089 – Exploring Digital Parenting Innovations in Kuwait

[00:00:00] David: Hi and welcome to the IDEMS podcast. I’m David Stern, one of the founding directors of IDEMS and I’m delighted to be here today with Kate Fleming, another director of IDEMS, which is a different introduction from last time we talked.

[00:00:21] Kate: No. I think we’ve had one where I was a director, not an interim director, but here we are.

[00:00:27] David: It’s great having you on board. I’m still excited. A few months on.

What are we discussing today? Should we dig into my recent trip to Kuwait?

[00:00:35] Kate: Yes, and I can do a bit of introducing only to show that I’m interested in it, and from the perspective of a listener, who will be bringing the same perspective. You have just returned from Kuwait, working with PLH on a deployment in Kuwait.

[00:00:50] David: We should say PLH is Parenting for Lifelong Health, and this is where we’ve been building digital technologies for them, including apps, parent app, this sort of thing.

[00:00:59] Kate: Yes. So, when you came back, the first thing I asked you was, how was it? And your first comment was on how different Kuwait is, and from the moment you landed, just your entire experience versus the environments and contexts you normally work in, and certainly the environments where PLH has deployed technology to date.

And there’s clearly need, just because a place has money doesn’t mean there’s not need for things, but it certainly creates a very different context. And I was curious to hear you talk through that some, and especially that you actually found that there was, I don’t want to say that, deep commonalities, I guess this is for you to describe, but you saw parallels between things in Niger and things in Kuwait, which I found very interesting. So there’s a lot there that I’m just so curious to hear about.

[00:01:53] David: This experience in Kuwait, I’ve never been treated so well in my life. I’ve been treated well in other places but this was just incredible. The hospitality there, really, it was wonderful. But I’m used to working in low resource environments. To be in an environment where actually, the financial resource is not the limiting factor was really interesting. We were invited there by the Ministry of Health who was wanting to offer this program.

They wanted to build from the Parenting from Lifelong Health Program developed by Oxford University with many other partners. And they recognized that the evidence behind that program was showing that this can have many different positive health outcomes. And my reason for being there was because they were going to be the first country that actually integrated the app technologies which have been built into the face to face delivery. This is going to be a really exciting next step, which we think a blended program would probably be better than any other, either face to face or purely digital. And so that’s where they started from, which is so exciting.

They brought us in and we were then meeting all sorts of people. They’ve recruited facilitators, they’ve recruited supervisors who are going to actually deliver the program to parents. And then we met a group of parents who will not be eligible to take the program because they’ve now helped us co design it in some sense. And so we’ve had discussions with them and we’ve taken them through different elements.

And, of course, the elements of the situation, just the access to technology, the access to internet, is better than certainly I’ve ever seen, it’s certainly better than the UK, it’s better than I’ve heard in the US, this is world leading in many ways, the environment. Everybody has 5G internet and access in what they need, when they need it in different ways. And because they’re focusing on the Kuwaiti population, and this is a sort of distinction, that in Kuwait you also have a lot of people who are not Kuwaiti but who are working there, because it has a lot of wealth, and the Kuwaiti population is supported by the oil one, to some extent.

And so the government actually has very high levels of, I suppose social welfare is really the best way I know how to describe it, where if you are a Kuwaiti national, then the government offers a lot of support.

[00:04:17] Kate: I’m going to interrupt you with a question there. Does that mean that there is a two tier society where you have Kuwaitis and then you have a working population, I assume from other places, who live in very different conditions? Maybe we want to put a pin in this and come back to it later, but I’d be curious to know what the interplay of those groups is and whether there’s the same access, whether they’re the same needs, various things. But maybe that’s not something you tackled on this trip.

