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IES BOUNDAR 62 WORLD AUTUMN 2013 STANFORD BUSINESS a week from hub health centers in their respective districts, the EHTs visit outreach posts to engage local populations in disease-prevention education and immunization. They also monitor the growth of infants and children and test bacteria levels in water and food supplies. Stanford GSB employs a team of seven data-collection officers who, in addition to conducting phone surveys, regularly visit health centers in their assigned districts to interview EHTs and managers of vehicle fleets at the district level. The data collectors have handheld scanners for copying monthly “tally sheets” of services performed at the centers and on outreach. Back at Stanford, researchers download the tallies and compile them. A more complete picture of health services delivery emerges, says Stanford GSB project manager Davis Albohm, when the tally data is combined with findings from the interview surveys of EHTs and tracking information obtained from global-positioning receivers attached to a subset of motorcycles and other vehicles. Real-time tracking data from the GPS program is fed to Stanford GSB researchers, who are working in partnership with geographic information systems (GIS) experts at Stanford’s Branner Earth Sciences Library. The GIS maps they create chart the routes and distances traveled by the health technologists. Population density overlays are applied to create colorcoded “heat maps” depicting what Kala Mehta, epidemiologist and lead research consultant on the evaluation study, calls “health-outreach coverage.” By linking this data with demographic health information surveys undertaken by Zambia’s Ministry of Health, an interdisciplinary team, including Eran Bendavid, an infectious diseases physician and assistant professor at Stanford School of Medicine, can draw correlations between EHT productivity, outreach coverage, and health outcomes broken down to the village level. Laura Hubbard, associate director of Stanford’s Center for African Studies, is one of four anthropologists doing qualitative research for the Riders study. Among them, Jess Auerbach, a doctoral candidate at the center, is focused on the human and technical aspects of transport allocation and staffing at Zambia’s Ministry of Health, gleaning insight into supply-chain sourcing and the trickle-down effects of transport decisions made at the top. REAL-TIME Data collection officer Mambwe Ng’oma (right) consults with an environmental health technologist at Masemu Health Center, Itezhi-Tezhi, Zambia. In an email, Auerbach recounts how one driver, at the end of a 12-hour shift in the Mazabuka district, received a call from hospital staff to pick up a patient at a remote clinic. Auerbach went along to observe. “First we had to collect a nurse from her home,” she wrote, “get fuel authorization [and] fetch a mattress from the hospital. Then we drove 90 kilometers in a Land Cruiser-turned-ambulance over sometimes all-but-non-existent roads.” At the clinic, an adolescent mother who had just given birth was collected with her infant and taken to the hospital by placing the mattress behind the front seats and hanging up an intravenous drip with wire. Usually that journey takes several hours by ox cart, followed by at least two more hours in one of the open-topped trucks that serve public transport needs in the region. In this case, it took just two-and-a-half hours. For Auerbach and the rest of the Stanford team, experiencing the adverse conditions firsthand has provided a deep appreciation and respect for those who deliver health care in Zambia — and driven home the idea that logistics and transport can have a big impact in underdeveloped settings, just as they do in developed economies. The study has broader implications for promoting economic development in places like Zambia, says Sonali Rammohan, associate director of the Forum. Indeed, understanding supply-chain dynamics can help companies and other ventures obtain agricultural commodities and other inputs, as well as finished goods such as textiles and artisanal crafts, from rural communities. There are also potentially valuable lessons for retail and other sectors looking to overcome last-mile distribution challenges. “Hopefully,” she says, “with what we learn, we can influence how multinationals and others practice,” in terms of sourcing and delivering goods and services. Δ Davis Albohm

EXCHANGE “It’s really important to get out and manage by walking around. Do not sit in your office.” — United Airlines CEO Jeff Smisek, speaking at Stanford GSB “You can’t come up with new ideas unless you observe the world with fresh, empathetic eyes.” — Author Lisa Kay Solomon at a Stanford GSB workshop on visual thinking for innovators 63 “If you hire, train, and mentor correctly, you’ll have someone who is better than you are. If they’re not, you haven’t done your job.” — Chef Thomas Keller, speaking at Stanford GSB BOUNDARIE IES SOME FINAL THOUGHTS ON BOUNDARIES EDITED BY NATALIE WHITE “When you’re starting a company or any venture, you’ve got to be open to alternative perspectives.” — Randy Hetrick, founder of TRX exercise equipment “See a picture of where you want to go and what you want to do in the world, and then work backward.” — Twitter cofounder Jack Dorsey, speaking at Stanford GSB “If you start something, don’t view your destination as final. Create possible exit points.” — Professor Anat Admati in advice to the Class of 2013 “The leader’s job is not to know the future. It is to create an organization that discovers the future.” — William Barnett Join the conversation @StanfordBiz