Admitting Failure: Trendy, but (at least for NGOs) not Prudent

This blog post is in response to the Second Aid Blog Forum: Admitting Failure, a topic forum proposed by anonymous blogger J at Tales From the Hood.

Admitting failure is apparently trendy these days.  As nonprofits and NGOs spend countless hours polishing their annual reports and filling them with rosy success stories to placate donors and stakeholders, a growing chorus of bloggers and development pundits are calling on aid organizations to be up-front and honest about their failures so that others can learn from them.  The idea took off when Engineers Without Borders Canada built a website where development groups could share failures and exchange lessons.  A “Fail Faire” was even held in DC last week to “celebrate” failure. 

While all of this openness and honesty is heartwarming, would I, if I were running an NGO, admit to (that is, publicize) a failed project or program?  To me, that answer is simple: Hell no.

Is there value to sharing failures that could be lessons for your own organization or others?  Absolutely.  But how much good does it do the average layperson to hear about a failed project?  And, once they get a hold of the story, what are the chances that it will come back to bite your organization in the ass?

Take, for example, the field day that the AP had with the results of an audit of grants at the Global Fund.  The Fund, which maintains a policy of “full transparency and zero tolerance of corruption,” published the results of an ongoing audit last year that discovered that several million dollars of grants (representing a very small portion of total funds disbursed) had been lost to fraud and corruption in four countries.  It then began to pursue legal action to recover the funds and prosecute the individuals responsible.  Sounds great, right?  Did the press or anyone else respond with gratitude or acknowledge the up-front and open nature of the Fund in publishing its findings?  If only.  It became a runaway news “scandal,” with the AP painting the “celebrity-backed” Fund as being “plagued by fraud.”  The result: Sweden, Germany, Denmark, and the European Commission froze their disbursements

While it is true that the Global Fund is a uniquely high-profile organization that deals in numbers with many zeros, I think the general tendency of people to react poorly to failure holds true across the board.  Particularly in the current atmosphere of fiscal austerity, the last thing people want to see is their tax dollars or donations being “wasted” on failed projects that were not originally designed to help them in the first place.  While most Americans support foreign aid, I imagine that a lot of them would change their tune if they thought that it did not work.  People have (reasonable, IMHO) objections to their tax dollars being used for “trial and error” projects.

There is, however, true value to learning from failed projects – this is part of the reason that researchers publish (albeit reluctantly) the results of unsuccessful experiments in professional journals and share them at conferences.  But that is precisely the point – the failures are shared with an audience that can appreciate them and the lessons they bring.  The aid community would benefit from creating supportive forums through which they can exchange lessons about failure, whether that be conferences like “Fail Faires” or practice-based journals in which such stories can be published.

Many organizations could stand to make their annual reports, particularly the finance portion, more transparent in order to give donors a better idea of their operations.  Saundra Schimmelpfennig has a great summary of resources that describe good standards and best practices.  But NGOs shy away from laying bare individual project failures, and for good reason.  Unless an individual has background knowledge on how aid and development works, it is difficult to put these stories into context.  It is a whole lot easier to simply decide to hold your donation (or call your Congressman) than it is to have faith in a charity’s ability to learn from its mistakes, especially when stories of ill-conceived projects abound.

Public Health’s “Benevolent Dictator”: Is Gates ruling us, or are we just ruled by money?

Last week, Laura Freschi and Alanna Shaikh published a piece in Alliance magazine that raised some interesting and thought-provoking question about the role of the Gates Foundation in setting the global health agenda.  They conclude that Gates is becoming a “public health dictator” because of his financial resources and the power and influence that come as a result.  They are, of course, not the first to complain about Gates’s focus on technological solutions to global health challenges.  Some of the most recent grumblings were in response to the Foundation’s “reinvent the toilet” campaign this year, but similar concerns have been voiced for years.  The Foundation places too much emphasis on technological innovation and “quick fixes”; their undue influence diverts funding from other priorities; their goals are not realistic.  These are all valid concerns which deserve to be voiced (heck, we have already written about it here), particularly in a field where nearly everyone has a different opinion on how problems should be solved.

But a dictator?

Bill Gates.
A dictator? Nah. Look at that face.
The Gates Foundation is directed by the priorities of Bill Gates, an entrepreneur who made obscenely large piles of money and who now wants to use some of it to make the world better.  Those piles are accomplishing just that by funding the initiatives that he likes, thinks are important, and/or believes will work.  After all, Gates made his money through technological innovations, so it is perfectly logical that the same types of ideas would be close to his heart – and, to be fair, it is his money.  It is also fair to criticize those initiatives, particularly if the interventions are ineffective or do more harm than good.

