doing dev better

circus, circus

By Alanna Shaikh | | 4 Comments |

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

Training that Sticks

By Alanna Shaikh | | 0 Comments |

 

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.

The Words I Don’t Use

By Alanna Shaikh | | 42 Comments |

International development is infamous for its constant, jargony, changes in vocabulary. It’s not the third world, it’s the developing world. It’s not the bottom billion, it’s an ascending market. They’re not people living with AIDS (PLWA), they are people living with HIV (PLHIV). It seems ridiculous, because it kind of is, and we all get tired.

But I do believe in the power of words to shape the way we think. It’s easy to laugh at each new acronym update, but vocabulary does affect how we frame things. So there are a few words and phrases I never use, because I think they lead us in the wrong directions:

1) Beneficiaries – I never use this word unless I am contractually obligated to do so. I know that it serves a useful purpose as a standard term for the people a project serves, but I don’t like it. It implies that people are sitting around passively waiting for a savior to help them. No project works if they don’t have partners to make it work. Even handing out lollipops to children requires children who’ll take candy from strangers and parents who’ll permit it and get the children to the lollipop distribution site.

Your partners might be a community, a local government, or a community organization. But those people are not passively benefitting. They are helping make the project happen.

2) Individuals – This word is just a synonym for “people.” But it’s a cold, formal word that helps you forget that the individuals involved are actual human being people.

3) The Poor – Pretending that poor people are a homogenous collective is poor thinking, and dehumanizing. People fall in and out of poverty for a whole range of reasons, and they cope with poverty in different ways. Fighting poverty requires that we recognize that, and terms like “the poor” are a barrier. (That bring said, two great books – The Poor and Their Money, and Portfolios of the Poor – use the phrase.)

4) Africa – Okay, there are appropriate ways to use this proper noun. Like in a discussion of continental geography. Then there are all the other ways: lumping all the nations on the continent together, as though Senegal and Somalia are exactly the same; using “Africa” in the name of your tiny MONGO that works in one village in Uganda; getting confused and lumping China, Russia, and Africa together as though they are equivalent political units. Let’s stop.

Photo credit: thinkretail

Change Hurts

By Alanna Shaikh | | 20 Comments |

There has been an interesting blogosphere discussion of crowdsourcing in the last few days. The usual crew of people who think about aid – this time humanitarian response in specific – seem to be polarizing slowly into pro and anti-crowdsourcing camps. I linked you to the calmest posts there. There are positions staked out all the way along the spectrum from “crowdsourcing is evil and will hurt innocent people” to “crowdsourcing is going to change the world all by itself.”

As always, I’m somewhere in the middle on this. Crowdsourcing is just a tool. It’s not a miracle cure for anything. It’s a good tool, and sooner or later most competent emergency response groups will find a way to use it. Some will be early adopters, some will trail in at the end. Eventually it’ll get trendy with donors and everyone will start mentioning crowdsourcing in proposals, whether they have a decent plan for it or not.  (I’d also like to point out the remarkable similarity between the rhetoric on crowdsourcing and the discussion of the last big miracle, microfinance.)

But this post isn’t actually about crowdsourcing. It’s about change.

Look, we all know international aid is a mess. The system is not selecting for efforts that work. Bad programs get rewarded. Useless programs get extended. Good programs vanish for no apparent reason.

There are a whole lot of reasons that aid doesn’t really work. Personally, I like to blame democratically elected governments and their need to control where taxpayer money goes.* You can also look at international politics, the challenges of data collection in poor countries, and the sheer complexity of the system. Just for a start.

Anyway, everyone who works in this field knows it’s deeply flawed. The chance to work for an effort that really works is like gold. It’s what we all dream of. We cling like barnacles when we find it. Because it’s too rare. (Too rare, but does happen. Let me make that clear. A broken system means inefficiency, not utter failure. There are development efforts that succeed, and we don’t want to lose them. That’s one reason that feelings run so high.)

Something has to give. We can’t make this broken system keep flailing along forever. Heck, even Rajiv Shah knows it. And when the system changes, it’s going to hurt everyone invested in the status quo. I don’t know if it’s going to be a formal system shift like Cash on Delivery aid, or a disruptive innovation born of some technical advance. But it’s going to hurt, and everyone that’s part of the current system is going to struggle to adjust.

So when tempers flare over whether SMS messaging has actually been proven to save lives, I think what we’re really looking at is fear and hope. Is this the disruptive innovation that’s going to change everything? And if it is, is that good or bad? What if the change makes a flawed system worse?

* No, I am not arguing for dictatorship. But I am saying that most democratically elected representatives aren’t going to be aid experts, and they do control the purse strings. This leads to inevitable mess.

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photo credit: fd

Chosen because barnacles were the only decent visual in the whole blog post.

Why don’t we do better?

