In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector.
At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here.
Patients can pay service providers directly for health care services delivered.
Service providers can use mobile transfer platforms to reward patients with monetary or airtime incentives for treatment compliance.
At the district, regional, and national levels, governments and organizations can improve management of funds and introduce better checks and balances by using mobile money platforms. Some uses include:
Mobile phones are being tried and tested in myriad ways in health care. They are used for data collection and disease surveillance, for ensuring treatment compliance, for managing health information systems and point-of-care support, for health promotion and disease prevention, and for delivering emergency medical services. Clearly, m-health, as this growing field is dubbed, is here to stay.
At the same time, achieving scale and sustainability in most m-health projects has been a challenge. One of the key aspects of beginning to think about ways to integrate m-health into health systems in a sustainable way is to establish financial systems to pay for health services and to ensure financial accountability within programs.
The Vodafone Americas Foundation and the mHealth Alliance are announcing a call for entries for the annual Vodafone Americas Foundation Wireless Innovation Project mHealth Alliance Award, a competition to identify and support promising wireless-related technologies to address critical social issues around the globe. Proposals will be accepted from September 27, 2010 through December 15, 2010, with the final winners announced in April 2011.
In the context of the rapid growth of mobile phone penetration in developing countries, mobile telephony is currently considered to be particularly important for development. Yet, until recently, very little systematic evidence was available that shed light on the developmental impacts of mobile telecommunication. The Information and Communication Technology for Development (ICT4D) program of the International Development Research Centre (IDRC), Canada, has played a critical role in filling some of the research gaps through its partnerships with several key actors in this area.
The objective of this paper is to evaluate the case of mobile phones as a tool in solving development problems drawing from the evidence of IDRC supported projects. IDRC has supported around 20 projects that cut across several themes such as livelihoods, poverty reduction, health, education, the environment and disasters. The projects will be analyzed by theme in order to provide a thematic overview as well as a comparative analysis of the development role of mobile phones. In exploring the evidence from completed projects as well as the foci of new projects, the paper summarizes and critically assesses the key findings and suggests possible avenues for future research.
Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.
Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.
Today's Mobile Minute is focused on mobile money. We've got news about Bharti's financial services in India, Rwanda's new mobile banking guidelines, Digicel's plan for mobile financial services in Haiti, ICT growth from 1998 to 2009, and the popularity of native apps on smartphones.
In Rwanda, mobile banking is becoming a more secure option as "The Central Bank has set guidelines for mobile phone payment systems that will cater for safety, integrity, efficiency and reliability according to a notice on its website," reported The New Times. (via Textually)
Digicel, a Caribbean telecom, announced they will launch a mobile banking pilot project in Haiti, starting this October. The pilot will allow users to transfer funds and give and receive cash via mobiles.
ICT4Dblog charted how ICTs have grown around the world, ranking mobile, Internet, and broadband growth over an 11-year period. The site then looked at how these numbers show the digital gap between rich and poor countries, and then reported on: "digital lag: the time gap between a given average ICT penetration level in the poorest countries, and the year that was achieved in the richest countries. Current digital lag is just under 10 years for mobile, and something like 14-15 years for Internet. For broadband, it’s just over 10 years but the figures are so low that this may not be meaningful."
A report from Zokem, a Finnish mobile analytics company, found that smartphone users' activity on native apps accounts for 50% of mobile Internet traffic. The large study took data from 10,000 smartphone users in 16 countries to arrive at their conclusions.
[Mobile Minute Disclaimer: The Mobile Minute is a quick round-up of interesting stories that have come across our RSS and Twitter feeds to keep you informed of the rapid pace of innovation. Read them and enjoy them, but know that we have not deeply investigated these news items. For more in-depth information about the ever-growing field of mobile tech for social change, check out our blog posts, white papers and research,how-tos, and case studies.]
The Institute for Reproductive Health (IRH) at Georgetown University, has pioneered a new way to inform women of their fertility status using mobiles. IRH conducted proof of concept testing in India for an SMS-based delivery of the Standard Days Method (SDM) as an information based, low-cost and non-hormonal method of family planning.
