WASH 2.

0
How mobile technology can improve sanitation and reduce the prevalence of disease in Africa & South Asia

Prepared for the Gates Foundation by:

Hattery Labs is a creative team of technologists, entrepreneurs, designers, engineers, business strategy specialists and development experts. Luis Arbulu, a Hattery Partner, is a former Google.org investments lead with extensive experience consulting on games and gamification. Ben Armstrong, a Hattery Associate, has implemented technology and business development projects in Ghana, Nigeria, and Uganda with Google Africa and other organizations.

TABLE OF CONTENTS

Executive Summary Introduction Water, Sanitation, and Hygiene (WASH) Local Technologies Games & Gamification Country Profiles Sanitation Games Conclusions & Recommendations Implementation Plan Appendix

4 6 8 12 14 18 22 32 34 36

EXECUTIVE SUMMARY
This report suggests a plan for designing and building an effective mobile game that will help drive improvements in the use and maintenance of sanitation systems in the developing world.

Access to mobile and internet technology is growing rapidly in Sub-Saharan Africa and South Asia, even among those who lack basic sanitation infrastructure. Sanitation experts have tried hardware, legal, and community solutions to promote behavior change that increases hand-washing, ends open defecation, and helps assemble the sanitation value chain. These efforts have demonstrated some progress, but have not used new technologies to amplify and repackage their message. This report examines how the technology revolution in the developing world might be able to improve sanitation behavior. It focuses on the potential for mobile games to drive community learning and engagement in making sanitation improvements.

Sanitation game ideas might promote handwashing, encourage engagement in the sanitation value chain, and introduce challenges into the process of using the bathroom, discouraging open defecation. These ideas support hypotheses based on interviews and technology research, but they require significant user research and user testing in local communities before any game design can begin. The implementation plan includes building partnerships with local and Games for Change developers as well as Nokias local teams. With support from local developers and WASH NGOs, partners can begin to test these hypotheses with users and build an engaging and instructive game. Gamification has great potential to mitigate sanitation challenges,

The typical mobile game player differs significantly from the population of citizens that needs improved sanitation most. The citizens who both play mobile games and face substantial sanitation challenges are typically young men from urban slums. This group has Nokia S40 phones that can download Javascript games from the Nokia Ovi Store with low resolution and basic gameplay. The games designed for these users would also need to work for rural populations and women, both of whom seek to benefit from the games lessons. The game would include a visual storyline so an illiterate citizen could participate, and the game mechanics would include rewards and validation that those without consistent access to a mobile phone could replicate in real life. The purpose of the game is to begin a conversation around the sanitation challenges that the game players face and can translate for their fellow citizens to play out offline.

but it is neither a panacea nor the only application of technology that can have a positive impact on the sanitation environment. SMS and other mobile reporting tools can build on the lessons that a mobile game communicates in order to strengthen the sanitation value chain and continue to engage citizens in keeping their community clean.

INTRODUCTION

More people in the world today have access to a cell phone than have access to a clean toilet, and improvements in mobile technology are growing faster than access to improved sanitation facilities.1
While the level of sanitation and clean water resources is improving in Sub-Saharan Africa and South Asia, the numbers remain startlingly low, ranging from 15% to 55% access in seven sample countries in these regions. Moreover, focusing on access data does The main questions that we tried to answer were: not solve many of the public health challenges associated with poor sanitation. Instead, behavior change surrounding the use and maintenance of sanitation facilities must accompany improved ac-

What are the behaviors that any effort is trying to promote?

cess in order to mitigate the negative effects that poor sanitation has had on public health. Hattery has worked with The Gates Foundations WASH Team to explore how the rapid expansion of technology access might be

What is the process by which citizens might adopt the behaviors?

able to help ilmprove hygiene practice and the use and maintenance of sanitation facilities in Sub-Saharan Africa and South Asia. The specific focus countries include Senegal, Ghana, Nigeria, Ethiopia, and Kenya in Sub-Saharan African and Bangladesh and India in South Asia.

Why havent behavior change efforts seemed to work thus far?

We focused on the potential for mobile applications particularly games to change behavior around the sanitation process and hygiene practices. Our research began with a basic understanding of the unresolved challenges that WASH organizations face. There are numerous efforts to improve sanitation and hygiene through policy and hardware distribution, but behavior change has often been the most difficult problem to address. The first section of this report discusses why behavior change is such an important component of improving sanitation.

The need for behavior change centers on existing patterns of using and maintaining sanitation facilities. Improved sanitation facilities might exist within a community, but the processes for maintaining them from emptying latrines to transforming waste into usable fertilizers often fail to uphold public health standards. Nearly 90% of sewage waste is dumped into rivers, lakes, and streams that local communities use for drinking water in the developing world.2 Behavior change needs to ensure not only that citizens adopt the best hand-washing practices and use sanitary latrines, but also that community workers use the best practices for keeping latrines safe and protecting the water supply. Community groups and international organizations have invested millions in trying to resolve these challenges. Governments have passed laws governing the use of sanitation facilities, and celebrities have mounted information campaigns, yet the problems persist. It is not that the current approaches are failing, but instead that there is room for new efforts that approach these challenges with an alternative mechanism: mobile technology.

Mobile and social games are an untapped applied technology that can communicate important lessons and engage citizens in learning them. Moreover, games present a unique opportunity to tackle embarrassing circumstances with funny virtual stories. Local gaming industries in Sub-Saharan Africa and South Asia have only recently emerged to translate traditional local activities into mobile and computer games. While most of these games have focused on elite users with smart phones, local developers are confident in the potential for Java Micro Edition (J2ME) games for Nokia phones to reach a broad audience and achieve wide adoption. Interviews with local game developers as well as game developers focused on social change revealed a number of interesting options for using game technologies to promote improved sanitation behavior. This report reviews the conclusions from these discussions and suggests a plan for designing and building an effective game that will achieve wide adoption and help drive improvements in the use and maintenance of sanitation systems in the developing world. Hattery Labs is a creative team of technologists, entrepreneurs, de-

Mobile technology in Africa and South Asia has experienced unparalleled growth compared to other innovations in these regions. Even illiterate Africans use mobile phones to connect with remote family members and conduct business transactions, using emoticons to store contacts and other localized adaptations of these international technologies.3 Not only have cell phones have become a staple of African business and social life, but internet access is also growing rapidly across the region. The inherent risk with the introduction of these new technologies is that they will allow those with access to amass more wealth while those without are left facing abject poverty and enormous public health challenges. The purpose of this research is to understand how broadening access to technology among impoverished citizens can improve sanitation systems and, by consequence, public health.

signers, engineers, business strategy specialists and development experts. Luis Arbulu, a Hattery Partner, is a former Google.org investments lead with extensive experience consulting on games and gamification. Ben Armstrong, a Hattery Associate, has implemented technology and business development projects in Ghana, Nigeria, and Uganda with Google Africa and other organizations.

