians during the prenatal visits.

Two weeks ago, we made the last changes to our prototype checklist and trained nurses, patient care assistants, and receptionists on this new tool. What I hadn’t considered was the fact that printing of the checklist would take time, because the process is a bit slower than I expected. This delayed the project by over a week. We finally received the printed files on Monday afternoon, and we started the testing period Tuesday morning.

At the same time that we rolled out this prototype checklist, we also implemented a new document called “Patient Reminders”. This idea came up after my week of observing the outpatient flow. When patients come for their prenatal visits, they bring a “Maternity Card” which is a booklet that contains all the relevant information about the patient’s pregnancy in case she needs to visit another health facility during pregnancy or for delivery. Patients understand the importance of this Card, and make sure to always have it with them when they seek care.

Picture of the outpatient checklist and my
mid-morning snack - coffee and Kenyan chapati

This Card is also important because nurses write the tests that are needed to be done before the patient’s next visit. There is just one problem with this care model: no one is held accountable for ensuring that the patient gets the tests she needs before she sees the nurse. And if she doesn’t get a test done before seeing the clinician, she might have to wait much longer because she needs to go back to the laboratory or ultrasound, wait for results and then return to her outpatient consultation. Receptionists are supposed to check the Card when the patient checks-in, but for many different reasons this is not always done.

The “Patient Reminders” document is meant to solve that problem. The document is small (about ¼ of a letter-sized paper) and is designed as a checklist. Now, when nurses see a patient, they only have to check the boxes for the tests that are needed before the next visit, and when the patient checks-in next time, receptionists have a much easier way of identifying the tests that were prescribed on the previous visit.

The new outpatient checklist tool for prenatal visits and the patient reminders document will be tested for the next two weeks, and we will make any adjustments needed after this trial period so that we can implement the final outpatient checklist and reminders document in the coming weeks. This outpatient checklist is the first step in moving the patient’s file to the EMR that was implemented approximately one month ago. The idea is to utilize this paper checklist while the hospital begins the process of redesigning the clinical portion of the EMR. Once the checklist has been incorporated into the EMR, clinicians will be able to take full advantage of the benefits of utilizing the system as a decision-support tool that aids them in their decision-making process.

A Day in the Life

Chris Owen - Ross School of Business and School for Environment and Sustainability

No morning alarm needed here in Madurai. Prayers are projected from a nearby temple via loudspeaker at four-thirty every morning. A street sweeper with bells on his broom acts as my 5am snooze button. And of course, the cacophony of beeps and bells, horns and honks by motos, bikes, and buses begins at six—a definitive dream crusher. Night owls have no hope here.

After a morning meeting or two via BlueJeans on side projects that are progressing stateside, I depart for the gym where I’m welcomed by Justin Bieber. “Let Me Love You” and “Despacito” are my fitness instructor’s favorite songs. He's had them on repeat for the past month and I secretly approve. After emerging from the sweatbox, breakfast is up one floor at “Temple City Family Restaurant.” Idly, dosa, vada, chutney, and Pongal complete the palate—South Indian food that’s both flavorful and fun to eat with your hands. I’m free entertainment for the wait staff who enjoy watching my unorthodox “shovel ‘n thrust technique.” I also have the dubious distinction of being the first person they've ever seen who's attempted to eat a soup with his fingers.

Off to work at 9am. I carpool with my neighbor, The Marvelous Mr. Selva. Despite the short distance, the commute always proves adventurous or, more accurately, treacherous. If a cat has 9 lives, everyone here has 900. My office is a glass palace—the home residence of the Chairman, a guru and gifted visionary. From nine to six I work on my core project and one of the Chairman’s top priorities—creating a coaching program for entrepreneurs in emerging economies. At 5:55 pm, as the sun slowly dips, the security guard kindly slips into my office to turn on my lights. At 6 pm, I kindly turn them off, pack my things, and depart for home.

I choose to walk home in order to stretch my legs and because nothing beats the thrill of a nightly near-death experience. Might is right on the roads in Madurai where pedestrians rank just above bugs on the commuter hierarchy scale. For dinner, I stuff as many mangoes in my face as humanly possible while squishing mosquitos so I don’t have to sleep with them. A little reading before bed, then repeat Monday through Saturday. Sundays are for letter writing (my favorite 19th century hobby), church (in Tamil), Bollywood flicks (“3 Idiots” is a must-see modern classic), and daydreaming of Culver’s Beef Butterburgers (something I must never admit aloud).

