Latest News Updates on our work in Ghana and around the world.

Founder and executive director Cliff Schmidt was in Ghana this past March and worked alongside Ghana country director Andy Azaabanye Bayor and program staff member Fidelis Da-Uri Awonodomo on Literacy Bridge’s Maternal and Child Health Program.

During his trip, Cliff met with the regional and district directors of the Ghana’s Ministry of Food and Agriculture, the Ghana Health Service, and non-profits, like CARE. All concurred on the urgent need for the Maternal and Child Health Program, particularly in the Upper West Region – the poorest region in the country and the most difficult to reach by government agencies because of the lack of infrastructure and inadequate roads.

Weeks before Cliff’s arrival, Andy and Fidelis hired and trained local Ghanaian staff to collect baseline survey information from a sampling of 20 communities in the Upper West Region. The survey information reinforced what the three saw during their village site visits – illiterate people living in the poorest areas of the world lack access to the fundamental, basic knowledge that can help them overcome disease, malnutrition and poverty.

Literacy Bridge is taking on a new program approach with its comprehensive Maternal and Child Health Program. In addition to integrating with existing women’s groups, the program will ensure that every pregnant woman in each community can take a Talking Book home for one week of each month during her pregnancy. She will be able to listen to local language audio recordings on how she can keep herself and her baby healthy during and after pregnancy.

Gozu Mother and Children

Literacy Bridge will also be rotating a Talking Book through each household, one week per month. The content will contain critical information on health and nourishment. Adults in the household will be able to learn basic health measures to reduce, and, ultimately, eliminate the incidences of and possible deaths from preventable diseases. The health information will be coupled with instructions on sustainable farming techniques and practices that will ensure families with adequate nourishment and food supplies through improved crop yields. This holistic program approach will enable people to learn new practices and adopt behavior changes that are far-reaching (within families and throughout the community) and trans-generational.

Gozu Children

Sandra Noni

Sandra Noni is 20 years old and expecting her first child in May. She and her husband work hard to grow enough food for the family. Yet for subsistence farmers who cultivate food using traditional practices – over 1 billion people worldwide – hunger is often a glaring reality.

Sandra, who lives in the Upper West Region of Ghana – an area noted for extreme poverty and illiteracy – also faces challenges with her pregnancy, similar to hundreds of thousands of expectant mothers throughout developing countries. Time and distance limit her visits to the local health clinic. She has many questions about her pregnancy and her unborn baby, and is worried whether or not she will be able to deliver her baby safely. But, in her words, “This is my first pregnancy… I don’t know who can answer my questions and I don’t know which information is good for me.” In each of her three clinic visits to date, Sandra has only been provided with the results of her routine examinations – nothing else, e.g., information on what to expect throughout her pregnancy and how to keep herself and her baby healthy and safe. The brochures she has received at the clinic are useless to her – Sandra cannot read.

Gozu Women Doing Chores

These experiences are widely mirrored throughout the developing world… the consequences of which can be deadly. In these regions, expectant mothers, many of whom struggle with hunger and malnutrition, have a one in 16 chance of dying in pregnancy or childbirth as compared to one in 4,000 in a developed country. Equally as alarming, more than eight million babies born to women, like Sandra, die each year before their first week of life. And the majority of these deaths are preventable only if basic health, nutrition and agricultural information is available and accessible.

Literacy Bridge has been successfully helping farmers improve their crop yields through our Talking Book Program, and we’re now outreaching to mothers and children through a targeted Maternal and Child Health Program. There are more than 200 villages in the Upper West Region, where the need for the program is the greatest. You can help seed the first set of 10 villages with Talking Books. The cost of bringing this program into the first 10 villages is $50,000 – only $5,000 per village, about $7 per person. Your generous gift will help provide the first generation of parents with a means to create a sustainable life for themselves, and raise their children free of hunger and fear of death by preventable diseases.