Giridharadas, Anand. Where a Cellphone is Still Cutting Edge.

This anecdote comes from personal experience working in agricultural

The New York Times. 10 Apr 2010.

2

development in Northern Ghana, where women farmers had used mobile phones to transact business, even though they were illiterate. The only male involved in the group was the secretary, who recorded meeting notes.

A. Carius, G. Dabelko, and A. Wolf. Water Conflict and Cooperation,

Policy Briefing, United Nations Foundation (2005).

WATER, SANITATION, & HYGIENE CHALLENGES

Local and international NGOs have generated substantial energy and fundraising for the Water, Sanitation, and Hygiene (WASH) sector.
WASH BEHAVIOR CHANGE AND EVALUATION
The public health goals underpinning WASH projects are: 1) increased use of improved sanitation facilities and 2) maintenance of the sanitation value chain from capture to reuse. The challenges associated with these goals are manifold. While existing data succeed in capturing access to improved sanitation facilities, they have been unable to determine if increased access corresponds to a similar increase in use. Thus, there is some uncertainty surrounding whether the installation of improved hardware will solve many of the public health challenges that stem from poor sanitation all of which relate directly to use, not access. Data related to access is a matter of infrastructure; data related to use is a matter of behavior. Surveys and other unverifiable data can help us understand use in specific contexts over time, but these are far less manifest and less accurate than access data, which is widely reported and has been tracked over time. There are nascent attempts to collect better data on the use of improved facilities, including a promising effort from SWEET Labs at Portland State University. SWEET has engineered and designed a prototype sensor that detects the use of water, sanitation, and other facilities to gather data that will allow NGOs and community organizations to respond to underuse or overuse of particular facilities. The detectors will not only allow such organizations to track progress, but also to manage the location and schedule of infrastructure construction and repair. This reports discussion of technology and mobile
Source: UN Joint Monitoring Programme

games is strictly concerned with the use of sanitation facilities and considers access largely a separate matter. While efforts to improve access are critical and admirable, the role for mobile, internet, and gaming is not to improve sanitation infrastructure, but to improve the practices associated with the use thereof. The sanitation value chain highlights the importance of maintaining facilities after they are used. Such maintenance is important irrespective of the quality of the latrine. We focus on the sanitation value chain out of recognition that sanitation infrastructure will long remain imperfect. The Gates Foundation has recommended that the sanitation community focus on building improved sanitation facilities without sewers out of concern that sewage systems will contaminate existing sources of drinking water, which sanitation run-off currently does. Current unimproved sanitation facilities as well as the new target sanitation without sewers will both require more active government, community, and commercial involvement in the storage, transport, and treatment steps of the value chain. Mismanagement of this process can render investment in improved sanitation facilities void. Methods of evaluating the sanitation value chain are currently weak, particularly compared to the importance of effectively executing this process. Mobile technology can both promote understanding of what an effective sanitation value chain looks like as well as evaluate how well the community is implementing that value chain.

Water, Sanitation & Hygiene Strategy Overview. Bill & Melinda Gates Foundation. July 2011.

This report draws wisdom from each popular WASH strategy while trying to avoid the recognized pitfalls of each. It is focused on seeing how technology can drive behavior change to:

Discourage open defecation

Deepen community involvement in the sanitation value chain

Promote the identification & use of improved sanitation facilities

Support the effective implementation of the sanitation value chain from capture to reuse

Underscore the community value of caring about sanitation

These are the foundational behavior change principles that guided our research around technology and games.

Source: The Bill and Melinda Gates Foundation WASH Strategy Overview (July 2011).

LOCAL TECHNOLOGIES

Mobile and internet technology in the developing world has grown rapidly in popularity and use over the past decade.
The initial uses of mobile technology were SMS and voice, and mobile quickly transplanted landlines in Sub-Saharan Africa. Cellular phones were cheaper to purchase, and the network was easier to develop. As coverage penetrated even far-flung regions of SubSaharan Africa and South Asia, urban and rural citizens alike have begun to purchase data plans and use the mobile internet. African entrepreneurs are now attached to their smartphones as Blackberrys become popular in Nigeria and Android devices gain more users in Kenya. Internet access is also beginning to extend beyond an expatriate luxury to an expectation of African business. However, smartphones are still limited to 5% penetration in SubSaharan Africa and internet familiarity is largely limited to the comparatively small African business class.8 Notwithstanding, even some of the cheapest new phones have features beyond SMS and voice, including JavaScript applications that allow for better organization, communication, and entertainment. The market for localized content on smartphones is growing steadily as the African and South Asian developer community expands and technical education programs improve. This section reviews the technology context in each of the focus countries particular attention to the

Internet users per 100 population

10

potential to build and distribute educational material focused on behavior change surrounding sanitation as a game or other technology application like a mobile comic book. It is important to recognize that while there is a consistent increase in access and use of mobile and internet technology, unreliable infrastructure limits growth in both of these industries. Poor electricity infrastructure prevents universities and large institutions from building out reliable infrastructure for the internet in many of the focus countries. Moreover, the electricity problem does not seem to be getting any better. It relies on a frustrating web of political and commercial arrangements that do not appear close to resolution. Of all the hopes for technology progress in these regions, electricity reliability is both the linchpin and the gatekeeper. Technology access and use varies widely across regions. Indian cities have emerged as technology hubs where mobile phones and

internet access are reaching more and more of the population, while rural India and all of Bangladesh continue to lack almost any access to the internet via computer or smartphone. Sub-Saharan Africa faces similar issues with inequality of access to mobile and internet technologies. Technology centers are sprouting in Lagos and Nairobi, but Ethiopia still lags far behind. The gap in access between urban and rural Africa is also widening as more creative hubs emerge in urban areas and rural areas sustain only limited mobile penetration. These are the main challenges that any sanitation program will face in deploying across the target region, and they remain a primary reason why any program should begin by focusing in one or two countries.

Africa lags smartphone market. Biztech Africa. 4 Nov 2010.

