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The intelligence belongs on the device

This is the second in a two-part series on rethinking artificial intelligence (AI) delivery for agriculture, based on MSC’s experience as we built digital farmer services (DFS). 

Infographic showing four barriers to farmers’ access to information: poor connectivity, limited smartphone access and storage, high mobile data costs, and fragmented information across scattered sources and complex platforms.

The first blog in this series, Why digital farmer services so often fail, argued that most AI platforms for farmers assume a decent phone, a stable connection, and cheap data. Farmers rarely have all three. Device memory runs out before the app does, a single advisory photo eats through a day’s data plan, and a dropped connection forces the network to resend the same data two or three times over.  

Platforms should depend less on the network where coverage is the main constraint. This benefits farmers who use the technology and agents who assist them. Bihar Krishi shows how this approach works. MSC helped design this government-owned digital platform targeting farmers in Bihar for the state’s Department of Agriculture. When the platform launched in 2023, farmer information and services, such as programs, market prices, and weather information, sat across separate systems. Bihar Krishi brought these services together.  

Bihar Krishi was built as a mobile app from the start. While a web version is also available, it serves a different purpose. Village-level assistants use it to help farmers who are not yet using the app themselves. 

The conversational AI feature came later to help farmers get the information they need without having to work out which menu or service to use. The AI interprets the question and directs the farmer to the relevant answer. Maharashtra’s MahaVISTAAR and the central government’s Bharat-VISTAAR platform use a similar approach. For example, “tell me more about maize” could refer to crop, seed availability, pest control, or a government program. 

Because Bihar Krishi added conversational AI to an existing platform, system questions are processed on a server, and the answer is sent back to the farmer. This approach made sense when Bihar Krishi was built. However, for AgriVOX, we asked what if more of the intelligence could sit on the device, so the platform depends less on the network?  

AgriVOX is the first version of X-VOX, MSC’s device-first product architecture for agriculture, finance, health, and other sectors. It is currently in testing. AgriVOX resolves a query in the following sequence, which stops when it finds an answer: 

  • A local intent classifier checks a compact FAQ database shipped directly inside the app. If the answer is already there, it returns instantly without a network call; 
  • If the answer is not in the app’s database, a server-hosted large language model answers anything the local database cannot, exactly as most current platforms do today; 
  • If the LLM does not have the answer because the question requires live data, it uses the Beckn protocol. The basis for Beckn is the same open, decentralized-network standard behind India’s Open Network for Digital Commerce (ONDC) and OpenAgriNet. It connects to external service providers for information no app can hold locally in advance, such as a live government program registry, current weather, or soil-testing results. 

The sequence works for farmers or people who assist them. A seed or fertilizer retailer at the counter or a village-level entrepreneur gets the same instant local answer. The system can escalate queries to a server or retrieve live program or price information. A smart intent-selection system helps route each question to the right service. 

Consider a real AgriVOX query: “I want to grow maize in the coming season. How should I prepare for it?” The platform divides the request into questions that different services can answer. The standard maize-growing procedure for the season comes from the local FAQ database. The system reads the current date to infer the season and respond without a network call. The local database can also handle field preparation, such as irrigation and ploughing. Yet, how, where, and through what mechanisms the government can help require checking live program eligibility against the farmer’s own demographic details, plus current seed and fertilizer vendor availability and nearby storage or logistics options. The server’s large language model (LLM) can reason through this, while the rest needs the Beckn-protocol lane to a live network source. 

Photo-based queries, such as a crop-disease diagnosis, follow a different path. Image-based identification needs a Vision AI model too large to run on a farmer’s phone, so this step goes to the server, which limits a single combined request. If the connection drops mid-transfer, only the failed lane is retried, with compression applied to that retry, not the entire upload resent from scratch. This is the problem Part 1 described with ordinary retry behavior. 

A second component, the FAQ-feeder, keeps the local database growing. It periodically reviews questions that had to be escalated to the server, converts the recurring ones into new FAQ entries, and, after a human review step, pushes them back down to the device. The app still needs to connect periodically to pull these updates, but it depends much less on the network. 

