DoctHERS-in-the-House: Improving health care for low-income women in Pakistan

Dr Sara Khurram is a young doctor from Karachi. In 2012, she got pregnant, and this led her to quit her residency and stop her medical career.

Sara’s story is common among Pakistani female doctors. While 80 percent of medical school graduates are women, only 25 percent ever practice medicine. Pakistan being a conservative country, many have to stop working once they get married or start having babies. That’s how an estimated 9,000 trained female physicians end up staying at home.

Pakistan’s medical crisis

This home restriction phenomenon puts an additional pressure on Pakistan’s collapsing medical system. With only 0.74 doctors for 1,000 people, active physicians are overwhelmed, and of course, this has a negative impact on the population’s well-being.

Pakistan is still struggling with poliomyelitis as well as with a high rate of stillbirth and tuberculosis cases. Moreover, the examples of malpractice and medical negligence are numerous. In Lahore, for instance, a toddler with a small burn on her hand passed away after a doctor injected her with too much anesthesia. A teenager had his appendix removed when in fact he was suffering from colon cancer. And every day, newborns with jaundice symptoms are misdiagnosed, making them either deaf or brain-damaged.

The main victims of this predicament are the 56 million Pakistani who earn less than three dollars per day. Whenever they get sick, they are left with three choices: get no treatment, go to an insalubrious public hospital, or visit the often unskilled local doctor. For pregnant women living in poverty, the situation is even more dramatic, as many refuse to be examined by a male doctor. Therefore, 95 percent cannot access quality health care; and in the countryside, 1 in 5 mothers dies every day, because she delivers at home, in an unsafe environment.

Bridging the gap between female doctors and female patients

While expecting her baby, Dr Sara Khurram had to spend most of her time on bed rest, and she was doing a lot of thinking. In particular, she thought about her own situation and the current medical crisis.

One day, she came up with a clever idea to circumvent Pakistan’s main socio-cultural barriers: she would open a telemedicine clinic! Thus, female physicians could stay at home, and yet, provide poor women with primary and OB/GYN cares. To lower the risk of misdiagnosis and enhance the human interaction, the young woman decided to rely on Lady Health Workers.

In Pakistan, there are about 90,000 of these community-based women, and they play a key role in preventive health care. Dr Khurram, therefore, thought she could hire some of them and train them further to assist the physicians.During an ante-natal visit, for instance, the nurse would conduct the patient’s examination, and since the entire consultation would be video-conferenced, the doctor would not only supervise her assistant. She would also see in real time what appears on the monitor, and thus, give accurate medical counsel.

At the time, considering opening a virtual clinic was a bold idea. For sure, telemedicine had been spreading across the world for a while. But it was far from having reached Pakistan, and it is well known that many people in the country are wary of ICTs. On the other hand, mobile penetration was already high (85 percent), and Dr Khurram believed mobile and video consultations were workable in most regions.

“On the seventh day, one patient came in”

It did not take long for the young woman to take the leap and give her ‘DoctHERS-in-the-House’ project a try. To test its feasibility and sustainability, she decided to start a pilot in Naya Jeevan‘s health center of Sultanabad, a conservative slum of 250,000 people in Karachi.

In May 2013, everything was ready, and Dr Khurram could open her virtual clinic, the first telemedicine facility in Pakistan. “For six days, she said, not even one patient came in; […] but on the seventh day, one patient came in.” Since then, the clinic has always been full, encouraging the young woman to hire more doctors and replicate her model throughout Pakistan.

It has turned out that video-conferencing is not an obstacle for the female patients. In fact, since DoctHERS-in-the-House started, women have been thrilled by this new type of consultation. For sure, they are happy to pay 50 percent less than they would do for an in-person visit. But what satisfies them the most is the good quality of the care they receive. In Sultanabad only, DoctHERS-in-the-House have provided 500 women with ante- and post-natal care. For 14 percent, they anticipated medical complications and sent their patients to a hospital, where they could get a safe delivery.

And this has certainly saved a few lives!

Sinar Project: Promoting Governmental Accountability in Malaysia

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Malaysia has been governed by the same political party, Barisan Nasional, since it gained independence from the United Kingdom in 1957. Barisian Nasional’s policies, which strongly favor ethnic Malay’s, have begun to lose support among young and minority voters, culminating in the 2013 elections when opposition leader Anwar Ibrahim won the popular vote. Despite the polling results, and amid allegations of voter fraud, Ibrahim lost the election.