Here are some of the villages that your gift will help impact: Gozu, Jeffiri and Ving-Ving.

There has never been a better time to respond to this call to action. Equally there has never been a better time to share the work of Literacy Bridge with your friends and family. Join us today in supporting this life-saving, life-changing program.

The Seattle Foundation

On May 2nd, Literacy Bridge is taking on The Seattle Foundation’s GiveBIG one-day challenge to raise the $5,000 needed to bring the life-saving and life-changing Maternal and Child Health Program into the impoverished Ghanaian village of Jonga. Click here to see why.

Your generous gifts of $10, $15, $25 or more will enable the families of Jonga to learn basic health measures that will help them prevent and overcome preventable diseases, like diarrhea and malaria. They will also be able to learn best practices in cultivating and boosting the yield of nutritious crops in order to feed their children and keep them healthy. GiveBIG on May 2nd to help bring hope and promise to the people of Jonga for a better life.

Thank you for your support of Literacy Bridge and the impoverished communities we serve!

P.S: Eager to learn more about GiveBIG? Learn how GiveBig works here!

Talking Books

For years, when a user turned on a Talking Book, it would respond:

“Welcome to the Talking Book. Press the right arrow to choose a subject.”

After pressing the right arrow, you might hear:

“To learn about health, press the up arrow. To try another subject, press the right arrow.”

Arrows for icons are useful for a knowledge device, and they are prominent on other audio devices found in rural areas of developing countries.

But, what do you do when you’ve designed an audio computer with four central arrow keys (up, down, left, and right) but you realize that most of your users have no word in their language for arrow? How do you refer to these buttons in your audio instructions spoken in the local language?

You have to talk about the arrows as a group of buttons with similar markings and then distinguish which arrow you are referring to by its position; but this is lengthy and more complex than an instruction should be, particularly for users without any formal education and who are not comfortable with technology.

Testing potential icons with residents of Gozu.

Instead, the ideal set of buttons would all have icons that are easily identifiable by simple and common words in the user’s native language. An audio computer, like the Talking Book, has no display or mouse. Instead, it interacts with its user by providing spoken instructions that direct the user to make choices by pressing particular buttons. If the users you want to reach the most have no formal education and are not very comfortable with technology, you need to make the initial experience extremely simple, and this requires simple, easily recognizable icons with simple names.

And so, over the last couple years, we have been experimenting with alternative icons to use on our next production run of Talking Books. There are few symbols that are common to multiple oral cultures. This means that you can’t rely on a simple drawing to represent an object unless it accurately depicts the shape of the object (e.g. a sun cannot be depicted as a circle with lines representing rays of light).

During my trips to the Upper West Region of Ghana in October of 2011 and March of 2012, I worked with our local staff (Andy, Fidelis, and now a new volunteer, Francis) to test dozens of new icon ideas as contenders for the next version of the Talking Book icon interface.

Matrix Used to Test Recognition of Potential New Icons

We were lucky to have the help of a great social impact design firm named Catapult Design. Noel, at Catapult, worked with us remotely by taking our ideas, photos of local objects, and field testing results and then responding with new icons, which we would print, tape onto a few Talking Books, and test again.

We conducted two primary activities to select a new set of icons: 1) we tested how quickly members of our target audience could identify each icon after hearing its name spoken in their local language; and 2) we presented these individuals with samples of Talking Books with various combinations of icons we found were most promising so that we could learn how that combination of icons on a Talking Book would make users feel. In other words, we wanted the icons to be clear and simple, but we also wanted the collection of icons to create a positive feeling from users.

We were very cautious not to select a set of icons that could make an elderly adult feel like the Talking Book was intended to be a children’s toy (which we worried might happen with too many animals or body parts, which would both be universally easily recognizable icons).