The first blog argued that most farmers’ phones lack memory to spare. Common app sizes put that constraint in context. WhatsApp’s Android app runs roughly 87 MB, and Facebook Messenger installs at about 97MB. Among agricultural apps, Plantix installs at roughly 21.48 MB, and DeHaat Kisan at 34MB. 

AgriVOX’s local FAQ corpus, more than 2,000 entries deep, takes up just 4MB. The full app, corpus, source-classifier, interface, and runtime libraries together total about 15 MB. This is still smaller than every app above—essential on a 2 or 3 GB device that already carries several of them. The same holds whether the device belongs to a farmer or to the retailer and village-level entrepreneur who often advises one. The device-memory constraint we mentioned in the earlier blog is real, but it applies to heavy, general-purpose apps rather than intelligence designed from the outset to fit. 

After the FAQ feeder has learned common questions in a district for one or two seasons, the local layer may answer half of farmers’ text and voice queries. Photo-based diagnosis always needs the server. However, for ordinary advisory questions, every locally answered query returns instantly, spends no data, and carries none of the retry-multiplication risk described in the previous blog. 

The financial impact scales with where the farmer lives. At roughly USD 0.16 per GB in India, the savings from a handful of daily queries are small, since Indian data is already inexpensive. At the Sub-Saharan African average of USD 3.31 per GB, the same reduction, halved, amounts to roughly a dollar or more per month on AI-related traffic alone. This saving matters more to households that carefully ration data spending. 

Local processing also makes the service more reliable. Half of conversations no longer require a nearby tower, a strong signal, or a successful first transfer. Agents who answer several questions each day can provide consistent advice even without a live connection. 

Everything so far in this blog assumes that the farmer has a phone, even an old one, on a slow network. That assumption does not hold in much of Sub-Saharan Africa, where network costs are high and mobile penetration is low and few farmers own a device. No AI architecture, edge, or server changes who owns a phone. 

However, someone in that same village usually does. Banking agents, mobile-money agents, and input and output retailers need phones to run their businesses. Agricultural extension has an obvious channel through the same agent who advises farmers directly, using a tool most farmers could never own themselves. 

A device-first architecture can therefore influence whether agents adopt the tool. A server-dependent AI advisory tool charges the agent a network cost on every query, for every farmer, all day. People who run a business on thin margins may find the recurring cost harder to justify. A device-first tool, such as AgriVOX, answers most of that same volume from the local FAQ layer, at close to no marginal network cost per query. It does not ask the agent to absorb a growing data bill in exchange for giving better advice. 

In these markets, agents offer a more realistic route than direct use by farmers. Established, trusted agents can use a low-cost tool to provide better advice. AgriVOX can make the agent’s advice better without making their business harder to run. 

Voice interfaces are also moving from servers to devices. Lightweight text-to-speech models fine-tuned on AI4Bharat’s open Hindi voice data now run entirely offline, on-device, in real time, using compact exports instead of a cloud call for every sentence spoken back to a farmer. Quantized models with roughly a billion parameters can now run on ordinary phone hardware without an external API call. Every layer of the interface a farmer touches, text or voice, is becoming something a modest device can hold on its own, extending local processing one layer higher, to the interface. 

AgriVOX does not solve the three constraints this series has described. Fixing rural bandwidth, closing the smartphone affordability gap, and rewriting the economics of mobile data are larger interventions for other actors and other debates. AgriVOX designs around those constraints as they stand today, so that adoption and inclusion do not have to wait for the larger interventions to arrive first. 

The distinction is the whole point. A technologist’s instinct is to build toward the best available benchmark, the fastest model, the newest capability, and assume the infrastructure will eventually catch up. MSC’s instinct, shaped by work closer to the ground, is to start from the stakeholder, whether a farmer or a retailer, and village-level entrepreneur advising them. We look at the phone they use, the signal they can get, and the data plan they can afford this season. The intelligence belongs on the device because a farmer can use it today. After sufficient field testing, the next post in this series will report how AgriVOX performs in practice. 

Why digital farmer services so often fail

This is the first of a two-part series on rethinking AI delivery for agriculture, based on our experience building digital farmer services (DFS). 

What happens when an AI tool designed to help a farmer cannot reach them when they need it most? The answer reveals a problem that goes far beyond the technology itself. Many artificial intelligence (AI) platforms built for farmers still begin with a simple picture: a farmer with a decent smartphone, a stable connection, and cheap data. 