The 2013 elections were a high-level indicator of the systemic lack of transparency and accountability in the Malaysian political system. According to the World Bank’s Governance Indicators, Malaysia is in just the 37th percentile for “voice and accountability.” These measures indicate an individual’s ability to participate in selecting their government, freedom of expression, freedom of association, and a free media.

The Sinar Project, an ISIF Asia award winning non-profit organization, is seeking to fill the void in governmental transparency and accountability in Malaysia via open-source technology. Sinar is producing platforms which help monitor all levels of government, from local municipalities to parliament.

Corruption Monitoring

In Ernest and Young’s 2013 Asia-Pacific fraud survey, almost 40% of respondents said that corruption and bribery are widespread in Malaysia. That figure is nearly double the average of the rest of the region. In order to bring awareness to the corruption of the Malaysian political system, Sinar launched their Accountable platform in 2012.

Accountable is a web application which actively tracks the people, issues, and organizations related to Malaysian corruption. The data is presented in a searchable, tab separated manner, allowing the Malaysian public to easily monitor the activities of, and allegations against, their elected officials. Sinar will soon add an additional monitoring feature to Accountable, indicating the status of individual cases, including data on the case out come (i.e. false allegation, money returned, and criminal charges brought).

A second anti-corruption tool that Sinar has developed is their Construction Industry Development Board (CIDB) database. Corruption in the Malaysian construction industry is at a “serious level”, according to the Malaysian Anti-Corruption Commission.

Utilizing scrapers, the CIDB monitors and aggregates construction project data in real-time, producing a readable CSV document. The CIDB database provides detailed information on all public-private projects, including contact information for company directors, budgets, contractor details, and registration numbers.

Governmental Accountability

Sinar’s most advanced accountability project, AduanKu, was launched in January of 2014. The platform enables users to report problems (think potholes, faulty street lights, etc.) directly to their local municipalities. Problems can be reported through a web portal with a smartphone or computer, and an app-based platform is coming soon. Once a user submits a problem, AduanKu sends an official report via email to the relevant Council. These reports contain mapping info of the problem location, a detailed description, and photographs when available.

The local user is then able to monitor their council’s response, and utilize a feature in AduanKu to publicly comment on whether appropriate action was taken. This interaction makes local municipalities directly accountable to their taxpayers, with municipal performance data publicly available through AduanKu. The Subang Jaya Municipal Council, for example, has had 292 problems reported, fixing 115 of them. AduanKu is currently available in a limited number of municipalities, but Sinar plans to expand the service throughout Malaysia.

Sinar also has a variety accountability projects on the national scale. Their BillWatcher application enables Malaysian citizens to monitor the status of upcoming bills in both the national parliament and state assemblies. Their Malaysian Representatives project aims to provide citizens with background information on all members of Parliament, including contact information, work history, and known assets.

While these applications are informational in nature, they help create transparency in the Malaysian political system by educating the voting public about the actions of their elected officials. For a nation with a voter turnout of over 84%, this sort of transparency can go a long way to bringing about change.

All of the Sinar Project’s code is open source, and can be found on GitHub here.

SafeCity: Mapping Sexual Violence in India’s Public Spaces

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Examples of similar indecent behavior abound from all around India. For women, going outside is often a nightmare: it exposes them to men’s comments, catcalling, harassment, and even abuse.

While traveling in the bus, the man standing behind me was trying to touch me.

According to the Crime Record Bureau, a sexual assault occurs every three minutes throughout the country; and every 20 minutes, a woman is raped. How frightening these figures are, they are largely underestimated. For decades, many victims have had no choice but to remain silent. Even now, 80 percent of them have never been to the police. They fear retaliation; or they believe the authorities will not deal with their complaint.

Mentalities are changing

It took a tragic incident in New Delhi for the mentalities to start changing. On December 16th, 2012, Jyoti Singh Pandey, a 23-year old physiotherapist intern, went to the movie with her boyfriend. On their way back home, it was dark already, and six men attacked them. The man was beaten; the girl was gang raped. She never recovered from her injuries, and two weeks after her ordeal, she passed away.