SDM is a scientifically tested fertility awareness-based method that is recommended by WHO as a modern, natural family planning method. From the first day of menses, in a 26-32 day cycle, a woman’s most likely fertile days are from days 8 to 19. Avoiding intercourse during these days of the cycle has been tested to show up to 95% effectiveness against pregnancy.
Because of the high use of traditional methods for family planning, and the ubiquity of mobile phones, IRH thought of developing an innovative mobile platform for reproductive health called CycleTel™. Currently in pilot phase, women can subscribe to the service via SMS on the first day of the menses, after which, a text message is sent to her mobile indicating her fertility status as per the 8-19 day fertile window.
To offer the Standard Day Method, a non-hormonal, periodic abstinence, information-based method of family planning, through the mobile phone as an SMS service. The aim of the project was to transform an existing fertility awareness tool, called the CycleBeads®, to a mobile phone version.
Brief description of the project:
Because of the high use of traditional methods for family planning, and the ubiquity of mobile phones, IRH thought of developing an innovative mobile platform for reproductive health called CycleTel™. Currently in pilot phase, women can subscribe to the service via SMS on the first day of the menses, after which, a text message is sent to her mobile indicating her fertility status as per the 8-19 day fertile window.
Target audience:
Women in developing countries, who are interested in using a traditional method of family planning that is non-hormonal, periodic abstinence and information-based. Or women seeking to try other birth control methods than the pill, IUD or condom. Or, women currently using the CycleBeads® tool for family planning, but would like switch to a mobile phone-based tool.
Due to literacy barriers observed in the proof of concept testing, the target audience may shift focus to middle and high income women, who have higher educational background.
While the SMS alerts were targetted to women, many male partners showed interest in also receiving the information to their phones.
Messages sent in "Hinglish" were best understood.
Men and women, who participated in Cycletel pilot test, were willing to pay for the service. In the focus group discussions, women suggested 20-25 rupees, men suggested 15 rupees and couples suggested 30-35 rupees as reasonable monthly price for CycleTel.
Prior to the pilot test, a large investment was made to involve potential users of the service to give input in the design of the service and composing of text message alerts.
What did not work? What were the challenges?:
A text message for the helpline number was sent later during the trial, and users preferred it to be sent earlier.
Women preferred responding to yes or no questions rather than entering key words like “red”, “date” or “agree”.
Women preferred that messages were limited to 1 SMS, instead of being broken into 2 SMSs.
Greetings, like “great”, “thank you”, confused participants and women did not know whether to answer or not. Often they thought they had to respond to every message they received.
After the pilot testing, there were several non-users. IRH learned that often their womens’ mobiles were switched off.
There was incompatibility between the major mobile network operators Vodafone, Reliance and Airtel that impeded their use of the CycleTel service.
Though initially, SMS messaging was thought to be a common practice, IRH learned quickly that many women who own a mobile phone were not in fact in the habit of actually writing and sending SMSs. Instead, women more commonly were accustomed to forwarding SMS.
Founded in 1985, Georgetown University's Institute for Reproductive Health (IRH) has contributed to a range of health initiatives and is dedicated to helping women and men make informed choices about their reproductive health. In particular, our work focuses on:- Developing, testing and implementing simple and effective fertility awareness-based methods (FAM) of family planning, including the Standard Days Method®, TwoDay Method® and Lactational Amenorrhea Method, - Fostering fertility awareness among young adolescents (ages 10 to 14) in the context of self-worth and respect for others,- Reducing stigma and discrimination to improve HIV prevention and care.
Decision making support for nurses and health workers, even when connectivity is poor or low, is possible with Sana Mobile, an Android-based mobile health application. Formerly known as Moca Mobile, the Sana technology facilitates remote consultations between health care specialists and community health workers in remote areas.
Sana Mobile started at MIT's NextLab, where developers, faculty and students collaborate to tackle a problem using mobile technology. The Sana technology was developed by Sidhant Jena, Sana team lead and Harvard Business School student and Russell Ryan, lead engineer and MIT student.
