Pioneers, champions and naysayers: Oh my!

Doussou Konate, a worker for Tostan’s program in Senegal, facilitates a campaign to spread awareness of the harmful effects of FGM. Photo by: James Fulker / DFID / CC BY 

Over the course of my 20-year career in global health, I’ve been involved in the introduction of several new ideas — three of which have since mainstreamed, and one in the works.

The first of these was the intersection between women’s health and women’s rights, which later introduced me to work in Africa and my native country of Egypt in the mid-90s to address female genital mutilation.

The second began concurrently with the third in 2000 with the engagement of religious leaders and organizations to address HIV and AIDS. The third, which took over a decade to gain momentum, but is now in full swing, is the strategic use of mobile technology as a tool to improve health and well-being in low- and middle-income countries.

My current fire in the belly is the need to rethink how we approach aging and aging populations here in the United States and throughout the world.

When I look back at the evolution of each new idea — they all built on successes and failures in prior “new ideas” — three essential ingredients emerged:

1. Pioneers

2. Champions

3. Naysayers  

Sometimes they worked together as an active community, sometimes independently all toward the same end, but they were all there. It underscores a favorite quote of mine by Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”  

However, it is the naysayers that galvanize, test and drive commitment of pioneers and champions. If it weren’t for them, social change and movements would not be necessary or possible.

I was born an activist, and battling the status quo in countries like Somalia, Egypt and Kenya at a time when women’s health and women’s rights weren’t particularly trendy made it both challenging and worthwhile.

It was there that I met outspoken leaders committed to ending a practice that was neither sanctioned by law nor religion: female genital mutilation. It was the creative and pioneering work of lawyers, priests and imams that simultaneously changed policy and practice and set a foundation for social change that has resulted in fewer and fewer girls subjected to the harmful practice.

I came into this “new idea” of leveraging legal and religious leaders as a participant observer, and the impact it had on the field and on my own career has been tremendous.

In that process, I also learned that a least likely proponent of a harmful tradition can often be the biggest hurdle. In the context of FGM, it was in a Somali village that I discovered that the mother and the mother-in-law, despite their own harrowing experiences and the imam’s denouncement of the practice, needed the reassurance that her daughter would be marriageable. It is not only critical to be proactive in advocacy, policy and practice, but to actively identify and systematically address critical barriers to change. It is overcoming the naysayer that enables true and lasting change.

The engagement of religious leaders on FGM was the inspiration for my formative work over the next 10 years in mobilizing them to support a multireligious and compassionate response to HIV and AIDS. Concurrently, after spending a year in 1999 in South Sudan rehabilitating a health system destroyed by civil war, a spark was ignited in me on the potential role that mobile phones could play in enhancing emergency response, supporting global health programs and strengthening health systems.

What started as a new idea in 2000 has become a way of interacting within the health system and the general population to improve public health in most countries in 2014. New ideas lend themselves very well to doctoral theses, and that’s what I did with the encouragement of a mentor from my days working on FGM.

I began my work on mobile phones and health in 2001, at a time when the naysayers strongly outnumbered the pioneers and the champions — and mobile penetration rates in most low- and medium-income countries was restricted to cities at approximately 3 percent. It was the naysayers that spurred me on to get my doctorate over the finish line in 2006, and to spend my free time engaging with the newly emerging community of pioneers as well as seeking out the champions. The pioneers became my friends and colleagues, the champions became my mentors and bosses, and while the naysayers were my nemeses for many years — they are the ones to whom I am most indebted.

In the early days, they simply scoffed at how ridiculous the idea that people in developing countries might have mobile phones in the first place, to which I asked: “But what if they did?”  

Then, as mobile phones became more widespread, they pitted the value of mHealth against proven health interventions like immunizations, which spurred on a movement toward evidence. Throughout the journey, naysayers have asked the difficult questions and highlighted critical barriers that could inhibit the widespread uptake of mobile phones for health. This helped to set an agenda for collective action that transitioned mHealth from an idea to a field.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

About the author

  • Patricia Mechael

    Dr. Patricia Mechael is principal and policy lead at HealthEnabled, an Africa-­based not-for-­profit that helps governments integrate lifesaving digital health solutions into their health systems. She also is the executive vice president for the Personal Connected Health Alliance and a visiting professor at Princeton University. @PattyMechael @HealthEnabled