This tragedy shocked the collective conscious of India. In the following days, thousands of people took to the street to protest against what some call an epidemic of rape and sexual abuse.

Else, Surya, Saloni, and Aditya — four young social entrepreneurs — were outraged too. Soon, they wanted to act, and they suggested to tackle the issue using a crowdsourcing model. They had heard of the HarassMap initiative in Egypt, and they agreed to develop a similar project in India.SafeCity was born.

Breaking the women’s silence

SafeCity’s top priority is to break the victim’s silence. A culture of quiet acceptance has expanded over the years in India, and it has created a vicious circle. Too often, the perpetrators never get prosecuted, which increases a sense of impunity amongst them. After a while, some tend to move on from indecent behavior to sexual assault. That’s why SafeCity aims at encouraging women to share their personal stories, at least on the Internet.

Else and her friends have designed an easy-to-use platform, and the victims don’t even have to reveal their name. For sure, anonymity makes it difficult to verify the testimonies; on the other hand, it helps the women to speak out. And it has been effective. Since the website was launched in December 2012, more than 3,500 people have reported experiences of sexual violence in the public space. This includes: verbal comments (1,847 stories), touching/grouping (1,109), sexual invites (300), and rape/assault (83).

Prevention

The only requirement for the user is to enter the time and exact location of the incident. The data are, then, aggregated to highlight local trends and map the unsafe areas. This enables women to check the safety rating of their destination before deciding to go there.

SafeCity’s founders claim that this is critical, as harassers and abusers tend to stay in their “comfort zone.” For example, in April 2013, a photojournalist was gang raped in an isolated compound in Mumbai. It turned out that the group had already perpetrated four rapes at the same place. Had the victims reported these crimes, the girl’s employer would have probably not sent her on an assignment there.

What is more, the administration or the community could have taken action. To induce the local authorities to do something, SafeCity’s founders have tried to involve them as much as possible. In Bandra, Else collected several stories of sexual violence in a 10-street area. After she showed them to the local police, they responded by changing patrol times. They also had the street lighting repaired and CCTV cameras installed in key locations.

A first step towards positive change

Of course, some could say this initiative is a drop in the ocean. In India, only 130 million people have access to the Internet, and in the countryside, the penetration rate is low.

Well aware of this digital divide, the founders of SafeCity have, thus, taken action at various levels. They launched an awareness campaign in Mumbai and Delhi and organized workshops in universities. In the near future, they plan to enable women without Internet access to report incidents using their mobile phone.

For sure, SafeCity will not put an immediate end to the issue of sexual harassment and abuse on the streets of India. But if women start speaking out, we can hope the change will come.At last.

Win $10,000 in USAID’s Mobiles for Development in Asia Award

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Do you have a mobile service, product, app, or add-on that is being used to address a development challenge in Asia? Do you want the opportunity to promote your mobile solution to a broader audience of development professionals? If so, apply for the Mobiles for Development in Asia Award!

The Mobiles for Development in Asia Award seeks to identify and highlight promising mobile services, apps, and other innovative uses of mobile technologies. Specifically, the purpose is to recognize Asia-based institutions and their M4D work that have the potential to impact development outcomes in climate change, food security, health, governance, biodiversity, and fisheries. While applications from any country in Asia are welcome emphasis will be placed on organizations and applications with deployments in Southeast Asia.

Key areas of focus are: climate change, food security, health, biodiversity, governance, and fisheries. Applications are due on November 14, 2014 and the complete rules and award criteria can be found here.

The strongest applicants will be invited to present their work at Mobiles for Development Forum Asia 2015 January 20-21, 2015 in Bangkok, Thailand. The Forum will be attended by USAID staff from across Asia, other donors, NGOs, technology companies, mobile network operators, and others.

Up to three finalists will receive a paid trip to Bangkok, including economy- class flights, up to three nights of lodging, and three days of per diem. One winner will receive $10,000 towards further learning and understanding in mobiles for development.