But now pundits are demanding accountability from the Foundation, calling on it to justify what it does:

If expensive polio and malaria eradication efforts, pursued not just by Gates but by the entire global health community at Gates’ urging, fail, to whom will
Gates be accountable for that failure?

We demand accountability from our governments because they spend our money – we have the right to demand that our tax dollars be used effectively.  But why, exactly, should Gates be accountable to anyone for wasting his own money?  More importantly, why would the “entire global health community” do something just because he told us to?

Dictators are people who arbitrarily enforce laws, throw people in jail for criticizing them, and deny their citizens free and fair elections.  Gates does not punish anyone whose global health solutions don’t appeal to him – he just doesn’t give them money.  He never lead any kind of “global health coup” or insist that we all adhere to his development philosophy.  Yes, the Foundation has lots of money, and would-be philanthropist who wants to launch his NGO would treat Gates like a god if he ever saw him on the street – but that is precisely the point: he has undue influence because we give it to him.  To paint Gates as a “global health dictator” because causes are prioritized based on what will get Gates Foundation funding villifies the wrong party.  What does it say about us as a body of professionals if we allow ourselves to be led by the nose by the guy with the most money?

The Economist raised another interesting point when it examined the same debate back in 2008:

At least in part, the gripes against the Gates Foundation are the churlish growls of a jealous crowd of bureaucrats and labourers at less influential charities. Some people at the WHO…openly worry that the foundation is setting up a new power centre that may rival their organisation’s authority. Such conspiracy theorists point to the foundation’s recent grant of over $100m to the University of Washington to evaluate health treatments and monitor national health systems—jobs supposed to be done by the UN agency.

Therein lies an irony. The WHO, one of whose captains now calls the Gates Foundation monopolistic, used itself to hold a monopoly in the fight against malaria, and it did a lousy job as a result.

I do think Shaikh and Freschi (and also Tom Paulson of Humanosphere) are on to something when they question the Foundation’s giving money to media organizations to increase coverage of global health topics.

Among the grantees is a growing list of media outlets including the Guardian newspaper (UK), ABC, PBS and the BBC – all to underwrite coverage of global health issues. While these grants all came with assurances of editorial independence, it’s hard to believe that such partnerships won’t influence the nature of the coverage in some way.

Even if it is objective, it never looks good when you fund your own media coverage.  Somebody probably should have thought that one through.

At any rate, the debate about what Gates is doing (and what he should be doing) with his money will undoubtedly rage for as long as he has money.  But if we believe that the Gates Foundation is distorting global health priorities because of its purchasing power, then we need to take a long, hard look at how we define our priorities.

Results for Children: Save the Children Introduces New Format for Providing Program Information

This is interesting. In this video, Save the Children’s president and CEO Charlie MacCormack explains that the organization is moving toward a new way of sharing information and updates about their various projects and activities. They plan on moving from an annual report to a quarterly one and changing the format of their reporting. On their Results for Children page, they explain:

We proudly present the first issue of Results for Children, an update showcasing Save the Children’s impact on the lives of children in more than 120 countries worldwide. With this report, we hope to more dynamically communicate with supporters: In place of our former annual report, Results for Children—a quarterly publication—brings you the latest results from our programs based on project data, stories and feedback from children in their own words.

They are also encouraging individuals to submit feedback to

There is No Silver Bullet

There is no silver bullet and frankly you probably don’t need one. It is far more important to be able to find the right kind of gun, be able to load the gun, be able to aim the gun, and perhaps most importantly, be able to figure out where the werewolf is.Matthew Oliphant

Vampire Selene uses bullets with silver nitrate to fight off werewolves in "Underworld." Unfortunately, we do not have "silver nitrate bullets" for global health problems.

I always scratch my head a bit when the global health community is dismayed at the revelation that one of its previously hailed “silver bullets” is revealed to not be the miracle cure it was thought to be. The latest disappointment making its way across the blogosphere right now is microfinance: after shady lending practices and harassment of borrowers (driving some to suicide) were uncovered on the part of commercial microlenders in India, the development community began wringing its hands at the unfolding political scandal. The forced retirement of Muhammad Yunus, founder of the Grameen Bank, Nobel laureate, and pioneer of the microfinance institution, looks like the proverbial nail in the coffin of microfinance’s status as the one-stop solution for ending poverty. Now experts are holding panel discussions to debate whether or not microfinance “works.”

This is not the first time we have found ourselves crestfallen at the failure of a silver bullet. When evaluating the results of his “Grand Challenges in Global Health,” Bill Gates admitted that the organization had been “naïve” in its expectations of breakthroughs in vaccine development. He underestimated the time it takes to move new products from the lab through clinical trials and manufacturing. “I thought some would be saving lives by now,” he said, “and it’ll be more like in 10 years from now.” Tell me about it: I worked for a biotechnology start-up in college, and the time it took to get approval for phase I clinical trials allowed bad management to completely unravel the company – it took less than five years. By the time we got the green light from the FDA, the company was being bought out, and we never got to test the product.