For smallholder farmers, these three conditions rarely reflect reality. The gap between these conditions and farmers’ realities matters more than AI quality. It helps explain why many farmer-facing tools work in a pilot but fail once they reach real users.  

A farmer in a village three hours from the nearest town points their phone camera at a wilting maize leaf. They need an answer before the disease spreads further. The app opens, but the upload stops. Their two-year-old phone cannot handle the camera and upload simultaneously. The nearest tower is congested, so the connection times out.  

They buy a data top-up that they can barely afford. However, the problem continues. They cannot get a usable connection before the evening. The next morning, they walk to town for advice from an agri-dealer instead. They are not an exception. Their experience is common among smallholder farmers across India, Sub-Saharan Africa, and South Asia. They represent the user that server-led AI designs often overlook. 

Design for the phones farmers use  

 

A modern AI app expects more from a smartphone than many farmers can provide. It requires processing power and available memory to run smoothly. Most farmers do not have that luxury. In India, the sub-USD 200 entry tier still dominates smartphone sales by volume. Low-cost devices typically have just 2 GB to 4 GB of random access memory (RAM), which is the phone’s short-term working memory. It affects how many apps can run smoothly at once.  

Infographic explaining why AI tools struggle to reach farmers: limited phone memory, costly data, and unreliable connectivity. It compares smartphone RAM, mobile data prices, and active mobile connection rates in India and Sub-Saharan Africa.

In Sub-Saharan Africa, the baseline is lower still. The GSM Association and African mobile operators have jointly proposed 2 GB of RAM as the minimum specification for an affordable 4G smartphone. The proposed specification sets a target below the current baseline. 

A 2 GB phone already runs a messaging app, a camera, and background sync, which leaves little room to hold a large upload in memory while a slow network catches up.  

Platforms designed and tested on newer devices can exclude the very farmers they seek to serve. The problem goes beyond what AI can do. The phone must also keep up long enough to deliver it. 

Data costs shape whether farmers use the service 

 

Data plans in South Asia look generous until you see what has to be shared with the allowance. For instance, Reliance Jio’s INR 349 (USD 3.66) plan, a standard package on India’s largest network, gives a subscriber 2 GB of data per day for 28 days. That 2 GB covers uploads and downloads, every app on the phone, and all other data use. A farmer must share the allowance across all digital needs, including crop-related questions.  

A geotagged, full-resolution photo from a modern camera uses roughly 3 MB to 6 MB per shot once GPS coordinates and device metadata are attached. A crop diagnosis requires the farmer to upload the photo and download the result. A single question can use a noticeable share of the farmer’s daily allowance.  

The numbers look very different across markets. Among the five cheapest mobile data markets in the world, two are in South Asia and the Pacific: Fiji and Cambodia. They have roughly USD 0.09 and USD 0.12 per GB, respectively, as per a study. India also has low mobile data costs, at USD 0.16 per GB.  

Sub-Saharan Africa is a different market. The same tracking study puts the regional average at USD 3.31 per GB, roughly 20 times the Indian rate. Zimbabwe alone reaches USD 43.75 per GB.  

So, the same advisory photo that costs a fraction of a rupee in India can cost real money in Harare, Zimbabwe. For a farmer working with a tight budget, that difference matters before AI even gets a chance to answer. 

Coverage does not guarantee a usable connection 

 

Coverage maps can make connectivity seem widely available. Yet, field data shows a different story. In India, 4G signal reaches 89% of villages. By early 2025, 5G had reached roughly 78% of villages as well.  Yet rural tele density, or the number of active mobile connections per 100 people, is only 59%, compared with 125% in urban areas. In plain terms, a village can have a strong signal on paper, while roughly four in 10 residents still have no working mobile connection to use it with. 

Even when a farmer has 4G, the connection may not perform well. Independent field tests of public 4G networks in rural agricultural settings rarely recorded speeds above 20 Mbps, and latency almost never fell below 100 milliseconds. Latency measures the delay between sending a request and getting a reply. Higher latency means longer upload times and a greater risk of failure.  