Odd Jobber: Connecting Lahore’s Rickshaws with Mobile

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Lahore, a bustling metropolis of over 9 million people, is nestled just inside Pakistan’s Eastern border with India. For Lahore’s unskilled laborers, finding work on a consistent basis can pose a daily challenge. Often times that challenge has nothing to do with desire, ability, or work ethic, but simply a lack of available work. Despite boasting one of Pakistan’s stronger regional economies, hundreds of thousands of people in Lahore live well below the poverty line. Pakistan, as a nation, ranks 177th out of 228 with a GDP per capita of only $3,100 per person per year.

Ideacentricity, a tech-startup located in Lahore’s impressive Arfa Software Technology Park, has created an SMS based marketplace called Odd Jobber to help directly connect this workforce with the consumers who need their services. Ideacentricity’s founder Adnan Khawaja describes the Odd Jobber platform as a combination of oDesk for odd jobs and Uber for rickshaws.

Currently, Odd Jobber is primarily focusing on their rickshaw capacity. The average rickshaw driver in Lahore, of which there are over 120,000, spends a large part of their day actively searching for fares. During this period the rickshaw drivers aren’t generating any revenue, and are expending cash on fuel and other costs. This is period of inactivity is what Odd Jobber is designed to alleviate.

Consumers have three ways to interact with Odd Jobber. They can call, send an SMS to 8001 with a pick- and drop-off address, or book online here. Once the request has been submitted, an SMS in Urdu goes out to rickshaw drivers who are close by, and they respond via SMS with a bid. The consumer chooses their preferred bid, which will soon be accompanied by driver rating, and the rickshaw should be on-site within 10 minutes. The Odd Jobber interface empowers drivers with direct access to customers, enabling them to generate revenue for the entirety of their shift.

Utilizing an SMS based platform instead of smartphone technology (think Über) is critical to the potential success of Odd Jobber. The mobile penetration rate in Pakistan is approaching 80%, while only 7-10% of the population have a smartphone. Ideacentricity is working to incorporate a rapidly expanding mobile-banking service called easypaisa (Telenor) into the Odd Jobber platform. This will facilitate easy transaction flow, and allow consumers to pre-pay for services.

Ideacentricity is attempting to expand Odd Jobber organically within Lahore. On their website, the company is encouraging consumers to request areas in which they’d like service. Expanding in this manner ensures that they are offering services in high-traffic areas, leading to optimal utilization of the rickshaw driver’s time.

This efficiency also carries over into the Odd Jobber business model. While Odd Jobber was launched with the goal of creating positive impact for Pakistan’s unskilled labor force, Ideacentricity is a for-profit company. On every ride they organize, or job they coordinate, Odd Jobber charges an 8% fee. The fee is added in addition to the bid that the rickshaw driver places, and is carried over to the consumer, allowing the driver to take home the entirety of their bid. Khawaja estimates that within 3 years, Odd Jobber will provide 40,000 rickshaw drivers with a combined additional income of $86 million (5:30 mark in linked video). For a workforce averaging $5-$7 a day, that increase is significant.

If you are in the Washington, D.C. area and want to learn more about Odd Jobber, Adnan Khawaja will be giving a talk with Uber president Travis Kalanick at the Annual Fulbright Conference and Prize Ceremony on October 17.

You can also check out Odd Jobber on Facebook.

Apply Now! ISIF Asia Grants

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ISIF Asia provides financial support for projects in the form of “small grants.” Small grants are not repayable as no money or interest must be paid back. Grants allocation is decided through a competitive process following a rigorous selection process. This funding mechanism allows the use of flexible and simple management tools.

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Grants will be provided to project proposals to be implemented in a period of 3 to 12 months for up to AUD 30,000 that are aligned with the funding categories and eligibility criteria. Project proposals should provide clear and concrete information about the proposed initiative so the evaluation committee can properly assess it. Innovation and a development focus should be an integral part of all project proposals received during the application process.

The funding categories are:

  • Innovation on access provision
  • Inovation on learning and localization
  • Code for the common good
  • Rights

Call for applications for 2015 is open until 31 October 2014. After the deadline to submit applications, all received submissions are subject to a process of comprehensive analysis, as described in the Selection process section of this website. Shortlisted candidates will be notified. Once all administrative requirements have been met according to the terms and conditions, an official announcement will be widely distributed.

What are you waiting for? Apply today!