Testing Preferences Among Potential Talking Book Keypads

Testing Preferences Among Potential Talking Book Keypads

Most of this testing occurred in the villages of Gozu and Jeffiri; but after dozens of hours of testing and redesigning, we ended up with a final set of icons that we are excited about. We have replaced the left and right arrows with left and right hands. We replaced the down and up arrows with a table and a tree (a mango tree, which is clearly identifiable as a tree due to its fruit hanging down). We used a bowl for the center button, and we changed the asterisk to a solid star. We didn’t change the solid black circle, but we removed the black outline circles that surrounded a few of the buttons. We found no need to change the + and – buttons, which are used for volume and playback speed.

Potential Talking Book Keypads Evaluated by Users

Winning Icon Set

In mid-April, we brought 30 Talking Books with these new icons for testing in the village of Gyangvuuri. We are looking forward to comparing how much easier people are able to use Talking Books with these new icons compared to the original set.

Written by Raymond Yeldidong Bayor, Literacy Bridge Accra Representative

Talking Books

Literacy Bridge is a duly registered Non-Governmental Organisation dedicated to using Information and Communications Technologies for Development (ICT4D), with a particular focus on improving rural health, education and income. Literacy Bridge acknowledges that a wealth of crucial knowledge is already available within developing countries; the problem is reaching people who lack literacy skills and live without electricity. Our solution to this problem is a simple and low-cost audio technology — the Talking Book. We designed the Talking Book to address the short and long-term needs of those we serve: it gets vital knowledge into their hands immediately, while enabling them to practice and improve their literacy skills over time. Literacy Bridge saves lives and improves the livelihoods of impoverished families through comprehensive programs that provide on-demand access to locally relevant knowledge.

Arguably, the world’s cheapest programmable audio computer that shares locally-relevant knowledge and improves literacy, Literacy Bridge’s Talking Book is one of the world’s user-friendliest and most interactive audio devices. When turned on, the customised verbal instructions lead users through the audio user interface. To access recordings, users are guided by audio prompts and respond with key presses. For instance, pressing the right and left arrows navigate through categories (for example, “health”, “agriculture”, “stories”) and once in a category, the up and down arrows rotate through individual messages. Thus, simple and actionable instructional messages that are repeatable and can be played when needed enable people to learn and adopt new practices to fight poverty, diseases and illiteracy.

The current version of the Talking Book is 12 cm x 12 cm x 6.5 cm deep and weighs 225 grams without batteries. It is typically powered by two, zinc-carbon, size-D batteries, which we have found in rural markets throughout Ghana, to be 60 pesewas. These batteries supply 12-15 hours of typical use. Power can be conserved using earphones, but a built-in speaker enables group listening. To improve robustness and affordability, the Talking Book has no display. Recordings are stored on an internal microSD memory card, which typically provides 17-70 hours of capacity. The audio computer was also built to survive life in dry, dust storms, tropical rain, and comes in different colours.

The software on the Talking Book is the heart of the device. Because it is a computer, we can work with our partners to customize the software to precisely fill their needs. The flexibility of its software remains the Talking Book’s sole hallmark of adaptability. This is one of the most programmable audio devices in the world, with the ability to record and play applications. Unlike most typical recording devices, the Talking Book allows users to engage with it more interactively, and in many dialects as well.

The Talking Book is so accessible and easy to use. Once it’s powered on, it guides you through performing tasks like listening and recording. Its navigation interface is also localised in the native dialect of the user, thus allowing people with no prior experience with technology to learn how to use it from their peers. The device only requires, as indicated earlier, dry cell batteries though it can also be connected to grid electricity. In the dark or night, users don’t require light as they can listen to the device by feeling the indentations on the interface. It is user-friendly towards the visually-impaired. And unlike mobile phones, which require funds for network time and comparatively more expensive handsets to function, the Talking Book plays on-demand content at absolutely no cost.

In the field.

Even though the device runs on batteries, and not electricity, it uses very little energy for playback, recording, and interaction. Once recordings are done, the user can access them time and time again without incurring further cost, unlike the case of mobile phones where network access and units are at a charge to the user. The Talking Book also allows for free device-to-device copying of content, unlike other physical media like DVDs or tapes. A single copy can ensure the spread of content throughout the community.

