Blood and Milk

I didn’t mean to read this book. I am in the middle of another book I’m reading for review – Ed Carr’s Delivering Development (which I am really enjoying, but it’s new enough to me that I am also carefully taking my time). But I picked Damned Nations off my to-read pile the other day because I was on my way to the bank and needed something while I waited. About five days later, I’m done.

Everyone new to aid and development should read Damned Nations. It didn’t have a lot in it that was new to me, but it’s a fantastic overview of almost every major issue in relief and development aid. Health, conflict, rule of law – packed into 200 well-written pages. I’m going to recommend this book to pretty much everyone who writes to me wanting to know more about aid, and I’m going to give it to my entire extended family next Christmas. Professors should be assigning this to their undergrads.

This is the book that explains the why and how of what we do. It’s about the issues that make aid necessary, the ways to do aid right, about being a better aid worker and a better donor. From SWEDOW to the Paris declaration to .7%, it’s all in there. And that’s woven in with compelling personal anecdotes and powerful imagery. This is a book my cousins will actually read. It is a beginner book, but it’s an amazing beginner book.

Like pretty much every book on aid, Damned Nations does a better job of identifying problems than solutions. The last chapter, in which Nutt talks about better aid, is by far the weakest of the book. I think that’s a forgivable flaw. These are giant problems and we’re still figuring out how to do things right. Nutt doesn’t have a set of handy prescriptions to fix aid because nobody does.

Now that I’ve finished my copy of Damned Nations, I’m ready to give it away. Leave a comment on this blog entry telling me one of your favorite books on aid and/or development and why, and I’ll enter you in the drawing. I’ll give you one entry for each comment. I’ll close comments on the 14^th, and I will mail the lucky winner their book at the end of the month when I am in the US for the TED conference.

(Amazon links in this post are affiliate links. I will earn a tiny pittance if you click them.)

Last week I took my son to the circus. Specifically, a traveling troupe of Chinese acrobats. It was quite clearly the troupe that plays Dushanbe, not the troupe that plays Moscow. They attempted the big stunts, but they didn’t always make it. Spinning plates got dropped, a human pyramid crashed, and one tumbler tumbled right off.

This is what interested me: it didn’t affect the show. They were ready for failure. They had spare plates standing by for quick replacement after droppage. The ribbon twirlers had fresh ribbon at hand in case of tangling. The air acrobatics had truly fantastic spotters. Everyone who fell had at least one person gracefully rush up to soften their fall. They responded to errors so quickly and smoothly that it was like a dance.

Ever since I saw the show, I’ve been wondering how we can build that kind of resilience into development interventions. How can we make sure our errors don’t wreck our work? One thought: maybe ongoing monitoring is the equivalent of those dedicated spotters who saved the falling acrobats. Collecting implementation data will let you know if your human pyramid is going askew, or keep the guy on the springboard from bouncing onto hard ground. Another: you have to be profoundly humble and honest to prepare for failure that way. You have to admit, up front, that mistakes are possible. If your spotters are hiding in the back room, they won’t catch the tumbler in time. You can’t seamlessly replace a knotted ribbon if the new one isn’t right next to you.

It’s a beautiful analogy. Would it be allowed in real life? True, some people do call this industry a circus. But do our donors actually want us to be honest and humble? Would people think we were just incompetent if we visibly prepared for failure? And what, exactly, would preparing for failure look like?

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Photo credit: Don Fulano

Now picture that top girl falling, and landing in the arms of a costumed spotter

This probably falls into the category of stuff everyone already knows, but it’s so important I wanted to mention it anyway.

Training is one of the most common interventions in international aid. It’s where we all start, when we think about problem solving. If the doctors/farmers/parliamentarians/journalists knew how to do their work better, everything would be just fine, right? But as we learn very quickly, training is one of the hardest things to get right. Here’s what I know.

Pre and post training knowledge tests are worthless. It doesn’t matter if people know more after your training. It matters if your trainees actually change the way they act after your training. The best solution I have found is competency-based training.

Competency-based training (CBT) means that you only teach people what they need to be able to do. Nothing extra. You don’t graduate them from the training until they can do it properly, in the context they need to do it in the future.

For a physician, then, if you are training on IUD insertion, you teach as much anatomy information as they need to do an IUD insertion. You then train them to do the insertion on life-like medical models and then you train them to do it on actual female volunteers. Finally, you observe them while they do insertions in patients in a clinical setting.

Notice what they are not doing: reading about IUD insertion or taking tests on their knowledge of female anatomy. Instead, they watch insertions being done, and they do them. Your physician officially completes the training and gets her certificate when she can insert an IUD correctly on her own in a clinical context.