Improving Adolescent Sexual Health in Nepal with m4ASRH

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Child marriage rates in South Asia are the second highest in the world. Despite stiff penalties for marrying under the age of 18, including up to 3 years in prison, this trend holds true for Nepal. A recent survey performed by Nepal’s Ministry of Health and Population showed that 41% of Nepalese women aged 20-24 were married before turning 18. The health impact of childhood marriage is significant. According the World Health Organization, pregnancy and childbirth complications are the second leading cause of death among 15-19 year olds globally.

Additionally, an estimated 26% – 38% of recent births in Nepal are from unintended pregnancies. In this region, women whose pregnancies are unintended are more likely to receive reduced pre and post natal care, resulting in negative health outcomes for both mother and child.

Taboos associated with sex and sexuality remain commonplace across Nepal. According to the Family Planning Association of Nepal, this results in a lack of subject specific teachers to teach sexual health in schools. If educational materials are present, they are often far out of date or in disrepair. Despite the lack of education, Nepalese adolescent pre-marital sex is increasing, creating a population vulnerable to HIV infection.

The Mobile Solution

The Nepali Health Ministry has taken a new approach to providing young people with sexual health and family planning education, launching an mHealth initiative called Mobile for Adolescent Sexual and Reproductive Health (m4ASRH).

The program, which got underway September 18, will reach out to at least 300,000 youth.

The m4ASRH initiative is performing four different types of outreach:

  1. On-Demand Information (Encyclopedia) – Adolescents will have access to an online encyclopedia, where they will be able to find the information and answers that they need, in a safe setting.
  2. Role Model Stories – Stories tailored specifically the adolescents’ age and gender which highlight the actions of role models will be sent. The recipient will have the capability to choose the path of the story and see different outcomes.
  3. Quizzes – To drive engagement and interaction, quizzes based on the content of the on-demand information and role model stories will be sent.
  4. Hotline – m4ASRH will provide adolescents with a hotline where they can talk directly to health care workers, allowing access to expert advice and guidance when needed.

There are several factors at play in Nepal that could help the m4ASRH initiative succeed. Despite being a mountainous country, Nepal boasts high mobile penetration. According to a September 2014 report from the Nepal Telecommunications Authority (available here), over 83% of Nepal’s population are mobile phone users.

Additionally, there is a rising tide of support from within Nepal for family planning awareness. The m4ASRH initiative was launched by Khaga Raj Adhikari, Minister for Health and Population, on Nepal’s first National Family Planning Day in Kathmandu.

Last Chance: Apply Now for Manthan Award South Asia & Pacific 2014

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Today is your last chance to apply for the Manthan Award South Asia & Pacific 2014 that recognizes the best digital initiatives using ICT tools for the masses.

Award nominations should be live projects with at least 6 months of on the ground activities, not pilot projects or business plans, and in one of the 36 eligible Asia/Pacific countries.

Governments, individuals, students, entrepreneurs, private sector companies, academic institutions, and NGOs can apply online for consideration in one of these categories:

  • e-Business & Financial Inclusion
  • Community Broadcasting
  • e-Culture, Heritage & Tourism
  • e-Education, Learning & Employment
  • e-Agriculture and Ecology
  • e-Governance & Institutions
  • e-Health
  • e-Inclusion & Accessibility
  • e-News & Journalism
  • e-Entertainment & Games
  • e-Science & Technology
  • e-Women & Empowerment
  • e-Inclusion & Localisation

The shortlisted nominees will be provided a space at the Manthan Asia Expo 2014 to showcase their winning nominations to the participants from all countries and the media. The final awards ceremony will be on 4th December 2014 at India Habitat Centre, New Delhi, India.

Can Mobile Technologies Solve Energy Poverty in India?

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Geetanjali is a 20-year-old Indian girl; she comes from a poor family; and her dream is to open her own designer shop when she graduates from college. Thanks tomobile enabled electricity, her dream may come true much sooner that she expected.

Energy Poverty in India

Geetanjali lives in a slum near Bangalore, one of India’s biggest cities; and, like 75 million people throughout the country, her family has had to struggle with energy poverty for years. Where they live, there are actually electric lines; but their house was built without a permit and they could not get connected to the grid.

And, even though they could have accessed it, they would probably have experienced 8-10 hours of electricity cuts every, as it is often the case in the poor neighborhoods. In India, experts say that under-electrification hits about 80 million people.

