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Design for Development: Building A Brand in Rural Nigeria

Earlier this summer, I received one of the more challenging design requests to arrive in my inbox: build a brand in rural Nigeria.

The assignment was in support of “My Voice”, an open source tool for citizens to provide feedback on select government programs that Reboot was developing in partnership with the World Bank. We were preparing to launch a pilot of My Voice in Wamba, Nigeria with a focus on collecting patient feedback from local healthcare clinics through an SMS-based survey. I was tasked with building the brand system to introduce—and encourage the use of—the My Voice tool in a new community.

Wamba is a rural county in the northeast corner of Nasarawa, a state right in the heart of Nigeria, and indicative of the many rural areas across Nigeria where healthcare service delivery occurs with very limited input from the patients themselves.

Here in New York, by contrast, I have many opportunities to comment on the quality of care that I receive. When I choose my doctor I use ZocDoc, a site similar to Yelp but focused entirely on healthcare. The site presents a long list of doctor options, which I can narrow down by specialty, distance from me, patient rating, and whether I want a male or female doctor. After reading the reviews left by other patients, I can make my final choice and visit their office for an appointment—vote with my feet, essentially. Following the appointment, I can enter my own feedback and review of the experience. A doctor or practice with too many negative reviews is not going to be seeing many more patients.

In Wamba, patients don’t choose their doctor. Typically, the doctor they see is in the nearest clinic they can access. That’s often the only option. When options don’t exist, the ability to shape your own experience doesn’t exist either. You can’t weigh options through others’ reviews, and you can’t vote with your feet. This situation challenges clinics too, which have to deal with whatever health issues come their way, regardless of available resources, staff, or proper equipment. Both sides of this service relationship want better outcomes, but have limited ability to realize them.

We built My Voice to help change this status quo, to provide patients with an opportunity to input on the quality of care that they receive and to provide clinics with more information about their patients’ needs. But just like ZocDoc—or any other crowd-sourced information platform—My Voice is only helpful if people are using it. The most intuitive, useful tool would ultimately prove useless if it failed to engage patients and health clinic staff.

This is where the need for brand building came in. We needed to build a visual identity to create awareness, define targeted messages to promote adoption, and ensure consistent communications to facilitate use. That much is clear in theory. Here’s how we did it in practice.

Recognizable Imagery, Responsible Use

We knew from the outset that the visual identity system needed to be firmly rooted in the context of the culture to effectively resonate with those using the service. In Wamba, that meant a visual language that was easy to navigate and straight to the point since many prospective users would be illiterate. We focused on building a system that would be highly visual, easy to repeat, and easy to recognize. We wanted to realistically show what using the system looked like. Photographs, therefore, became key to the system,  instead of iconography or illustration.

In the course of our research, we had taken plenty of photos that could have been visually appropriate. But they weren’t ethically appropriate since we hadn’t informed the individuals in those photos that their images would be used for anything beyond our own research. We keep a strict photo policy of informed consent and responsible use. We ensure that people know how and where their photos will be used, and that they are always asked permission before we take their picture.

So we needed new photos.


We revisited Wamba General Hospital and identified scenes that would be easily identifiable as clinics in Nigeria: periwinkle-colored curtains and a waiting room filled with wooden benches. We place our own team members into the scenes and took their pictures. We also got permission from clinic staff to use their photos in posters, flyers, and other materials for the My Voice system.

Having the right images is always important, but making sure we get them in the right way is much more so.

Different Users, Distinct Messages

With the visual identity defined, next we needed to work on our messaging. Patients, health clinic managers, and health clinic staff all experience healthcare services differently, based on their unique roles in the system. Our messaging, therefore, needed to be tailored to demonstrate the benefits of My Voice with respect to each of their different experiences. Here’s where we landed:

  • Patients: “They care, so I share.” Patients wanted to know that their feedback was going to a trusted place, and that they could feel safe sharing. These messaging themes let patients know that by sharing their stories, they are helping their hospital to improve and better serve their needs.

  • Health Clinic Management: “I care, so I become aware.” The primary benefit to health clinic management is that the My Voice data provides insight into their hospital’s performance. This messaging theme tells them that by becoming aware of what their patients are experiencing (both positive and negative), they can be better informed about changes that will improve patient experiences.

  • Health Clinic Staff: “I care, so I send the questionnaire.” This was the toughest. We realized early on that the clinic staff were truly the “gatekeepers” to the process, since they have the task of informing patients about My Voice and registering them for the service. But if they view the program as a threat to their jobs, they’re certainly not going to use it. We addressed this by positioning them as an important role-player in the system. Their targeted message emphasizes expressing care towards patients, along with the importance of their position in the system, by giving patients the opportunity to share their stories.


Communications in the Context of the Service

Finally, we had to decide the most appropriate communications materials to ensure patients were aware of and knew how to use My Voice. For this, we looked to the context of the service. We asked ourselves: what did the environment and the design of the My Voice system offer in terms of touch points to design materials that would reach our target audience groups? Broadly, we developed three kinds of communications materials:

  • Promotional Materials. These include posters, table tent cards, and stickers. The posters are for clinic waiting room, treatment rooms, pharmacies, and offices. The table tent cards are for the clinics’ registration desks. One side faces the patients as they check in and out of the clinic. The other side faces the nurse or hospital staff registering them into the My Voice system. This interaction is an important one, making the registration desk a visible part of the system for both patients and staff. Lastly, the stickers are for placing on pharmacy bags as a reminder once patients leave the clinic. They are also given out at the registration desk as give-aways.

  • User Guides. These are for both patients and clinic staff to further aid in explaining the system. Patient user guides are folded into patients’ hand cards when they check out at the registration table. The patient hand card is a little pink booklet that tracks an individual’s medical history and important ID numbers. Since these documents are well-cared for, it ensures that the user guide would be kept close at hand and act as a visual reminder once patients leave the clinic.

  • Interactive Weekly Performance Posters. These posters help build awareness too, but more importantly close the feedback loop for patients inputting into the system. Here clinic staff fill in the survey data from the previous week. This demonstrates to both patients and clinic staff that their responses aren’t going into a black hole of bureaucracy.

Building the My Voice brand and all of its requisite components was a unique and exciting design challenge, to say the least. Often designers are tasked with changing behavior. In this case, the job was to create behavior in a very complex context. Since My Voice launched in mid-July, it’s been exciting to see that behavior begin to take root, but our work is far from complete. As the pilot period comes to a close in early September, we’ll be looking to feedback from patients, health clinic staff, and management to help us perfect both the My Voice tool and the brand we’ve built around it.



A group of people collaborating

World Bank Restructuring Could Benefit Open Gov

It is an uncommon sight to see an open government actor “talking shop” with a traditional good governance practitioner. But why? Are the stereotypes true: is the former tech-obsessed, and the latter lacking in innovative ideas? Both parties work to improve public spending and services, and many even agree on the fundamental ingredients to achieving this, so surely there is reason to believe that these two groups can and should ban together. Is this possible and what would the next phase of open government look like if so?

The challenge

The lack of empathy we have written about and recognize as a challenge for working across governance institutions can help to explain a concerning phenomenon that I have seen firsthand: minimal engagement of traditional development actors (multilateral and bilateral agencies) in open government reform efforts.

First things first, engagement between the open government community and traditional development agencies is not new. Huge strides were made and credit is owed to aid transparency leaders who succeeded in forming International Aid Transparency Initiative (IATI) and World Bank Open Data. The Open Government Partnership’s (OGP) recent partnership with the Asian Development Bank (ADB), their fifth multilateral agreement, illustrates further progress.

Many open government advocates, however, emphasize the roles and responsibilities of individual governments and citizens, overlooking the agencies that direct and shape significant resources of the governance agenda. Anecdotally, the community shares a belief that traditional development agencies are too bureaucratic, meaning hairy to navigate, slow to progress, and outdated in thinking. On the contrary, there is widespread and open recognition that public sector experts play a significant role in development agency operations, and hold valuable knowledge and experience. In reality, a simple stocktaking of attendees at international open government conferences such as the annual Open Government Partnership Summit and Open Knowledge Festival reveals a near absence of those who have worked extensively on good governance issues for decades.

The opportunity

I come to Reboot from the World Bank at a time when there appears to be significant change taking place within the organization. Rumors have been circulating about the institutional restructuring for some time now and even internal actors are unclear about what’s next. The goal, as told by the president Jim Kim, is to break down existing silos to promote cross-collaboration. The new organizational matrix aims to eliminate disparate conversations taking place amongst, for example, African and Asian specialists both working on infrastructure issues. New global practices are responsible for the operations, knowledge, and learning around their focal area and a handful of thematic areas cut across them. Top layers of management have also been shuffling about in structure and individuals.

As of July 1, there is a new Global Governance Practice (GGP), a change that leads me to believe it is an opportune time for the open government community to meaningfully engage with the World Bank. The restructuring elevates open governance principles by bringing public financial management (PFM), information and communication technologies (ICT), and social accountability experts together under one roof.  In this mix, team leads using participatory budgeting methods sit side-by-side with those who offer performance-based budgeting skills. The changes have also energized internal actors to partner externally for operationalizing goals. One example of this is the formation of a new Digital Engagement unit that builds partnerships in each effort to bolster citizen feedback and government responsiveness.

Next steps

To avoid remaining siloed from traditional governance actors like the World Bank, the open government community could benefit from reflecting on how to take advantage of these changes and best meet shared goals.

What could this look like in practice?

Engagement needs to go beyond making partnerships and exploring synergies to push for transparency.  These rarely trickle down to the project level, where design and process are king and what ultimately determines outcomes. Directly targeting project work is necessary and could happen in the following ways:

  • Understanding institutional operations to effectively “work the system”

    As is in any bureaucracy, structure and process drive operations. Institutions like the World Bank are no different. If the open government community takes a moment to learn the essentials of internal operations, injecting external ideas and tools for project implementation can work. For example, the World Bank approaches all projects with a high-level Country Partnership Framework (CPF) and kicks off the project cycle with a Project Appraisal Document (PAD) that offers context, defines scope and goals. It would be useful to directly link open government goals to the relevant approaches in a CPF and attach them to the discussions had to frame a PAD.

  • Introducing new approaches to traditional systems

    We employ methods that do not fit the traditional project management mold. One such technique is ‘adaptive management’ which embraces iterating on decision-making and execution in project planning, implementation, and learning.  An approach like this one is used by open government actors across the board—from open data gurus, to data journalists, to community mappers—and it can be offered to project leads in development agencies.

  • Empowering intrapreneurs

    Yes, we all know the select open government champions who work within these organizations. But have we asked how we can help them navigate their own country offices and client governments? There is an opportunity to support change from within if we can better understand their needs and constraints because believe it or not, they are as frustrated as we are.

Why should the open government community care?

Institutions like the World Bank hold deep and longstanding relationships with governments (not least a product of legitimacy derived from government ownership of the institution).  While the open government community is full of influencers of governance outcomes, let’s be honest, the trusted connections to governments (particularly in the Global South) are minimal. Critical to improving governance, whether through mapping community needs, visualizing money and politics, or distributing public service information via mobile, is the role of the government who has the power to embrace transparency and translate it into accountable systems.