PILOT RESULTS:
In January 2009, Literacy Bridge piloted Talking Books in Ving Ving, a remote village in the Jirapa District of the Upper West Region of Ghana. After conducting over 100 interviews to evaluate the impact of giving farmers on-demand access to agricultural guidance, it was found out that 91% of residents using Talking Books in their homes applied a new health or agricultural practice; farmers who had access to the Talking Book had an average increase in crop production of 48% compared to non-users decrease of 5%; this program created a return of more than three times the current investment in just the first year.

When asked how they would use the extra crop yields, 75% of farmers said they would sell their new surplus to pay for health insurance, invest in farming inputs, improve their houses-especially before the next rainy season, and pay for their children’s school fees. Obviously, the use of the Talking Book demonstrated such a great impact on rural agricultural practices.

This pilot, which Literacy Bridge began by collaborating with local experts to produce content for the devices, enhanced the lives of the rural communities. Experts included officials from the Ministry of Food and Agriculture, Ghana Education Service, and Ghana Health Service.
The impact evaluation paper of this pilot was invited for presentation at the ICTD (International Conference on Information and Communications Technologies and Development) 2010 Conference in London. Based on these results, we have more interest than ever from organizations around the world who want to use Talking Books to increase their impact. In June 2010, the Ghanaian Government purchased Talking Books, which are being used to give women better access to farming information. As our current capacity allows, we are launching partnerships to enable even more rural people gain access to information and improve the health and income of their families.

In July 2011, another pilot-the maternal and child health programme-was launched by Literacy Bridge. This programme seeks to significantly reduce the number of preventable deaths by loading actionable, on-demand recordings unto to the Talking Book. Officers of Wa and Jirapa District Health Services said the program would complement their efforts in reaching even more rural communities with health messages. Later, in August 2011, Literacy Bridge worked with directors of the Ghana Health Service in Lawra, Jirapa and Wa districts to determine the following messages: exclusive breastfeeding for six months after delivery, delivery with skilled birth attendant, use of treated mosquito nets, washing of hands with soap, and oral rehydration therapy. This has been against the backdrop that seven doctors serve 600,000 people, with an even worse situation in the villages where no doctors are stationed. This ratio is a far cry from the case of the USA where 1,872 doctors serve 600,000 people, and that of Europe with an average of 2000 doctors to 600,000 people.

Dapuoha was one of the three communities where Phase I of the maternal and child health programme was piloted. Mothers and their families in this community received strategic health and nutrition information in the form of songs, stories, and messages recorded on the Talking Book. These mothers and their families have, since the launch, been listening to the Talking Book messages and learning practical ways of keeping themselves and their families healthy. This phase marked the distribution of Talking Books in group setting in order for the message to be heard by majority of the people.

When the Literacy Bridge team visited the community around November 2011, children were heard singing songs that were used as messages in the Talking Books. The questions that were posed by the women indicated that they had learnt things they previously thought could not be harmful to their children. The baseline survey for this program, which will be will be subjected to expert review, is ready, and marks Phase II of the program. This survey seeks to help assess the impact of the program.

Indeed, Literacy Bridge’s Talking Book proves to be Ghana’s panacea to the challenges of rural health, agriculture, and illiteracy. Further information can be obtained from Literacy Bridge’s website: www.literacybridge.org.

From Ghana’s capital of Accra, it takes an average of 14 to 18 hours by bus to get to Ghanaian villages in the Upper West Region, where Literacy Bridge’s work is focused. An average of 500 to 900 people live in each of these villages without running water or electricity, and little, if any access, to medical care. Health care facilities are generally hours away by foot. Motor vehicles are a rarity.

