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Health and Development in Africa: What are the Engines for Growth and Change? Anne C Petersen, PhD Center for Advanced Study in the Behavioral Sciences.

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Presentation on theme: "Health and Development in Africa: What are the Engines for Growth and Change? Anne C Petersen, PhD Center for Advanced Study in the Behavioral Sciences."— Presentation transcript:

1 Health and Development in Africa: What are the Engines for Growth and Change? Anne C Petersen, PhD Center for Advanced Study in the Behavioral Sciences Stanford University Global Philanthropy Alliance Invited Lecture, Penn State, 4-23-07

2 ACP Background Research: biopsychosocial development at adolescence Research: biopsychosocial development at adolescence Experience in philanthropy Experience in philanthropy MacArthur Foundation (3 years)MacArthur Foundation (3 years) Kellogg Foundation (10 years)Kellogg Foundation (10 years) Global Philanthropy AllianceGlobal Philanthropy Alliance Consider development through those lenses Consider development through those lenses Development in general; Africa later Development in general; Africa later

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4 Key Drivers of Development: People Multinational development enterprise (foreign aid) doesn’t work Multinational development enterprise (foreign aid) doesn’t work Global philanthropy may work (anecdotal evidence) Global philanthropy may work (anecdotal evidence) Money is not the solution to poverty Money is not the solution to poverty Health & human development central Health & human development central

5 Foreign Aid Story What is foreign aid? What is foreign aid? Who is involved? Who is involved? What is the problem? What is the problem? Conclusion Conclusion

6 What is Foreign Aid Western (Europe/US) countries shifted post WWII in language and thought Western (Europe/US) countries shifted post WWII in language and thought Shifted from colonialism to: Shifted from colonialism to: Foreign aidForeign aid Benevolent military interventionsBenevolent military interventions West vs Rest: West decided Rest a “blank slate to be taken care of” (Easterly, 2006) West vs Rest: West decided Rest a “blank slate to be taken care of” (Easterly, 2006)

7 Some Quotes over Time Nobel Laureate Gunnar Myrdal (1954): the answer to poverty is a plan Nobel Laureate Gunnar Myrdal (1954): the answer to poverty is a plan Cameroon lawyer & journalist Jean- Claude Shanda Tonme (2005): “They still believe us to be like children that they must save,” with “their willingness to propose solutions on our behalf.” Cameroon lawyer & journalist Jean- Claude Shanda Tonme (2005): “They still believe us to be like children that they must save,” with “their willingness to propose solutions on our behalf.”

8 Who is Involved? New Institutions International Monetary Fund International Monetary Fund World Bank World Bank USAID/DFID USAID/DFID Development Banks: Inter-American, African, Asian Development Banks: Inter-American, African, Asian UN Development Program UN Development Program World Health Organization World Health Organization Food and Agriculture Organization Food and Agriculture Organization International Labour Organization International Labour Organization UN Children’s Fund (UNICEF) UN Children’s Fund (UNICEF) + others + others

9 What’s the Problem? Trillions spent, little to show Trillions spent, little to show Some good programsSome good programs High level plans disconnected from intended beneficiaries High level plans disconnected from intended beneficiaries Some funds misdirected Some funds misdirected To bureaucrats who don’t partnerTo bureaucrats who don’t partner To dysfunctional governmentsTo dysfunctional governments Evidence of harm Evidence of harm Appropriate conceptualization and motivation? Appropriate conceptualization and motivation?

10 Examples of Good WB Programs Food for Education (Bangladesh) - paid parents cash for child’s school attendance Food for Education (Bangladesh) - paid parents cash for child’s school attendance Rural Roads Project (Peru) – improved roads to get crops to market in 1/10 previous time Rural Roads Project (Peru) – improved roads to get crops to market in 1/10 previous time Good health programs Good health programs With WHO – directly observable treatment of TBWith WHO – directly observable treatment of TB With UNICEF – child nutrition (Tanzania)With UNICEF – child nutrition (Tanzania)

11 Foreign Aid and AIDS Devastating effects in Africa Devastating effects in Africa On women and menOn women and men On workersOn workers On familiesOn families Too little, too late Too little, too late Many deaths could have been prevented with early action Many deaths could have been prevented with early action Still doing too little prevention Still doing too little prevention

12 Effective Health Projects Specific goals Specific goals Clear action in projects with outcomes Clear action in projects with outcomes Examples: Examples: Vaccination campaign in southern Africa virtually eliminated measles 1996-2000Vaccination campaign in southern Africa virtually eliminated measles 1996-2000 National campaign for oral rehydration therapy Egypt cut infant death 82% 1982-1989National campaign for oral rehydration therapy Egypt cut infant death 82% 1982-1989 Childhood trachoma cut 90% since 1997 in MoroccoChildhood trachoma cut 90% since 1997 in Morocco River blindness in West Africa virtually halted since 1974River blindness in West Africa virtually halted since 1974 Smallpox eradicated worldwideSmallpox eradicated worldwide Near eradication of guinea worm in 20 Africa/Asia countriesNear eradication of guinea worm in 20 Africa/Asia countries

13 Conclusions about Foreign Aid Fund Fund Individuals or groups (eg, social entrepreneurs) not governmentsIndividuals or groups (eg, social entrepreneurs) not governments Projects not plansProjects not plans Create feedback loops from the intended beneficiaries to funders and performers Create feedback loops from the intended beneficiaries to funders and performers Create marketplaces with choice; people as customers Create marketplaces with choice; people as customers