Sub-Saharan Africa shows the same gap on a larger scale. Roughly 85% of the population lives within reach of 3G or 4G broadband, but 63% remain offline inside that same coverage area. 

A weak or congested connection also worsens the cost problem. Mobile networks do not resume a broken upload at the point where it stopped. They restart it from the beginning. On a lossy connection, one retry can become five, and five can become 50 before a transfer succeeds. Each failed attempt uses more of the same data allowance. A photo that should cost a single debit against the day’s allowance. Network failures can make it use two or three times as much. The farmer pays for the network’s failure to deliver a reliable service. 

A platform that already confirms this 

 

Maharashtra’s own farmer advisory platform makes this point unintentionally. MahaVISTAAR-AI launched in May 2025 as a smartphone app. It delivers weather updates, market prices, and pest advisories to registered farmers across the state. Within a year, the state government added a voice-telephony layer to the same platform.  Farmers could reach it by phone without downloading an app, a smartphone, or an internet connection. This addition is more than a new feature. It shows that the original app-based design could not reach every farmer it was built to serve. The voice layer brings the service closer to the farmers described by the data above. 

What this means for AI in agriculture 

 

Device memory, data cost, and connection reliability are not separate problems. They compound each other and define the baseline condition of the market that these platforms seek to serve. These conditions are not an edge case that better infrastructure will eventually solve. A weak connection can delay an answer and increase the data cost of getting it. For farmers with a tight data budget, that cost can determine whether they use a tool or give up on it. AI in agriculture must account for how and where farmers can access the intelligence.  

A model that depends on a round trip to a well-provisioned server moves the constraint from the AI’s capability to the farmer’s access. Declaring a problem solved does not make that constraint disappear.  

For the farmer with the wilting maize leaf, access matters as much as AI capability. They need an answer on the phone they have, with the connection and data they can afford. 

MahaVISTAAR-AI has already found a partial answer through the phone network. The next blog in this series explores the next step. It examines what changes when the AI model itself runs on the device. This model can match the hardware farmers actually own and use, which has little or no network access. 

Blog part 2: “The intelligence belongs on the device” 

A generation at risk: How Southeast Asia’s climate inaction is endangering adolescent health and resilience

In Metro Manila, 15-year-old Angela fainted on her way to school. Like a thousand others across the nation, her school was closed due to a severe heatwave. Angela is just one among countless people across Southeast Asia who bear the brunt of changing climate. Each year, over 460 million of them face at least one environmental hazard, while 210 million face three or more. This reveals a structural gap in how the health and well-being of adolescents are often overlooked. Without urgent, evidence-based investment, climate change will reverse valuable gains in adolescent health, education, and gender equity.

Background

The East Asia and the Pacific region is home to more than 1 billion children and adolescents. Southeast Asia falls under one of the world’s most climate-vulnerable regions. The Intergovernmental Panel on Climate Change (IPCC) has warned that the region will face extreme exposure to heatwaves, floods, vector-borne diseases, and sea-level rise over the next two decades.

April 2024 was when the region experienced one of its most extreme heatwaves. In Bangladesh, heatwaves forced all schools to close, which impacted 33 million children. Temperatures soared above 50°C in parts of the Philippines, Cambodia, and Thailand. Governments across these regions continue to struggle as they respond to the heatwave crisis. Such closures deprive students of essential services, such as school meals, menstrual hygiene products, and psychosocial support.

Compounding health risks for adolescents

Adolescents’ developing thermoregulatory systems make them uniquely vulnerable to the physiological impacts of extreme heat. Research has also found that prolonged exposure to temperatures above 35°C can lead to dehydration, heat exhaustion, and cardiovascular strain – outcomes that are severe in undernourished or anemic adolescents.

Besides rising temperatures and urban congestion, air pollution is another increasing public health risk. Adolescents are exposed to a high proportion of fine particulate matter (PM 2.5), which increases the rates of asthma, infections, and reduced lung capacity, especially in cities, such as Jakarta, Bangkok, and Manila.

Moreover, vector-borne diseases, such as dengue, malaria, and measles, also affect adolescents disproportionately. Rising temperatures expand mosquito breeding zones, which spread these diseases to new areas. A 2024 analysis by UNICEF on the “effects of climate change on child health and well-being” found that climate-sensitive disease outbreaks disrupted the education of more than 40,000,000 children annually.

