On process

A friend of mine recently attended a meeting that was intended to develop a process to guide the preparatory meetings for the coordination meetings with the Ministry of Health. And the thing is, when you’re in the thick of it, these meetings make sense. You do need a unified message before you talk to your host government, and without some ground rules, the prep meetings to develop that message can get genuinely ugly.

All of this led me to think about process, and its sibling, bureaucracy. I’ve always had a pretty unpopular belief in the value of bureaucracy. Bureaucracy, to me, is the core of an organization. It’s what keeps an organization functioning when its staff changes. Without the forms and the regulations, you don’t have an organization. You have a cult. The structures are what makes it about more than just whoever works there at the moment. Bureaucracy puts the “organize” into organization.

That does not mean, however that bureaucracy should rule your work. It’s supposed to help the work get done. The work does not come second. And everyone accepts that. In fact, most non-me people hate bureaucracy.

Unfortunately, this is not the case with process. Plenty of people will sing the praises of “process.” Having a well-thought-out process means that you are Doing a Good Thing. If your intervention fails – the village women don’t feed their children more beans, or the Ministry of Education refuses to adopt your snazzy new curriculum – well, at least your process was good. Everyone benefits from being part of it.

I call shenanigans. Process is a jargon word that we use to obscure what’s going on. If your process is a series of meetings (and it almost always is), say so. And a good process is a process that achieves your goals. No more and no less. Nobody benefits from your stakeholder interviews if their input never turns into anything.

Lastly, some food for thought. A project I was connected to wanted to solve a problem they were seeing in a lot of rural clinics. The clinics would just use up all of their medicines, and then request more from the central supply. Since new drugs didn’t arrive instantly, there could be stock-out periods of a week or more while they waited for the new drugs to come.

To fix this, the project wanted to implement a pharmaceutical logistics system. They brought in a consultant from Europe, who worked with a group of clinic managers and Ministry of Health staff to estimate ongoing demand from different kinds of drugs. Based on these estimates, they then set re-order points for drugs. So, if you distributed, say, 10 IUDs a week, you would reorder IUDs when you were down to 15 of them, giving you a week and a half of time until the new ones came. The consultant turned these plans and estimates into a training system, and the project went around training rural clinics to use the new method.

Nobody ever did. Despite the training, and the eminent logic of the system, nobody ever did. Rather than try to determine why, the project wrote off the exercise as a failed pilot project and carried on. (My own suspicion is that clinics ordered their drugs when they knew that central supply had them, and were afraid that if they ordered according to some system, their orders would go unfilled.)

One of the project staff, when describing the whole fiasco to me, said something I’ve always remembered. “We paid thirty thousand dollars for the consultant, the curriculum, and the trainings,” he said. “If we’d given that thirty thousand to the government in return for a promise to improve their ordering system, every clinic in the country would be using it by now.”

(photo credit: markhillary)
Chosen because that’s exactly like many of the meetings I attend.

Anger, control, and finding the zone

I have, once again, given up substantial amounts of control over my life.

Living overseas does that to you. Part of it is the expatriate experience. The language barrier makes it hard to know what’s going on much of the time, and the cultural gap means that even when you’ve got the language skills, you’re still missing most of the nuance of everything that’s happening around you. You don’t get to customize your environment like you would in your home country – you accept whatever flavor of juices is offered to you, and you let them paint the walls any color your landlord likes. Doing anything else is an exhausting and unpleasant way to spend your time. People who can’t give up control should stay home.

The loss of control runs deeper than being an outsider, though. The fact is that poor people have less control over their lives. This is the damage done by poverty. They cannot easily change jobs or locations, they are less resilient in the face of crisis, and they are at the mercy of often autocratic governments.

And when you go to live in a poor country, you accept those same limitations. You get special treatment for being an expat, yes, but there are limits to this. The police officer will do what he wants regardless of the facts of the situation. There is no treatment for HIV. The government just repossessed your house and now it will be torn down. Women can be beaten for undercooking dinner. That is how it is and your foreign passport can’t fix it.

It’s a fine line between realistically facing limitations, and accepting the very conditions that you are there to change. If you’re working for an anti-corruption project, you need to stay angry at cops who require bribes. If you’re trying to improve health, you need to identify the obstacles to HIV treatment (generally lack of funds and inability to write decent Global Fund grant, coupled with provider inexperience) and find a way around them.

If you push too hard and get too angry, you burn out, fast. It hurts you and it doesn’t do much for your projects. It could get you kicked out of the country. But if you are too laid back and do too little, you’re just a waste of funding that could be used for something that matters. You have to find that sweet spot, somewhere in between, where you don’t mind a late plane but you do mind physicians who must be bribed to provide care.

Finding that mental space is hard. Staying in it is harder. But it’s one of the many things you have to manage if you want to do things well.

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(photo credit: Ko:(char *)hook)

Chosen because it’s a nice harmless photo of a control room – searching Flickr for “control” brings you freaky, freaky things.