[00:04:47] David: It’s something where my knowledge is very limited. What I can say is that, yes, there is that element that the Kuwaiti population, if you have Kuwaiti nationality, I thought that I was very privileged because I have British nationality, but my privilege for having British nationality, if I had been born with Kuwaiti nationality, I would be even more privileged. It’s just an incredible nationality to have because as a small country with such oil wealth, it has created a situation for its citizens where they are, they’re a melting pot, the Kuwaiti nationals actually originally come from all over the world in different ways, because it’s sort of part of the world where, it has had so many different influences. And just being taken around a little bit, Kuwait city, and just seeing some of those influences, it’s just an amazing place.

But you’re right, if you don’t have Kuwaiti nationality, and you are living in Kuwait, then it’s not the same as having Kuwaiti nationality and living in Kuwait. However, as I understood it, the Ministry of Health is responsible for everyone.

[00:05:57] Kate: That was the core of my question, is who is the target audience? And so you are answering that question. Yes.

[00:06:03] David: As I understand it, and this is what we were told, is that the end goal is for this program to be available for everyone. But, again, because of the privilege of the Kuwaiti nationality, the first priority is of course to start with the Kuwaiti nationals. So this is where the program would start. So our initial program is going to be for Kuwaiti nationals. And there is a need, because this sort of programme is needed everywhere in different ways.

Having programmes to support parents is something where this has been demonstrated to have positive impacts in so many different ways. From parental mental health, child mental health, all sorts of positive indicators come out of this across all sorts of high and low resource environments. So, starting with the programme, and the programme starting with Kuwaiti nationals, is, or with a small set of Kuwaiti nationals, I think it’s just 200 or so, I think maybe it got pushed up to 270; it’s around 200. And they’re going to have this sort of eight week parenting program supported by the app. And that program is supported by Clowns Without Borders. It’s a fun program. When we first started working on PLH and we found out that Clowns Without Borders were involved, we couldn’t say how happy we were to be working with actual clowns on this.

[00:07:33] Kate: And I will say, when I first heard someone say Clowns Without Borders, I was like, oh, clowns must be an acronym for something. And then I realised, oh no, it’s clowns. So yes, to clarify for anyone listening, indeed it is clowns.

[00:07:52] David: And it’s meant that these sorts of programs are incredibly joyful and fun, they’re really great. And so this program is coming out and I can actually say the head trainer who’s going to go and train the facilitators and the supervisors is a former clown. He’s now a professor at Oxford. But he’s a former clown, so this is deeply embedded in the program and in the way that this is delivered.

And I think one of the areas where my expectations in some ways were really challenged by this was that we were discussing the situations, I found all these parallels with Niger, where I grew up. I actually felt incredibly comfortable in Kuwait because of my experience growing up in Niger. And it was interesting as I was able to articulate this to our collaborators there, it really does come about the sort of religious context.

And so maybe I’ll just say a little bit more about… I’ve mentioned in other episodes, that I grew up in Niger, it’s an Islamic country. But when I was there it was so tolerant as a society in so many different ways. It was a very tolerant Islamic society. And in many ways, Niger, when I was there, which is quite a long time ago now, but it wasn’t just a tolerant society, in some ways, despite being very poor, the support structures, the sort of social networks that were there, it was an inspiration to me, and it’s been an inspiration all my life.

To now go and to sort of experience in Kuwait, actually what is a very similar parallel, again, an Islamic country, but with extremely high, sort of networks of social support and high levels of tolerance and openness and, women’s rights, which are better than I’ve seen almost anywhere else.

[00:09:48] Kate: When you talk about the social support, are you saying like government social programs, or are you talking about social fabric, like community networks, that kind of social, or everything?

[00:09:59] David: Both. This is what was so incredible to me as I was learning a bit more about the society and different people’s roles in it in different ways, that there’s baked into society, both culturally and government support and so on, there are support and empowerment for women. So let me give you something which just blew me away, which I love. The only other place I’ve heard anything like this was Portugal, where there were more female Portuguese mathematicians than male. In Kuwait, apparently, there are more female engineers than there are men. The education system is such that, actually, it supported this and it’s become, in terms of working rights for women, they go back a long way. Really impressive thoughts about how as a society women could be supported to work.

