On September 15th, I had the honor of being invited to speak with the U.S. Agency for International Development in Uganda and its development partners about country ownership as part of their Development Speakers series. The text of my remarks and the accompanying slides illustrate the evolution of country ownership in the 21st century from when the concept was first developed in the postcolonial period to incorporation into development doctrine at the turn of the century. If you are interested in how I think it has changed, I encourage you to check out my remarks and presentation.
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A version of this post originally appeared on Girls’ Globe. Reposted with permission.
Opening up the panel, Greg Beck, FHI 360‘s Director of Integrated Development, told the story of one particular attempt to aid in relief efforts. After great effort, and amassing donations and supplies, they opened boxes to find stacks of things like inflatable toilets and acne cream.
Asked Beck, “How is this going to help anybody rebuild their life?”
Beck’s point was an extreme example of a nonetheless integral point: development and aid are not straightforward, not simple. They don’t consist of simply hurling donations and good intentions at a problem and hoping something sticks.
The term “integrated development” means just that — that development is complex and requires coordinated, planned effort across sectors.
It operates around the idea that development does not exist problem by problem, sector by sector. You can’t improve global health without improving education without improving women’s rights. Naturally, there are some specific efforts that require a concentrated approach, but overall, a holistic view is more effective, and organizations and governments need to address what people really lack in the complex, multilayered environments in which they live — not just what we think they need.
A version of this post originally appeared on K4Health. Reposted with permission.
The international community is abuzz with excitement about the new global development agenda, the Sustainable Development Goals (SDGs). Officially being launched this month, the aims laid out are more ambitious and all encompassing than ever before. As such, they’ve generated an expectedly broad, diverse and loud chorus of suggestions for their implementation. Everyone seems on the hunt for the best new idea or technology to carry the agenda forward. Yet, after decades of work and untold millions of dollars in investments in research and ideas, surely we must know something useful today that could be put to good use? Perhaps while smartly pursuing innovations that keep pace with our changing world, we can also put some real investment behind some of even the simplest things that we already know to be true and which might just need a little more traction before we can finally benefit from their full potential impact.
For example, right now we have a tool available to us that spans almost every SDG. It’s a relatively inexpensive solution that can simultaneously improve global outcomes in education, health and wealth. It can help preserve our environment and ensure food security for people around the world. You may be wondering why you have not heard of this amazing tool, but it’s far from new. Drumroll … it’s fully meeting the global demand for contraception. That’s right — sound evidence from around the world tells us several things.
Impressed with their success in Kenya, the donor installed state-of-the-art hand pumps along Somalia’s Jubba River, confident that community members would also benefit from the highly effective water delivery system.
A year later, the water pumps sat broken and unused.
When my colleagues and I visited the community to ask why folks weren’t using the pumps, they told us that a regular (earthen) catchment system to capture water during the rainy season or a hand-dug well along the riverside would have better jibed with their way of life. That’s what they would have preferred. But no one talked to them before installing the hand pumps.
It’s a scenario I’ve witnessed time and again in global development, whether the goal is to improve reproductive health outcomes for women or rebuild communities in the wake of a natural disaster or conflict. For too long now, donors and development practitioners have taken a top-down approach to addressing complex global challenges — or even the seemingly simple ones, like providing water during the dry season. We predetermine the solutions. We package them into artificial, often unrealistic time frames. And we do it all alongside of rigid funding structures.
I have three long-haired boys, and wherever we go in Cambodia, people are confused, certain they are girls. We are constantly asked, “Why?” The answer is simple: They like having long hair. My boys’ push against traditional gender expressions is perhaps acceptable only because Cambodians have come to expect odd behavior from foreigners.
Yet, it is a different matter for a Cambodian transgender individual with long hair. Transgender individuals in this setting face many acute challenges, and their unconventional appearance is only one of them.
Transgender individuals in Cambodia carry a high burden of HIV. According to a study conducted by FHI 360 in select urban centers of the country, transgender individuals have an HIV prevalence of 4.15 percent (compared to 0.6 percent for the general population). Despite this striking percentage, they have historically been left out of HIV prevention and care programs. When they were included, they were incorrectly targeted as men who have sex with men. This means that there were no distinct behavior change communications or services for this group.
Our thinking about development has been dominated by the metaphor of the machine. But, as deterministic systems, machines must be predictable to run smoothly, and their behavior is dictated by their structure and parts, along with the instructions of an external operator. The smallest change or variation can bring a machine crashing to a stop.
Using the same mechanistic model, project managers apply multiple controls to reduce variety in the system, with the goal of trying to make input-output relations more predictable and efficient.