Quality of electricity supply

11

GAMES & GAMIFICATION

Games have proven the most successful technology tool in teaching and ushering behavior change.
Games have proven the most successful technology tool in teaching and ushering behavior change. The gaming industry in the western world has grown significantly in recent years with the advent of lucrative social network games. Gaming experts have begun to employ techniques that coax serious gamers to progress through a virtual world in ways that will make them more capable of solving real world challenges. Technology firms that build games in pursuit of positive social impact (Games for Change developers) have begun to design games that teach financial literacy, environmental awareness, and hunger in the developing world. This section investigates what makes a game and begins to discuss why games have been effective tools for behavior change. The purpose is to develop a shared language around games and generate shared assumptions around why we think that games can be a powerful agent of behavior change. Games are not just typical online or offline experiences; they have specific characteristics that separate them from ordinary life. It is important to understand that games must be:

GAME MECHANICS

Fun: must be enjoyable Separate: circumscribed in a specific time & place (game environment) Uncertain: outcome of activity unforeseeable (win/lose, different scores) Non-productive: participation does not accomplish anything useful as its primary objective (though games can have positive side-effects) Rule-based: has boundaries that are different from everyday life Fictitious: accompanied by the awareness of a different reality 9

12

The most important elements of any specific game are the rules that govern it and how those rules engage the player. The mechanics of the game not only drive the player toward a certain outcome, but they also can determine the players ultimate enjoyment. Game mechanics are the building blocks of how to make a game fun and entertaining. Decisions underpinning game mechanics are based in three main categories.

See A Brief History of Social Games poster on p.16

First, how does the game navigate the player through a game environment?

The game mechanics determine how the game communicates with the player to guide them through the course of the game. Are there turns between the game player and another? Are there different benchmarks that the player must meet and past? Does the player progress through stages, levels, or specific tasks? Are there multiple different game environments or just one consistent setting? Answers to these questions inform game design and gameplay.

Second, how does the game test the players skill?

Does the game set specific challenges that the player must overcome to proceed? Games can institute point systems, adversarial arrangements, or levels based on completion of specific tasks in order to assess the players craft. Good game mechanics vary the level of obstacles for different players and allow players to remain challenged over time.

Third, how does the game validate the users experience and reward the players performance?

Perhaps the most important element of game mechanics and gameplay is validating the players performance. Games include leaderboards, badges, and point systems to give players signals of their success. Badging has been particularly successful recently in order to build a players sense of status and provide incentive to improve over time.

Recent Addition

Social gameplay is a more recent addition to game mechanics, which layers on players social networks to improve the players challenges through collaboration or competition with friends and others in the same game environment. Interaction between fellow game-players can also enhance the validation that a player receives from achieving points or badges as validation for successful gameplay.

Caillois, Roger. Jeux et Les Hommes (Games and Men). 1960.

13

USER EXPERIENCE & BEHAVIOR CHANGE

The two key components of user experience for games are enjoyment and problem solving. Particularly for games with change, good game design masters a balance between the two. Making a game enjoyable involves the nature of the challenges that the player faces. Sports games and racing games, for example, integrate adrenaline-filled challenges that excite players and keep them returning to the game. Humorous games can keep players entertained and curious about the circumstances that the game might expose. As we will explore below, the fictional and separate characteristics of the game environment are particularly well suited to capture embarrassing situations, add humor, and transform them into an enjoyable game environment.

The main challenge with enjoyable games, however, is to communicate substantive lessons. Enjoyable games might often have clear challenges that players can overcome and achieve rewards, but the enjoyment might last longer than the awareness of the environmental context in which the player is acting. The player might not realize why they are solving a particular problem in a particular way. They might not recognize success until they receive the badge or achieve a certain point total. The game can be structured to communicate lessons and a narrative, but the player might focus exclusively on game mechanics and moving to the next level. This is the challenge for designing a game that both communicates a lesson that sticks with the player and achieves enough popularity to reach a wide audience. The lesson needs to be subtle enough not to dampen the games enjoyment, but present enough to translate into real life behavior.

14

Source: Baranowski, Tom et al. Behavioral Science in Video Games for Childrens Diet and Physical Activity Change.

GAMIFICATION
The most recent upsurge of technology startups has generated substantial excitement around gamification (g10n): applying the principles of game mechanics to real life challenges in order to make them more engaging. Organizations have gamified processes large and small from the basic challenge of providing personal information for a web service to overcoming critical challenges in the education system. G10n has been used to promote innovation, healthcare, and employee performance. Scientists designed the Foldit game to predict protein-folding patterns that will help develop treatments for HIV, Cancer, and Alzheimers. Play ers interact with amino acids and develop protein arrangements that provide important data points to support medical research. gDitty is an activity meter that seeks to improve child health by providing positive feedback and rewards for children who exercise. There is reasonable fear that gamification can cheapen the importance of the original challenge, like exercise or cancer research. If the very definition of games defines them as fictional and separate from the real world, how does gamification merge game principles with the real world? Done correctly, gamification does not transform the real-life activity; instead, it makes the activity more engaging and more validating. Good gamification will also work to ensure that this same engagement and validation exists with the activity once the game is removed. The challenge with sanitation games as described below is to translate the positive behavior that a player might exhibit in a game into real-life behavior that a player practices daily.

15

COUNTRY PROFILES: TECHNOLOGY AND SANITATION

10

A fitting country must have demonstrated some progress in sanitation infrastructure, but still face significant challenges with open defecation and the sanitation value chain.

The purpose of this section is to review the national characteristics of technology and sanitation that might make a country a good fit to test a sanitation technology program, particularly a game. These countries will also have good mobile penetration and reasonably sound technology infrastructure in rural and urban areas alike. It is this overlap between improving sanitation and somewhat developed technology that is key for building and testing a programmatic technology response that promotes behavior change around sanitation.

Source: Hattery team analysis of public data (1:most developed, 7: least developed)

10

The sources for Facebook penetration data come from internetworldstats.com, and the sources for internet penetration include both Internet World Stats & World

Economic Forum Data. World Economic Forum data is the sole source for mobile penetration and electricity data in the focus countries. All country-specific sanitation data comes from the WHO/UNICEF Joint Monitoring Programme statistics.