And this, of course, historically hasn’t been true for everyone, but as we were meeting people, there were this element about women’s education and women working rights was just so paramount within society. I cannot think of another country in the world where you have women engineers outnumbering male engineers. That’s rare. And off the top of my head, I don’t have another case I can pull out. I know a couple of cases with mathematicians where that’s been the case.

This is something where I know enough to know that these differences in balance are all about culture. They’re not about aptitude. So it’s not that Kuwaiti women are necessarily more apt at becoming engineers than Kuwaiti men, just as elsewhere, it’s not like British men are more apt to becoming engineers than British women. But these imbalances are created because of the cultural fabric.

And so to think about how you get a cultural fabric, which leads to having this imbalance in terms of female engineers is wonderful and very interesting and challenges any preconceptions that I might have had.

[00:12:02] Kate: Does this have any parallel in Niger? Would you see things, it might not be exactly that example, but does that social fabric, or do those social systems produce interesting opportunities or interesting, unexpected…?

[00:12:22] David: So in Niger, where it’s a very low resource environment, no, the opportunities for women’s working rights in different ways, these are battles which are still being fought. But the tolerance, that’s where I see the parallels. And this is where the barriers that are imposed, it’s not the barriers that are imposed, it’s the sort of, the Niger I grew up in, the tolerance towards people who are doing things differently, or from a different place, who have a different religion, or whatever, as an Islamic society that was extremely tolerant, that’s what I saw the parallel with, where there’s a lot of the sort of positives you find that come related to institutions, and how elements of Islam build the society, which is then present.

But there’s in many people’s perceptions from the outside, there is an awareness of extremist, you know, what’s happening in Afghanistan at the moment, where it’s a very intolerant society, getting rid of women’s rights. And to recognize that this is not coming from the religion, this is coming from an interpretation. And there are multiple interpretations. And just as any religion, there are different groups who interpret it differently. And to be in a society which is so tolerant, it is incomparable, I think, just as I learned a lot about peace living in Niger, I could see that same tolerance and acceptance and peace, in this society.

[00:13:57] Kate: Do you think that a parallel that exists there is if one economy is very poor and everyone is poor and one economy is very wealthy, but in both cases, that’s somewhat evenly experienced? It sounds like a little bit of a thread there might be that there is not such extreme experienced inequality, that in the absence of that extreme inequality, do you think that it creates more room for tolerance because, I’m not even sure, I’d have to think through that theory more, but is there something in there where, it gets mapped to religion, but actually it’s much more related to the economic realities of society?

[00:14:42] David: I don’t know.

[00:14:43] Kate: I don’t either, I was just…

[00:14:45] David: But I think my hypothesis would be no. So my hypothesis would be in both these societies, I think if we looked at the inequalities, they would be great. And they would always have been great. In Niger, the inequalities were huge. And I’m sure in Kuwait, despite the baseline being raised, my guess is the inequalities are huge as well.

[00:15:05] Kate: I would qualify that to, just as a quick insertion, I would say perceived. I think inequality is always there, in all societies there’s lots of inequality. Is it perceived and experienced inequality? But again, I don’t want to get us caught on this path.

[00:15:22] David: Yeah, I understand, I hear what you’re saying, there’s theories around this which show that when you have lower inequality in different ways, then this does tend to lead to better social outcomes. But no, this isn’t what I believe in this particular case it is related to.

I think it is just, as societies, there are elements about some societies being more extreme in their differences, and others being more tolerant. For me, the unifying perspective is, even compared to the UK, which is a pretty tolerant society, it is not a very tolerant society, but it is a melting pot in different ways, and it has been quite tolerant compared to others.

The tolerance that I experienced when I went to Niger was just different levels. There were elements of the way that you think about others as being different and you welcome them and you do that, which were way beyond my previous experience. And I felt that was the sort of parallel, that this element of really deep, ingrained cultural tolerance, that’s the thing which I think is what I observed.