Parting Shot: The best part of my internship is the balance between autonomy and support from my project partner.

Pictures Below: 1. The glass palace. 2. South Indian breakfast. 3. My mustache (which I promptly shaved off despite it being the predominant style in India)

About the Author: Chris Owen is a rising second-year dual-degree student with the Ross School of Business and the School for Environment and Sustainability at the University of Michigan. He is passionate about social entrepreneurship, sustainability, and people strategy. He joins the 2018 WDI Global Impact Fellows program after serving for three years in Ecuador with the U.S. Peace Corps, first as a business consultant in the natural resource conservation program and then as a Regional Volunteer Leader.

Gunung Agung: Beauty and uncertainty

Nadia Putri - Ross School of Business

On Thursday, June 28th 2018, I was sitting at East Bali Immersion (EBC's ecocamp), almost couldn't believe what I was seeing. EBI is located NW of Gunung Agung, and I could see small sparks of lava accompanied with tall smoke coming out of the crater. It was really beautiful, but a bit scary at the same time for someone who has never seen anything like it before. We were listening to radio station that keeps everyone updated on which areas have been evacuated.

EBI team watches over Gunung Agung on Thurs, June 28 night

History of Gunung Agung

Gunung Agung (gunung = mount, agung = majestic) is the highest volcano in Bali, towering 3,031 meters (9,944 ft) above sea level. Balinese, whose religions are mainly Hindu, consider and respect mountains as the dwelling of the Gods - with Agung holding the highest degree of sacredness. Pura Besakih (pura = temple), the most important, largest, and holiest Hindu temple in Bali, is located on the slopes of Gunung Agung.

Prior to current activity, the last eruption of Agung started on February 18, 1963 and ended on January 27, 1964. During this period, there were 1,148 casualties and 296 injured victims (PVBMG Indonesia). This eruption was one of the largest in the 20th century, generated heavy ashfall along with lahars that caused extensive damage. Below-average temperature was observed years after the eruption happened. Ash spewed by volcano can cause much struggles to farmers, burying agricultural areas and damaging crops. However, they also increase soil fertility in the long-term.

Map of areas located in danger zone and EBI + EBC locations.
(Source: PVMBG Indonesia)

Current status of Gunung Agung

Gunung Agung started becoming active again in August 2017. In September, The Indonesian National Disaster Management Authority declared a 12-km evacuation zone around the volcano. Gradually, the activity decreased over time, leading to lowering of alert level to 3 out of 4.

But, late November 2017, Gunung Agung erupted five times. The Indonesian National Disaster Management Authority raised alert level to the highest once again, ordering citizens located in 10-km radius of the volcano (~100,000 people) to evacuate. Since then, Gunung Agung has been erupting with a varying degree of impact.

East Bali Cashews and disaster readiness

EBC factory and EBI are located approximately 14 km NW of Gunung Agung. This means EBC area is still located outside the evacuation zone. But, this does not mean that the management was able to rest easy. In 2017 episode, earthquake can be felt throughout the factory every few minutes. At first, everyone was anxious, scared, and panicked. So, EBC implemented some programs to prepare their employees for any disaster that might come and make sure everyone feels safe at work.

• Tore down one of the factory walls and created larger emergency exit for employees to get out in case of any incidence.
• Trained employees to evacuate in a calm manner, determined gathering area for people to evacuate, and assigned team leaders to call absence when this happens.
• Aaron, EBC's founder, presented volcano simulation to the employees to show what happens when a volcano erupts and how the areas around it will be impacted.
• Management from Denpasar and Jakarta rotated to stay in Karangasem throughout the whole episode, staying together with the employees and keeping everyone calm

These programs and general readiness attitude from management prepared the employees really well. During my stay there, minor eruptions and earthquake happened. But, the employees did not show any panic sign while still keeping in mind what procedures they need to do if anything happens.