What brought me to Reboot is a shared belief that redesigning governance is not about avoiding what exists and building anew.  It is more difficult than that precisely because it requires understanding what we have, what limitations exist, and what small opportunities we can seize to make incremental progress.

The Problem with Public Security in Latin America

Lucia Aguirre sells food in Flor del Campo, a neighborhood in the south of Tegucigalpa, Honduras. Each day she pays $10.00 to the local gangs for the right to run her small food cart business. Her husband Pablo Dominguez, who drives a bus for Tegucigalpa’s public transportation system, also pays a regular extortion fee of  $26.00. This month he has received at least three death threats from rival gangs who are fighting ferociously to be the landlords of his neighborhood.

The Dominguez family, like many others in their neighborhood, live terrified of gang violence. Last month two bus drivers were murdered in their area. Neighbors prefer to pay the gangs rather than report them to the police, since gangs know how to enforce their threats and police can’t stop them.

Frightful stories like these abound across Latin America where crime and violence affect the lives of millions. According to the UN Office of Drugs and Crime, the region is the world’s most violent with 30 percent of all homicides committed globally and the only zone where homicides increased between 2000 and 2010. Central America has a homicide rate of 24 victims per 100,000 population (2011), which is four times higher than the global average. At the country level, Honduras had the highest homicide rate in the world outside of an active war zone in 2011, with 90 homicides per 100,000 persons, followed by Venezuela (54), Belize (45), El Salvador (41), Colombia (31), Brazil (25) and Mexico (21). The picture worsens at the local level, where cities like San Pedro Sula, Honduras had more than 170 victims per 100,000 persons in 2011 or Acapulco, Mexico with 143 homicides per 100,000 inhabitants in 2012.

At the heart of the violence epidemic in Latin America lies a broken relationship between citizens and their governments. National and subnational governments are unable to deliver effective public security to protect lives and property—the sine qua non service for which people give up individual liberty to the state in a social contract.

The reasons of why Latin American states fail to deliver security to their citizens are numerous.

First, there is the problem of corruption. Law enforcement institutions, namely the police, courts and prisons, are often on the payroll of both local governments and cartels. In other cases, even when there is goodwill from local police forces, they lack the numbers, training, and equipment required to deal with violent gangs and drug cartels. Local authorities commonly face the choice between “plata o plomo”, or “silver or lead”—either cooperate with criminal organizations by accepting bribes or risk being shot.

Second, there is a problem of capacity. Most resources are directed at fighting major criminal organizations at the top, leaving citizens exposed to other threats to their security. For example, when major drug cartels are broken up, the remaining cells need to fund themselves to fight competitors. To make ends meet, they diversify their criminal activities through extortion, human trafficking, and kidnapping, all of which directly affect the livelihoods of  communities.

Third, severe inequality and the poor quality of education has not created societies with a more equitable distribution of opportunities. Latin America has 148 million people between the ages of 15 and 29 years-old. Economists call this a “demographic bonus” that can help the region boost economic growth. But the bonus can easily become a nightmare if this population cannot access high quality educational opportunities that can link them to well-paid jobs or other opportunities for personal development. Education can be an important means out of poverty and violence for thousands of children from neighborhoods such as Flor del Campo in Honduras or Badiraguato in Mexico. Through education they can escape the somber future of being recruited by gangs and dream about becoming doctors, architects, engineers, and astrophysicists instead of narcos or maras.

Finally, mano dura (iron fist) policies against crime have actually exacerbated violence. A case study of El Salvador, Honduras, and Mexico found that these policies, like those implemented in Mexico between 2007 and 2012 and in El Salvador from 2000 to 2009, have multiplied turf wars between rival criminal organizations.

All of these reasons contribute not only to the failures of governments across the region to deliver public security, but also to the lack of trust citizens have in their authorities. In Latin America, public trust in the police is less than 30 percent compared to 47 percent in the United States. A study of Argentina, Bolivia, Guatemala, and Venezuela found that 60 percent of the people think that their local police have been involved in criminal activities.

Fortunately, the concept of security in Latin America has been evolving away from a state-centered vision like mano dura, where maintaining order and protecting the state’s sovereignty from external and internal threats are the core objectives. In its place the concept of citizen security, where security is human-centered and the main goal is to create a peaceful environment for people to live free from crime and violence, is gaining traction.

Citizens, after all, know their communities and neighborhoods best. They can help their local authorities to design and implement better targeted public security strategies, policing routes, crime prevention policies, or even alternative conflict resolution mechanisms. Civil society groups can also be a watchdog for corruption and help elicit transparency and accountability from the state’s law enforcement agencies. Interestingly, the case study of El Salvador, Honduras, and Mexico cited above also found that approaches rooted in citizen participation have shown greater success in reducing violence.

But for citizen security to succeed, two ingredients are required. The first is a participative and proactive citizenship engaged in the task of creating a peaceful environment for coexistence. The second is a responsive and accountable state that provides reliable services. The question then is how to stimulate citizen participation where crime-related violence has broken the relationship between states and citizens?

Given the current lack of trust in their authorities, people are unlikely to participate in a new initiative actively. Maybe they fear retaliation, or maybe they think it is meaningless. Imagine asking Lucia and Pablo to participate actively with the Flor del Campo community and local authorities in an environment where the state has been almost entirely replaced by violent gangs.

ICTs have a role to play here. ICTs can help facilitate citizen participation, improve citizen security, and bridge the trust divide between government and its constituents. But it is important to note that ICT-based systems will not help improve citizen security by themselves. ICTs are only a tool.

Stay tuned for my next post, where I’ll dive into ICT-based systems across Latin America to explore what works and what doesn’t about these tools for improving public security.

Photo: Flickr user: daviditzi

Some Ideas for the Open Knowledge Festival

How can we ensure open government initiatives live up to their promise?

The movement for more open, accountable governments is gaining momentum the world over. But too often, open government initiatives are deployed without careful designs that enable them to achieve their intended objectives.

Exactly one year ago, I had the privilege to serve as the rapporteur for Aspen Institute’s Forum on Communications and Society and highlight some of the hurdles our community of practitioners must overcome to move toward the next phase of open government. This week, I’m especially excited to take that conversation further at the Open Knowledge Festival (OKFest) in Berlin, where Reboot is leading a session titled “Opening Society in Challenging Contexts”.

In particular, we’re interested in not just highlighting hurdles, but actively discussing solutions.

How to enable participation in open government initiatives from hard-to-reach citizens? How to ensure governments provide meaningful responses to citizen input? How to move beyond trial of new platforms to sustained adoption and engagement? How to look beyond the numbers to evaluate the effectiveness and impact of our work?

These are the questions we seek to answer every day at Reboot. After building the world’s first national mobile voter registration system in Libya, implementing Africa’s first sub-national open data program in the Niger Delta, and—just this last week—launching “MyVoice”, an open source mobile tool for citizens to provide feedback on public healthcare delivery in rural Nigeria, we’ve learned a lot about what it takes to realize the principles of open government in practice.

One question that cuts across each of these projects (and is relevant to OKFest) is how to use data—whether those provided by an institutional body, or generated through a project—to improve government accountability?

Conversations on open government data and governance data are often dominated by data providers, academics, and donor organizations. Conspicuously underrepresented are those whose actions they seek to influence (“data users”): governments and those that influence government behavior. The underrepresentation of these user voices in open government discussions means that discourse and action are biased towards the technical dimensions of data. Technical quality is important but insufficient.

Governance is ultimately about the structures and allocations of authority and power. Influencing governance processes therefore requires shifting the distribution of authority and power. Data platforms and products that seek to change governance outcomes in a particular context must be designed to respond to the social and political dynamics in that context.

Nudging data providers to think about the sociopolitical dimensions of data platforms and products means we can put the age-old saying of “context matters” into practice. The result could be, for example, a movement away from governance rankings that create competing goals of faring well globally and making progress locally, and toward measurement that better aligns government incentives with citizen needs. (To this end, we’ve been glad to see several peer organizations uniting around the Governance Data Alliance to improve governance data quality and usage. Going forward, we look forward to contributing to this network through its working group on User Feedback.)

We’d like to connect with those interested in better understanding how open government data can be leveraged to influence governance outcomes. If you are at OKFest and find yourself asking similar questions, come find us, we’d love to hear your thoughts! As with all our work, we aim to learn and share as we go. Reboot’s session is tomorrow (Wednesday, July 16) from 12:00pm–1:00pm in Space F2 (Kulturbrauerei), where I will be discussing some of our recent experiences and asking you to show off your creative problem-solving skills.

Thanks to Janet Haven for early conversations that helped shape some of this thinking.

Image Credit: Open Knowledge Foundation


Introducing Mexico’s Agentes de Innovación

Mexico City is a beautiful, vibrant, historical city with a great climate and even better food. But for me, it’s also the first city where I lived as a working professional instead of a student, doing work that would influence the rest of my career. (I learned the word for “deliverable” in Spanish before I knew what it was in English.) That’s why it was a delight for me to return to Mexico City with Reboot last month as part of a new project (and not just for the opportunity to visit all my favorite taquerías).

This time, I was there for the launch of Agentes de Innovación, a civic innovation fellowship led by the Coordinación de Estrategia Digital Nacional (CEDN, the Coordination for the National Digital Strategy, for you non-Spanish speakers.) Reboot will be a process research partner, accompanying the implementation of the program to understand the human, contextual, and institutional factors that influence its outcomes. We will be documenting and sharing our findings with the goal of advancing the collective knowledge of those in the civic innovation and open government space. Over the course of two and half weeks, we have already learned a great deal about the program and its participants.

Research on public sector innovation (see this literature review by Bekkers, Tummers, and Voorberg) points to a range of potential barriers such as a risk-averse environment, the existence of rule-driven path dependencies, and dominant civil service cultures, all of which inhibit innovation rather than foster it. Innovation initiatives often hope to help address these barriers by introducing outside talent and new ways of working to the public sector.

In this way, Agentes de Innovación shares much in common with similar fellowships like the Presidential Innovation Fellows or the “Code for…” model. It is structured as a civic innovation fellowship that will leverage technology to address pressing problems that are a priority for the Mexican government. The program is being implemented by Coordinación de Estrategia Digital Nacional, a group within the Office of the President that was formed to support the implementation of the National Digital Strategy.

One of the unique features of the program, however, is that it focuses not only on bringing in outside innovators but also on supporting the innovators already working inside of government. The program’s explicit goal is to create a mechanism for the co-creation of solutions to problems facing the public, and it stresses the importance of open innovation that brings together ideas from both inside and outside of government. The Agentes program has identified five innovative individuals already working within government, and paired each of them with someone currently working outside of government. The issues these teams will address are components of the National Digital Strategy and span health, education, citizen security, finance, and entrepreneurship.

In speaking with the internal and external Agentes, as well as members of their extended teams, it was clear that participants are excited to start the process of solving their teams’ target problems. Many spoke with enthusiasm (and some with surprise) about the government’s willingness to create a space to test new approaches to problem solving. Just about all of them felt it was sorely needed. The design of the program stresses the idea of the “co-responsibility” (of both government and citizens) for improving government, and Agentes from both sides of that coin were excited to take on their roles.