Now, having said this, my knowledge of Kuwait is very limited. I’ve been there for a few days. I’ve been basically shacked up in a workshop for most of that time. We didn’t get out that much. But we did meet lots of different people. And that range of people that we met and that we interacted with was so insightful in all sorts of different ways.

[00:16:49] Kate: And I guess, to bring it back to why you were there, which was related to PLH and the app, that would be what I’d want to understand. How do you think that tolerance that you were observing, and you don’t have the parallel example of Niger because we haven’t launched anything there, but if you’re thinking about the work we’ve done to date, and then what you experienced in Kuwait in that context, because a lot of what we talk about is context and adaptation, and also how best practices in a place can inform adaptations that get deployed everywhere because they’re actually really valuable for everyone. Did you see things in the context you were working in that led to innovations in your thinking or just how you think about the app, how it will work, how it will be used?

[00:17:34] David: Most of our work has been in low resource environments. And the big thing that we observed, this is a high resource environment. And in high resource environments, where people are highly digitally literate, and where, there was a term which came out about passive consumption, people don’t want to read if they can watch, or if they can listen. This idea of actually being able to have passive consumption and why this would be, in this context, so much more important than it was in low resource environments, I think was very interesting.

And how the ministry putting in that bit of extra effort to make things which are… and the vision is for it to be world leading. And this is what was so amazing, to be there working with the ministry where they recognize they’re sort of, if you want, late to the party with this sort of program, the UK has had parenting support for parents for a long time, and many other high resource environments have.

And in some sense they’re starting late, but their vision is to get to something which is word leading. And that was so impressive to see, that that sort of desire to say, no, if we’re going to do that , we want to do something which is going to really work. It’s not just going to work in our context. It’s going to be of really high standard.

And you could see that the openness to consider something which has good evidence behind it and then to make it their own, one of the things which was there quite a lot, and they’re going through this sort of localization process, was this isn’t Kuwaiti, this is what it would mean to be Kuwaiti. That localization process and the ownership they were taking for it was wonderful to see. And it reinforces what we’ve always discussed, this idea of it’s not about building something and then using it in lots of different places. It’s about giving people the opportunity to have that local ownership to make it their own. There was a discussion about them sort of building something which then could be used by their neighbours and other countries in the Gulf.

But they said, that’s fine, but this is Kuwaiti. We’re wanting to make it so that it will first of all serve our needs, and then we’re happy to help others.

[00:19:55] Kate: And that gets back to ownership, that when people feel ownership, it also makes you more invested in seeing something be successful, than if somebody has just presented you with something that says what it is, you will use it. And it’s eh. Yeah.

[00:20:08] David: It’s going to be, I think, the first time that the infrastructure that we built is going to be totally taken over by the ministry. Their IT team was there, we had good interactions with them, and they’re going to be the ones who are actually deploying it, not us, which is great. That’s that level of ownership. But it’s not just about them taking ownership, it’s about them taking ownership in collaboration.

They want the best, and they recognize for them to get the best they want to work with people who are going to help them to get something which is going to be world leading in their context. And we’re going to work towards that. My hope is this is going to become a collaboration which will really carry on as we can be challenged by them and challenge them to build something which is then going to be the envy of what we can do.

In this small project to get things off the ground is one thing. The vision they had, the ambition, oh, it’s beautiful. And you can see, you could feel that this is something where, if they’re going to do it, they’re going to do it well. Ah, it’s a wonderful position to be in and I had a wonderful time. Yeah, it’s not normal for me. I like working in low resource environments and so I feel a little bit guilty sort of having such a good time in a high resource environment.

[00:21:28] Kate: It’s like staying in a really nice hotel after you’ve been backpacking, like camping every night or something.

I do have a question for you which comes back to the very specific details of the product, of the technology. One of the things that we talked about before you ever went to Kuwait was Kuwait, everyone has phones. They have a million apps. They’re very sophisticated, highly polished very engrossing, addictive technology.

[00:21:54] David: Yeah.

