Localization: Why it Matters

By Eamon Penney, Implementation Lead at THINKMD

Localization has justifiably become a central pillar in the strategies of major players in setting the global health agenda. The U.S. Agency for International Development (USAID) has committed to directing a quarter of its funding to local organizations and “shifting funding and decision-making power to the people, organizations, and institutions that are driving change in their own countries and communities”. In the humanitarian sphere, the Grand Bargain, an agreement between some of the largest funders of humanitarian response, established localization and quality funding as two of its two ‘enabling priorities’. Shifting the money is one part of the localization equation, but it also involves shifting decision making power, leadership, centers of innovation, accountability structures, ownership, and the overall culture of the global health enterprise.

At THINKMD, we’ve been reflecting on why localization matters and, as a US-based technology provider, assessing our role in achieving it. In the digital health sphere, localization typically refers to adapting a product or service to a specific language and cultural context, and engaging in pre-implementation adaptation and principles of user-centric design. But in many ways, these measures are the bare minimum of digital health localization. Not engaging in these practices is setting your project up to fail.

“To make digital health flourish within sub-Saharan Africa, enabling environments need to be created that are firmly anchored within the local context, driven by African needs, endorsed by decision makers such as national governments and supported by global key players such as the United Nations and WHO.” – Lancet

Fundamentally, localization must go well beyond translation and as THINKMD continues to grow, we’re reflecting on our implementation track record across 10 countries and strategizing how we can support and align with the localization agenda. Here are a few of the themes on our minds:

• The centrality of local implementing partners – Technology solutions are a necessary but not sufficient part of creating impact in the global health space. Just as a measles vaccine requires community outreach, trained staff, a cold chain, and a host of other necessary components to reach the arm of a child, technology solutions require well designed implementation and integration plans, trained users, feedback mechanisms, and ongoing support to reach scale and foster innovation. While we understand the high-level building blocks of a successful implementation, we are in a poor position to actually adapt and carry them out in every potential country-specific context. For this reason, establishing complementary partnerships with local implementing organizations has been a cornerstone of THINKMD’s approach.
• Welcoming more direct accountability and better alignment – Currently, organizations like THINKMD serve two sets of  interests that should be aligned but all too often are not: international funders and local institutions or health systems. By shifting money and decision making to the latter, we’re bolstering how demand-driven the system is. The space for misalignment  is decreased as those with the most skin in the game are more empowered to call the shots.
• Digital health infrastructure – Digital health infrastructure is still developing in many parts of the world. Technology partners have a responsibility to meet countries where they are in terms of infrastructure, by focusing on offline-first capabilities and designing for optimal performance on low-end devices.  Data storage and health data sharing is also a critical consideration for sustainable solutions, which means integration and interoperable software is important. Technology that optimizes HL7 FHIR standard-based data storage supports this.

The push for localization has a long way to go but holds tremendous promise. While we are still learning how to successfully support localization, THINKMD is committed to the critical importance of it. Not only does it help to improve the experience of service or product, but it makes it more likely to be understood and used, increasing adoption, satisfaction, and eventually impact. It also builds trust and credibility, supporting the efficient implementation of solutions that can grow, adapt and scale with communities. 

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