Mount Agung, on my way from Karangasem to Denpasar on Friday, June 29

--

Going back to my experience, I was supposed to fly out to Jakarta on Friday June 29th, the day after I watched Gunung Agung erupted from EBI. When I woke up Friday morning, I found out the airport was closed following the eruption to ensure flight safety. Volcanic ash is dangerous for planes as it makes airport runways slippery and can get into plane engines. Typically, whenever my flight plans are disrupted (believe me, this happens a lot. People know I'm quite unfortunate in terms of flying..), it would ruin my mood for the whole day. I'm tired of all the hassle in lining up at the customer service booth, rescheduling my flights, staying longer (even overnight) at airports, etc.

But, that day was different. I was reminded of my experience the night before.

I remembered watching Gunung Agung with EBI staffs. They've seen it before, yet, they still admired how grand the lava, smoke, and Gunung Agung looked that night. They appreciated the beauty despite the uncertainty of what might come. So I told myself, that it was fine to have my flight plan disrupted - just like thousands others who were trying to fly out of Bali, that in the end everything will be OK, and that I just saw the most amazing evidence how powerful and beautiful our nature is.

Defining Entrepreneurship in Nepal

Matthew Carney - Ross School of Business and School for Environment and Sustainability

One of the most eye-opening aspects of working with entrepreneurs in emerging markets like Nepal is the degree to which the very concept of entrepreneurship differs from what is taken for granted in the United States. In America, most startups follow a familiar game plan; identify a robust market, disrupt existing firms by offering new services, scale up efficiently to maximize market share, and ultimately try to go public or get purchased by a larger competitor. Having spent six weeks working with energy entrepreneurs in Nepal, it is already clear how foreign this concept of “entrepreneurship” can be. In particular, this manifests in three distinct ways.

First, the basic infrastructure that undergirds our domestic economy is often taken for granted. For example, the CEO of a new software or direct-to-consumer apparel company will know they can count on ubiquitous internet access and expansive highway system to deliver those products. Local entrepreneurs in emerging markets have no such privileges.  When considering potential targets for decentralized solar power systems in Nepal, the realities of limited infrastructure not only hinder the entrepreneur but also the customer.

Secondly, entrepreneurs in emerging markets tend to rely on partnering with nominal competitors much more than those in the US. While most startups in America focus singularly on expanding and protecting their market share at the expense of their competitors, resource limitations in developing countries necessitate collaboration. Given how many people simply don’t have access to the market, working together connect with potential customers is worth the effort even when each company’s individual market share is diminished.  

Both of these factors are evident in the different approaches taken to scaling. American startups are often judged by their ability to add customers and increase revenue while keeping their marginal costs low. For example, it won’t cost twice as much to run a social media app with one million users as one with half a million. For energy entrepreneurs in emerging markets, however, each project must be profitable on its own and costs largely correspond to earning potential. Given the limits this imposes on startups’ potential profitability, it can make it much more difficult for entrepreneurs to attract outside investment - limiting their prospects from the outset.

The stark difference in constraints and opportunities between American and Nepali startups provides a learning opportunity for entrepreneurs of all stripes. It is an important reminder that the skills that makes an entrepreneur successful in one context may not be applicable in another.

The Importance of Entrepreneurship in India

Chris Owen - Ross School of Business and School for Environment and Sustainability

People are pouring into cities.

In India alone, urban centers are expected to grow by 250 million during the next 20 years--nearly equivalent to the entire population of the United States. Rural Indian residents are moving into cities for work, for the lure of modern conveniences, or simply to be closer to fellow migrant family members. Indian farmers, in particular, have been forced into urban areas by water wars, below-market value pricing for their crops, and debilitating debt. Considering that India will also have the largest millennial workforce in the world by 2027, we must ask: Where will all of these people work?

Government funds are already being stretched thin by increasing demands on transportation infrastructure, waste management systems, and an expanding energy grid. National or international aid organizations may provide relief for society’s most destitute, but that still leaves a large middle class searching for economic stability.

This is precisely the purpose of Poornatha--my counterpart organization based here in Madurai, India. The mission of Poornatha is “to foster socio-economic vibrancy and entrepreneurial resilience, thereby contributing to nation-building.” In collaboration with the Michigan Academy for the Development of Entrepreneurs (MADE) and the William Davidson Institute (WDI) at the University of Michigan, Poornatha is designing an affordable, world-class coaching curriculum for entrepreneurs in emerging economies. The goal of this program is to equip and empower entrepreneurs as confident, evidence-based decision-makers who build enduringly successful businesses that strengthen their local communities.