CBT generally includes checklists that define the proper performance of whatever thing they’re teaching, for trainers to use as they observe trainees. If you want to use the best possible practice for your training, you don’t officially certify your trainees until they’ve been back at work for a while and you observe them using their new skills properly in their work practice.

Next, you need to make sure trainees are allowed to use their new skills. That means, at the very least, making sure that their supervisors understand and support the new approach and making sure that the new approach is legal. If you train teachers to use a new technique where students choose which topics to study, it won’t work if the principal won’t let them or the national curriculum requires certain topics during certain months. Training entire cohorts – everyone in one office, say – also helps support people to use their new skills.

Finally, if you want trainees to share their new skills, you have to put something official in place. It does not happen on its own. It doesn’t happen because people like being the most competent person among their peers and don’t necessarily want to share, and it doesn’t happen because just learning something new doesn’t make you a natural or comfortable trainer. You could, for example, require that all new trainees give a presentation to colleagues once they complete training (and you could plan for that by adding a session to the training itself for participants to develop and plan their presentation for colleagues). This probably won’t get those colleagues to change their behavior, but it will at least help everyone understand why one staff member is doing things differently.

Possibly the biggest challenge to getting impact from training is keeping your employees once they’re trained. Newly trained staff may leave through natural attrition, or because they are poached because of their updated skills. You can try positive incentives – pay raises, benefits like internet access or plots of land for kitchen gardens, but you can only provide so much in a resource-restricted context. Or you can try punitive methods – make people sign a contract to stay for a certain amount of time after training and pay a penalty of they don’t – but that can make people nervous about being trained.

I think the best solutions are long-term. You can train so many people that it makes up for natural attrition and floods the market to reduce demand. Or – this is my favorite solution – you can incorporate training into professional education. If every nurse learns patient counseling skills in nursing school, then you don’t need to come along and train them at all on the topic later.

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Photo credit: US Army Africa.

Chosen because it’s competency based training in action. They’re not sitting there reading about house-to-house search.

Voices from the Inside October 9 2011

For every expat aid worker who swans in and out, complaining about Delhi belly and inadequate per diem, there are at least ten host country aid workers doing the real work of international aid. They don’t live in hotels, they don’t get special treatment, and they’re the ones who’ll still be there twenty years from now.

We don’t hear much from those aid workers. They don’t tend to blog, and the media prefers the pretty story of whites in shining armor. But these aid workers – the “global south” – are the heart of the work we all do. We ought to be learning from them.

In that spirit, I am proud to announce my new podcast series, “Voices from the Inside,” where I’ll be interviewing the aid workers who actually come from the developing world. Some of them are expats now, but that’s not how they started.

These are the voices that can tell you the real story of aid work.

Find the first episode right here, where I talk to a woman I met during this trip to Bishkek.

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photo credit: livepine

This is an important, useful, well-written book. And it’s not all that long, so there is really no excuse not to read it. The book looks at the Darfur advocacy movement, and seeks to answer two major questions: 1) Did the movement have an impact on US policy in Darfur and 2) How much impact could the US actually have on the situation in Darfur?

To answer these questions, Hamilton has done an exhausting amount on research. She has talked to just about every major player on Darfur, from US State Department and USAID officials to Darfuri refugees, Sudanese government officials, and the leaders in the Darfur activism groups. The result is a dispassionate, even-handed analysis of what went wrong in advocacy for Darfur.

It turns out I am terrible at writing book reviews (sorry everyone who’s been sending me review copies!) so I’ll move on to some bullet points that I took down as I read the book:

• This is a book about advocacy on Darfur, not a book about Darfur. If you don’t already have a basic background on the genocide and what came after, then you’ll have a hard time getting everything out of this book. Hamilton recommends A Short History of a Long War for background on Darfur.

• In many ways, this is a book about the waning of American power. However much the activists could influence US decision-making, the US alone could not help Darfur.

• Activists for Darfur were suffering from two major flaws in their perception. First of all, they lacked context on Sudan beyond Darfur, and on the history of Darfur and the nation as a whole. That led to a focus on certain policies and interventions that were not necessarily what was best. Next, they overestimated American power projection. By the time they understood that US power alone could not “save” Darfur, they had missed a number of valuable opportunities to work internationally.

• I was proud of USAID throughout the book. USAID officials were some of the first to speak up about the genocide, and they seemed to consistently fight for the safety and welfare of Darfuris and Sudan as a whole in a way other US government officials did not.

My overall conclusion: buy this book. It’s useful for anyone who wants to know more about Darfur activism, or learn about international activism in general. I am very glad I read it.

Here’s the Amazon (affiliate) link if you want to buy:

I was recently lucky enough to receive a review copy of Fighting for Darfur, Rebecca Hamilton’s new book on the Darfur advocacy movement. In the book, she attempts to answer the big questions: what was the impact of the Darfur advocacy movement on US policy? And how much could the US actually influence the situation, anyway?