Family homes are typically composed of two or three small one-room buildings made out of mud brick with straw roofs and dirt floors. Each area has its purpose. It serves as sleeping quarters and/or living and cooking areas. Areas usually covered by bushes outside of the compound serve as toilet facilities. Subsistence farming is the way of life and the source of food and income for every family.

Dapuoha Household

Dapuoha was one of three such villages where we launched Phase I of our maternal and child health program this past September. Households in Dapuoha consist of six to 17 people per household with anywhere between one and nine children per household under the age of five. The majority of the adults have had very little, if any, formal education. Malaria and diarrhea are the most common illnesses and the most common cause of death in their children.

The purpose of the maternal and child health program is to reduce and, ultimately, eliminate the number of preventable deaths in pregnant women and young children, particularly in low-literate, remote rural communities. Given that seven doctors serve 600,000 people living in the Upper West Region of Ghana, our program targets villages with little or no access to doctors or health clinics. This ratio is striking when compared to an average of 1872 doctors per 600,000 people in the United States or an average of 2000 doctors per 600,000 in Europe.

Mothers and their families in the Dapuoha community received strategic health and nutrition information in the form of songs, stories and messages recorded on the Talking Book through the maternal and child health program. Mothers and their families are listening to the Talking Book messages and learning practical ways to keep their children and themselves healthy and safe. See our Ghana Country Director’s blog for more information.

Mothers and their families in Dapuoha

Phase I of the Maternal and Child Health Program has ended. Lessons learned from Dapuoha and the other three villages during the first phase of the maternal and child health program will be incorporated in Phase II, which is underway. A large number of remote rural villages are currently being surveyed to determine if they meet the criteria for maternal and child health program – that is, a large number of families with pregnant women and young children under the age of five, low-literacy rates and little or no access to doctors or health clinics. From the qualifying communities, we will randomly select 20 villages to participate in Phase II of the maternal and child health program, which will undergo rigorous evaluation to determine program effectiveness and cost effectiveness.

More information on the communities selected and families involved will be forthcoming in upcoming issues of our e-newsletter. Meanwhile, our thanks to the legions of Literacy Bridge supporters whose generous gifts make programs, like the maternal and child health program, possible. Click here to join in this important effort.

A report from the field by Literacy Bridge Country Director Andy Baylor

 The purpose of  our maternal and child health programme is to significantly decrease the number of preventable deaths through the Talking Book  with actionable, on-demand recordings from health experts and community leaders on safe birthing practices and steps to avert illnesses, like diarrhea, and malaria.

The programme seeks to improve the health of 24,000 pregnant women, mothers of neonatal children and mothers of children under the age of five in 75 low-literate communities across rural Ghana. The goal of this programme is to maximize the number of positive health behaviours adopted by making relevant health information readily available to them.

In July 2011, I introduced the programme to the officers in the Wa and Jirapa districts of the Ghana Health Service.  They were delighted to learn about it, and said that it was a program that would greatly complement their efforts in reaching out to rural communities.

In August, I worked with directors of Ghana Health Service in Lawra, Jirapa and Wa districts to determine the information that they wanted to convey to  help  pregnant women, mothers, and their families in order to effect  behaviour change. The directors  developed messages on five key topics: exclusive breastfeeding for the first six months after delivery, delivery with a skilled birth attendant, use of treated insecticides bed nets, hand washing with soap and oral rehydration therapy. The  messages were then recorded into the Talking Book  for use in the programme.

In September, the programme was officially launched.  I worked with Ghana Health Service in each district to produce a list of 40 communities based on the need of access to health information, availability of community health centers, and distance  to the nearest health facility. From those 40 communities, 20 would be randomly selected to receive the Talking Book program and 20 would be used as a control group.

We conducted formative research in four communities. We verified the population of the communities, whether the community had access to health information, and we documented the antenatal and postnatal activities of women in our target population. The formative research information was made available to the Wa and Jirapa district health officers necessitating some slight changes in messages. The formative research showed that the communities had similar low literacy levels and access to health information.  Also, during the same time we wanted to establish a baseline survey with which we could then measure the outcome of the maternal and child health programme.