When general practitioners lack the expertise to diagnose a case, they refer patients to specialists, who may not be easily accessible. The Sana technology addresses the lack of accessibility to specialty care in places, where specialist doctors and tertiary care centers are sparse.
One of the largest problems facing the developing world is a lack of trained physicians. While there is not a shortage of untrained or semi-trained workforce, many health workers in many developing nations are not able to dispense adequate care due to a lack of expertise.
The Sana technology seeks to address the lack of accessibility to specialty care in places, where specialist doctors and tertiary care centers are sparse.
Brief description of the project:
Oral cancer is one of the most common cancers in India. It is related to the cultural practice of chewing paan masala and gutka, forms of chewing tobacco. It is estimated that about 40% of men and 15% of women chew tobacco on a regular basis. Detecting risk of oral cancer earlier is important for affordable treatment as late stage tumors can be very expensive to treat. To survey the risk of oral cancer in their community, Mazumdar Shaw Cancer Center and the Narayana Hrudayalaya Health to ran a pilot test in and around Bangalore over six months. One pilot was run in Belgaum, Raichur, a rural town about 12 hours away from the city of Bangalore. The other pilot was run in Bangalore. Equipped with the Sana application, ASHAs (community health workers) went door to door in and around Bangalore, asking questions and taking pictures of oral lesions, which were evaluated by oral surgeons. In six months, they were able to screen about 400 high-risk cancer patients and detected numerous lesions using Sana. Twenty ASHAs were trained in using the Sana software in Belgaum.
Target audience:
For this pilot, risk of oral cancer was assessed for men and women chewing tobacco. But the Sana application is also being used to do a large scale risk assessment for cardiovascular disease, to screen maternal complications (e.g. preclampsia) and assess nutritional status of children.
Length of Project (in months) :
6
Status:
Ongoing
Anticipated launch date:
What worked well? :
Sana invested in building local developer capacity in India. Local developers cost less than having an international technology consultant to conduct training.
Lots of enthusiasm from leaders at the Narayana Hrudayalaya hospital
Funding for Sana developers at MIT to travel to India to test and train users came from external support, not from program budget of the clients.
What did not work? What were the challenges?:
Semi- to low-literacy amongst community health workers can be a challenge if an application is available in limited languages. CHWs in Belgaum did not speak Kannada (the local script) or English. Developers adapted Sana to replace text in the medical procedures with voice prompts and pictorial labels
Health workers/nurses were not familiar with the touchscreen and needed some additional training and practice in order to understand how to use it (i.e. using fingerpad or fingernail to enter data)
Cost of phone was a major limiting factor
Some resistance faced from physicians, who were not quick to adopt a technology-based work flow management tool
The Sana Team is a volunteer based organization, and it is difficult for the team of developers to contribute time resources, but they consistently offer feedback to Sana users on their google group.
Sana, is a student organization based at the Massachusetts Institute of Technology (NextLab, Center for Transpotation and Logistics, Engineering Systems Division) that offers an end-to-end system that seamlessly connects health workers to medical professionals. In addition, the group assists its partner organization with implementation through collaborative innovation. The team consists of volunteers with diverse background – medicine, computer science, clinical informatics, health policy, social sciences, and business and operations management. It strongly believes that there is a need to bring together experts from various disciplines in order to design an operating system around the delivery of care that is facilitated by mobile technology. The technology is crucial, but not the sole component of the solution. It is the centerpiece of a learning system that is designed not only to improve clinical outcomes, but the health delivery process itself.
Today's Mobile Minute brings you coverage on using SMS to access social networks in Nigeria, Organizing for America's new iPhone app that aids political canvassers, HTC's development of a dual GSM and CDMA phone, a pilot project that uses SMS to send information to pregnant women in Peru, and a Pew Research Center report on U.S. adults' mobile phone usage habits.