When this approach is applied to complex development problems, it falls woefully short. It can even be dangerous. The realities we try to change — the big questions of development — are not machinelike at all. They involve exceedingly complex systems of interaction, coevolution and emergence, which are more like ecologies than machines. In ecosystems, as well as economies, variation or innovation provide the very possibility for change.
Read the remainder of the blog here.
Youth and contraception: two words that when used together excite visceral responses throughout the world. The response is even more fraught when we consider long-acting, reversible contraceptives (LARCs) for youth. Both intrauterine devices (IUDs) and implants are LARCs, and the challenges for young people who wish to use them — lack of access, myths and misconceptions, provider bias and community stigma — are pervasive. We have to understand more about these challenges in order to overcome them.
In late May 2015, FHI 360 and partners — U.S. Agency for International Development, PSI, MSI and Pathfinder International’s Evidence to Action project — sponsored a symposium, called “For Youth, a Healthy Option With LARCs” in Washington, DC. The meeting convened more than 100 experts from around the world, including program advisors and implementers, researchers, health providers, donors and advocates, as well as young people themselves. The meeting’s goal was to encourage participants to share experiences, tackle tough questions and advocate for wider access to LARCs for young women.
As human development practitioners, we have been talking a lot recently about how a changing world is demanding new approaches to development in the way we finance, implement our projects and measure the results of our work. But what has been missing is a discussion about how to change the way we think about the world and mental models we use as we try to make our world a better place. While we all agree that the world has changed, our mental models lag behind, and we desperately need a mental model upgrade.
Otto Scharmer, an economist, organization theorist and keynote speaker at the upcoming Challenge Conference in Washington, DC, wrote in Leading from the Emerging Future, “The success of our actions as change-makers does not depend on what we do or how we do it, but on the inner place from which we operate.” In other words, our awareness provides the underlying ground out of which our thinking and doing emerge.
With a new global development agenda on the horizon, debates abound over which actions and investments will be the most influential for meeting the new Sustainable Development Goals (SDGs). Arguments for or against narrow, targeted solutions are becoming increasingly lost in the cacophony. Meanwhile, demand is growing for discussions that better reflect the complex, interrelated nature of the updated goals and targets.
One promising framework for sharpening this dialogue focuses on the next generation — youth — and how strategically integrated investments in their well-being can accelerate progress toward the SDGs, reaping dividends for everyone along the way. Integrated development strategies have the potential to provide today’s massive youth population with the knowledge and skills to grow into healthy, successful adults.
There are currently 1.8 billion young people in the world between the ages of 10 to 24, and among this largest generation of youth in history, 89 percent live in less developed countries. For instance, in sub-Saharan Africa the median age is roughly 18 years old versus around 38 in North America and 41 in Europe.
Final results from two research studies presented at IAS 2015 yesterday demonstrated clear scientific evidence on the benefits of early initiation of antiretroviral therapy (ART). Building on early results of HPTN 052 released in May 2011 that then showed a 96 percent reduction in HIV transmission, the study results presented yesterday provide conclusive evidence that ART should be provided to all HIV-positive people as soon as they are diagnosed for the benefit of both themselves and their sexual partners.
Jens Lundgren of the University of Copenhagen presented the initial results of the Strategic Timing of AntiRetroviral Treatment (START) study, a randomized trial looking at whether starting ART in people with CD4+ cell counts above 500 cells/mm3, rather than waiting for CD4+ cell counts to drop below 350 cells/mm3, reduces the occurrence of serious morbidity and mortality. START was recently unblinded by the international Data & Safety Monitoring Board (DSMB) 18 months early due to data that showed very clear benefits of immediate treatment versus delayed treatment. Previous studies and guidance from the World Health Organization (WHO) suggested that ART should not be given to patients unless they had symptomatic HIV and/or CD4+ counts that were below 350 cells/mm3. The interim results from START show that ART is safe and effective for all HIV-infected persons regardless of CD4+ count.
One effective way of improving the quality of education in low- and middle-income countries is to invest in information and communications technology (ICT).
Providing schools with internet access and computer hardware opens doors to an abundance of information that teachers and students can use to make lessons more relevant and effective. Teachers can use online portals to connect with each other and to share lesson plans and best practices, while students can use ICT to access online libraries and to master new technologies.
Many of FHI 360’s education projects use ICT as a tool to enhance the quality of teaching and learning, encourage community participation in education and increase school access. Bringing ICT to middle school classrooms in Senegal was a critical part of FHI 360’s Education de Base project. This project, which was funded by the U.S. Agency for International Development and reached more than 93,000 students and 4,500 teachers in Senegal, won the Innovating Secondary Education Skills Enhancement Prize from the group Results for Development. The prize was awarded, in large part, because of its effective use of ICT.