Reboot has previously written on the bounty of civic innovation initiatives that cropped up globally in recent years. What has not proliferated so quickly, however, is the body of research to document the lessons learned from implementing them. When it comes to motivations and program design, many of them have similar raw ingredients—open data, technology-based solutions, open government, etc. These are all ideas that seem to have the potential to reinvigorate governments, but they are no guarantee. This is why Reboot is excited to be undertaking deep research on the implementation of the Agentes program, drawing lessons that will be relevant not only to improving the program itself but also to the larger open government and civic innovation communities.

As we learn, we’ll be reporting back regularly here.

Understanding Mobile Access From an Ecosystem Perspective

The expansion of mobile access has been a common refrain in international development for years now. It plays an important role in supporting human development, from economic and educational opportunities to political freedoms and human rights. Increased access to mobiles has been linked to positive social outcomes in dozens of countries.

Mobiles have been driven largely by market forces, but these forces have their limits. The GSMA reports that unique subscribers have grown at an annual rate of 7.3% from 2008-2013, but projects that it will slow to 3.5% per annum over the next seven years. There are currently 3.4 billion unique mobile subscribers—about half of the global population. The slowing growth reflects the fact that the other half will be harder to reach: it is more rural, less literate and numerate, and poorer. Given the potential benefits of mobiles, a lot of development agencies are thinking about how to promote this access further to these populations.

Organizations promoting access often talk of a “mobile ecosystem”. The metaphor is apt. Having access to something requires a whole system of elements to come together. For example, my access to clean water in New York requires pipes, water treatment, government agencies, regulation, financing, watersheds, aqueducts, and a lot more. These elements can interact in unexpected ways: changes in environmental protection could lead to mismanagement of the watershed, requiring further funding to purify drinking water, leading to a political backlash, and so on.

Similar knock-on effects can occur in a mobile ecosystem. Program planners and implementers need a strong understanding of these elements and their interactions in order to increase access and integrate mobiles into their work.

Understanding this ecosystem starts with the user, but it cannot end there. Any conceptual framework for analyzing access should build out from the user to the broader forces and context. Thinking about the system, therefore, looks something like this:

1. Start with the end-user capabilities, constraints, and interests. Mobile usage is one part of a fundamental human choice about how to engage with the economy and how to connect with those around us. Adoption of new technology is not strictly a question of the user’s education or generation. Cultural and gender dynamics complicate adoption. So the fact that any given mobile user sits along certain demographic, educational, cultural, economic, and other dimensions can influence whether they are able to use mobiles. Perhaps most importantly, the channels and initial uses through which technology is introduced can play significant roles: a device initially used as an economic tool can become a social tool, or even a political tool.

2. Branch out to the market environment, physical infrastructure, content, and connections. This is the “next layer out” from the end-user, with factors that are directly relevant but external to the individual. These include mobile network signal coverage and availability of user-appropriate devices, as they provide interested and capable end-users with services. The content and connections are also important in generating interest.

Just as we saw with clean water, the interactions of the mobile market environment with user behavior can yield unexpected results. For example, in countries where mobile service providers set high tariffs for cross-network calls or where signal coverage varies by network, users have grown accustomed to swapping SIM cards in their phones; this has led handset manufacturers to create dual- and even quad-SIM phones (see photo). This outcome points to the ecosystem nature of access: user habits (SIM swapping) pointed the way to a hardware solution (multi-SIM phones) to an access barrier creates by service providers (signal coverage and high tariffs).

3. Assess the relevant policy and regulatory structures. Finally, there are the regulatory structures and policies that impact either end-user capabilities and interests or the market environment. Naturally, telecom regulation is central. Equally important are the regulation and structure of related sectors that may be able to leverage mobile networks: banking, transportation, health, education, aid, and more. This layer starts to touch on the political and institutional aspects as well.

4. Find the leverage points. Cutting across the above factors are the leverage points that can be used to increase access. How can a policy change improve market competition? How can a new content offering increase interest? How would providers respond to a cultural or generational shift among users?

This is where systems thinking becomes especially important. The leverage points are not obvious unless you first understand the other elements, and bring synthesis techniques to surfacing the connections. These can be revealed through a combination of actor mapping and analysis of trends, feedback loops, and root causes in mobile access.


The market forces spreading mobile access are limited because access is a compound phenomenon. Multiple factors must align in order for an individual to make use of mobile technology. By understanding how these factors interact in the mobile ecosystem, we can continue to expand access and the social benefits that accompany it.

Where We’re Going

In celebration of the launch of our new website, we’re taking a look back at Reboot’s three-and-a-half years of growth and change—and looking forward to our plans for the future. Over the last two weeks, we kicked off with Our Story and What We’ve Learned. This week, we’ll be looking ahead.

Experimenting with our model and examining our results is a constant process for us. After three years of learning, over the last several months we’ve developed a new strategic plan that builds on the work we’ve done thus far, and focuses on expanding uptake of Reboot’s empirically-backed ideas across our broader community of practice.

As we often get questions from clients, partners, and candidates about our trajectory, here are a few of the areas that we’re planning to grow (with your help!).

Sharing and Advocacy

This new website is one of the major steps in an effort to increase our advocacy among our community of practice.    From the outset, we understood that our mission would be best fulfilled if we paired the empirical evidence drawn from our consulting projects with strong advocacy for change. When we first started, however, we didn’t have much evidence of our own and had no desire to join the ranks of those who advocate without having ‘the ground truth.’ As a result, our external communications have been small compared to all that we’ve wanted to say.

That’s changed now that Reboot has learned through more than 30 projects in 17 countries. We feel confident taking stronger and more public positions on the issues we care most about. We know that  the open inquiry and context-specific design that we have brought to our projects can benefit many more organizations than we can serve directly. We’ll be much more active as contributors and participants in the community, and hope that we can help decision-makers and fellow practitioners in their attempts to serve the public good. We expect this to also produce more opportunities for feedback and learning amongst our team, further improving the quality of our practice. To extend our efforts, we’re actively looking for partners with common interests who may want to collaborate in helping our shared knowledge reach a wider audience.

Systems Integrator

We have seen some of the greatest impact when we’ve worked with and between multiple actors, including international donors, governments, grassroots advocacy groups, and local communities. It is our ability to understand these group’s varying incentives, capabilities and perspectives that allows us to better align those factors towards social progress. One client called us the “systems integrator” of governance, and we agreed with the importance of this role.

Moving forward, we plan to more formally embrace this value add by pursuing initiatives where we can serve as an independent bridge among these diverse actors. We’re not quite sure what this will look like in practice, but we’re brainstorming with collaborators on how we might gain the financial independence to allow Reboot to function in this role without the support of a client resourcing.

Highlighting the “Operational”

Having worked with some of the world’s largest bureaucracies, we’ve learned that operational processes can significantly hamper or enable delivery of impact. Increasingly, we have been working with our clients to help them understand how they can do better, more innovative work through adapting their operational procedures. Funding and contracting modalities, and the incentives they impose, frequently prevent responsive, effective problem solving and lead to poor outcomes.

From conducting an institutional ethnography of a major bilateral donor to informing policy dialogues on how to approach performance evaluation of public financial management systems, we’re excited to help our partners ensure their organizational physics aren’t a barrier to impact.

Greater Flexibility

We’ve had the great fortune to work with some amazing clients and collaborators, and have cherished these experiences. But in these past years, we’ve also learned the constraints associated with sitting in the consultant chair.

Increasingly, we see opportunities to advance our vision of inclusive development that are not attached to an existing client or partner. We get frustrated when these opportunities for impact pass by because we can’t rapidly identify a client with the interest and unprogrammed resources. Even more heartbreaking are those instances where a successful initiative comes to an end to the dismay of all parties solely because of resource availability. While we’ll continue our consulting work, and the success we’ve built, we’re finding new opportunities that may give us the chance to address some of the consulting model’s limitations.


In setting these new goals, we are in many ways back to where we started—cautious optimists with lofty ambitions.  We have come this far thanks to the support and inspiration of our trusted clients, colleagues, and the spirit of debate and improvement that defines the broader field. We’re looking forward to deep discussions and hard work for years to come, as we continue building a 21st century social contract together.

What We’ve Learned

In celebration of the launch of our new website, we’re taking a look back at Reboot’s three-and-a-half years of growth and change—and looking forward to our plans for the future. Last week, we kicked off with Our Story, the first post of a three-part series. This week, we’re outlining some of the most important lessons we’ve learned about what it takes to run an enterprise that’s able to balance mission and business.

So without further ado, here are five lessons we thought were worth sharing…


1. Values first. Always.

Every time a new opportunity comes across our desks, we use a matrix to decide whether or not to take it on. At the very top of our list of criteria is the client’s alignment with our values. It’s not just a Boolean ideological rule, e.g., “We don’t work with tobacco firms.” It’s a deep examination of whether our fundamental vision and approach to development and social justice aligns—not just with the organization as a whole—but with the specific counterpart team we’d be working with. It’s important that both parties bring complementary views and values to answering tough questions throughout the project, even if that means swimming against institutional and political pressures.

We apply similar thinking to the promises we’re willing to make to our clients and partners. If we can’t field the best possible team to try and tackle an initiative, we would rather pass on a project than bring anything other than our best.

Many exciting opportunities have unfortunately passed us by. But following these rules makes sure we keep our for-profit social-enterprise in line with our original values and goals. We have all seen firms grow to a size where they need to “feed the beast,” eventually having to take on undesirable projects in order to sustain the desired rate of growth. So we manage our pace closely, even as we grow ambitiously, to mitigate the risk of having to take on work that doesn’t align with our values.


2. Success takes humility.

As a people-first organization, we rely on an incredible team to solve tough challenges. We are unjustifiably lucky to have such brilliant, passionate staff dedicated to this work, and have seen time and again what factors are the most crucial to success. Skills and experiences matter, but we find that intangible qualities—psychographic, ethical, and personal—are often the factors that make or break a candidate’s ability to thrive in our environment. At the top of the list are humility and generosity.

Pursuing social change is challenging and rarely glamorous, especially as we eschew quick-fix solutions. Addressing corruption in a resource-poor, conflict-affected context, or advancing human rights and social cohesion in a newly democratic state—these things just don’t happen overnight. The work can be frustratingly slow.  Maintaining humility, putting others before self, and putting in the effort even when the results may not be realized in our lifetime—that’s what it takes to do this work well.


3. For best results, avoid labels.

We often get asked whether we’re a design firm, a management consultancy, or a social enterprise. But the best description we’ve found is: “Reboot is a social impact firm dedicated to inclusive development and accountable governance.”

While it’s honest, it’s a bit wordy, so we understand when our colleagues offer other labels. We’ve  been called an “ICT4D firm,” an “open government shop,” and (our favorite) “a radical, anarchist collective for good governance” (this was from a client we deeply respect; we took it as a compliment).