Another barrier that adolescents struggle with is poor mental health, which remains overlooked and has a profound impact on adolescents. Climate-induced displacement, loss, and disruption are linked to rising rates of anxiety, depression, and Post Traumatic Stress Disorder (PTSD) among adolescents. A strong correlation has been confirmed between extreme weather exposure and adolescent psychological distress, particularly among girls and marginalized youth (PMC Pub Med Central).

Schools as frontlines of climate disruption

Climate crises directly impact educational systems. Schools in Thailand, the Philippines, and Cambodia closed due to unsafe conditions during the April 2024 heatwave. Students in regions like Sylhet miss up to eight weeks of education each year. The Guardian reported that classroom temperatures exceeded 40°C in Bangkok, which violates national safety thresholds for indoor environments.

School closures disrupted more than learning as adolescents were deprived of meals, vaccines, menstrual health support, and psychosocial care. A study finds that school closures affect adolescent girls disproportionately due to the limited menstrual hygiene infrastructure and gendered responsibilities during such crises. Despite their physical and social vulnerability to climate threats, adolescents are notably missing from national adaptation and health plans.

When schools are closed, adolescents, particularly girls, lose a lifeline. They suffer further disadvantages due to inadequate water, sanitation, and hygiene (WASH) infrastructure. Plan International’s report cited that floods or droughts increase the chances that menstruating girls will temporarily or permanently drop out of school. These setbacks increase the risk of early marriage, gender-based violence, and intergenerational poverty.

Structural gaps in policy and systems

Despite the growing burden of climate impacts on adolescents, policy frameworks remain adult-centric. Per the UNICEF report, only one-third of Southeast Asian countries explicitly address adolescent health or education in their nationally determined contributions (NDCs) or national adaptation plans.

Even when governments introduce programs for maternal and child health, they often underfund services for adolescent mental health, reproductive care, and disease prevention. This shows that health systems are misaligned and inaccessible, especially in rural and informal urban areas.

Education ministries also rarely integrate climate resilience into infrastructure or curricula. A UNESCO SEAMEO (Southeast Asian Ministers of Education Organization) 2023 audit found that fewer than 20% of public schools in ASEAN countries are built to withstand flooding, and fewer than 5% have heat-resilient classroom architecture.

Investing in resilience is good economics

Healthy, educated adolescents become productive adults who sustain growth, innovation, and stability. Every dollar invested in their climate resilience yields long-term social and financial dividends. Private capital, public programs, and youth innovation must converge around this goal. Companies that embed adolescent-health resilience into their ESG strategies, by supporting climate-proof infrastructure, mental-health tech, and inclusive education, will not only build reputational capital but also strengthen the markets they depend on.

The current climate crisis presents an opportunity for stakeholders to center adolescents in climate policies. National climate with age plans must include adolescent-specific health and education indicators, with age-specific monitoring. The following interventions show how adolescent needs can be operationalized across health, education, and climate systems.

Climate-resilient-adolescent-health-systems-

  1. Climate-proof schools and health centers: Governments must prioritize resilient infrastructure, such as cooling systems, flood barriers, and solar-powered water systems, in urban and rural schools.
  2. Scale adolescent mental health and psychosocial support: Stakeholders should invest in training frontline workers to detect and address climate-induced stress in adolescents, especially in post-disaster zones.
  3. Provide gender-responsive WASH services: Every school and clinic must include private, functional menstrual hygiene management facilities, particularly in climate-affected districts.
  4. Support youth-led advocacy and innovation: Programs that fund adolescent participation in climate governance and solution-building should receive adequate support to yield higher accountability and innovation outcomes.

The business cost of inaction

Beyond being a humanitarian issue, the health toll of climate change is an economic one. When schools close, when adolescents fall ill, when communities relocate, productivity, innovation, and future labor supply all decline. The ILO estimates that heat stress could erase up to 5 percent of working hours annually in ASEAN economies by 2030.

Yet most corporate sustainability agendas still treat adolescent health as someone else’s responsibility. That must change. The private sector has both the means and the incentive to safeguard this generation – not through short-term philanthropy, but through long-term investment in resilience, innovation, and workforce well-being.

