The photo above is of a scene that is only too common in global health – equipment donated and infrastructure built with good intentions, but lying unused. As global health attracts more and more interest from donors, practitioners and learners it is imperative that we look at the global health paradigm and identify effective strategies for the involvement of academia…strategies that go beyond short-term service projects and beyond infrastructure development. I would like to offer for consideration that the role of academia be centered on the need for adequate effectiveness research and the need for long-term educational partnerships with a goal of building human capacity.
Sustainability has become a key term in development and we do need projects to be sustainable, but we cannot forget that effectiveness matters as much, if not more than sustainability. There are several political regimes around the world that have arguably been very sustainable, but have also been gloriously ineffective. Having written reports to donors in the past I realize that there is an implicit pressure to, and it is easy to, make assurances of sustainability. But how often is funding available for follow-up to assess the sustainability of an intervention or a project, let alone measuring continued effectiveness. As a community, especially within academia, we need to ensure that we focus on outcomes and effectiveness, while concurrently ensuring sustainability.
One of the major challenges facing the global health community is the length of funding cycles. Funding for development work is typically provided in short cycles (less than 5 years). This may be adequate for focused infrastructure projects such as building clinics, providing equipment, etc., however, most of us would agree that these interventions alone cannot build an effective health system. A core strategy for effective development must focus on human capacity. This is not without challenge since building human capacity is a long-term project, with difficult to measure/report short-term impact. It also does not give donors the satisfaction of having a plaque with their logo on a physical entity. Let me be clear – there is absolutely a need for short-term interventions, be they focused on infrastructure development or humanitarian relief, but these need to be coupled with long-term projects that build local human capacity, and encourage local initiative and innovation.
Donors are limited by the practical constraints of providing adequate oversight and determining effectiveness, while implementing partners such as non-governmental organizations (NGOs) are limited by the length of funding/project cycles. This is where academic institutions can play a role. We have faculty, staff and students who are eager to be involved in long-term global health projects but often cannot make the commitment to be on the ground for long periods of time. We have expertise in conducting surveys, assessing outcomes and determining effectiveness, and are willing to do so for the carrot of publication and academic advancement. And we have a key resource that is essential for human capacity development – the ability and resources to teach.
This brings me to my last point – how do we build human capacity. I propose using a strategy I refer to as the 3Es: Expose, Exchange and Educate. This approach is centered on pairing/twinning academic institutions to promote a long-term and continuous exchange of ideas, skills and knowledge. First, I will state the obvious for most of us with involvement in development work – an individual in a target area may believe that they need to improve their knowledge and skills, but they also want to be treated as partners and not be simply told what to do in a paternalistic manner. The first step then should be to expose them to different ideas. The human brain is capable of immense creativity and simply exposing people to other ideas and systems can unleash innovative and locally developed ideas. Then it is time to develop exchanges whereby personnel from the target institution/region/country can spend time at the host institution and vice versa, with the goal of greater buy-in and understanding of context. Finally, there is education – this does not have to be in the form of cost-prohibitive, formal degree programs but can take the form of shorter, cheaper workshops conducted locally that give local personnel the tools to develop and implement their own ideas – imagine local incubators.
Development is a natural process that takes time, is not top-down and can be supported but not forced. We cannot leapfrog critical steps by simply transferring knowledge or providing direct service, but we can provide the tools and environment to learn in and empower with. We can and should provide a humanitarian safety net, but beyond that the role of academia should be to participate in partnerships with donors, NGOs and local institutions that share essential skills and tools via long-term involvement with an emphasis on strategies that concurrently measure and publicize effectiveness and outcomes.