The truth is that we very purposefully work in and draw practices from all of these fields and more, without subscribing to any single one. Our work is predicated on the idea that there is no single magic bullet that will solve social challenges rife with geographic and institutional politics. Identifying with a single field or school of thought is a kind of myopia.

We’ve adapted tools and approaches from various disciplines. While we have drawn perhaps most heavily from the practice of human-centered design, we recognize the limitations of traditional design practices, and our various projects have drawn in methodologies used in economics, public financial management, applied ethnography, journalism, and more.  We don’t believe in blueprint approaches, or applying global “best practices” from one context to another. Because we take an ethnographic approach to research and participatory design, our analysis and interventions are uniquely tailored to the contexts in which we’re working.


4. Entryism works.

We embed as deeply into our client and partner organizations as possible—an entryistic approach that has helped us address social issues at a scale and speed that would otherwise be highly challenging for an organization of our size. If we set out to build our own infrastructure and staff, our impact would be limited by the rate of our growth. Instead, we’ve been able to leverage the resources and minds of the world’s most influential organizations such as national governments, the World Bank, and the United Nations.

We also work hard to get executive buy-in throughout the process. As a result, we’ve continued to grow our collaborations with several clients over the years. We consider it part of our mission to  help our client counterparts influence dialogues within their own organizations about how governance and development work should be done. The type of access we’ve gained and relationships we’ve built with senior decision-makers would have been far more difficult had we worked as a grantee or outside advocate. Ensuring support from leadership also makes us and our work better; it forces us to fit our bright ideas through real-world constraints and increases the likelihood of sustained commitment to whatever we’re working on.


5. Never stop testing our model and assumptions.

Although we’ve had success with our model, we recognized from the start that this was just one approach. As a young organization, our capacities and experiences are constantly, growing. Thus, we believe that our model should also consistently be challenged, to make sure that it remains the right one for us.

For example, we set out to work with large institutions—namely, governments, multilateral development organizations, and international NGOs—because of their reach, resources, and influence, and what these factors meant for improving human development. While we’ve been happy with the results this approach has produced, we’ve begun to feel it is too limiting given the many other paths to achieving social progress.

To that end, since 2013 we’ve experimented with working with different kinds of organizations, including small non-profits, advocacy groups, philanthropic foundations and technology startups. In this work we’ve also trialed several different models of collaboration. Beyond our standard consulting model, we’ve made grants, provided pro-bono or in-kind services, worked as part of larger consortiums, taken on short-term targeted assignments, and served as mentors and trainers.


Drawing from what we’ve learned, we’ve spent the last several months detailing out plans for Reboot’s next three years. We’ll share more about those in part three of this series.

Our Story

Looking around our offices today, it’s hard to believe how much Reboot has changed in more than three years of practice. From our beginning—two people, a home office, and a quixotic quest—we’ve grown to a 20-person collective of “practicing theorists”, with 34 projects in 17 countries under our belts. We’ve helped leading global institutions and grassroots community groups alike set policies, develop processes, and deliver services to alleviate human suffering and advance social justice.

This week, as we celebrate the launch of our new website, we’re proud to highlight our growing capabilities, and keen to contribute our theories and models to the wider community of practice. So to that end—as well as to show our appreciation for our brilliant staff and the inspired partners who have trusted us with their missions—we’re taking this opportunity to look back at Reboot’s growth, offer a glimpse of where we’re going, and pass on a few of the lessons we’ve learned along the way.

This post marks the first of a three-part series and starts at the beginning: how we came to be, why we exist, and what our model for change is.

Our Mission

Reboot officially opened its doors in 2011. But the seeds for Reboot were planted a year earlier, when Panthea and I met at a geeky, weekend barcamp on government transparency.

I was working at the Center for American Progress, Panthea at the UN. We found a common frustration with our field; we had seen firsthand how many government and development organizations, despite significant resources invested, were not always effective at meeting the needs of the communities they sought to serve.

It was not for lack of effort. We knew how deeply our colleagues were invested in their work and committed to their missions. It was the tools, theories, and ways of working that we believed were too often ineffective. And we joined many others in  hypothesizing that our basic model of democratic governance needed significant rework.

We felt that the deepest challenge was in the public sector’s indirect accountability chain. Private corporations face a straightforward litmus test: do consumers believe a company’s offerings add value to their lives? If the answer is “no,” then consumers simply go with another company and offering.

But in the public sector, there’s rarely another option when critical social services don’t deliver. When stakes are highest—usually for citizens of certain income brackets, ethnic backgrounds, and geographies—the choices are often most thin, and the failure of a public service has dire consequences. When an infant in rural Nigeria dies because she lacks access to clean water, where can her grieving parents turn?

Private companies, which live or die by the quality of the services they provide, have long employed a variety of means for understanding and serving people’s needs. Our mission was to find a way to bring these tools and techniques to the service of those delivering public benefit, and to design services and interventions that effectively met people’s needs. Similarly, just as companies are constantly learning to optimize their infrastructure and internal processes around consumer satisfaction, we wanted to help governments and development institutions optimize their policies and practices around improving human well-being.

Our Model

When people ask, “What does Reboot do?” the answer is long, because, depending on the engagement, we may act as a management consultancy, grant maker, research and design shop, program implementer, and/or strategic communications firm. In short, we have done a great many things in a variety of different places, but broadly we can say our work falls into three core areas:

  1. Research and Design: We draw upon time-tested approaches from diverse disciplines, including economics, anthropology, design, and engineering, to understand challenges and design interventions that improve public service delivery or advance accountability in public institutions.
  2. Implementation: We stand by our designs by working with our clients and partners, including civil society organizations, private sector, and target communities, to implement programs that promote human development.

  3. Evaluation, Learning, and Advocacy: We examine the lessons and results of our programs, and those of others, to refine our theory of change, and to share and advocate for effective, evidence-based approaches to advancing global development.

It’s a model that has been fulfilling in terms of our mission and values,  although it’s not always operationally easy. Each of our three areas of work requires different operational models, and we adapt staffing, financial structures, and logistics management as necessary. This is also one of the reasons why many organizations focus only on one of these three elements. And, indeed, our advisors and many business books have counseled against this approach. Specialization is a safer business model.

But we started Reboot to create change, not run a business. We saw that operating across these distinct but overlapping realms makes us more thoughtful, more well-rounded practitioners. We’re able to design better programs, manage their effective implementations, and contribute back to global conversations because we are invested throughout the process.

We also made the choice to operate as a consultancy because we saw that our impact could be greater by assisting major public sector and development organizations in achieving their missions. We knew these institutions’ strengths, and saw opportunities where they could operate better. By working with them as advisors and implementers, we saw a more effective and sustainable path to influence global development practice.

Additionally, we are proud to be a for-profit social enterprise. Working under contract with our partners means we have direct accountability for the success or failure of our ideas. The global development space is prone to lively debates and constant experimentation around how to better deliver on its promise. If our results can’t withstand this competitive market of ideas, then we might as well all go home.

Thus far we’ve been fortunate in this regard, which has allowed us to be able to invest 100% of what (relatively little) profit we’ve gleaned back into our mission. As soon as we were able, we began providing pro-bono services to mission-oriented organizations and have recently expanded our charitable activities to include offering catalytic grants to early stage social enterprises. We’ve also used our profit as working capital to finance a staff that works without the constraints of being tied to specific project funding and as the resources to advance our advocacy.  So we think our case demonstrates how for-profit can easily be for-good.

Drivers of Growth

Thankfully, the market response we’ve seen in the past few years suggests that we may be on to something.

Our consulting projects and pro-bono engagements are allowing us to explore approaches to fulfilling what we call a “21st century social contract”.  We are humbled and amazed by the incredible opportunities and lessons offered along the way.

We started an organization—as most founders probably do—because we were frustrated about the way the world worked, and because we thought (perhaps naively) that we could do something to change things for the better.

Today—well, we remain frustrated and still naïve, though hopefully less so—we are channeling our frustration more constructively. Through our work, we have been able to translate our vision and theory of change into actionable practice. In the process, we have played a part and taken steps, however small, toward creating the world we want.

From our very first project, conducting research on financial inclusion for an academic institution, our capabilities have grown: We’ve brought the perspectives of marginalized populations to design policies and programs in Tunisia, Pakistan, and Nicaragua. We’ve worked on human trafficking, public sector governance, media development, civic innovation and other diverse issues. We’ve established an office and discovered a wonderful community of partners in the Niger Delta. And we’ve helped advance inclusive development in several troubled and post-conflict states; this includes supporting a transitional government to administer legitimate elections in a newly democratic state still plagued by unrest.

None of this would be possible without the commitment and passion of our team—the more than 20 brilliant, talented thinkers and doers in our ranks (and we’re looking for more), as well as 20-plus collaborators and partners who have contributed in generous and insightful ways, both large and small.

Equally important are those who entrust us with their important challenges. We are thankful for our clients, whose values and perspectives align with that of our work, and who welcome moving beyond a traditional client-vendor modality towards deeper partnerships to achieve collective goals. They have come to us with some of their most difficult issues and important initiatives, and given us the space to ask tough questions and experiment with approaches in our joint pursuit for better answers. We are deeply grateful for their trust and for the opportunities they have provided.


The most important part of all this is how we do it. So up next, we’ll talk about our model and the important lessons we’ve learned to date. Stay tuned part two!

What’s Wrong With Being “Soft” in Advocacy Evaluation?

Measuring program effectiveness may sound like the bean-counting afterthought to the real work of program implementation. But measuring program effectiveness in the social sector can feel pretty high-stakes for organizations competing for limited funding dollars. And there’s plenty of controversy around how it should be done.

One particularly persistent debate centers around whether or not some programs are too “soft” to evaluate. Are the outcomes of, say, advocacy or empowerment initiatives too subjective, complex, or nuanced to evaluate with “hard” objective metrics?

A recent Stanford Social Innovation Review article by representatives of the Walton Family Foundation argues that this does not have to be the case, declaring “advocacy isn’t ‘soft’”. The authors describe how they have been able to apply logic models and performance measures to their advocacy projects in more or less the same way that they might to direct services programs.

As someone who thinks ways can be found to at minimum approximately measure just about anything, I view attempts to measure advocacy grantee effectiveness as a generally positive thing.

But an acceptance of the assumption that being “soft” is bad, and that all interventions should be evaluated in the same way as direct service programs, isn’t the only way forward. While this can provide a good start for laying out how any intervention can be monitored, many examples of performance assessment still focus primarily on outputs instead of the changes those outputs are intended to produce.

The SSIR article, for example, described a report produced by an education advocacy organization. Evaluation of the report’s performance included tracking indicators like the number of times the report was downloaded and the number of media mentions it received (including one very powerful mention from Secretary of Education Arne Duncan).

But understanding how advocacy outputs lead to behavior or opinion change and, ultimately, to impact is more difficult than just getting creative about which output response metrics feed into performance assessment templates. Sure, I can understand that a certain number of people have downloaded a report. But without digging deeper, how can I know if it was read once downloaded, and then if it changed anyone’s mind? What’s more important: the number of media mentions that a report garners, or whether one mention in particular led a lawmaker to author new legislation or vote in a different way?