Private innovation filling public gaps

Public health systems in Southeast Asia remain under-resourced; few allocate more than 3 percent of GDP to healthcare, and even less to adolescent mental health or preventive care. Private innovation can help bridge, some, if not all, of these gaps.

Across Asia, a surge of digital and mental health enterprises is showing what scalable, affordable solutions look like. In India, more than 400 private mental-health startups now offer AI-enabled chatbots, teletherapy, and wearable devices that extend care to millions. Similar models can be adapted for adolescents in climate-vulnerable communities, especially for providing low-bandwidth, multilingual access to psychosocial support after disasters or heat events.

In the Philippines and Indonesia, health-tech startups are piloting mobile screening tools for stress and dehydration among students, linking them to digital counselors or clinics. Corporate Employee Assistance Programs are also expanding to cover adolescents in their employees’ families, embedding continuity of care across the household. These approaches reinforce how private enterprises can extend public health delivery without duplicating it — reaching more people, faster, and often at lower cost.

What next?

More than demographic statistics, the 243 million adolescents in Southeast Asia are a resilient generation at risk. Although climate change has made their vulnerabilities visible, it has also underscored their potential as change agents. The current policy vacuum is a critical failing, but it can be reversed with immediate, inclusive, and strategic investment.

Adolescents must be repositioned at the center of Southeast Asia’s climate resilience agenda. The private sector holds a decisive role in this equation – by financing innovation, scaling digital health, and building climate-resilient infrastructure that gives every adolescent a fair chance at the future. In a region where the next generation will inherit both the economic promise and the climate burden, investing in their health is the smartest business decision of all.

Beyond the classroom: Building real-time financial capability for last-mile users​

MSC’s Digital Financial Capability (DFC) platform provides personalized, multilingual financial education tailored to users’ knowledge levels. After an initial assessment, users access content through audio lessons, flashcards, and interactive activities. Topics include opening bank accounts, withdrawals, and safe use of financial services. An integrated AI-powered assistant answers questions in local languages. Users can monitor progress. Multiple users can access lessons on a single phone. The platform makes financial education accessible, relevant, and practical, with support for sustained engagement.

Are we addressing the real constraints to health-worker performance?

A woman in labor develops a complication that requires urgent referral. The Auxiliary Nurse Midwife (ANM) attending to her recognizes the danger signs, follows the protocol, and initiates the referral. But the ambulance is unavailable. The nearest referral facility does not have the capability to manage the complication and the blood that may be required is not available. The woman does not receive the care she needs in time. 

Where, in this case, did the failure occur? Was it a gap in the ANM’s knowledge or skills? Did she fail to recognize the complication or act on it? Or did the breakdown occur elsewhere in the pathway that should have enabled her actions to translate into care? 

The answer matters because how we diagnose the problem determines how we try to fix it. When poor service delivery is attributed to health-worker performance, the distinction between a competency gap and a system constraint is often overlooked. As a result, training can become the response to problems it was never designed to solve. When a health program underperforms, a common response across ministries, donors, and implementing organizations is to retrain the health workforce. This instinct is not unreasonable. Human resources for health (HRH) are the point of contact between health systems and the people they serve, and their knowledge and skill genuinely matter. But the problem arises when we default to retraining without first understanding what is causing poor performance.   

This is not to argue that training doesn’t work. Where a cadre genuinely lacks the knowledge or skill a role requires, training closes that gap well. Evidence from Peru shows that training alone is not a sufficient intervention because it leaves untouched the deeper problems like attrition and weak supervision that shape how a worker behaves on the job. The question then is whether poor performance reflects a genuine competency gap or whether constraints elsewhere in the system are preventing the worker from performing effectively. 

Figure 1: World Health Organization’s (WHO’s) six building blocks of a health system

 

One lens to address this question comes from the WHO’s health systems framework (Figure 1). The framework’s emphasis on interconnectedness highlights that health-worker performance depends partly on how well the surrounding health system functions. This implies that a health worker’s performance is not something they generate on their own. It depends on whether their role is clearly defined, whether they have access to the medicines, equipment and information they need and whether the facilities and referral systems around them are capable to respond.  