I’ll put up my review on Tuesday, but I’ll get us started now, with a brief interview I did with Rebecca last week:

AS: What made you decide to write this book?

RH: Genuine curiosity on my part. I was at Harvard being supervised by Samantha Power, talking to the people who believed that creating an outcry would make a difference. As it became clear it wasn’t working, I wanted to know why.

AS: Did writing the book upset anyone?

RH: It was a genuine research question, and the people I was speaking to had similar questions themselves. They also wanted to know if this isn’t working, then what are we doing wrong? It was probably helpful that I came from that movement, and that I really made an effort to talk to people in the advocacy movement. I didn’t come at this with a certain belief. My position was that for the most part, most advocates were driven by good impulses, but that doesn’t mean you can’t be critical of what they ended up doing.

I wasn’t coming into this with an agenda, and people trusted that.

AS: Fighting for Darfur is a book about the Darfur advocacy movement, not necessarily Darfur itself. If people want to read a companion book about just the situation in Darfur, what would you suggest?

RH: A Short History of a Long War, by Alex de Waal.

AS: In the book, you talk about lessons we can learn about advocating on genocide. Are there lessons that international advocacy in general can take from this?

RH: Be clear about what your theory of change is. I think the advocacy community – and I was part of this as a student activist – took too much for granted about what the right theory of change was. It was derived from Rwanda and didn’t update for new context. Not only because Darfur was not Rwanda but because the world had changed and the US position in the world has changed, and pushing Washington was one very small part of the story.

Recognize we are not in a position where the US has ultimate hard and soft power in every situation of mass atrocity. It’s also about how to move other actors in the global geopolitical realm.

None of these things are facts. Part of the problem with Darfur is that we took the lessons of Rwanda and just superimposed them. I hope the message people take away is not just to cut and paste directly onto the next situation. In another decade the may be situations where the US is the best actor.

We have to be very careful about how we apply lessons learned.

AS: Were there subjects you’d like to have covered in more detail in the book but didn’t get the chance?

RH: The draft I submitted was nearly twice the size of what I submitted. I felt hugely constrained by word limits. There was so much. I was already pulling together 2 strands of the story – the advocacy community and the diplomatic realm, so the third strand of Darfur I had to remove. I had to take out broader questions on peacekeeping and what we can expect of peacekeepers.

The other was spending more time on this shifting geopolitical moment, where US influence is not at its height but it’s not clear what role China and BRIC will play in preventing mass atrocities. It would have been nice to keep in those broader questions.

AS: Do you have another book project planned? What are you doing right now?

I have ideas on new projects, but for the moment I feel like I haven’t finished this one. I still have a lot of work to do just getting the messages from Fighting for Darfur out into the public realm, and I want to focus on that.

I recently got an email from a reader frustrasted by how little he has learned after 30 years of being a donor to international developement causes. With his permission, I am posting our email exchange here:

The letter

I have been giving to aid organizations such as Oxfam America and Trickle Up for over 30 years. Yet my thinking has not benefited from 30 years of direct feedback. I have no independent means of hearing from the people served by these organizations.

Recently, it occurred to me that I should focus on a single region in a particular country where there is a program in place. I would see if I could develop direct relationships with people in that region. Then I would be exposed to different perspectives.

Is it plausible to think that using modern forms of communication, I might be able to form lasting long-term relationships that would give me a useful, local perspective on various aid efforts?

I am also wondering if a problem such as malaria might offer a way to partner with others who are working in the target region.

Are these sorts of relationships for two-way learning and long-term problem solving possible? Can individuals learn from each other and not have the learning mediated by the media or aid organizations?

My Answer

You’re up against one of the most frustrating situation for a committed donor: it feels like throwing your money down a well sometimes. You can’t tell if things are changing because they change so slowly, and when they do change you can’t tell how much of it was because of you. I think that feeling is a big part of what drives the current trend toward randomized controlled trials on international development interventions.

In terms of connecting with people who actually interact with aid programs, I think the answer is a qualified yes. Most of the developing world is rapidly coming online and using social media in particular. People are using the internet even when they don’t have water or consistent electricity.

However, the question that comes to mind for me is: what’s in it for them? What is the motivation for a 22-year-old Malawian to communicate with you about aid programs and their impact on her life? You would benefit from getting a local perspective on where your money goes, but how does your dialogue partner benefit? Their time is valuable and internet access is not free – why should they spend that on you?

If you can find a way past that hurdle, then I think yes, interpersonal learning is completely possible.

One final thought for you – are you familiar with the work of GiveWell.org? I don’t agree with all their conclusions, but they do an excellent job of identifying organizations that perform, and share, genuine impact evaluations. You might consider shifting your giving to such an organization.

(photo credit: jaymiek)