[00:21:55] Kate: And there are a lot of practices built into this app, which are getting people offline, you don’t want them to be addicted to the app. It’s go be with your children, be with your family, have good experiences. I would assume, and I’d like to hear you talk through this, I would assume that creates a very different problem set, a very different need to think about the app and what it does. And maybe not maybe if there’s a problem that’s unsolved, it’s actually pretty universal. But I’m curious how that played out, or if it’s something that you see being an issue along the way.

[00:22:26] David: I think it’s something which over time, I hope if we get to continue to collaborate with them, I think this is something which we’ll really be able to dig into much further. But it was very interesting how this actually played out in some very specific ways. So one of the ways which I’m really excited that it came out was when we were talking to parents about interactions, spending time with their children, one of the things that came up is when playing video games with them.

And that’s, of course, something which is a way to spend time with your kids in different ways. And one of the things which then came out as something to aim for is exactly having these activities, which are, maybe they’re not low resource activities, they might be high resource activities in different ways, but they are offline activities. They are things which are happening, and to have that as a central piece in the app in certain ways.

And this was little discussions that were happening, this wasn’t a central theme, but it was something where this is part of what’s in the app. And actually it’s one of the areas where I was, in terms of the support team building the app, I’ve offered my help and say, look, I’m happy to be involved in that because that’s going to be a really important piece to see how this works and what this does.

But having these sorts of educational activities which people want to do, but that are offline, and that people might not have the idea to do it beforehand. And just being able to bring that in, and see if that resonates in this high resource environment. And so this is the same problem that you’d get in the US, in the UK, anywhere where you’ve got high resources.

And to be able to then actually try to sort of, conceive in that environment, well, they probably don’t need as many activities. So we discussed actually there was a whole bank of activities. I’m saying I won’t put them all in, just focus on a smaller number. But each of them needs to be high quality and how you do that.

And thinking about that, it’s a very different mindset. In a low resource environment, you’re trying to give a range of activities because there’s a scarcity. Whereas in a high resource environment there’s lots of stuff which is there. So what you want to do is have a few things which are really good.

And that sort of different way of thinking was really interesting. And again, we, in this small phase, in this small project, we can only do a little bit on that. But I can absolutely see how, as a way of thinking about these programs, from the ministry’s perspective, this is something where if they’re able to get this right, it could have added benefits, which I don’t think we’ve been observing in Tanzania, where we’ve just done the trial.

[00:25:13] Kate: Yeah, that is what I’m hearing as you’re talking. And it’s exactly, I think, what we have always conceived is when you start to scale something, really that things be adapted by context, but you’re still collaborating, you’re doing all these things. The possibility, the exchange of best practices, this works in this environment, and there’s something really good here, but yes, it requires lots of resources. But why couldn’t we in some way figure out how to adapt this for a low resource context? That just surfeit of learnings and possibilities that come out of it, I think are what’s most interesting.

[00:25:46] David: Let me just pick you up on one thing, because you mentioned the learnings going from high resource to low resource. I feel the deep learnings here are the fact that actually going from low resource to high resource, the app we’re building for them is totally different from if we’d started in Kuwait. And I think it’s better because of it.

[00:26:07] Kate: Yes. I think mainly because you have been thinking towards solving problems that if you started in a high resource context would just have never been in your mind. So you’re arriving with a different framework, which the normal framework most of us arrive with is, oh, I started this in the U. S. and now I’m going to this other country and I’m just gonna bring the same logic and underpinnings to build something here and it just doesn’t take you in the same direction.

[00:26:31] David: Yeah, let me give you a really concrete example. Offline first. This was needed in Tanzania, offline first, because internet connectivity wasn’t there. In Kuwait 5G for everyone, not a problem. Yeah? But we still have an app, which is offline first.

When we discussed this, when we got to the bottom of it, the reason the offline first was still desirable was that actually, there’s no problems with actually having things downloaded rather than streaming them. And actually being able to then share them, you can share them as artefacts, rather than maybe sharing them through a platform, where you might have to have adverts, or something like this.