16

SENEGAL
While Senegal has long been a political example for the rest of West Africa, its economic growth has been comparatively weak. However, more recently Senegals mobile and internet industries have started to grow and promise to expand even more after companies like Google have opened offices in Dakar to build a presence in Francophone Africa. Senegals sanitation indicators all demonstrate improvement with remaining room to reduce open defecation in rural areas. There remains a large gap between sanitation practices in rural and urban areas, which might make introducing a solution in one context difficult to gain traction in another. Senegals internet penetration is strong by African standards at 16%, and its Facebook penetration is 5%, but these numbers are still not sufficient to use as a platform for building a sanitation application or game. The telecom market in Senegal is comparatively competitive for the region, and the mobile penetration is high and improving. One problem area is electricity: Senegal recently experienced a rapid decline in the reliability of its electrical infrastructure, which could bode poorly for certain telecom networks. However, this unreliability should not largely affect the potential for a mobile game. Senegal does not have a well-developed technology industry, though the growth of mobile and internet industries have attracted international conglomerates like Google and local development companies like Joko Labs. The commercial support for game development is still weak with comparison to Nigeria, Ghana, and Kenya, but the market is worthy of further exploration.

NIGERIA
Nigerias enormous population and crowded slums present significant opportunity for impact, but also an unwieldy technology challenge. Nigerias technology is concentrated among the upper classes wielding Blackberrys and enjoying among the most reliable access to the internet in the region. Nigerias sanitation is relatively mediocre, and its number of mobile subscribers is the highest on the continent (due to its enormous population), but the percentage of mobile subscribers is largely unimpressive and the reliability of its electrical infrastructure is even less so. Notwithstanding the discouraging statistics, Nigeria has the most vibrant commercial technology community in the region. Nigerias developer community includes incubators and young programmers who have experience building apps and games. The ethos for supporting technology that solves social problems is present in Lagos, but it remains an open question whether the infrastructure in-country is the most appropriate to support widespread adoption of a mobile game to tackle sanitation challenges.

ETHIOPIA
While Ethiopia faces the most difficult sanitation and water problems of the focus countries, it also has the most implacable technology challenges. Ethiopias longstanding authoritarian regime imposes a telecommunications monopoly on its people that has prevented expanded mobile phone penetration and almost any internet access. While a game might be an excellent fit to respond to Ethiopias urban and rural sanitation challenges, it is unlikely that the technology exists to support it. Moreover, while Addis Ababa has experienced remarkable growth in recent years, it has not attracted the technology talent that Nigeria, Kenya, and Ghana have. This is likely due to the confluence of a poor education system and minimal technical infrastructure to support innovation. As a result, there might be potential to introduce a mobile game in Ethiopia, but the game itself would need to serve as a driver of innovation, not a tool introduced in response to existing innovation.

GHANA
Ghana presents a remarkable opportunity to confront sanitation challenges with technological tools. The small West African democracy has among the worst sanitation access and highest open defecation rates among the focus countries. Alongside a flagging sanitation sector is a booming telecommunications industry, which leads the focus countries in mobile penetration. While fewer Ghanaians than Nigerians, Kenyans, or Indians use smartphones, mobile phones have the broadest penetration in Ghana, which speaks positively of the breadth of distribution for any potential game. Ghanas developer community is growing alongside the presence of Google and a focus on hosting more events for developers to engage with new technologies and improve their skills. Leti Games, with presences in Ghana and Kenya, presents one particular opportunity to learn more about this market.

KENYA
Kenya is a very strong fit to feature technology solutions that address sanitation. Access to sanitation remains a significant challenge in urban and rural Kenya. In rural Kenya open defecation has gone up over the past decade, while some of the most expansive slums

17

KENYA (CONTINUED)
on the continent exist in Nairobi. Public health challenges in Kenya have persisted while the technology community has blossomed. Mobile and internet technologies are emerging as their own industries as international tech companies establish offices in Nairobi and Kenyan entrepreneurs build their own enterprises that build new products and even incubate new ventures like they do at iHub in Nairobi. The game and app development community in Kenya is thriving with the recent launch of Ma3Racer, and they are interested in tackling local problems that require their attention and could use their support.

INDIA
India presents a very strong opportunity for technology to promote positive public health change, particularly in the reduction of rural open defecation. Despite booming technology operations in Bangalore, Hyderabad, and Delhi, internet and mobile penetration in India lags behind certain African countries per capita. However, the commercial and technical infrastructure in India remains unmatched in the region. There are over 120 Million active internet users, and multiple social networks boast millions of Indian users. The Android platform is growing rapidly in urban Indian communities, but smartphones have yet to penetrate rural communities, where sanitation is the largest problem. Rural India faces the worst open defecation problem of any of the focus countries with 67% of rural citizens using the practice. India combines a strong technical infrastructure and mobile phone use with very poor sanitation statistics and a sanitation value chain in need of serious attention. This represents a particularly appropriate setting for technology applications like games to have an effect.

BANGLADESH
Bangladesh has among the highest quality in sanitation infrastructure with 57% of the urban population and 55% of the rural population who enjoy access to improved sanitation. This is not only the second highest among the focus countries, but it also demonstrates a remarkable equality of resources between the rural and urban populations. This is in stark contrast to most countries, which seem to fail on most rural metrics. However, there has not been any progress in urban sanitation in the past twenty years, while rural sanitation has improved by over 20%. There are a few possible interpretations of these numbers. The first is that urban areas have long had the infrastructure to improve sanitation, but they have focused on changes in sanitation use and behavior, while the rural infrastructure caught up. Alternatively, investments in rural infrastructure have brought new infrastructure and drastically reduced open sanitation, but the maintenance and protection of the value chain underpinning these facilities. The plummeting open defecation numbers are encouraging, but there is high potential in Bangladesh to work on follow-up behavior change with rural citizens to ensure that they adopt appropriate maintenance practices around the new infrastructure. While Bangladesh has encouraging sanitation infrastructure, the existing technology access is low. GrameenPhone, the leading mobile operator, offers some mobile payments options, but overall technology is very low in rural Bangladesh, where sanitation efforts seem to be most needed. Only 3.3% of the countrys population are internet users, and mobile phone is also the second lowest of the focus countries. Thus, while Bangladeshs sanitation sector has demonstrated some promise, the technology infrastructure does not appear to be sufficient to support an innovative mobile or internet solution to behavior surrounding sanitation.