We’d do well to remember and embrace the fact that advocacy is political in nature, yielding unintended results and patterns that are difficult to predict and that resist simple measures. Outcomes are based on interactions between individual actors with different incentives, capabilities, and needs all responding to any given intervention. As a result, politics evolves in a nonlinear manner, where one action has numerous effects that may alter the intended trajectory of said action.

Any effort to evaluate such complex interactions demands “trained judgment”, which is based in tacit knowledge and not just a scientific method. And tacit knowledge starts with a deep understanding of the incentives that inform people’s everyday behavior, the institutions they build, and the political landscape within which they operate. Measuring the effectiveness of advocacy efforts as if they were the same as direct service programs sells advocacy, and the complex social dynamics it takes on, short.

Advocacy requires understanding the people whose beliefs and behaviors the intervention hopes to influence. People are subjective, complex, and nuanced. It should follow that an advocacy program attempting to change behavior and how people interact with institutions and each other deserves to be evaluated as both “hard” and “soft”.

Measuring What’s Working for Health Systems Strengthening: Lessons from Governance Reform

The clearest representation of healthcare is a doctor sitting with a patient. Whether it’s a routine checkup or a serious procedure, direct interaction is central to how health care happens. If you want to improve health outcomes, this interaction is a good place to start: putting new technology in the doctor’s bag, ensuring vaccines or essential medicines reach patients, or simply building new clinics.

But, of course, we know that there are hundreds of other people who make that interaction possible: diagnosticians, administrators, insurers, janitors, receptionists, truck drivers, cooks, regulators, researchers…the list is endless. These are the people who compose a health care system. And the design of such a service delivery system can dramatically impact the effectiveness and efficiency of the care provided.

The global health sector is paying increasing attention to the systems that ensure care reaches people who need it most. Last month, experts from several major NGOs and donors gathered at the Center for Global Development to talk about investments in global health and how an enabling environment can make investments more effective. Though a bit meandering, the conversation frequently came back to the importance of systems strengthening, as I discussed recently on Humanosphere.

However, the event left a big open question around measuring the impact of systems strengthening efforts. This measurement is challenging because health systems are incredibly complicated. They involve a wide range of public and private actors, their performance depends on countless exogenous factors, and they take different forms in every country depending on the population being served and the other institutions in place.

Unlike tangible health outcomes, system elements do not lend themselves to clear indicators.

Health systems strengthening may be able to learn from measurement in broader governance reform efforts. There is already a great deal of overlap between the two. When I posed the question of impact measurement to a few of the panelists, Karen Cavanaugh of USAID commented that other development sectors are probably ahead of healthcare in terms of systems-level indicators.

Generally, governance indicators can take two different approaches:

  • Measuring governance itself usually means looking at the rules and processes of government—for example, noting whether certain laws are on the books, whether the legislature passes a budget, or whether certain agencies exist and have funding—as well as how government functions in practice. This sort of measurement can be fed smoothly into diagnosis (you can quickly identify the gaps) and reform (you can design and advocate for changes). However, because governance is measured against how government “should” operate, this carries a normative bias that can be hard to justify. It may well miss many positive capacities of a governance system that fall outside its framework, and potentially encourage isomorphic mimicry (the creation of institutions that look like they meet international standards, while performing entirely different functions).

  • Measuring the outcomes of governance, on the other hand, guarantees a focus on performance.  What did the government actually accomplish? This necessarily pushes into other sectors; governance itself accomplishes nothing, except as it improves health outcomes, educational opportunities, employment, peace, or some other end. For example, Matt Andrews has proposed under-5 mortality or birth registration rates as possible governance performance indicators. Though these performance indicators can lead to cross-country comparisons and support advocacy, they aren’t well-suited for diagnostics or attribution for reform efforts.

Clearly, neither approach to indicators is fully satisfactory on its own.* We need each to serve as a check on the other. Measuring outcomes ensures that our measures of governance itself are actually relevant, while measuring governance itself gives us more actionable guidance than outcomes alone.

Translating this back to health systems, we do need both kinds of indicators. The outcomes are somewhat straightforward, and they are the same outcomes that health care is always concerned with, such as reducing disease incidence or saving disability-adjusted life years. Health systems-level indicators (analogous to measuring governance itself) also exist (see the World Health Organization’s handbook on indicators for health systems). Improving a governance system requires a combination of both types of indicators, supported with research to ensure that they are actually linked in a given context.

The need for both kinds of indicators also points to the need for humility about what indicators can accomplish. Indicators are great tools for managing linear, cause-and-effect relationships, but governance and system reforms are far from linear. Relationships between system elements are often complex, dynamic, and dependent on feedback loops that can be easily misunderstood. In such a context, indicators merely point the way to problems. Designing solutions requires deeper engagement, including a certain amount of iteration and muddling through.

This deeper engagement doesn’t lend itself to indicators or a value-for-money mentality, and it can seem far removed from the direct interaction between doctor and patient. But herein lies the hard work of systems strengthening.

Bill Savedoff refers to this distinction as governance determinants and governance performance. Somewhat analogously, a recent ODI paper from Marta Foresti and Leni Wild call this form and function. Others refer to it as rules-based and outcome-based, with slight variations in emphasis.

Time to Move From Pruning Trees in Global Health to Forest Management

Global health efforts in the past decade or so have taken an aggressive and largely successful targeted approach to some of the world’s most harmful diseases such as HIV-AIDS, TB and malaria.

With an unprecedented increase in funding for such efforts in this new millennium, the global health sector has made major gains against particular diseases and other health threats. But funding is limited, and has plateaued of late, focusing attention on getting more ‘value for money.’ Many leaders in this field say they are now seeking to identify the “best buys” in global health.

This was the stated purpose of a recent event hosted by the Center for Global Development (CGD) along with Population Services International (PSI), PATH, Devex, and Merck for Mothers which featured experts from those organizations and others. The event was linked to the release of PSI’s Impact magazine issue on “best buys” in global health, which included findings from a survey of global development professionals.

As Humanosphere pointed out, the conversation at the event itself was unfocused. Participants tried to shoe-horn points about systems strengthening into the “best buys” rhetoric, and no one seemed interested in talking about the survey that was ostensibly the basis for the event. Nevertheless, the event served to emphasize the attention that sector experts are paying to health systems.


Despite the fuzzy rhetoric, it is time to move past targeting the big, diseased trees on the global health landscape to something more akin to comprehensive forest management. Rather than pruning back each threat that arises, we need to cultivate a stronger ecosystem for health.

Groups like Innovations for Poverty Action and GiveWell have done great work to create evidence bases for specific high-impact interventions, and to advocate for funding those interventions. Some of these, like bednets and deworming, have made their way into the popular understanding of global health. There’s also a lot of press around the gadgets and apps of global health tech, from mHealth and tele-medicine to low-cost diagnostic kits. These are all likely candidates for health funding “best buys.”

But experts in the field contend we need to move away from our focus on the trees and better manage the entire forest. That means health systems, service delivery, and community ownership are the most important places to invest in global health.

A country’s health system includes several interrelated parts: physical infrastructure, regulatory frameworks, supply chains, public and private sector care providers, educational and workforce development systems, patient education efforts, community involvement mechanisms, and more. These parts all work together in order to deliver healthcare effectively and efficiently. Improving the system means tackling any number of these elements, depending on the needs of the country in question. It might require better training for community health workers, a new human resource management system for the national government, an SMS-based feedback system for patients, or something else entirely.

The importance of these systems elements isn’t a new idea. Wonks often talk about the distinction between “vertical” interventions (targeting a specific disease) and “horizontal” interventions (building health systems). Similarly, institutions have received attention in development thinking for years.

What seems significant now is the recognition that investment in health systems is more critical than any specific health intervention. We’ve spent the past decade raising awareness and targeting funds at specific diseases, such as the US government’s focus on AIDS through PEPFAR, or the Gates Foundation’s efforts against malaria. Now the pendulum is swinging a bit toward health systems.

Even if there is broad support for this swing among experts, it may be challenged by our current approaches to funding. The problem with the “best buy” and value-for-money mindset is that it encourages you to look for a clear link between money spent and lives saved. Systems and institutions don’t provide that clear link: such attribution is complicated and easily disputed.

Directing aid dollars toward systems strengthening might be even harder in global health than in other sectors. As Karen Cavanaugh of USAID pointed out at the CGD event, we have been successful in convincing the public that global health challenges are not as intractable as they seem, and are therefore worth tackling. That’s left an impression of simplicity about the interventions needed: delivering vaccines, developing new products, or sending doctors on medical missions are all more straightforward than systems strengthening. We need to encourage a more nuanced understanding.

Part of this nuanced understanding requires seeing how systems strengthening and specific interventions are two sides of the same coin. In any sector, investment in platforms and capacities can make delivery of other products and services possible. Campaigns targeting specific diseases could build on and develop existing system capacity, or could undermine and displace that capacity. Similarly, systems strengthening will have the most success if it produces tangible outcomes on the most critical health issues a system faces. These two approaches should work in tandem.

As health systems receive more attention, we should be able to better understand these nuances. Funding mindsets and mechanisms will be slower to adjust, but shifts there will allow us to ultimately strike the balance between interventions and systems.

This piece first appeared on Humanosphere, a news blog devoted to covering and analyzing issues on global health, aid, and development.

Navigating Certifications for Greater Accountability

Early this year, World Policy Journal mapped illicit diamond market activities in all their complexity. A 3-month long investigation into the efficiency of the Kimberley Process—an international agreement that seeks to identify and certify non-conflict diamonds—showed that conflict diamonds can pass through multiple subsidiaries in tax havens that are largely deemed “Kimberley Process-certified.” In this way, diamonds are erased of their true origins, making it harder to identify which are conflict and which aren’t.

At first glance, the problem seems to be the inefficacy of the Kimberley Process. Questionable jurisdictions that can erase diamonds of their true origins shouldn’t be certified. Simple as that.

But a closer look reveals a systemic issue that plagues all certifications and standards that are established with the best of intentions. As the World Policy Journal article states:

“The root cause of the problem does not lie in the ineffectiveness of the Kimberley Process as a monitoring mechanism for actual conflict diamonds. It lies in the Kimberley Process’s commendable goal of removing the stain or reputation of “conflict” from diamonds, through a process of certification.”

We live in a world full of certifications. From the grocery store to the airport to the elevator, stamps of approval show us products and experiences have been deemed safe and worthy of our support. Certifications are intended to assign a concept or practice to a class or category; to identify the good and bad, and alleviate concerns. And in doing so, certifications brand credibility and empower consumers and end users.

While certifications can identify what is working, they have an equal ability to disguise what isn’t.

But while certifications can identify what is working, the illicit diamond trade investigation above shows that they have an equal ability to disguise what isn’t. Putting trust in certifications—and turning a blind eye to the rest—dampens motivation to understand what’s hidden behind the stamp and hold others accountable.

This problem crops up in private and public sectors alike. Countries are signing up for the Open Government Partnership, gaining association with “open government” practices. But what does “open government” really mean when, according to the Committee to Protect Journalists, the Obama Administration’s surveillance activities and fear of leaks deter officials from speaking freely and keep the press at arm’s length? Similarly, what does “corporate social responsibility (CSR)” mean when an Inner Mongolian steel company leaks pollution into a village behind the veil of its sustainability reporting and reputation for strong environmental protection CSR initiatives?

