Sathy Rajasekharan is the co-Executive Director of Jacaranda Health. Frustrated with the speed of change within larger institutions, Sathy joined Jacaranda to be part of a small, agile, and experimental team. His mission was to lead the charge on local innovation. He joined at a pivotal time, when Jacaranda Health was transforming beyond its origins as a private healthcare provider to create a digital health non-profit. At the helm of Jacaranda’s operations in Africa today, Sathy is committed to Jacaranda’s work to generate rapid, grounded innovation. This means he needs to make tough choices on what experiments to keep, and what to cut. Even today he’s constantly asking the question of how to incubate new ideas, through what team and what structure. As he seeks to expand their influence across Kenya, he also comes head to head with the practical and policy gaps of scale. For example: Jacaranda strives to adopt the highest standards of data protection, but what happens when this approach collides with common practice in Kenya?

Show Notes

• Jacaranda Maternity is a set of private clinics in Nairobi, Kenya, with a strong focus on innovation and learning. This is the sister organization of Jacaranda Health.
• Jacaranda Health is the non-profit is the non-profit that Sathy leads, with a mission to scale successful innovations from Jacaranda Maternity across Kenya through the public sector.
• Kenya’s Data Protection Act: Kenya adopted its Data Protection Act in XXX. It draws much inspiration from the rigorous principles of the GDPR in Europe. Highlights of this act can be found here.
• Rippleworks: Sathy’s shoutout goes to Rippleworks. Rippleworks has helped Jacaranda build connections to a variety of global technology initiatives. It is an organization that supports impactful ventures to thrive through mentorship, capital, and connections.
• The Martian by Andy Weir: For fun, Sathy recommends this easy read about a man stuck on the planet Mars who struggles to survive. It captures the spirit of “try and fail” that has informed many of Sathy’s experiments.
• The Hard Thing About Hard Things: Sathy’s recommended reading for when “you’re really stuck”, particularly as an organizational leader.
• Reasons to be Cheerful Podcast is Sathy’s last recommendation. He describes it as a “refreshing change” to all the doomsday news we often hear.

Similar Episodes

If you enjoyed hearing Sathy’s experience of innovating and growing a technology nonprofit in Africa, you might enjoy these other conversations with African-based founders:

• Nic Pottier of Nyaruka
• Gerry Douglas and Baobab Health
• Evelyn Castle of eHealth Africa

Excerpt

This is an automatically generated transcript from the full interview. Like humans, machines aren’t perfect, so there may be some inaccurate or amusing transcription errors.

Who owns your health data?

Sathy: This is the kind of space we’re working in right now. Just trying to figure out, well, is there a policy gap? And on data protection and implementation of a data protection policy, there are gaps and we’re trying to navigate that just like everyone else.

Rowena: What is the gap as you see it, and how would you like to see it filled?

Sathy: Well, what’s happened in the region is related to GDPR [the European regulation on data protection and privacy]. Many countries have just adopted GDPR policies as part of the Data Protection Act – which is great. So that is protecting the information of the beneficiary or user of a platform, or whoever’s data is being collected. What I see a lot and where there’s a lot of confusion is, “What’s the role of a Ministry?” There’s an assumption that has been there for years that the ministry is the owner of all health information. And actually that contravenes the data protection laws. Because technically the owner of the information is the client, the end user, whose information is being collected.

Sathy: We’ve seen that education process for the clients to learn, “this is your health information.” If by any chance someone shares your health record with someone else that should have been covered by a consent process. But I have not seen this embedded within ministry structures. It frequently gets applied to partners, but not within. ministry structures.

So we actually end up in a tough situation where sometimes we’re telling our county counterparts we have no choice. We can’t share this information with you. It belongs to the user as per policy, and they will say, no, that’s our data. You have to sit down and chat with them and walk them through and say, well, what information do you need if it’s not sharing PII [personally identifying information] we can aggregate it, etc.

Sathy: We’re not trying to be antagonistic, but it just shows that policies have been set up, but that that sort of implementation ecosystem isn’t quite there yet.

Rowena: I love that you’re highlighting that tension because I can see that arising and I haven’t heard it discussed as much as one would expect.

You’re talking about how an individual is providing their health data to one of your clinics, let’s say, the private sector clinic. And then they’ve given up their health data. The government wants it. In a lot of our digital health policy dialogues, we say, OK, we should always give our data back to the government.

But what you’re saying is that that data belongs to the individual and maybe the individual wants to share it at a certain level. Maybe they don’t. But it’s it’s their data and they should have that choice and that agency of where it goes. Right?

Sathy: That’s exactly what I’m saying, I just don’t see any other way around that.

You know, let’s fast forward 10 years, when [we have] wearable [computing e.g. body-borne sensors] and so much information being collected. It should be the person who controls what’s happening with that information, not any other entity, not Jacaranda, not the government, not anyone.

Rowena: Fascinating. Inasmuch as this is policy at the ministry level. There needs to be the training for government staff to enforce these policies.

Sathy, a critique that I’ve heard often on topics like this – and this is not my position, but just to state the position – I’ve heard the capacity of individuals, both the effort to train and provide visibility into that consent versus providing training on core health behaviours. Some critics out there would say that an illiterate woman in a rural community, the effort of really making sure she understands what’s going on with her data compared to the effort of imparting the importance of hand-washing or other basic health issues.

There’s a real tension there, not in the ideology behind it, but in the practicality of resources and staff and hours available to provide life saving interventions. What is your reaction to that kind of statement?

Sathy: I hear it. It is definitely an a valid sort of realist critique in terms of what’s possible. But the something I find quite frustrating is the assumption that it has to be zero to one. So now you want us to to tell every user that these are the privacy considerations versus just thinking about, OK, let’s take a five year time frame. What do we need to put in place in terms of general public education on privacy rights so that we can get there. So it’s not today, but it’s at some point.

Because without that, it’s a super slippery slope. Because the assumption is no, no. “The individual doesn’t have the capacity to understand what we’re doing with them.” And that is thinking that has influenced many disastrous public health campaigns in the past. So ethically, there’s there’s no way around it.

And from a practicalimplementation perspective, it’s not going to be easy. But at least let’s put it up there as an objective. I think that’s what I’m missing. I’m not hearing people talk about it as a key objective and in the big global dialogues.

Rowena: Agreed. I think that’s a really important point. And when we conveyed this message, it doesn’t have to be a 10 page written document. It can be something very simple. Like, “who do you want to have this information? Are you comfortable with this person seeing it?” It also prevents us from making decisions on behalf of the people that we’re trying to serve and assuming that we know better for them than they do.

Sathy: Absolutely.