18

19

SANITATION GAME DEVELOPMENT AND ANALYSIS

Expanding access to technology has created an opportunity for new approaches to persistent problems like unimproved sanitation.
The rise of Games for Change and gamification in recent years offers a solution even more targeted toward eliciting behavior change. This section begins to investigate what games for sanitation would look like. What would they try to accomplish? What game mechanics might they use? What technology might they employ? Which partners might be able to build and deploy the game? Interviews with some of the regional and Games for Change developers from the table below explored more specific possibilities around sanitation games.
Image Credit: gamesforchange.org

GAME OBJECTIVES
Any sanitation game has three purposes. First, it seeks to increase awareness around the importance of sanitation to the community. Games can highlight the value of sanitation processes to public health and make a convincing link between the two. The primary lessons that they communicate might also improve discernment between improved and unimproved sanitation infrastructure. Second, sanitation games can encourage specific behavior change around sanitation practices. They can focus on ending open defecation or promoting hand-washing at the individual level. They can encourage better maintenance of latrines and the avoidance of waste runoff into the water supply. Third, games focused on the sanitation value chain seek to make community members more engaged in the outcome and sustainability of the sanitation ecosystem. Engagement of this kind requires more than mere awareness, but is not linked to a specific call to action. Instead, playing the game demonstrates that some new action is required in order to maintain the sanitation value chain.

LOCAL GAMES
The volume and quality of content coming from India and the remainder of the focus countries has differed sharply. As expected, the Indian developer community has produced a variety of local applications and games that appeal to the broad Indian user base. There are a number of large game developers on the sub-continent with a focus on appealing to the growing Indian upper and middle classes who have begun to play online games and own smartphones. The Indian gaming sector is a particularly diverse and changing industry, where Indian developers might generate local content or provide inexpensive contracted game design or development services for western gaming companies. Their reputation among western developers seems to be that they employ a rote process from which they generate a high volume of games with the same basic model and gameplay. There are fewer African game development operations, though they are focused almost exclusively on generating local content. African

20

Games for Change

Regional
Source: team analysis

games have emulated real life experiences like a crowded car park or a bus weaving through traffic. Developers have built these games for mobile and online platforms, including the Apple Store, Google Play (f.k.a Android Market), Nokia Ovi Store, Facebook, and SMS. Because they have yet to scale widely, African game developers have been highly customized on the games that they develop for their users. They understand a specific target demographic and adapt the game to their usage habits. The local relevance of the content, coupled with the focus on specific local users make African game developers powerful potential partners. These local games also have significant limitations, some of which relate to infrastructure problems in country and others of which derive from inexperience and technology platforms with finite potential. The few local African games that exist have frequent bugs in the programming and some flaws in the game design. One game focused on a crowded car park, for example, has inconsistent and

poorly enforced rules around the time allotted for the player to extract their car from the lot. These inconsistent rules make the validation of points and progress less effective and render the user less engaged. Moreover, while sports and racing games have proven the most popular games in many contexts, this subject area focus poses a challenge for developing a local social impact game. If players expect a game to capture what they find the most stimulating and entertaining, they will be less likely to engage with a game that they find preachy or centered on a less comfortable subject matter. However, these obstacles are definitely surmountable; a sanitation game can adopt analogous gameplay to the entertaining and delightful experiences associated with sports and racing games. Even still, since this game seeks to target users in urban slums and rural areas who face the most serious sanitation challenges, it is less likely that the users will be experienced gameplayers. Thus, the game will have a short grace period where it is a fascinating and new experience for which players do not have exceedingly high expectations.

21

SOCIAL IMPACT GAMES

Companies focused on social impact games have grown rapidly in recent years with a particular focus on education and environmental awareness. A number of technology companies have built games that help communicate these lessons, including International Racing Squirrels, which focuses on financial literacy; Career Explorer, allowing students to explore and consider various professional options; Climate Change, exploring a world in which we cannot take natural resources as granted; and Food Force, which exposes the user to the challenges of distributing food aid in poor countries. These games and others like them take serious social challenges that are interesting or important to a specific audience and make them fun and engaging. The education in these games is often subtle. Channel 4, a leading news organization in the UK, sought to tackle the growing problem of youth indebtedness. 50% of British young people are heavily in debt, and 20% of all British are behind on their payments. They reached out to Playniac, a social gaming company that had experience communicating these problems through games. Playniac found a particularly indirect way of helping students understand the problems of debt and the importance of money management. International Racing Squirrels is an online game allowing young players to manage a racing team and compete, all the while spending and managing a strict budget that they need to balance in order to continue playing. The challenge in the

game mechanics is not necessarily to win races, but to remain financially solvent. This is the brilliance of good social games. They reappropriate familiar game environments with new game mechanics that place additional importance on validating the lessons that the game is trying to communicate. Points and badges become associated with mastery of the educational lessons rather than with smaller victories that might have been traditionally associated with that environment. These games have been built on a variety of technology platforms with an increasing focus on social sharing through Facebook. Experienced game developers have designed and built them well with few bugs and wide access. They have a strong focus on having a positive social impact with sound research on behavior change to support their claims. However, these games often feature unrealistic game environments with minimal focus on how the lessons might translate into offline behavior. In the same way, these games can measure how much users engage, but they have difficulty assessing how that engagement might lead to behavior change. Thus far, popularity has been conflated with successful behavior change in Games for Change. Games for change need a new metric for evaluating their success. Finally, Games for Change have not successfully adapted games to local contexts. This is not a flaw of the industry; it is just an area where they have not been tested. Their games have proven interesting and popular in western contexts, but there is minimal evidence for us to evaluate how these strategies would work in the focus regions.

BUILDING A SANITATION GAME

We interviewed leading local and Games for Change developers to gather a more specific understanding of how best to build a sanitation game. The interviews generated strong insights regarding:

The nature of the gaming ecosystems locally and for social impact games The technology on which popular local and social impact games have worked The user who is most likely to play local or social impact games The game mechanics most effective in communicating local sanitation lessons The partnership model through which we could test & distribute the game to users

22

This section reviews specific insights that we drew from conversations on these topics. Where there was general consensus among a group of developers, we state the insight broadly. Where the insight came specifically from one developer or organization, we attribute it to that source. It is important to recognize from the outset that while technology and gaming environments often differ significantly within countries and within regions, there is a stark contrast between the gaming ecosystem, user, and technology in India versus the rest of the focus countries. These conclusions will discuss the conclusions for India alongside insights for Sub-Saharan African countries. Since there were no specific developers who generated technology for Bangladesh with whom we spoke, we can only offer our best inferences on which technologies might apply.