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15 Global Philanthropy What is this? What is this? Who is involved? Who is involved? What do we know about it? What do we know about it? What works/what doesn’t?What works/what doesn’t? Conclusions Conclusions

16 What is This? Giving of time and money Giving of time and money Individuals: 76% of $ ($41 T) Individuals: 76% of $ ($41 T) Large enterprise in the US (and some European countries) Large enterprise in the US (and some European countries) Most foundations do no evaluation/ assessment of effectiveness Most foundations do no evaluation/ assessment of effectiveness Many variations within philanthropy in motivations/ extent donor driven Many variations within philanthropy in motivations/ extent donor driven Live donor/ dead donor issue Live donor/ dead donor issue

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20 Source: Foundation Center – Foundation Yearbook, 2003 Types and Number of U.S. Foundations, 2001 Independent – 55,120 Operating – 3,918 Corporate – 2,170 Community – 602 Total Number of U. S. Foundations - 61,810

21 US International Grantmaking Rapid growth over last decade Rapid growth over last decade Faster than domestic grantmakingFaster than domestic grantmaking Biggest new contributor: GatesBiggest new contributor: Gates Dip after 9-11-2001, then recoveryDip after 9-11-2001, then recovery Increases despite US Treasury guidelinesIncreases despite US Treasury guidelines Africa less than Asia, Europe, LACAfrica less than Asia, Europe, LAC Steady commitments from long time global foundations Steady commitments from long time global foundations Increasing numbers of new foundations giving outside the US Increasing numbers of new foundations giving outside the US Since 9-11 funnel more through US-based organizationsSince 9-11 funnel more through US-based organizations

22 Who? Gates Gates Moore Moore Ford Ford Kellogg Kellogg Packard Packard Many, many others, especially small foundations Many, many others, especially small foundations

23 What Works? What Doesn’t? What Doesn’t? What Doesn’t? Donor-driven top-down designDonor-driven top-down design vicious cycle: donor in system->dependency vicious cycle: donor in system->dependency African proverb: giver above recipientAfrican proverb: giver above recipient What Works? What Works? Supporting capacity building, ideas of those who will benefit, technical assistanceSupporting capacity building, ideas of those who will benefit, technical assistance Funding “with” (not “to” or “for”)Funding “with” (not “to” or “for”)

24 Examples of Effective Grants CIDA – College in Jo’burg, SA CIDA – College in Jo’burg, SA Free education, best business education practices, latest technologyFree education, best business education practices, latest technology Initiated with Kellogg funds/business contributionsInitiated with Kellogg funds/business contributions Sustainability through student commitments to support student, high demand from students & companiesSustainability through student commitments to support student, high demand from students & companies Sweet Mozambique Sweet Mozambique Banana plantationBanana plantation Technical assistance to improve product, find marketsTechnical assistance to improve product, find markets Sustainability through market feedbackSustainability through market feedback Bus Factory, Jo’burg, SA Bus Factory, Jo’burg, SA Crafts cooperative market from villagesCrafts cooperative market from villages Initiated by 3 ministries, KelloggInitiated by 3 ministries, Kellogg Sustained by high quality, feedback (no middle person), continual improvementSustained by high quality, feedback (no middle person), continual improvement

25 Conclusions from Philanthropy Work with intended beneficiaries Work with intended beneficiaries Get their feedback/ build trustGet their feedback/ build trust They ARE the sustainabilityThey ARE the sustainability Support Support Good ideas (social entrepreneurs)Good ideas (social entrepreneurs) Technical assistanceTechnical assistance Capacity buildingCapacity building Link with complementary partners Link with complementary partners Learn (improve) Learn (improve)

26 Hear Similarities? Same kinds of projects are effective with foreign aid and philanthropy Same kinds of projects are effective with foreign aid and philanthropy Underlying principles Underlying principles For fundingFor funding Support individual’s (or small groups) sustainable ideas Support individual’s (or small groups) sustainable ideas Provide capacity building, technical assistance Provide capacity building, technical assistance For operatingFor operating Get feedback from intended beneficiaries Get feedback from intended beneficiaries Focus on what do well Focus on what do well Partner with those who do other things better Partner with those who do other things better

27 Also Similar to Lessons from Human Development For especially adolescents but also adults For especially adolescents but also adults Externally imposed programs don’t workExternally imposed programs don’t work May get superficial “compliance” but not sustainable behavior changeMay get superficial “compliance” but not sustainable behavior change Change requires personal motivationChange requires personal motivation Adolescents still have hope Adolescents still have hope Some adults have lost itSome adults have lost it Working “with” requires relationships, love Working “with” requires relationships, love

28 Remaining Challenges All require relationships All require relationships Partnership PrinciplesPartnership Principles Mutual interest Mutual interest Mutual benefit Mutual benefit Mutual responsibility Mutual responsibility Mutual respect Mutual respect Scale up Scale up Infrastructure Infrastructure Do no harm! Do no harm!

29 What about Africa? Resonate with Africa – love everything about it! Resonate with Africa – love everything about it! Work there because Work there because Great challengesGreat challenges Great rewardsGreat rewards

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32 Thanks !


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