Today's Mobile Minute brings you news on the state of the mobile web, California's plan to be the first state with a mass mobile alert system, Cisco's (rumored) move to buy Skype, a guide to installing PercentMobile on different platforms, and results from a study on the effects of SMS reminders for taking birth control pills.
Femi Soremekun, managing director of Nigeria-based Biofem Pharmaceuticals, is all too familiar with the fight against counterfeit drugs. In late 2008, a distributor notified him that he suspected that one of Biofem’s products, Glucophage, was being counterfeited. After checking batch and inventory numbers, Soremekun reassured him there was no evidence of such activity. It was only after more allegations surfaced that he sent a sample to French manufacturer Merck & Co. to be analyzed. Turns out the claims were correct. “I was very shocked,” Soremekun says. “[The counterfeiters] got into my market, counterfeited my product, and I wasn’t even aware of it. I was losing sales.”
It was around this time that Soremekun learned about Sproxil, a start-up company that is part of a consortium that includes Nigeria’s pharmaceutical industry association and the country’s regulating agency. The group explores technology-based strategies to tackle drug counterfeiting. On the sidelines of the consortium, Biofem and Sproxil discussed implementing a drug-certification process in order to restore Biofem customers’ confidence in Glucophage. Following a successful five-month trial in Nigeria involving about one million units of Biofem’s product, the company has seen sales pick up again. “We ended up being called the guinea pig,” Soremekun jokes.
Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., Fu, L., Ossman, J.
Publication Type:
Report/White paper
Publication Date:
1 May 2010
Abstract:
This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.
The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.
The major thematic areas include:
Treatment Compliance
Data Collection and Disease Surveillance
Health Information Systems and Point of Care Support
Health Promotion and Disease Prevention
Emergency Medical Response
The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.
The Mobile Minute is back with a video explaining the M-PESA mobile money service, news about maternal health insurance via mobiles, an app that helps users determine if a hybrid or plug-in car will be useful to their lives, a report on why you might want to turn off the geo-tagging system on your mobile, and FailFaire in The New York Times.
Katherine Sarah Lavoie, Victoria H. Jennings, Meredith Puleio, Priya Jha, Rebecka Lundgren
Publication Type:
Other
Publication Date:
1 Nov 2009
Abstract:
Results of proof-of-concept testing for an mHealth solution for reproductive health in Uttar Pradesh, India. The text messaging tool based on FrontlineSMS, is a family planning service that relies on the Standard Day Method system of birth control. This method of birth control depends on the woman's fertility cycles to avoid pregnancy. Women can text the date of their menses and user receives their fertility status. Additionally, women can receive information about other family planning options, and support. Presented are observations on the appropriatenss of the technology from focus group discussions. The authors share the input given by target users in the product and service design. Women tested the solution to give insight on feasibility and design.
Based on two experiences using mobile phones in Africa to address women’s rights and social development, the author tries to understand whether mobile technology will bring social progress to the economically poor of Africa.
The author first examines mobile phone use in the campaign for the Protocol on the Rights of Women in Africa, adopted by the African Union (AU)in 2003 and in need of ratification by 15 countries. The technical barriers to message transmission in the campaign and the message spamming that it attracted inhibited the success of this particular application of mobile technology but did not reduce the campaign effectiveness because the uniqueness of the cell phone campaign strategy drew a large amount of publicity for ratification.
In the second example, the UmNyango Project intended to promote and protect the rights of rural women in the province of KwaZulu Natal (KZN), South Africa, from domestic violence against women and landlessness amongst women. The project created "an SMS gateway through which messages could be distributed to all those enrolled in the project, and it enabled every individual to send messages to the organisers and to the local paralegal officers where they needed assistance with regard to any incidence of violence or threat to their access to land....In practice, the project found SMS to be prohibitively expensive, despite the fact that some level of subsidy was provided by the project towards the cost of SMS." The author states that, "Mobile phones, after all the hype, are like pencils, tools for communication.... Like all technologies, tools do not themselves do anything." He uses the example of SMS hate mail messages to support the position that effects of technology result from the underlying values and morals of its developers, not from the tools themselves, and concludes: "In capitalist societies, all technologies have the potential for magnifying and amplifying social differentiation. It is only through the imposition of the democratic will of citizens can this inherent tendency of technologies be overcome."