THE GAMING ECOSYSTEM

Local developers and Games for Change developers employ a hybrid business model. Some of their work is based on contracts to develop games for companies and organizations, while they also can build and launch their own games online. Games for Change developers, in particular, rely heavily on a partnership model in which their funding comes from NGOs, governments, and other organizations focused on social impact. Thus, the games for change developers typically have a partner to provide research on the behavior that the game should elicit. Playniac, for example, has partnered with the BBC, DreamWorks, and British Gas, while Playerthree has partnered with the United Nations and the Special Forces Police. The partnerships with these organizations began with a problem that the non-technical partner wanted to address or a lesson that they wanted to communicate. The Games for Change developer then used their expertise in game mechanics and development to build a game environment that responded to the partners research and guidance. Indian game developers seem to have a similar contractual relationship with certain organizations, though not focused on games for change. There are a numerous of Indian game development organi11

out an advertising network or some way to make game development sustainable in a local market where demand exists only for free games on platforms where the opportunities for advertising is limited. The challenges of this marketplace has made it such that some developers build games on the side while maintaining paying technology jobs during the day, like Planet Rackus, who developed the enormously popular Ma3Racer game for Kenyan mobile phones. Other game developers have left their technology careers to build applications and games full time, like the co-founders of Pledge 51, which works full time on application and game development at a Nigerian incubator. In addition to launching a popular Blackberry application on the Nigerian Constitution, the Pledge 51 team has built Danfo, a traffic game resembling Frogger where users navigate a common Nigerian bus through oncoming traffic on their feature phones. Finally, Leti Games is the most developed African game developer with a presence in Ghana and Kenya. Letis portfolio of games is primarily client work, though they have built some proprietary games that they have launched online or through various application platforms. African technology advocates like the Fate Institute of Design, which has incubated Pledge 51, and the Meltwater Entrepreneurial School of Technology, which has supported Leti Games, have been instrumental in supporting the growth of the African game industry thus far. These organizations can only help game developers for so long before they need to build out a client base or a payment structure that can support their continued development. Growing mobile payments infrastructure in West Africa and a strong M-Pesa network for payments in Kenya provide a sound foundation for some payment transfers for mobile applications based on use and appreciation, but it remains to be seen whether these types of transfers could help sustain a business.

zations that have generated and marketed their own game materials and launched them on the Android Market or online, but this approach is less common than developing games under contract with larger organizations. The nascent African game development industry has taken a different approach. With only a handful of developers in the marketplace and no organized demand for local content projects, African game developers have sought to build their own games and market them for free. These developers are beginning to look for new opportunities to build

11

The reputation, according to one Games for Change developer, is that there is an abundance of Indian developers who seek contract work but do not produce

high-quality games on their own. Instead, they re-use game concepts that have already been deployed and adapt them for their specific purposes. This sentiment was not repeated, though it is important to worth noting considering that we only had limited interaction with Indian developers throughout the interview process.

23

THE TECHNOLOGY
The most accessible technology platforms for the target population are Javascript Micro Edition (J2ME) for feature phones like the Nokia S40 Series and SMS games where players send and receive texts in pursuit of a particular goal in a specific game environment. Games for Change have typically been built for different computer platforms, but they are mostly online games with significant Facebook integration. These are not terribly relevant models for the countries in which we are focusing. Playerthree, for example, had a developer who built games for Java-enabled devices, but has since shifted to develop for iOS (Apple) devices. Multiple Games for Change developers suggested that building a game for J2ME would be particularly difficult considering the poor graphics and limited game functionality on feature phones. Nonetheless, these same developers understand the technology limitations of the local environments and accept that such games are possible and the most accessible for the focus populations. Indian developers had some disagreement over what would be the best technology platform to host a sanitation game. Yash Sharma, a technologist who founded Change Republic in India, said that this should be a mobile game if it seeks to reach those who are most affected by sanitation problems. Moreover, since Nokia phones remain the most popular in India, a J2ME application for Nokia would work well. Khel Studio thought that a computer game or tablet game might make more sense, even in rural India. The Indian Government is making substantial investments in the Aakash Tablet, a low-cost device for childrens learning in rural India that supports Android games. It is unclear how functional these devices will be and the The African developer community almost uniformly agreed that mobile J2ME was the best platform on which to build a sanitation game. If citizens have a phone, the phone is probably a feature phone with J2ME capabilities or a dumb phone with only basic SMS and voice functionality. Planet Rackus estimated that the Nokia S40 Series supporting J2ME has about 80% market-share among the population that we are targeting in Kenya, and the numbers are similar for Sub-Saharan Africa writ large. Local developers are tempted to build games on more sophisticated platforms than J2ME (Flash, Android, iOS), but all recognize that J2ME is necessary for the game to achieve wide distribution. Internet penetration is less than 10% in most of the focus countries, and smartphone penetration has even lower figures. The more basic option is to build a game through SMS, which is a possibility, but has far less interactivity than a J2ME application. Thus, for mobile applications in Sub-Saharan Africa targeting a poor population with minimal access to sanitation, J2ME games are the best option. The popularity of the Nokia S40 series presents a distribution opportunity through the Nokia Ovi Store, which we will discuss in more detail below. extent to which they can support an interactive game. However, if the deployment of Aakash tablets proves promising, it would provide a ripe opportunity to develop more interactive sanitation games that can reach millions of children across India. The opportunity with Aakash tablets is largely speculative, so this report mentions it more as a potential option pending successful distribution rather than part of a platform that we should rely upon for implementation.

24

THE USER
Typical game players are young males. While gameplay among women has grown in the US with the rise of social games,12 local games in Sub-Saharan Africa typically appeal to urban males between 16 and 30. Local game developers research has indicated that women are more likely to read comic books than play an interactive game on a mobile phone. Reaching women is critically important in designing a technological solution to sanitation challenges, and we will offer recommendations that speak to this challenge. In India, a leading gaming entrepreneur said, the Target Audience in India that does play games has ample knowledge of sanitation and hygiene. Its the truck driver and the maid servant who need the lessons unfortunately they only use voice services. Another Indian technologist disagreed with this assessment, arguing that there was some penetration of J2ME-enabled phones in urban India. The disputes between sources in India revealed more than anything that technologists are not keenly aware of the user who faces these types of sanitation challenges since they do not cleanly align with the typical game player in the region. The same goes for Sub-Saharan Africa. Local developers largely guessed at the user habits of those who faced significant sanitation challenges because they did not typically interact with or design applications for these citizens. Nonetheless, most African developers were confident that a J2ME application would reach a wide audience in urban slums they were less confident about reaching citizens in rural areas. This is the primary challenge: sanitation problems are worst in rural areas while access to technology is best in urban areas. The best solution reaches those with access to technology and sanitation behavior in need of improvement. There are still substantial sanitation challenges in urban areas where technology is There is an outstanding concern that a mobile game will not affect enough women directly. Womens sanitation practices are probably the most important in the community, and it is critically important that any message channeled through technology reach the communitys women. There is great potential in combining a mobile game with a mobile comic book that appeals to womens technology use habits and communicates the same sanitation messages. Local developers can also create local applications that crowdsource improved sanitation facilities so women can find the nearest facility with SMS. However, determining the right functionality with a SMS application will be particularly difficult with rural women because many are illiterate. There is no easy answer to keep women engaged, so it will be critical to maintain gender equity during all user research and user testing to understand in more depth how women use mobile technology and how game developers might be able to communicate an engaging message. more concentrated, but the game would fall far short of its potential if it did not penetrate rural areas, which pose a much larger distribution challenge. Ultimately, urban game players need to ensure that the game and its lessons travel to rural areas either when they visit their family in the village or via word of mouth with their family and friends outside the city. Planet Rackus suggested that this model was how local games gained traction in rural areas urban players recommended the games to family in friends in rural areas. Moreover, when urban-dwellers travel to rural areas and bring their mobile devices, their younger cousins play with the device and can interact with the games. This particular use case of knowledge transfer from city to village should inform elements of game design. In particular, it is important to develop the game so that components that exist on the device can be reproduced and extended in real life interactions.