Madurai is an ideal test site for this program. Located in the southern state of Tamil Nadu, Madurai is a gritty trading center with an aspiring manufacturing sector, reminiscent of an American Rust Belt metropolis. It’s home to rubber factories, sand mines, raw material distributors, a robust textile industry, and an engaged entrepreneurship network. Poonatha provides first, second, and third generation entrepreneurs in Madurai with training in cash flow analysis, marketing and brand management, leadership development and, most importantly, data-driven decision-making. Our hope is that this program helps cultivate a business ecosystem that ensures stable, sustainable economic growth for the region.

Overall, by investing in strong local economies, India can address its dual-challenges of rapid urbanization and rising unemployment. Indeed, for this reason, entrepreneurship in India--and the work of Poornatha--is becoming increasingly important.

About the Author: Chris Owen is a rising second-year dual-degree student with the Ross School of Business and the School for Environment and Sustainability at the University of Michigan. He is passionate about social entrepreneurship, sustainability, and people strategy. He joins the 2018 WDI Global Impact Fellows program after serving for three years in Ecuador with the U.S. Peace Corps, first as a business consultant in the natural resource conservation program and then as a Regional Volunteer Leader.

References:
1. https://www.mckinsey.com/featured-insights/urbanization/indias-urbanization-a-closer-look
2. https://www.financialexpress.com/economy/indias-millennial-generation-bigger-than-china-to-boost-nations-workforce-to-worlds-largest-by-2027/836248/
3. http://www.thehindu.com/news/national/growth-in-urbanisation/article23925543.ece

Measuring the impact of gender-equality programs in Brazil

Rebecca G-K  -  University of Michigan Ross School of Business and Medical School

I am thrilled to be a WDI fellow this summer working with Plan International Brazil. Plan international is a global development organization with a focus on the health, safety, and education of children. The organization was founded in 1937 and is now active in 70 countries. Programs in Brazil began in 1997 and are headquartered in São Paulo, with program offices throughout northeast Brazil where poverty rates are highest. In the remote northern state of Maranhão, the average per capita monthly income is $157, less than half of Brazil’s national average.

Local street market in São Paulo 

In recent years, Plan Brazil has shifted its program focus to gender equality; the current programs are designed to reduce gender-based violence, promote reproductive health and healthy relationships, and advance female leadership and representation in Brazilian society and politics. Child marriage is a particular problem in Brazil. Brazil ranks 4th in the world for absolute number of married or cohabiting girls under age 15. Brazil ranks 4th in the world for absolute number of women who gave birth by age 18, following India, Bangladesh and Nigeria.  A recent study by Plan and Promundo found that the high rate of child marriage in Northeast Brazil is closely associated with unplanned adolescent pregnancy, interpersonal violence, limited economic opportunities for girls, and social beliefs about gender. Plan notes that its work is especially crucial in a climate of reduced federal support for reducing gender-based violence; the funds for tackling violence and promoting women’s equality were reduced by 74% in this year’s federal budget.

Plan Brazil implements numerous interventions with young boys and girls. One of their flagship programs is a female football league, in which girls learn to challenge gender stereotypes and occupy social spaces traditionally dominated by boys. Other programs train adolescents to teach their peers about reproductive health, teach young children how to protect themselves against child abuse, and enroll young women in an extracurricular Leadership School with modules on human rights and political participation. To learn more, check out this video.

My project this summer is focused on performance measurement. Before arriving in Brazil, I spent one week at the WDI office preparing and learning a ton about social impact measurement from the brilliant Performance Measurement Initiative team. I’ll be working with the Plan team to analyze their current monitoring and evaluation practices and launch a new methodology in order to capture the social impact that Plan’s work aims to achieve. I’ll also be collaborating with the finance team on a cost analysis project. 

Flag on a car's side-mirror: World Cup spirit is everywhere! 

Outside of work-related news, this week Brazil played its third match in the World Cup. The streets are all decorated for the world cup with brazilian flag banners and street art. The entire country pauses business to watch the matches! The Plan office did not even open until after the 9:00am game today so that everyone could watch. It was a tense game, with Brazil tied against Costa Rica 0:0 up through the last few minutes of the game. Then Brazil scored 2 goals for a victory! The streets erupted with firecrackers and vuvuzela horns. You can root along for Brazil next Wednesday as they play their next game!