The same idea applies to “best practices” in international development. The implementation of anti-corruption efforts in Uganda since the 1980s has yielded the creation of anti-corruption bodies—the Inspectorate of Government and the Directorate of Ethics and Integrity—that had been proven effective in other countries. But over the years these power structures have been manipulated and undermined. According to a report released by the Institute of Development Studies, an increase in tax revenues initially indicated success in tax revenue authority, but this rate of growth has since flattened and is accompanied by corruption. Successful civil service reform was evidenced by initial bureaucracy downsizing, but this has since reversed. Some believe that international “best practice” anti-corruption efforts implemented in the Ugandan context have assuaged foreign donors instead of truly addressing the problems behind what is often called “corruption”.

While best practices work in certain contexts, the “best practice” label does not guarantee suitability or success. In fact, as UN knowledge management and monitoring and evaluation specialist Ian Thorpe describes in his critique of best practices, following guidelines can in fact deter practitioners from thinking outside the box to look for more appropriate interventions.

The above examples show that certifications, be they labels or standards, have a tendency to create a sense of trust that may evolve into complacency. So how can healthy skepticism make sure certifications reflect reality?

The first step is understanding the certification by breaking it down. This involves analyzing who administers the certification, what their interests are, what stakeholders of all sides and sizes think of the certification, and what systemic factors are outside the certification’s realm. In the case of Kimberley Process certification, the World Diamond Council plays an important role to determine process implementation. Members of the Council include a variety of vested interests from De Beers and other diamond manufacturers worldwide. Groups like Amnesty International and One Sky have found that the process still remains open to abuse.

Next, standards and practice need to more accurately reflect one another. The goal should be outcomes—outcomes that meet standards, and even strive to exceed them. Outcomes should be embedded in practice and operations rather than reported certifications with questionable basis. As my colleague Panthea Lee has written before, “open government” needs to be more than releasing thousands of datasets on an open data portal; efforts need to prioritize solid outcomes around social accountability and constructive citizen-government interaction. In that same vein, “CSR” and even “B Corp” need to more accurately reflect sustainable business practices to a company’s core, as Dane Roth explains in his analysis of alignment for more sustainable CSR.

Finally, outcome-oriented practices can stretch and innovate on certifications to make them more relevant and effective moving forward.

Achieving certification should be more than an end goal, a trophy on a shelf. It should be a step along the way to striving for higher self-accountability, sustainability, and safety beyond certification itself.

“Best practices” may work in certain times and places, but that shouldn’t stand in the way of finding even better, more appropriate practices.

Looking beyond certifications to understand the incentives and situations behind them can motivate understanding of the full story and further improvement. This way, certifications will not cloud the wisdom, creativity, and empathy needed to build lasting public and private sector accountability.

Casa Materna: A Critical Service in Need of Redesign

Last month, we explored how policymakers can channel empathy in policymaking, using as an example our work with UNICEF to identify diverse needs and challenges of children in Nicaragua’s North Atlantic Autonomous Region (RAAN). Our community-based approach highlighted success stories as well as services in need of redesign. Today, we’ll go to a casa materna, a “maternity waiting home”,  in Puerto Cabezas to see how this important resource for women can better serve as a source of medical and emotional care.

The women of the Puerto Cabezas casa materna have come from near and far. They’ve made journeys of up to multiple hours over rough roads, by foot and in designated ambulances. They’ve come to get the care they need as soon-to-be mothers.

There are 88 casas maternas spread throughout Nicaragua, and seven in RAAN. The government has invested in them in recent years in an effort to reduce maternal mortality. Funded by the Ministry of Health, they are a critical bridge linking rural women to modern facilities in Puerto Cabezas and other cities.

Casas maternas are part of a wider model of healthcare present throughout Latin America. The casas are intended to provide a supportive environment for women who are in the final stages of pregnancy, and especially for women with at-risk pregnancies. Women in earlier stages of pregnancy may also stay at these homes to attend prenatal exams when these services are not available in their own communities. While some casas provide significant medical services, their main purpose is to serve as a refuge and link to other sources of care.

The women at the Puerto Cabezas casa materna arrived at a brand new building: walls painted in bright shades of red, teal, and yellow, beds and mattresses for 16 women, a full kitchen, and a small medical exam room. At the time of our research, three nurses rotated to staff the facility 24 hours-a-day, and at least one doctor attended to the women staying here daily. Women are transported to checkups at the local public clinic—right next door—and then to the hospital to deliver their babies.

Contrary to what the new building may have implied, the physical upgrade of the casa materna was not emblematic of a higher standard of care offered. Many of the women reported disappointment with the attention they get from caretakers and doctors. They find themselves on the receiving end of harsh treatment and obligations to contribute to the daily operations of the facility when late in their pregnancy. When the facility’s water tank broke, women were made to haul heavy water buckets from the backyard well. One woman said she was even forced to mop floors just a few days before her delivery date.

Casas maternas are supposed to be places of support, but regulations meant to maintain an orderly experience at the facility end up regimenting the experience, limiting the diversity and quality of personal supportive care women receive.

Many women report feeling bored and confined because they’re not allowed to leave the grounds to run errands or even take a walk without special permission. Some women went so far as to refer to themselves akin to prisoners. Little socializing among residents reduces potential for camaraderie beyond nurse-led “chats” about important maternal and infant health-related topics.

Perhaps most damaging is the restriction on visitors. According to the casa materna model, it is common to allow expectant women to bring along family members and friends to accompany them throughout their stay. But the casa  in Puerto Cabezas appears to follow a less inclusive model, running counter to many women’s expectations.

One pregnant teenager was told by a nurse at her local health post that her friend could accompany her to the casa. When the two girls arrived, the nurse on duty said the friend was not authorized to stay and would have to leave. The friend had no way to return to her community, and knew no one in Puerto Cabezas to turn to for help. Fortunately, the night nurse later overruled the previous decision and allowed the friend to stay, but the situation could have easily ended far worse.

When women face experiences like these, they share them with others in their home communities, advising others to not go to casas maternas. A casa materna can be a life-saver and a foundational resource for women. But asking a woman to voluntarily separate herself from her children, mother, and partner during pregnancy is hard enough. How can this woman then be expected to stay somewhere where the care she receives—even if technically high quality—isn’t delivered with compassion?

A service as critical as the casa materna should be built for the women it attempts to serve, with women’s health—both physical and emotional—at its core. Making women feel welcome, happy, and safe is the only way to encourage them to reach out for the service in the future.

Connecting Company and Cause for Sustainable CSR

During the 2013 holiday season, Mazda launched its Mazda Drive for Good Campaign to raise funds for St. Jude’s Children’s Research Hospital, the American Heart Association, the American Red Cross, and a collection of charities supported through the Mazda Foundation. Similar company efforts to support social causes, such as Nivea’s donation to the Breakfast Club of Canada, have long been part of corporate social responsibility (CSR) efforts.

But it’s hard not to wonder, why is a car company is putting its efforts toward addressing medical research issues?


What is “Alignment” in CSR?

Business and CSR “align” when the selection of social causes, methods of intervention, and implementation partners fit with the existing expertise and resources underlying a company’s business success.

For example, Pfizer capitalizes on its expertise in the pharmaceutical manufacturing business by donating medicine to a wide range of health initiatives in developing countries. Through its RTC Fellowship program, pharmaceutical giant Merck draws on its employee’s expertise in health issues to support public health NGOs.

It’s reasonable to think that a company with health industry expertise would be better aligned than a car company to support health-related causes. A health product company can donate medicine at production cost or provide expertise to a medical research or public health NGO. Greater value, same or less cost. On an individual level, people from related sectors—like health care product developers and public health workers—can share experiences and knowledge, fostering empathy between partnering organizations and bolstering long-term partnership success.

The key to unlocking the benefits of aligned business resources and CSR lies in pinpointing to what social cause the skills of a company can be most effectively applied. In other words, identifying a company’s competitive advantage in doing good.

So how could a car company’s CSR initiatives achieve alignment with social causes and the goals of NGO partners?

Thinking hypothetically, the Global Alliance for Clean Cookstoves could benefit from engineering skills. Many car companies have been perfecting cleaner burning systems and efficient production methods for years, overcoming design and production challenges in the process. These companies could give not only money, but also valuable knowledge, to save children and their families.

Alignment and Return on Investment

But companies are not charities. And the jury’s out on whether or not CSR can provide strong return on investment (ROI). CSR initiatives live outside core business activities and hold a tenuous position within the company, replaced if the championing manager leaves or cut first if finances become tight.

But when CSR initiatives align with business goals and resources, a stronger case can be made for maintaining these programs and opportunity for increased ROI is greater. CSR initiatives don’t have to drive a company’s success, but to be sustainable they do need to address the business reality of ROI.

When alignment is achieved, companies earn consumer trust, directly benefitting business and brand. CSR initiatives have struggled to overcome consumer skepticism for years. Consumers believe only 5% of companies deliver on social responsibility promises. This is likely in part because, say, car companies are engaging in CSR for medical research. “Saving children” may beat “fixing stoves” on the PR front, but without alignment and with an increasingly informed consumer population, skepticism triumphs and business takes the hit.

In the past, CSR has been a way for companies to do good.

But for informed, socially-minded consumers, brands can’t just do good; they have to be good.

Alignment presents a sensible and compelling narrative of a caring company that is, to its core, good.

And it’s not just the company’s ROI that benefits. Social ROI for implementing partners increases when alignment is achieved. Non-profits may find more interests, skills, and experiences in common with companies that pursue initiatives related to their business practices. Cultivating empathy between partners through shared experience and channeling relevant resources greatly benefits social causes.

When a relationship based on empathy and skill-sharing is achieved, a company is more likely to commit to a particular issues or initiative. Longer engagement with an issue presents more opportunity for companies to gain potentially profitable experience or understanding to support a feedback loop whereby philanthropically driven actions can drive business growth and vice versa.

Integrating CSR in Business Strategy

If a social cause and business goals align, it may even be possible to integrate the cause into overall business strategy. CSR can transition from a PR stunt to a long-term market research, brand expansion, product development, and business growth asset.

For example, Danone, working with Grameen bank, developed a yogurt to help address nutrition issues in Bangladesh. Danone entered a new market, learned about expansion into developing markets, and established a flagship initiative to attract socially-minded hires. All while increasing access to nutritional food for the poor in Bangladesh.

Widespread acclaim quickly transitioned to criticism when the new enterprise functioned at a loss and did not have the magnitude of impact hoped for in rural communities. It is common for new ventures to struggle, and Danone was dealing with the added challenges of developing a sustainable business to support a social cause in a country it had no prior presence in.

But what’s especially worth noting is Danone’s response: Danone revised its model of intervention and expanded with its own long-term business goals in mind. It is doubtful that such dedication and ability to respond would have emerged in a Danone project supporting animal shelters or another issue less relevant to Danone’s core business.