12

Ingram, Matthew. Average Social Gamer is a 43 Year Old Woman. Gigaom. 17 Feb 2010.

25

SANITATION GAME MECHANICS & DESIGN

The most interesting content from each conversation with developers centered on how to build a game that promotes behavior around sanitation. In the course of brainstorming, we agreed that the users were young urban males (age 16-30) who live in urban slums and use Nokia S40 series mobile phones, which they primarily use during their commute to work and during waiting periods. From these assumptions, we agreed on a series of ideas that might work as part of a sanitation game. While the following offers several inferences regarding what might work best for sanitation games in the local context, it is important to remember that these are just hypotheses. Extensive user research and user testing with the local population are required to confirm these initial inferences. The chief component of the game mechanics is the narrative. More important than the gameplay is the story that you are trying to communicate, Planet Rackus insisted. The story is not only what helps teach the sanitation lessons, but it also makes the game relevant to users. Each games storyline needs to focus on one or two specific sanitation goals toward which the gameplay can drive. For example, a game that tries to promote the importance of soap in hand-washing will highlight dirty hands as the game environment. In order to tailor the game to these specific users, who are often illiterate and speak different languages in different regions, the narrative will be highly visual. Telling a story with visual cues on a low-resolution screen is perhaps the most Once the basic storyline is set around a fundamental sanitation goal, the game designer can build specific challenges and achievements into the gameplay. The table above outlines a few sample challenges that respond to hygiene objectives. The challenges can respond to unhygienic behavior, and rewards can be distributed according to demonstrated understanding of good sanitation. Moreover, the gameplay that integrates those challenges should respond to demonstrate use cases for the game. Some players will engage with the game in short spurts of downtime while others will spend more sustained time trying to master the game. Gameplay should accommodate both of these diverse use cases. While the table below demonstrates a few examples that capture basic game mechanics in a few sanitation scenarios, our research explored a few game ideas in greater detail. difficult challenge of game mechanics. The primary method of avoiding a confusing storyline built on visuals is to stage a number of small scenes as a progression that builds the narrative and gives the user multiple opportunities to understand the primary argument.

More important than the gameplay is the story that you are trying to communicate.
Planet Rackus

26

27

SAMPLE GAME IDEAS

0:30

GAMR345

LEVEL 2

12

Soap Wars
The first game seeks to encourage hand-washing with soap. The player dispenses soap particles on a pair of hands that need to be washed. The soap dispensers objective is to eliminate all of the advancing bacteria and other germs on the hands. The games educational purpose is to highlight the importance of soap to public health and contextualize where it should be used. The levels of the game will focus on hand-washing in different contexts. Each level is introduced with an image of the person in context (e.g. before eating food, after going to the bathroom, after playing football, after doing manual labor). The next image represents two hands preparing to wash with a soap particle dropping onto the hands. Finally, there is a microscopic view of the soap dispenser shooting soap particles to destroy germs on the hands. The image progression builds the storyline without adding text. The user will use the keypad to move the soap dispenser right and left to aim the soap particle shots at the germs that threaten the hand. At each progressive level, there are more germs to defeat that might require more soap to dissolve. Player will collect points for each bacterium defeated and bonus points for defeating particularly big (disease-causing) germs. The player will only have a pre-determined amount of time (i.e. 100 seconds) to complete each level. The gameplay is simple, but the narrative around using soap to defeat evil germs is critically important.

Sanitation Heroes
The users in this case play as community sanitation officials at different stages of the sanitation value chain, including dumping, transporting, storing, and reusing feces. The game frames sanitation workers as community heroes who save lives and teaches citizens to value the work of keeping their water and sanitation facilities clean. The game is designed as a mix between a comic book and a memory game where players associate various images with each challenge in the sanitation value chain. The player is prompted with a series of images that denote the particular stage in the value chain. Subsequently, the player must complete a challenge (in the form of a minesweeper- or memory-type game) to confirm the correct course of action at that stage. Once the player has completed the challenge successfully, they can see the particular stage of the value chain implemented. As validation, the player can see the community health score increase with each successful choice. We can source details and images of the scenarios in the sanitation value chain from user research and WASH experts.

28

Toilet Hunt
The purpose of toilet hunt is to end open defecation and highlight the other options for defecating in more sanitary locations; this game can use the same mechanics to encourage more hygienic behavior around hand-washing and bathing. In this game, the user plays as a citizen of an urban slum who needs to use the bathroom/sink/shower. The purpose is to acculturate citizens to understand and employ the most sanitary process in finding the right public health facility to use; using it; and cleaning up afterwards. The game adds a level of excitement to an otherwise banal process of personal hygiene, placing obstacles between the user and doing their business. Each level begins with an image of a players face that makes it clear they need to use the bathroom (or another image that suits the type of hygiene activity required). The next screen displays an overhead view of the player situated on a map of an urban slum. The player can navigate into buildings to see if there is a sanitary toilet where they can use the bathroom. Once the player finds and decides to use the appropriate facility (within a limited time period), they are awarded points for their speed and accuracy. The successive levels present the player with new challenges (e.g. hand-washing, shower, cooking, bathing). The Each level will have a pre-determined time limit within which the player will need to find and use the appropriate facility. The player will at times be prompted with a bonus round where they can decide the appropriate way to clean and maintain the facility. The challenge with this game, as with the others, is finding rich enough graphics in a J2ME game to communicate these stories and choices without words. The game design will need to make the messaging abundantly clear on a very small screen with poor resolution. However, since these storylines strike at the heart of problems that affect millions of lives around the world each day, a strong effort is worth it. player engages with the game on a map screen where the user can choose to move with the 2,4,6,8 keys. When the player reaches the entrance of a potential facility, they can use the Select/enter key to go in. Once in a facility, they will be prompted with the choice to use it (# key) or find another (* key).