[00:27:11] Kate: Or you have to have downloaded, I think the main point would be, everyone has to have the app. We have this issue sometimes when we’re trying to collaborate on things, oh, actually I need you to download this software platform. And then people are like, oh, it’s so irritating. And I find it irritating because I actually just want to share the information. I don’t care what the platform is. So I think it’s an example of that.

I also would say just as a point, I think the point is it’s low resource to high resource and back again is very different from high resource to low resource. It’s what is that collapsing the power dynamics in a way that the low, and I think starting in a low resource environment does this automatically, is that they’ve started with the advantage, we’ve solved for this problem, and then other people are reacting to what exists from that context, rather than not having enough resources. It’s so difficult to push back against the force of like, we have 5G and everything works really well here and yeah.

[00:28:14] David: Yeah. And everything’s been designed for that. Whereas actually once you have the base design being something which works everywhere, and then you’re saying we could easily, and we probably will, be able to make things available, stream, so if people don’t want things downloaded to their device, then they don’t have to. But we don’t have to.

And the point is that that sort of design choice, you don’t assume it in the same way that we would have otherwise. There’s no doubt that if we’d started in Kuwait, everything would have been streamed. But the fact that actually well, we’ve got the infrastructure, we don’t need to stream it, we can stream it if you want, but then you have that dialogue which is open, and maybe we don’t want to, and maybe there’s advantages to not, and so on. And that is so exciting.

And what was really interesting is there were different requirements that came from talking to people, but actually none of those requirements challenged being offline first. I was really surprised. I was expecting people to come up with something and they’d say, oh yeah, we should just do this. So what you’re actually wanting is something where we’re assuming everybody’s online all the time, but no, that never came up. Because it actually, although that’s what people start with when you’re in a high resource environment, it’s not what people necessarily need.

And it was very interesting then, listening to what people actually need, where they want things to be different, and where actually, this will work well for me. No, it was very interesting, really exciting stuff.

[00:29:42] Kate: Yeah, and I think very revealing about where demand actually is in many ways. There’s definitely, there’s always like you’re in search of your total addressable market and people need to be able to do this, and we need to lock them into these behaviours to achieve these goals. Where this is actually working with parents and what do they want in their families and you’re actually getting really different insights when you’re approaching it, what problems are you trying to solve?

And they’re very different problems, actually. There’s still fundamentally the same problems. We want to reduce violence in the home, or we want to encourage joyful learning or whatever those things are, but I don’t need to assume that the be all end all goal is how will we continue to generate profits from these behaviours?

[00:30:28] David: That of course in this context is not even a question. And what was really interesting for me was the vision that they have for not just the app but the programs is to sort of actually create this to be able to be a companion for people as they go through it. And again, that’s a very different concept of how you can build technology. Building technology to actually be with you through your life’s journey, in some sense, literally, they want it from pre birth to 18, stay with the parent to help, through that child’s life journey in that way.

And I can absolutely see how that will mean glueing together things which are currently rather separate. But they have a vision for this, which is so exciting to me. And that joined up thinking, in low resource environments, people would express a desire for this, but it’s not realistic.

Whereas here I would be surprised if 10 years down the line they don’t have a world leading parenting support system for pre birth right the way through. That’s partly because the team leading this are just phenomenal. They are world class and just have the skills, the drive, they’re going to make it happen. What a privilege to be working with people like that!

[00:31:49] Kate: You’ve made me so curious to see what emerges. I think, it sounds like it’s going to be really interesting to watch. And obviously PLH will be documenting it. They will report on it. So yes, I think we can all watch this space. But yeah, it sounds, really interesting.

[00:32:04] David: Yeah. I had a great week. If they happen to be listening, thank you so much. It was wonderful.

[00:32:10] Kate: Thank you for talking me through it. It sounds really interesting and, thanks David.

[00:32:13] David: Cheers.