Not every aligned CSR initiative will lead to a new revenue stream, nor does it have to. But alignment allows companies to apply their resources to a social cause in a way that increases potential for ROI. And if the social cause does find its way into the business portfolio, the commitment will greatly benefit both company and social cause.

Committed and Sustainable CSR

There is always potential for good when companies donate money and time to causes they believe in, no matter how disconnected from their business. But companies could do so much more with aligned CSR.

When the Honest Co., a toxin free baby product company, donates supplies and employee time to Baby2Baby, a nonprofit providing products for children to families in need, that makes sense. And CSR should, ultimately, use resources in ways that are efficient and that make the most sense, to value both social cause and company.

If we allocate our resources most wisely, with alignment in mind, benevolence can be good for business, and business can be better for us all.

Data Visualization in Context

Our ever-growing access to information and tools has profoundly changed the way we can use, digest, display, and share data. Put an internet connection and a laptop together and you have a tool that can empower people—regardless of experience—to visualize and dictate data’s meaning and impact.

But as data use becomes more frequent, more creative, more far reaching, is the information we share and the way we share it using data accurately? Are we sharing knowledge  responsibly or perpetuating the obscurity of data?

In a recent post, “Can Data Visualizations Help Mediate Between the Worlds of Research, Policy, and Practice?” AidData addressed data visualization—a way to visually represent raw and unprocessed information in a clear, sharable, and relatable way. The abundance of data we have access to is certainly overwhelming and, as the post suggests, a “vortex”. Data visualization offers hope for a shift from a whirling mass to something more real. The above post stressed the need to convey “relatable information at a glance,” highlighting single layers within complex data as a means of reaching audiences previously naïve to the information presented.

But while compelling and accessible, data visualization often falls prey to the very data misrepresentation that it seeks to avoid. The intention of reaching and being relatable to many people is noble, but delivery often seems to perpetuate rather than tame the swirling vortex.

Take for example the ideal set in the above AidData article. At first glance, we can see that “My Fridge” consumes more electricity per capita than Ethiopia, Tanzania, Liberia, Nigeria, Kenya, or Ghana. We’re led to the shocking conclusion that our visualization creator’s fridge is more advanced than these African nations.

But what is this visualization not telling us? Why do these nations consume low levels of electricity? Is it a reflection of electricity use or access? How does information compare to previous years? What are we supposed to do with this information? To its credit, the graphic has the ability to speak to fridge owners. But its purpose is hazy.

If the purpose of data visualization is to join previously separate worlds, it needs to go a few steps further; from being merely shocking to accurately compelling. It needs to build deep understanding through the creation of something that is both relatable and substantive. Visualization offers a lens through which we can view information, but that lens shouldn’t overlook context, causation, or other contributing factors behind the data.

This becomes especially important as data becomes readily available through open data initiatives and technology innovations. Data visualizations have the power to inform policy, service design, and our collective thinking. Shallow messages won’t cut it—real people and real lives are often found at the roots of data; they are a crucial component of the context we need to encourage understanding of citizens affected by policies and programs. People are the substance behind the data, and policymakers need to make decisions based on people, not numbers, to design inclusive policies and services.

For example, in a recent attempt to visualize data on public spending, we started with data on cost increases for public service projects. It quickly became clear that visualizations headlining 200% cost increases would create impact at first glance, but misrepresent the story behind the numbers. There are costs that simply weren’t budgeted for, and there are also costs that are necessary to deliver the best possible outcome.

It became clear that we had to show a greater depth of information to get from a data-driven narrative—“This project cost 200% more than it was supposed to. It was a budgeting failure.”—to a narrative embedded in context—“The project cost 200% more than was budgeted for, but its scope (road length) doubled and included additional actors and aspects (road materials, walkways, streetlights, drainage) not accounted for at the outset.”

Data consumed through visualizations “at a glance” runs the risk of discouraging engagement and understanding of the people the data is trying to represent. That said, we’re also up against the daily challenge of keeping up with short attention spans in our fast-paced digital world—anything that doesn’t immediately connect to the viewer is likely to be overlooked, losing the battle to Twitter in a neighboring browser tab.

But we can’t overlook the fact that the causation or insights behind related data simply don’t get the consideration they deserve in a graph with a five-second lifetime. And as designers it’s our responsibility to visualize data in a way that embraces the inherent complexity behind numbers.

As Victor Papanek once wrote, “Design has become the most powerful tool with which man shapes his tools and environments (and, by extension, society and himself)…This demands high social and moral responsibility from the designer. It also demands greater understanding of the people by those who practice design and more insight into the design process by the public.”

Let’s look beyond the seduction of graphs seeking a shock factor, beyond quick one-glance charts. According to John Emerson, “People who might not be persuaded by raw numbers or statistics may be more likely to understand and believe what they see in a chart or graphic.” It’s our job to facilitate, not manipulate, their understanding.

Running on Heart: Puerto Cabezas Baseball Academy

Last week, we explored how policymakers can channel empathy in policymaking, using as an example our work with UNICEF to identify the diverse needs and challenges of children in Nicaragua’s North Atlantic Autonomous Region (RAAN). Our community-based approach highlighted success stories of people designing programs to fit their own needs. Today we’ll go to Puerto Cabezas, RAAN’s capital, to see how local programming has stepped in to provide unique opportunities for the region’s children.

School is out for the afternoon, and boys across Puerto Cabezas are drawn to the ball fields. Some biking and others even running, they are rushing to get to practice on time.

These are the boys of the Puerto Cabezas Baseball Academy.

Dr. Wilfredo Cunningham Kain first funded the Academy to encourage his young son’s love of baseball. Over the years, the Academy has evolved into an after-school and weekend program that supports more than 400 boys on the road to manhood.

Some dream of growing up to play in the U.S., while others play for pure love of the game. For many, baseball provides a much-needed diversion in a place with few extracurricular opportunities for youth.

A program like this is greatly needed in Puerto Cabezas. Young people often receive little support at home and see few options for their futures. They lose interest in school and, in a place lacking healthy, organized activities, many boys turn to gangs, drugs, and alcohol for solace.

There are few systems to catch these boys as they begin to withdraw.

The Academy serves as both a safety net and a springboard. Each coach assumes a somewhat overburdened mentor role overseeing about 100 boys. The program funds all expenses to prioritize inclusivity regardless of financial background.

And there are rules: the boys have to arrive on time with clean uniforms. They have to keep up their studies by going to class. And they have to get at least one adult family member involved in the program.

This last requirement is the least followed. It’s hard—not a lot of kids have parents who can spend the time. But baseball is a great forum to build relationships. Dads find a sense of pride watching their sons slide into home or throw a winning pitch.

The program actively seeks to place players in the Nicaraguan national team and minor league teams abroad. Although the program is only six years old, its team of 11-13 year-olds has held the national youth championship for the past five years—a national record.

But Dr. Cunningham Kain isn’t shooting to field the country’s next all-star team. He has greater plans. He envisions a formal baseball academy that produces not just players with top skills but, more importantly, young men with strong values.

The academy is the ideal place to teach discipline and values that stick. These values are tied to an activity the kids truly care about, fostering personal investment in baseball and studies. It matters to the kids if they have to do their warm-up run alone because they’ve arrived late. It matters if they can’t play because they haven’t been going to class.

While the program has not been formally evaluated, its growth, and the players’ dedication to keeping up their end of the bargain, speaks for itself.

Dr. Cunningham Kain tells the success story of a boy who had been withdrawing from school. He was getting heavily involved with gangs. He seemed to be out of control, beyond help. But this boy started participating in the program and discovered an innate talent for the game. Over time, and with the support of coaches and teammates, his confidence and self-esteem grew. He re-engaged in school, dedicated himself to practice, and eventually became the program’s star pitcher, playing at the national level.

The Academy’s programming is inherently adaptive, changing to fit needs and make the most of available resources. Driven by passion for its mission, this organic growth has been one of the program’s strongest attributes. The program has not succumbed to over-regulation, which would curtail the flexibility that has enabled it to support children through difficult family situations, trouble with gangs, and other obstacles.

Dr. Cunningham Kain contributes personal funds to the program, but he is actively seeking external funding to expand the program and hire a team social worker, a child psychologist, and more coaches trained in nurturing boys’ athleticism and character.

There is significant potential to increase the program’s impact, but until it receives more funding, it will continue to run largely on heart.

Above photo: The Puerto Cabezas Baseball Academy is a homegrown program that teaches responsibility and social values while giving boys the opportunity to play the game they love.

Empathy in Policymaking

In Nicaragua’s Northern Atlantic Autonomous Region (RAAN), there is no single experience of childhood.

For a child in seaside Prinzapolka, a highlight of daily life might be playing on the town’s sandy beaches. In rural northern Wangky Maya, the picture of home might be mother and sisters standing over a smoking wood stove in the yard. Children may spend their after-school hours helping split firewood and carry well water home; others might join friends around the neighborhood church for a pick-up soccer game or help with a small bread baking business run out of the family house.

Equally diverse are the constraints affecting these children’s lives: economic weakness in RAAN, poor physical infrastructure, lingering effects of conflict and natural disaster, and sociocultural complexity. Almost one-third of RAAN children suffer from chronic malnutrition and poverty affects 34 percent of children up to 17 years of age—nearly twice the rate of poverty in and around Nicaragua’s capital, Managua.

For policymakers in RAAN keen to draft a comprehensive policy to protect children’s rights, this reality presents a challenge: how to design a policy that can account for the diverse array of circumstances and needs facing the children of the region?

Channeling Empathy into Policymaking

Empathy is a good place to start.

Empathy is the ability to understand and share the feelings of others. Channeling empathy into the policymaking process means intentionally seeking a deep understanding of the lived experiences of those a policy will affect to inform how that policy is designed.

Previously, we’ve written about how operationalizing empathy in international aid institutions can support more successful development programs. When applied to the policymaking process, an empathetic approach helps ensure: 1) the process is collaborative, grounded in regular engagement between policymakers and constituents; and, ultimately, 2) the resulting policy is both inclusive and appropriately tailored to the local context, able to serve as an effective framework for guiding programmatic interventions.

Together with UNICEF, we implemented this approach to help channel empathy into the policymaking process in RAAN. Some of the concrete steps we took included:

  1. Engaging policymakers in constituent experiences. We helped structure a research process that exposed policymakers to an intimate portrait of their constituents. Rather than holding town hall discussions or consultations with local leaders, policymakers engaged with constituents at all levels of society and across the region on constituents’ own turf—in their schools and churches and homes. Where constituents spoke different languages, policymakers brought interpreters. Where they were in remote communities, policymakers took the time necessary to reach them. From these experiences, policymakers brought back stories, photos, and lasting impressions. Policymakers also engaged in service trials that allowed them to personally witness the rich variation of personalities, infrastructure, environments, and activities that exists in RAAN. These trials provided a rich perspective into the services shaping children’s health and wellbeing, such as schooling, maternal and infant health, and childcare.
  2. Creating buy-in through collaboration. We worked with a core group of policymakers representing different institutional factions, some of whom trusted each other and some of whom didn’t. By collaborating together throughout the full duration of the engagement, we we were able to help cultivate greater trust among factions and generate personal investment in the policymaking process. This brought a diversity of perspectives and expertise, as well as political buy-in, to the process. This is operationalizing empathy at the institutional level.
  3. Focusing on systems, not collections of individual problems. We facilitated synthesis exercises that encouraged policymakers to think in terms of systems by building connections between individuals’ stories and their contexts. Through this process, policymakers could explore the role of social, cultural, economic, and other key factors in shaping these systems.
  4. Thinking about policy from the individual up. Together with policymakers, we acted out the observed challenges and constructed archetypes: composites of individual lives that are representative of a larger group. Archetypes put a name and face to the challenges of parents and children in RAAN. Policymakers told us that this process encouraged them to connect the stories of others to their own lives. The process helped them think through programmatic interventions in the context of challenges they now understood on a far deeper level.