Many are also astounded at the current descent from grace of Greg Mortenson, of Three Cups of Tea fame. Details of his inspiring Quixote-esque story of building schools for girls in rural Pakistan and Afghanistan are now being questioned, and donors are appalled at reports of mismanaged funds and schools being used as storage sheds. But don’t we already know that graft happens, and rookies make (sometimes colossal) mistakes? How reasonable was it to expect the Central Asia Institute, Mortenson’s charity, to “fix” Afghanistan by building schools? On the other hand, why are countries and large-scale donors pulling funding and creating a fuss over the graft that the Global Fund revealed through its own investigations?

Why are we continually disillusioned when the simple solutions to the complex problems of global health and poverty turn out to not be so simple? Part of the problem is marketing. Saundra Schimmelpfennig, who has made it her mission to point out and tackle issues surrounding charity (mis)representation and shady fundraising practices, points out that

Whether it’s TOMS A Day Without Shoes or CAI’s Pennies for Peace, schools and teachers are using what are essentially commercials for a charitable product to teach children about the larger world and philanthropy. As is the case with most commercials, these “awareness raising activities” often distort or over-simplify the problems faced in ways that benefit their own organization.

This is extremely worrying as the children brought up on these myths and misconceptions are going to turn into businessmen, philanthropists, and lawmakers. How will the decisions they make be impacted by a distorted view of what the world is like and how to really help?

Another part seems to be that despite each revelation, we are constantly drawn to the prospect that we will somehow still find that magic “something,” that the next innovation or big idea will be the much-sought-after silver bullet. Despite coming to terms with his naiveté, Gates is now saying that energy innovation is the key to beating climate change. Programmers are busily developing cell phone apps in the hope that cell phones can help end poverty.

The problems that we devote our careers to tackling are nowhere near simple, and it is unreasonable to expect to find simple solutions to them. Heck, we don’t even adequately fund the silver bullets we already have. As professionals more knowledgeable than me continually point out, our best bet is to strengthen health systems, focus on measurable improvements, admit and learn from failure, and – perhaps most importantly – have a little patience.

Annual Meeting, Day 3: NTDs, Kids, and Careers

I started off my morning with two unpleasant experiences: a burnt cup of coffee from my hotel’s breakfast buffet and a session on neglected tropical diseases (NTDs). Please don’t misunderstand me – the session, hosted by Dr. Hélène Carabin, was very interesting, but pictures of the clinical manifestations of those worms will make even the sturdiest of young professionals’ skin crawl. I learned more than I ever wanted to know about onchocerciasis, or river blindness (did you know that those worms can live for 14 years in the body?); helminthes; baglisascariasis, or raccoon roundworm (in Brooklyn, of all places); neurocysticercosis, and trachoma. These diseases have rightly earned their designation as NTDs – they are inexpensive and easy to treat and prevent, yet most people have never heard of most of them. (Alanna Shaikh has a theory that giving them more descriptive and graphic names will attract attention to them – you can read her proposed naming scheme here.)

Next up was a session hosted by Dr. Elvira Beracochea on aid accountability and effectiveness. There were several very insightful talks and an interesting discussion (Dr. Beracochea always likes to involve the audience, which can be fun). After a lunch of Vietnamese fast food, I attended a session on child survival and child health, to which I was invited by Ms. Beth Charpentier (Ms. Katherine Robsky’s colleague from Global Health Access Program). While I believe that maternal and child health is very important (and I am thrilled that it is enjoying so much attention from Secretary Clinton and other development advocates), I am not very familiar with that area, so I learned a lot.

Finally, I attended the “Careers in Global Health” panel that is organized by Dr. Carabin every year. There was a very useful presentation on the key knowledge areas and skills that currently global health leaders identified as crucial to the incoming workforce. Ms. Carol Dabbs provided some practical information on the different points of entry with USAID, and then Dr. Eckhard Kleinau told his incredible story of breaking into global health after finishing his residency (he and his wife sold everything they owned and drove to Burkina Faso – from Germany! – in a VW van). If you would like any of this information, please contact me by e-mail at jmkeralis [at] gmail [dot] com.

Finally, the section held its closing business meeting at 6. After committee updates, Dr. Miriam Labbok was recognized for her hard work as section chair for the past two years. I personally will always remember her as a very welcoming face when I attended the annual meeting for the first time last year as a CDC fellow – she encouraged us “newbies” to jump right in.

Tomorrow’s Global Health Luncheon promises to be a real treat (though I probably will not be able to attend – I will have to navigate public transportation back to the airport). The malaria session is always well-attended, however, and it is in the morning – so hopefully I will see you there!