A “system” failure hence is not a single black box. It is usually a chain of decisions, a district store that under-ordered, and a supervisor who never visited. Yet, it is often the health worker who absorbs the blame because they remain the most visible actor in that chain. A dysfunctional referral pathway, a non-existent supervision structure, or a deployment decision made several levels above them sit further back in the system and can therefore go unexamined and unaddressed. This also helps explain why retraining so often becomes the default response even when the actual constraint sits elsewhere in the system. 

The pathway from training to better service delivery, therefore, has several links: training must build competency, competency must translate into performance, and that performance must connect with a functioning service-delivery pathway. A failure at any one of these points can produce the same visible result: poor service delivery. 

Illustrative examples of where and how the system might break down 

  1. Unclear roles: Before competency can be verified, there has to be clarity on what a health worker is expected to do. Without this clarity, we risk adding tasks and training to cadres without considering whether those tasks belong within their role.  Getting the right person, with the right competencies, to perform the right role, therefore starts with clearly defining what each cadre is expected to deliver.
  2. Inadequate supervision: Even when roles are clearly defined, health workers may not receive the supervision needed to translate those expectations into practice. Studies consistently show that supportive supervision measurably increases direct patient care. In practice, however, supervision can remain focused on compliance rather than on assessing competencies, identifying performance gaps, and supporting workers to improve.  
  3. Poor deployment: A well-trained and supervised worker cannot compensate for being posted in the wrong place. For instance, in Indonesia, only 4 of 38 provinces have one doctor per 1,000 people. The challenge, therefore, is not only the workforce size but how effectively it is distributed in relation to population need.  
  4. Facility-level constraints: Even when the right worker is in the right place, performance can still be constrained by the absence of basic inputs. A trained health worker cannot deliver services effectively without the medicines and equipment required for their role. This holds particular relevance for Community health workers in low- and middle-income countries, who face stock-outs of essential medicines nearly one-third of the time.  

Together, these examples show how a performance gap that appears at the level of the health worker may originate elsewhere in the system. They are not exhaustive. Financing, workload and staffing, referral systems, technology, governance, and other system-level factors can similarly shape whether health workers are able to perform effectively. The specific constraint will vary across contexts, which is precisely why identifying where the performance gap lies must come before deciding how to address it.  

What actually moves the needle 

Rather than defaulting to training, the first step is to understand what is driving the performance gap and where in the pathway does it occur. The framework below provides a simple way to diagnose whether the constraint lies in the worker’s role, competency, enabling environment, ability to sustain performance, or the wider health system. 

A framework to identify where the performance gap lies in the health system:

 

Identifying where the performance gap lies is only the first step. The next is determining who is best placed to investigate its cause and act on it. This should not automatically be the actor closest to where the failure becomes visible. Instead, ownership of the diagnosis should follow three simple questions: 

For example, if a health worker is unable to demonstrate a competency required for their role, a supervisor or clinical mentor may be best placed to diagnose the gap. If trained workers across a facility are unable to deliver services because essential commodities are repeatedly unavailable, the diagnosis needs to involve facility and district management. If patients are consistently lost between referral points, the district or program team may need to bring together the actors responsible for referring, transporting and receiving patients. Where the same deployment, financing, or governance constraint recurs across multiple districts, diagnosis may need to move further upstream to the state or national level. 

The principle is simple: the actor at whom a problem becomes visible should not automatically become the actor held responsible for diagnosing or fixing it. The person who experiences the constraint, the person best placed to diagnose it, and the person with the authority to address it may all be different actors. 

Conclusion 

The aim is not to train less, but to diagnose better. Not every performance gap is a training gap, and the actor closest to the problem may not always be the best placed to address it. When service delivery falls short, the first task is to understand where the pathway is breaking down, what is causing the gap, and who is best placed to act on it. 

The diagnosis should then guide the programmatic response. A competency gap may require training, an unclear role may require role redesign or clearer responsibilities, an enabling gap may call for better supervision, deployment, commodities or tools, and constraints in the wider system may require changes to referral pathways, financing, governance or coordination. The value of the framework is therefore not simply in identifying the problem, but in helping programmes match the right intervention and the right actors to the gap they are trying to solve.