A how-to guide on using and implementing RapidSMS for mobile data collection and communication.
Ths manual give an overview for how to implement and use RapidSMS in a mobile data collection project. RapidSMS is a SMS framework for data collection, group coordination, and complex SMS workflows. The tutorial outlines when and when not to use RapidSMS, guides the user through project steps and milestones, outlines factors for a successful implementation, and provides worksheets for project planning. Example training materials are included.
The aim of this paper is to encourage reflection and discussion around the potential of mHealth in developing countries and to consider how early experiences can inform the way forward. Toward this aim, I synthesize many reviews and presentations from the eight years I have been studying the evolution of mobile phones and health in developing countries. I include observations and discussions that are now shaping the creation of mHealth as a field, to highlight the ingredients we need to move from a series of pilot projects and isolated business opportunities to a full-scale maximization of health-related benefits.
I begin by reviewing the strategic priorities within global health, where mobile telephony can have the greatest impact, along with organic health-related uses of mobile phones, and examples of formal mHealth interventions. I then demonstrate the potential for mobile phones to become an extension and an integral component of eHealth, describing how information and communication technology (ICT) can be used in health care, as well as mHealth, as a subset of mServices: using mobile devices to deliver services such as banking and health. I also show how trends and interests are converging among key stakeholders within the mHealth ecosystem, thus forming a foundation on which we can scale up and sustain more and better mHealth activities. Finally, I present some tactical guidance for a way forward that will further the objectives of both public health and business, particularly in outreach efforts to emerging markets, the bottom of the pyramid, and the next billion mobile phone subscribers.
Presented here is an overview of the operational needs of NGOs and CBOs and the role information systems can play to increase their accountability and efficiency. Information systems need to fit the diverse operational needs of NGOs and CBOs, which include coordinating activities, training and monitoring staff, documenting results, accounting, reporting, decision making and learning, acquiring external information and encouraging community participation.
Unfortunately, there are gaps in information systems that impede the ability of NGOs to embrace ICT. To name a few, the lack of open, accessible, cross-platform mobile development tools, limited opportunities and resources provided to local small software companies to engage with NGOs, and the lack of long distance networking technologies to reach remote locations.
Two examples of technologies that were applied successfully are shared: Self Help MIS, an application to monitor activities of small microfinance organizations and credit groups and DigitalICS, an application for data collection used by agricultural cooperatives. The author stresses that ICTs should be viewed as a tool to allow local change agents to be more effective and accountable and shows how computing is able to support local organizations by inspiring innovation, implementation and dissemination of projects, and measuring impact.
This guest post was written by Nicolas di Tada, Director of Platform Engineering at InSTEDD. He writes about an ingeniousway for health workers to accurately transmit semi-structured data via mobile. His post is reprinted here with permission.
During August 2009, we went on a number of field trips to health centers in remote areas of Thailand and Cambodia. The idea was to conduct a few usability tests on Geochat syntax alternatives that we were exploring. Our goal was to simplify the interaction between health workers and the system to ultimately allow them to report disease cases in a semi-structured way.
The case information always originates at the local health center level - this is where the patient comes and gets diagnosed. Most of the case reports are made through phone calls to the district level (the higher administrative level). Case details get lost when the district level summarizes the information by disease and reports the quantity of each to the provincial level.
The use of mobile phones for quick-time data collection is proliferating around the world. To get a better understanding of the scale and scope of these new data collection efforts, we partnered with UN Global Pulse initiative to conduct a survey of present and planned mobile data collection efforts. The survey results will help identify new, quick-time data sources.
The first findings of the global survey have been compiled in an inventory. The inventory is a living document that will be regularly updated as we become aware of new projects. If you are managing a mobile data collection project and you would like to have it featured in the inventory, please contact us or leave a comment.