By Alanna Shaikh | | 5 Comments |

Sam Brownback

I have mentioned two or three or thirty times that I am not the only person in the development world who obsesses about how we could do our work better. Everyone has ideas; it’s a very common topic of conversation among people who work in this field. Most of us have the same ideas. So why don’t we ever get to act on them? There are a few reasons I can think of:

Donors don’t always know what they are doing. Government donors are usually democratic nations, which means in practice that foreign aid programs are often defined by legislatures with no real background in international development. So you end up with earmarks for pet ideas, rules forbidding useful practices like harm reduction, and an overall lack of direction. Private donors tend to go for exciting quick impact ideas like mobile health clinics and cash-for-work projects. Overall, complicated, unsexy ideas like health system strengthening may go unsupported.

Donors are politically motivated. I have seen health projects where the donor chose the pilot areas because of mysterious HQ calculus about the possibility of terrorism or political instability. Or take a look at how funding goes to Gaza and the West Bank. Donors have reasons for supporting international development funding that go way beyond supporting international development, and it can be hard to take that money and make it useful. Many (maybe most) organizations tend to try anyway.

Lack of time. There is a steady supply of new research on what works in international development. There is no steady supply of time in which to read that research and figure out how to apply it in practice. Some places have a technical team at headquarters to keep up with new research and recommend how to use it. That’s not as common you would think, though, because that kind of work counts as an overhead expense. High overheads make it hard to get grants and donations.

Host country capacities. A good development program works with the host country government to build its skill set, so that impact will continue once the program is over. Sometimes that means obeying host country regulations that contradict best practices, or spending a year convincing a government to change its rules. For example, some countries in Sub-Saharan Africa were achingly slow to adopt community therapeutic feeding (plumpy’nut and other RUTFs) even when the data showed it was much more effective than older ways of treating malnutrition. It’s miserable being stuck in a project that could be doing far more than it is allowed to, but I think the alternative – setting up an aid system that is parallel to the government – or worse yet, contradictory – is worse in the long term.

Funding and evaluation cycles. It’s very hard to design a program that will have a long term impact and also start showing results in two years. It’s not impossible; I’ve worked for several projects that managed it. But it’s hard. It limits your options severely. And inexperienced or unskilled NGOs may just aim for quick results and worry about the long term later.

This is not an exhaustive list. It’s just off the top of my head. What am I missing?

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Photo Credit: Iowa Politics.com

Chosen because Senator Brownback once tied up hundred of hours of manpower from an HIV/AIDS program because he didn’t understand the difference between harm reduction and risk reduction.

Sixteen Ways to Tell a Health Project is Doomed

By Alanna Shaikh | | 8 Comments |

weird scary stencil of a scary guy

1. It focuses on AIDS, TB, or malaria but is not coordinating or harmonized with global fund activities in country.
2. The staff are all clinicians, with no public health people.
3. The staff are all public health people, with no clinicians.
4. There is no plan to involve local or national health authorities in the project.
5. The project director is a clinician with no management experience.
6. It is planning on developing its own training content instead of adapting existing curricula to the current situation.
7. It depends on practicing physicians to serve as trainers, but has no plan to teach them the skills they will need to become trainers.
8. There are no women on staff.
9. It ignores the role of nurses in health care.
10. The underlying conceptual model doesn’t make any sense or staff have trouble explaining it in a way that makes sense.
11. The only monitoring indicator is how many people were trained.
12. Training success is identified by pre and post tests of participant knowledge instead of testing their skills and whether they are actually using new skills in practice.

Special guest additions:
13. Local partners/beneficiaries cheerfully insist that another expat program manager is the ONLY WAY to make the next phase sustainable… (from Tales from the Hood)
14. It’s a two-year contract and the only local staff are secretaries and drivers. (from Texas in Africa)
15. You visit the public health office and they want to know why you’re taking away their public health volunteers. (from Good Intentions Are Not Enough)
16. The per diem for your capacity building event is less than that for the World Bank project just down the road. (from Ian Thorpe)

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Photo Credit: REDRUM AYS
Chosen because searching for “doom” on flickr gets scary quickly, and my initials are AYS

How I’m Judging You

By Alanna Shaikh | | 16 Comments |

Statue of Justice

These are my (arbitrary, personal, non-evidence-based) rules of thumb for identifying good development work:

Bad signs

  1. Starting out by buying cars.
  2. Claiming to work in “Africa” without specifying a location.
  3. More than four partners in your implementation coalition.
  4. A local to expat ration of less than 5:1 (10 or 15 to 1 – or more – is far better).
  5. Planning/budgeting for more than 4 visits from HQ a year.
  6. Extensive use of international interns.
  7. Using program staff as translators and interpreters.

Good signs

  1. National staff in management positions over expats.
  2. Terrifying, highly experienced financial staff and a rigorous financial reporting system.
  3. Close collaboration with government on its lowest level – with city, town, and village authorities.
  4. Sharing of monitoring and evaluation data with the communities the projects works with, and training those communities on how to review the data.
  5. A clear vision of what the target area (group, community…) will look like once the project is over and what will have changed. Approval from the target area/group/community of the vision, and support for it.
  6. Extensive use of paid local interns.
  7. Specific rather than standardized indicators for monitoring and evaluation.
  8. Translators on staff.

PS – Thanks to Brendan for reminding me why I write.

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Photo credit: Citizensheep
Chosen because, you know, judging, justice…look, it’s not easy choosing images.