29

CONCLUSIONS & RECOMMENDATIONS

The idea of a sanitation game merits a limited pilot program where a local developer builds a prototype and conducts extensive user research and user testing alongside a community sanitation organization.
The prospect of a mobile game that promotes good hygiene is exciting for the technology and the WASH communities alike. The idea merits a limited pilot program where a local developer conducts extensive user research and user testing alongside a community sanitation organization. The two organizations can work with the Gates Foundation and its technology partner to answer critical questions on the detail of the games sanitation objectives, mechanics, and how it would be distributed. The key is to make sure that those facing sanitation challenges play the game, or are somehow exposed to the lesson that the game seeks to espouse. It is unreasonable to think that all or even most of those who live in poor sanitation environments will play the game on their phone, but then we need to target users who have strong social networks and trust within the community to spread the lessons. Distributing the game to teachers or community leaders along with free devices is a particularly compelling model. It is critically important that the game is accessible for illiterate citizens. This does not mean that it cannot include any words or phrases, but the images do have to tell a story independently. In order to ensure that the game is accessible offline, these images can be replicated as teaching materials around the community that become memetic representations of sanitation behaviors based on familiarity with the game. There are numerous ways to begin generating energy behind the game development process. One is to host a WASH 2.0 weekend in which technology partners across the focus countries host hackathons where developers and community sanitation organizations While the definite game mechanics and storyline cannot be determined without significant local input, it is important to begin the process with a model for partnering with developers to conduct the initial research and game design. As described in the table below, we highly recommend that a local developer take the lead in researching, designing, and building the game, but we think that a Games for Change (western) developer could advise on building the storyline through images and game mechanics to fit the storyline. The geographic focus of the game should initially focus on Ghana and Kenya, where the combination of sanitation challenges, mobile phone penetration, and willing developers best align. India also presents a strong opportunity for impact, though the diversity of and uncertainty around the local technology community has prompted just as many questions as answers. come together to brainstorm ideas and develop prototypes of games and applications that improve sanitation in their communities. This can begin in the cities but gravitate toward the rural areas over time.

PARTNERSHIP MODELS

30

Advisors

Development Models
DEVELOPER SHORTLIST
Ghana and Kenya are the best locations to research and test a sanitation game; it is even more encouraging that some of the most creative and promising local developers came from those countries. Leti Games and Planet Rackus are the top two local game developers that we interviewed. Leti Games has experience working on contract and has a presence in Ghana and Kenya; however, Planet Rackus has more graphics skill and ultimately seem to be more talented developers. The Games for Change developers with the most excitement and insight associated with this idea are Playniac from the UK and Ayogo Games from Canada, both of which expressed interest in advising on any resulting development project.

ALTERNATIVE PLATFORMS
India has enormous challenges and a buzzing technology industry that the recommendations above largely ignore. In addition to building a J2ME game for specific African contexts, which from our research appears to be the most appropriate focus, there is also an interesting opportunity to build a more interactive Android game for the Aakash Tablet to distribute in Indian schools. This process, as mentioned above, is ongoing and will require close attention to the capabilities of the tablet and any restrictions on its use. In any case, building the tablet game would align with nearly all of the game mechanics discussions above, though it would unlock plenty of new game opportunities depending on internet access and ease of use.

31

IMPLEMENTATION PLAN

1
CHOOSE PARTNERSHIPS After presenting this research to key stakeholders within the organization, the first steps are to choose a partnership model and select technology partners, including developers and a general WASH 2.0 partner to manage developer relationships, hackathons, and the pilot programs.

2
HOST A LAUNCH EVENT The next stage is to host a launch event to define the goals of WASH 2.0 and engage community organizations and the top local technologists. We suggest a WASH 2.0 weekend of hackathons in coordination with local technology hubs, incubators and multi-national corporations for support organizing and executing these events.

32

3
CONCEPTING, TESTING & RESEARCH After building hypotheses with partners and during the launch event, community leaders and developers will begin testing game concept hypotheses with local user research to see what types of games they would like to play and which they find uninteresting.

4
BUILD ALPHA & BETA PROTOTYPES With initial results from user testing and user research the developer partners will begin the game design and build an alpha prototype for continued testing. That prototype will be released to a limited group of trusted testers who will provide feedback for the beta product, which the partnership will release to a broader pilot community.

5
RELEASE GAME After soliciting extensive user feedback on the beta product and making revisions, the partnership can release the game on the Nokia Ovi store.

6
COLLECT DATA With particular awareness of the challenges evaluating the games success, the local developers and community leaders will collect anecdotal and systematic data on whether and how sanitation behavior changed after the game was introduced.

33

APPENDIX

LOCAL GAME DEVELOPERS

Co-Creation Hub (Nigeria)
Bosun Tijani Femi Longe Tunji Eleso

GAMES FOR CHANGE DEVELOPERS

Playniac (UK)
Rob Davis

Ayogo Games (Canada)

Michael Fergusson

Planet Rackus (Kenya)

Mwaura Kirore

Playerthree (UK)
Pete Everett

Leti Games (Ghana, Kenya)

Eyram Tawia Wesley Kirinya

ThreeRings (USA)
Daniel James

Kola Games (Uganda)

Daniel Okalany

Pledge51 (Nigeria)
Bayo Puddicombe Zubair Abubakar

Khel Studio (India)

Rajnikanth Sagar

Games2Win (India)
Alok Kejriwal

Change Republic (India)

Yash Sharma

34

OTHER RESOURCES
Nokia Africa: Agatha Gikunda MIT Technology Review: New Apps for the Bottom Billion. 7 May 2012. Journal of the American Medical Association: Interactive Games to Promote Behavior Change in Prevention & Treatment. 29 Mar 2011. Masawa: Kicking Poverty in the Apps. Masawa.org. Aakash Tablet: $35 Tablet supported by the Indian Government. Aakashtablet.org. InsightsAfrica.com: African technology use data. Insightsafrica.com. Google Public Data Explorer: www.google.com/publicdata

35