An Approach to be Further Explored

Our work in RAAN was a first step toward an approach to policymaking that channels user research and individual empathy into contextualized policy interventions backed by political investment. But the process illuminated key challenges that will require further exploration to develop this approach.

First, how can an empathy-based policymaking approach be made more accessible and less overwhelming? This approach can be time- and effort-intensive.

Policymakers are often pegged as “being behind the curve.” But what if they just don’t have the tools, resources, or expertise?

Partnerships have the potential to ease the burden, but significant iteration will be required to determine the sweet spot for cooperation and stakeholder involvement depending on the environment and political interests.

Second, how can the results of empathy-building user research be channeled into sound policy?

There is no “off-the-shelf” formula to pull from here. Policymaking is, ultimately, a political activity and greater empathy is not necessarily a guarantee for more politically palatable solutions. In RAAN, this approach cultivated a shared experience for institutional factions with contentious histories, allowing them to work productively together. But this might not have been the case in another context.

With this in mind, the challenge is now to further explore the strong potential of greater empathy in policymaking to help manage and channel political interests in regions worldwide, while serving those whose needs are being overlooked. If we are able to continue working toward a more sophisticated approach to policymaking in different contexts, we will succeed in truly valuing those for whom these policies are built.

Above Photo: A RAAN policymaker builds the story of community member archetype the research group created. Archetypes helped to put a human face on research findings during Reboot’s recent work in Nicaragua.

Toward Political Intelligence in Aid

The word “politics” is loaded. It conjures images of backroom deals, self-interested maneuvering, and elite manipulation. It carries a negative connotation in any context. Outside interference in political affairs is even worse: as unseemly as politics can be, it’s meant to stay within the family.

Nonetheless, there’s been an increasing discussion about politics in aid over the past year.

With aid-receiving countries pushing back on interference by donor nations, technocratic multilaterals frustrated by stymied reforms, and academics searching for the root causes of institutional failures, the political factors that both influence and result from aid have become more apparent.

It’s long been an open secret that bilateral agencies use aid to support friendly regimes. And the sector is admitting that aid has political impacts—both intentional and unintentional—within receiving countries. Though the historical and economic relationships between many aid-giving and aid-receiving countries makes this a sensitive issue, the pretense that aid should be separate from politics is crumbling in the face of the facts.

Even this is not enough. We need to go one step farther: not only is aid political, but aid also needs to be politically intelligent. Political economy analysis, though increasingly popular in the sector, only gets us halfway there. We need to get straight to political analysis.

By understanding what we mean when we say that aid is political, the path to politically intelligent aid becomes clearer.

Is aid political?

Of course. But this question actually misses the point somewhat.

Aid is political in the same way that aid is economic.

When money is transferred, there are economic impacts. When governments interact, there are political impacts. That has more to do with the definition of “politics” and “economics” than it does with the nature of aid.

The political realm is much broader than the power struggles around elections or policy decisions. Politics are how the affairs of any group of people are managed. People in any context will debate, negotiate, advocate, collaborate, and conflict over how to use their collective resources or power to pursue better lives—and even over defining what “better lives” means.

Each context’s politics are shaped by the institutions that have been established, cultural norms, and the incentives and accountabilities that various actors face. Whether in a legislature or a ministry, a university department or a corporation, politics exists in all arenas.

In the case of aid, money flowing from one country to another—whether through official public channels or through private actors—influences the contextual factors in the receiving country. Money changes the incentives faced by countless actors; technical assistance changes professional cultures and institutions; contracts change accountabilities. A seemingly simple service delivery program can shift local politics by serving one constituency more than another. National-level programs with significant resources have even more impact, as they can become focal points for power struggles.

Far from wondering whether aid is political, we’re left wondering, how could it not be?

Oxfam’s Duncan Green recently used the term of “political sterilization” to describe potential channels for aid to have benefits without disrupting politics. I’m doubtful that such channels are possible. Worse, I’m worried that the very real effect of fooling ourselves into thinking that aid can be apolitical—which happens in social service and cash transfer programs—is that we fall victim to someone else’s political priorities. Even no aid at all is a political choice.

Politics as seen by economists

New political thinking in aid is driven by the frustration felt by the economists and technocrats who have long steered aid thinking: the technical analysis is sound, yet these darn politics keep getting in the way. As the “Washington Consensus” economic policies failed in the face of institutional capacity constraints and political blowback, aid institutions broadened their view to include governance and politics. The political scientists were offered a seat at the table.

This has meant a rise in political economy analysis, as described in a recent World Bank report. Aid agencies are increasingly using these methods to better understand the political landscapes, including the interest groups and incentives that determine who will benefit from, support, or oppose particular engagements.

Unfortunately, there’s a big difference between “politics” and “political economy”. The lobbying firms and advocacy groups on K Street in DC don’t conduct political economy analysis. The underlying socioeconomic, cultural, and historical dynamics are important shapers of political contests and we do need to think systemically. But politics is ultimately about people. Political economy analysis, in contrast, intentionally avoids focusing on individual actors.

Politics is ultimately about people.

Making aid more politically intelligent

In order for aid agencies to be more politically effective, they need to understand the people involved. Their analysis has to go beyond the broad structures to the particular coalitions and individuals making decisions. At a recent event hosted by the Center for Global Development, Pablo Yanguas noted that this already happens in most aid agencies, but it’s a bit under the radar and not very systematic. Staff are navigating the contexts they face, with informal or implicit political analysis guiding their decisions.

This analysis could be strengthened if it were a program requirement (“mainstreamed”, as they say) or if political savviness was considered a management competency (though admittedly, a difficult one to evaluate in potential staff). Most importantly, it has to happen on a tighter loop than a pre-program political economy analysis. It has to be iterative throughout the course of engagement, synthesizing evidence from multiple sources, informing action steps, and willing to make calls in the face of ambiguity with less than academic levels of rigor.

That aid has political impacts is obvious. It’s high time we found ways to understand what those are, and ensure that they are more positive than negative. Making aid practices more politically intelligent will be one step in that direction.

Above Photo: Nigerians in Nasarawa talk about a donor program in their state.

CSR Needs Empathy for Successful Partnerships

For years corporate social responsibility (CSR) initiatives have been applauded, criticized, and debated. Between headlines like “When Corporations Fail at Doing Good” and “Is Responsible Capitalism a Farce?”, one insight has become abundantly clear: CSR initiatives are often a necessary part of business, but those with the potential to make a difference are easier discussed than delivered.

This is especially true for companies supporting social services in complex environments that are new to them. On the one hand, companies have a great deal to offer the social sector: financial resources, human resources, managerial experience, technical expertise. And, for most companies, there is little choice—consumersemployeesinvestors, and even governments are all demanding CSR initiatives.

But when companies enter the social sector, there are many challenges to overcome. Many companies are most interested in numbers and marketing, showing little effort to discover added value—social or environmental benefits—beyond profits. Even when companies have genuine intentions, they may invest millions of dollars in CSR initiatives but take on a role that may not be appropriate for the project’s local context. Many companies are simply unaccustomed to contributing to and measuring the success of social service projects.

The reality is that the social sector is not a private company playing field.

The reality is that the social sector is not a private company playing field. In the design of an effective CSR program, the donor and implementer need to identify an appropriate way to apply corporate skills to on-the-ground realities. This is especially true of companies whose products and expertise, if properly channeled through a CSR initiative, can make discernable improvements to public health in some of the poorest communities.

So what makes some initiatives more effective than others, and what factors should be considered in the design of CSR programs?

Corporate-NGO partnerships allow donors and implementers to fill knowledge, access, or expertise gaps; be it knowledge of local landscapes, access to funds, or relationships with local institutions. But the unique skill sets and mandates of NGOs and corporations are married to the organizational structures those skills have demanded. With such different backgrounds and expertise, companies and NGOs face the daunting task of understanding each other’s widely different operating contexts and program expectations, and learning how to make them function together.

NGOs and companies are in need of work practices and mechanisms that facilitate deeper understanding of each other’s needs and the needs of those served. Empathy can help ground these practices—and related interactions—in a more nuanced understanding of the perspectives, contexts, constraints, and histories that inform each side’s organizational structures, operations, and communications.

The process of integrating empathy into projects can be described as operationalizing empathy. Operationalizing empathy in partnerships between NGOs and corporations has the potential to ensure effective application of company resources in social service projects.

To operationalize empathy effectively, NGOs and companies would do well to remember that partnerships do not exist in a vacuum. Corporate donors should be aware that they are likely one of multiple public and private donors that an NGO is working with simultaneously and learn to tailor demands to the NGO’s available resources. Microsoft, for example, fully expects to be one of many donors on a given project, deliberately ensuring the NGO takes the lead in drawing support from other funders. Similarly, implementing NGOs need to be aware that many CSR projects hold a secondary citizen status within companies; those in charge are often forced to defend the value of a given initiative—far from an easy task in the business world.


Partners solely considering their own perspective run the risk of limiting partnership success by overlooking the expertise and constraints of each other and related actors.


Partners operationalizing empathy gain direct knowledge of each other, beneficiaries, corporate stakeholders, and implementing partners, resulting in a productive and successful partnership.


Marks & Spencer and Oxfam have achieved a partnership that is often upheld as an example of collaboration based on knowledge sharing and mutual, defined goals in their clothes recycling campaigns. The partnership is well-aligned with Marks & Spencer’s business objectives and supported by strong communications campaigns. But mission-aligned pairings like this are still exceptions.

Those working in the space of corporate-NGO partnerships recognize a need to deepen understanding between partners. Groups like the mHealth Alliance have found success fostering understanding among organizations from private, public, and NGO spaces. Through working groups, summits, and knowledge sharing, organizations can identify areas where their perspectives align—a base of collaborative action. CiYuan Corporate-NGO Partnership Development also facilitates cross-sector collaboration through roundtables and consultancy services to enhance philanthropic endeavors in China.

These are strong starts, but in order to ensure successful partnerships we need to go one step further. We need to explore the context and motivations behind NGO and corporate behaviors and identify where these motivations align.

Achieving collaborative outcomes remains difficult, because what you see depends on your vantage point. And few vantage points are as far apart as those of a massive conglomerate and a 10-person NGO. But by beginning to understand and contextualize each side, we can begin to make funder and implementer vantage points mutually accessible to build foundations for long-term, effective partnerships.