We are also currently conducting for UN Global Pulse a mobile phone survey across multiple countries including Uganda, India, Mexico, Ukraine and Iraq. The survey is being conducted via text message and uses simple questions to understand how populations in different parts of the world perceive. We are drawing on our extensive network of partners on the ground to conduct the survey and will make the results publicly available (albeit in an anonymous and aggregate format). The survey is an exercise in rapid, bottom-up data collection. Questions in the survey focus on economic perceptions, including:
This guest-post is by Arturo Morosoff who completed recently a project with D-Tree International and BRAC Tanzania to provide videos on mobile phones to assist Community Health Workers (CHWs) for health education. It is posted here with permission.
I recently completed a five week volunteer project working with Irene Joseph and Gayo Mhila of D-Tree International to provide videos on mobile phones to Community Health Volunteers with BRAC Tanzania in the Mbagala district of Dar Es Salaam.
A bit about me: I have no formal training in ICT or public health. My background is in technology and business and I live and work in the San Francisco Bay Area in California. I was on a two month trip in Tanzania and volunteered to help D-Tree with this project. As such, the project needed to be completed in a short time and we began with modest goals.
Among BRAC’s programs to help alleviate poverty is its health program, which relies on an all-female team of Community Health Volunteers (CHVs) to conduct monthly home visits to provide health education and support. Each CHV visits 150 – 200 homes each month, asking health related questions and providing healthcare information. In Tanzania, D-Tree has been collaborating with BRAC to provide the CHVs with a mobile phone-based tool called Commcare, to help improve the effectiveness of their home-based programs. About a year ago there was discussion with the CHVs of providing them with health education videos suitable for use on phones to provide additional support for their home visits.
Catholic Relief Services' maternal and neo-natal health monitoring program in Uttar Pradesh, India is incorporating mobiles into its work. The pilot project, which launched in June 2009, uses mobiles to increase volunteers' ability to share and gather health information.
The program uses SMSs to allow ASHAs (Accredited Social Health Activists who are local volunteers) to report statistics on maternal and neo-natal health metrics. According to O.P. Singh, who gave a presentation on the program as part of the SHOPS/mHealh Alliance online conference, several problems in the current system led to the adoption of mobiles: the existing paper system was difficult to use, workers at village and block levels had limited access to information from headquarters, and the paper system was slow. The organization hoped that incorporating mobile phones would give the volunteers a better sense of the health landscape, since they would have access to real time information and be able to instantly share their results. During the presentation, Singh illustrated the system with the following graph:
To increase communication flow and collect data via community health workers
To teach local health workers to incorporate technology into their work
To more accurately track births and deaths
Brief description of the project:
Catholic Relief Service's "Texting with a Purpose" gave mobile phones to community health workers (ASHAs) in the Uttar Pradesh region of India in order to track live births and deaths. The ASHAs filled out mobile forms and submitted them via SMS to a central database in order to better monitor maternal and neonatal health in the region.
Target audience:
The target audiences are:
36 volunteer accredited social health activists
Pregnant women and newborns in Uttar Pradesh, India
Length of Project (in months) :
10
Status:
Ongoing
Anticipated launch date:
What worked well? :
The project has raised the level of reported births to almost 100%. Because the data is compiled instantly, less children are missed than under the old system. The Catholic Relief Service has also seen that the ASHAs view the SMS system as a viable plan for the future or reporting on maternal/neonatal health and that they are working hard to master the system.
What did not work? What were the challenges?:
So far, 65% of the ASHAs still need support from family members or the Catholic Relief Services staff in order to manage the SMS texting; reasons for this include a lack of familiarity with mobile technology and low literacy. Another challenge is the coded SMS system; it has to be filled out very precisely, which can lead to errors.
Catholic Relief Services carries out the commitment of the Bishops of the United States to assist the poor and vulnerable overseas. We act to promote human development by responding to major emergencies, fighting disease and poverty, and nurturing peaceful and just societies; and we work with local, national and international Catholic institutions and structures, as well as other organizations, to assist people on the basis of need, not creed, race or nationality.