In October, we began Phase I of the maternal and child health programme in two of the four formative research communities with lots of health messages created on the five key topics. The essence of Phase I was to learn as much as possible before expanding to the rest of the communities.

We have learnt so many things about the best methods of distributing Talking Books in a group setting so that the messages can heard by the  majority of the people. We have learnt so many things that could work very well and those that we need to be careful with in Phase II. For example we realised that we needed two people each from each group to be trained on the use of the Talking Book, and these two people should not be the leaders of the group because there were issues of conflict of interest. We also learnt so many other helpful things about groups that I know would be beneficial in Phase II.  The questions that women were asking indicated that the Talking Book was helping them learn things they previously did not feel could be harmful to their children or during their pregnancies.

The last time I was in Dapuaha, one of the formative research communities, I could hear children singing songs that were used as teaching messages in the Talking Books.  It was awesome!

participants at a user training session

In November, Fidelis and I began visiting the communities to familiarize ourselves with the locations, the communities , and to interact them. We also have plans to organize some youths in the communities to train in January as volunteers and community contacts.

Right now, we are continuing to learn as much as we can about these communities. We have also finished the baseline survey questions for Phase II, which will be reviewed by experts. Once we have the survey questions completed, we will be conducting surveys in all the communities. There is a lot of work to be done but the end results are saving the lives of women and their children.

Cliff Schmidt, along with Tricia and Jeff Raikes, Robbie Bach, and Bill and Melinda Gates, was a featured speaker at the Microsoft Alumni Foundation’s 2011 Integral Fellows Award Celebration. More than 500 Microsoft alumni and guests were in attendance to hear from Cliff about Literacy Bridge’s work this past year and why the Talking Book matters. Cliff received the Integral Fellows Award in 2010. The following is an excerpt from his speech.

Cliff walks to the stage with this song playing in the background.

Nice song, right? That was the “diarrhea song”.

The women who recorded it had fun with the song, but their words are quite serious: “diarrhea can kill your baby”.   In fact, it’s the 2nd leading cause of child deaths worldwide.

Today, mothers in West Africa are playing this song and accessing dozens of other health messages and audio interviews where they are learning how to prevent diarrhea by washing their hands with soap, and how to treat dehydration with a mixture of sugar, salt, and water.  If everyone had this knowledge, nearly 1 million lives could be saved each year.  These mothers now have access to this knowledge and much, much more.

My organization, Literacy Bridge, is delivering this type of life-saving knowledge in a form that doesn’t require literacy. We work with local partners around the world to create compelling audio recordings, which we then load into this “library of spoken knowledge” – a device we call the Talking Book.  People then use Talking Books to learn about and discuss these issues, and to record their own thoughts and feedback about the content.  Our goal is to create the most cost-effective learning platform for the poorest people on earth so that they can improve their health and productivity.

And here’s what an improvement in productivity looks like: This subsistence farmer, Braole Felix,  planted half of his corn crop with his traditional practices that he learned from his parents and grandparents. Here’s what that half looked like.

Then he planted the other half of his crop using what he learned from his Talking Book’s agriculture recordings of his crop.

The Talking Book that Felix is holding is powered by software. Taking a page from Bill Gates and Microsoft, we want our software to run on the best available hardware for the job.  But there’s currently a real gap in affordable and usable hardware for people living on $1/day who want to learn, but can’t read and don’t have electricity. So we filled that gap with the Talking Book….

Thank you to Microsoft, the Alumni Foundation, and many of you in this room for the opportunity to respond to Dr. Martin Luther King, Jr.’s question ‘What are you going to do for others?”  I truly hope there is a person or a cause that inspires you in the same way that Dr. King has moved me to do my part to help people in the most impoverished places on earth have access live-saving and life-changing knowledge.