Geetanjali’s parents do not have much money, and up to last year they would use kerosene lanterns to address their lighting needs after dark, whether it was for cooking, studying, sewing, or simply for eating. However, kerosene light was inefficient, lasted no more than one hour and caused strong indoor pollution. For Geetanjali, it made it very hard to study long hours after dark and in the longer run it would have been a major hurdle to her success.

Of course, her parents could have purchased car batteries. Battery-powered light is often brighter, and it would have enabled them to charge small devices too. For them, it was not the right solution, though. As fuel price has constantly increased over the past decade, car batteries have a cost too, and to some households, it can account for 30 percent of their spending. Besides, they would have had to go regularly to the charging plant and leave the batteries there for two days, which they thought was not so convenient.

Geetanjali’s parents wanted to go solar, just like their neighbors did a few years before. But, however convinced they were about the benefits of solar home system, they had to wait until October 2013 before they could switch to a solar solution when this was made possible by an innovative energy company called Simpa.

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Selling Solar Home System Like Cell Phones

Simpa was started in 2011 by two dynamic American entrepreneurs who strived to expand the access to off-grid solar solutions to the base of the Indian economic pyramid. To achieve this ambitious objective, they came up with a simple idea, which was to replicate the success of India’s mobile revolution in the energy sector.

In India, there are 850 million cell phones throughout the country, and it took less than ten years to reach both the richest and the poorest. According to Michael Marcharg, Simpa’s co-founder, the key factors to this incredible success were the fall in handset prices but also the pay-as-you-go model, which has enabled the lowest-income people to adapt their consumption to their actual revenues.

For Marchag, many disadvantaged households actually have the money to pay for the ongoing costs of a solar home system; but often they cannot make the upfront investment. They need time to raise the required funds and as their revenues are highly variable, they need to be able to pay as they go. This is why Simpa worked on a software solution that allows both progressive payment and flexible pricing.

Indian people can therefore get Simpa’s solar home system for a $20-40 initial payment. To have electricity, the users have to purchase prepaid cards of 50, 100 and 500 rupees, on which there is a code. With this simple code, they are able to activate the whole system and generate as much power as they prepaid for.

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By purchasing these energy credits, Simpa’s customers do not pay for the light only; they also pay down the cost of the product itself. To most people, it takes them three to five years before they can reimburse the full purchase price; but once it is done, they own the solar home system and can enjoy free electricity for 10+ years.

For low-income households, this progressive payment model makes all the difference, and it is not surprising that Simpa expects to reach more than 60,000 Indian households by 2015. Taking the example of Geetanjali, her parents could indeed afford to pay outright for Simpa’s solar home system; and, for 100 rupees only, they can now get electricity for one or two weeks in a row.

For them, life is much easier. They can power their home with 25-50 watts lamps, but also charge a cell phone, a fan, a mixer or even a television.

As for Geetanjali, she can now practice painting and sewing until midnight, maximizing her chances to achieve her dream!

Vote Now for 2014 ISIF Asia Community Choice Award

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We are very pleased to announce that ISIF Asia received 93 applications for the 2014 ISIF Asia Awards. 34 applications from 12 different economies have been selected to take part in the awards process. The ISIF Asia selection committee has officially started the assessments of the applications to select 4 award winners, one for each one of the award categories to be announced during the first week of July.

Each award package comprises of 3,000 AUD cash prize plus a travel grant to attend the Internet Governance Forum in Istambul later this year, to participate in the discussions about the future of the Internet.

Community Choice Award

In addition to the 4 awards selected by the Selection Committee, the Community Choice Award is given to the application with the highest number of online votes. The online voting is open until midnight on 26 June.

Please vote for your favorite project:

  1. Login to be able to cast your vote.
  2. Review the Award Nominees and choose your favorite applicant.
  3. Click on the red square with the word “Vote” to cast your vote.
  4. Verify the information on the pop-up window to make sure the vote is valid.
  5. Another pop up window will appear indicating that your vote was successfully submitted and inviting you to promote your vote on social media. Please share widely, to increase your favorite project’s chances to win.
  6. Logout from the system so that others sharing your computer will be able to vote from another account.

Please note that Facebook likes are NOT counted as votes.