Creating Impact: Alone or Together?
“Treading heavily on each other’s toes, bickering violently amongst themselves and competing in sometimes unseemly ways for ascendancy…” – Graham Hancock, Lords of Poverty
In last few months of the fellowship, I have had chances to meet top management of other NGOs, decision-makers in central health ministry and country heads of international development/aid organizations in Cambodia. With an aim to build partnerships to combat tuberculosis in the country, I tried to approach these meetings objectively. But many a times, I got to hear subjective opinions from the other side. The situation got worse in one such meeting with one of the world’s largest bilateral aid organizations; I was taken aback by a question from the Country Head on the definition of ‘default’ in tuberculosis treatment (one of the most important KPIs for the evaluation of a TB program).
There are numerous accounts on how multiple development and aid organizations with their own agendas and specializations (plus ignorance) are at the core of third world catastrophe. With funding tied to regular appraisal of targets, non-profits race for the results every day in isolation.
Imagine the scenario where impact investor funds a non-profit to treat patients and measures impact simply on the basis of number of patients and population under coverage. Now take the non-profit (investee) out of this scenario and 60-70% of patients end up receiving healthcare from the public sector. So the impact gets reduced to 30-40% in terms of patient numbers. In an ideal scenario, the investee would deliver solutions [through service models], which or where the government is not able to provide, there by complementing the existing system. Though it’s a simplistic example and real world systems are very complex, but it does give a sense of direction.
Working as a single agent to create impact may not be efficient and in some cases, the work may actually prove to be overlapping or damaging. In contrast, a complementary set up of impact investors working between philanthropists and governments might be better equipped to create long-term effect on policies and models employed by the public sector. Knowingly or unknowingly, I am also a part of the system now. But the current state needs a change and impact investors, prioritizing social returns, would required do so in future. Otherwise, they might be reduced to yet another agency funneling thousands of dollars into a country on a program doing temporary work but failing in bringing a long-lasting change in peoples’ lives.
It’s true, I see it here in Africa where everyone wants to know “the exact number of babies that are being saved” regardless of the price of the system or the overall value that is being added to the healthcare system overall. Organizations go building systems, collecting data, only to be shutdown by policy makers who either don’t want to know the correct numbers or are worried that it’s going to show the real issue when it comes time to integrate the data and that the money that was supposed to be used on upgrading the system went towards their brother’s pet project.
In our situation, the real change would come through having the organizations team up and leverage connections to put pressure on the policy makers to get their act together so we can maximize the value of the data and systems we’re putting in place as opposed to building something parallel just to report back to donors that we’re creating “change”. By integrating and upgrading the medical records, systems, and policies, it would then put an umbrella over the heads of many while maximizing results for tax payers, and creating a bridge for transparency and thus accountability.
Another example of the nightmare happening in daylight on the ground:
As we are talking , the country arm of WHO is being held responsible for the panic they triggered for the recent outbreak of latest EV71 virulent strain in Cambodia (60+ kids died in last 3 months). The agency claimed it to be a ‘mysterious illness’ to have never occurred before. CNN and other news teams have arrived in Cambodia on the basis of that and pictures/video have started to appear on television. But little regional awareness and coordination would have kept WHO informed that the disease is nothing new in Philippines, Vietnam, Brunei and China which have faced such intermittent outbreaks in last 5 years. Furthermore, the type of disease announced is not the same which is confirmed now (after the WHO announcements).
The ‘overall value’ is a very interesting concept. I draw parallel lines with the HTA (Health Technology Assessment)frameworks being developed for pharma industry in Europe. It evaluates new drugs for additional benefits per extra unit cost (paid in addition to current drugs). This puts a cap on the price you can demand from market. I believe, in future, same can be applied to non-profit programs with funding tied to what value they are creating in the system.
Totally, I feel that knowledge share should be one of the largest outcomes of all the aid organizations instead of each one trying to grab its chunk of the market and feed the numbers back to the funders to meet some quota. I’ve been in contact to the GSMA mHealth alliance down here and that’s what most of problem is that two aid organizations can be operating in two villages right next to each other, using two different “standards” for technology, two different standards for HIV & health related terminology, when really trying to combat the same health related issue.
We have thousands of technical tools, most of them free, millions of people operating on the ground, but no centralization of data, ideas, and little communication between the teams on the ground. There needs to be a middle layer between the giant aid organizations and the NGOs on the ground that take market segments and experiences and make sure that everyone is on the same playing field.