A sea change is coming
At Results for Development (R4D), our mission is to support change agents in low- and middle-income countries — government officials, civil society leaders and social innovators — who are working to build strong systems that support healthy and educated people. As we live out this mission, we are constantly asking ourselves what change agents need most from us and what our role should be — particularly as expertise and capacity grows among our country partners. We sense that many other international organizations are asking similar questions, and we’re hungry for more dialogue on this topic. We’d like to share some reflections here, and we invite you to join the discussion by leaving a comment at the bottom of this post.
Instead of speculating about what change agents need (and appreciate) most, we asked them. After conducting in-depth interviews with partners from 11 countries, and many more informal conversations, some themes have emerged. Our country partners tell us that the best solutions to address pressing systems challenges emerge when local ideas and analysis are inspired and influenced by global evidence and experience. They want to learn more about the challenges their peers have faced and what solutions have worked. They want access to experts that can help them answer, in a timely on-demand way, specific technical questions, by applying global knowledge and experience to their context. And sometimes it helps if these experts can reinforce and validate ideas and messages to increase country buy-in.
These change agents also know that good technical ideas and evidence alone are insufficient for lasting results. They want support facilitating complex reform processes. Technical know-how must be combined with well-designed processes that routinely use data to assess progress on key goals and identify the root causes of lack of progress, engage multiple stakeholders to address their needs and ensure buy-in, manage implementation and scale-up plans, and engage in continuous learning to test, iterate and adapt solutions. The change agents we work with want to build their own capacity and the capacity of local organizations to lead these processes.
In parallel, we’ve noticed increased calls from partner countries and funders to build or strengthen the capacity of the country and regional institutions that will sustain long-term systems-change efforts. For example, Ghana’s President Nana Akufo-Addo recently shared a vision of “Ghana Beyond Aid,” and USAID Administrator Mark Green has repeatedly stated a goal to put countries on a “journey to self-reliance.” Many funders now aspire to channel more of their resources directly to local and regional organizations.
All of this has led us to ask ourselves: what are the appropriate roles — if any — for international NGOs? How can we strengthen country and regional institutional capacity? And once this capacity is built, can international organizations like R4D still add value?
Based on feedback from our country partners, we think international NGOs can continue to add value. But this will require unlearning some of the old ways of operating, developing a better understanding of how local systems and regional contexts operate and taking on new roles and new ways of thinking. It will also require an adaptive learning mindset in which new models and approaches are tested, evaluated and adjusted — and sometimes jettisoned.
Here are some of the ways we think international NGOs can continue to support change agents in meaningful and lasting ways:
Play “coaching” rather than “doing” roles.
R4D is frequently asked to provide technical expertise or assistance to governments or non-government partners. But we have been shifting how we approach these engagements, where possible, serving as coaches rather than doers. For example, in the past, we might have completed an analysis and handed over a technical report with recommendations. Now, we increasingly work with a country to identify a key policy challenge or window, support a participatory, multistakeholder process to identify technically, fiscally and politically feasible solutions, supported by targeted commissioned analysis to answer specific questions related to the policy challenge. This approach is often slower and costlier in the short-term than just producing a technical deliverable, but it creates learning opportunities for local experts, promotes the type of local ownership necessary for sustained action, and develops institutional know-how that can be used to solve tomorrow’s problems.
Advise local and regional organizations as they institutionalize new functions.
We take the coaching role to the next level of impact when we help a partner organization create new roles and processes that will be sustained after our engagement ends. Sometimes this also involves helping to stand up a whole new institution. For example, we worked with Vietnam’s Health Strategy and Policy Institute who, with our support, built a new function focused on designing, implementing, and evaluating pilots.
Develop and connect regional networks of coaches.
There are many strong technical experts and institutions in the regions where we work, but they often don’t get the opportunity to play critical technical assistance roles because of the way development assistance has traditionally flowed to well-known experts from organizations in high-income countries that have experience bidding on funding opportunities. We have started to support and increase the visibility of local experts and institutions by creating networks that link local coaches with governments who need their technical support. These networks can ensure that coaches have access to the latest global knowledge. And they can enable coaches to learn from each other about how to promote successful management of complex reform processes, how to facilitate stakeholder engagement, and how to effectively translate global evidence for local contexts. At the institutional level, these networks can also offer support for local organizations that need to build additional finance and governance capacities to qualify for donor funding.
Design more efficient and effective knowledge translation.
Though big gaps in knowledge remain, there is no shortage of evidence generated through research and new ideas that come from innovators. The extent of this is reflected by a proliferation of global knowledge aggregators and online knowledge hubs. But all too often, this knowledge is not effectively accessed and interpreted at crucial policy or implementation moments. We think new approaches are needed, and our recently completed research on evidence-informed policymaking inspired us to test one such approach — a service for policymakers and other change agents that provides on-demand, synthesized, relevant and actionable knowledge (from existing knowledge aggregators and interpreted by a qualified knowledge translator). We’ll be launching this service next year and we’ll let you know how it goes.
Document, synthesize and disseminate knowledge of what works.
Our work across multiple contexts enables systematic harvesting of lessons learned — about what works, and importantly how it works — from various country experiences. And these lessons can be shared with others facing similar challenges. We work hand-in-hand with local partners in multiple countries to design experiments that generate conclusions about what works and what doesn’t. We expose partners to new adaptive learning methodologies that systematically, rapidly and rigorously test interventions and then adapt quickly with new and improved interventions. As a global partner, working with multiple local partners testing similar interventions in different places, we are well-positioned to synthesize the results and share them widely.
Facilitate global action-learning networks.
Our global scope enables us to identify opportunities for one country to learn from another, and to convene peer networks for shared learning. Collaborative learning simultaneously builds practical transferable knowledge of what works to address common challenges and immediately supports the implementation of that knowledge into practice in multiple locations. We have learned that successful action-learning networks require strong leadership from multiple local nodes of the network, but global organizations like us are well-positioned to effectively facilitate and coordinate across those nodes.
There may be other roles as well, but one thing is certain: We will only be successful if we work with strong country and regional, governmental and non-governmental partners. We’re currently experimenting with different partnership models and thinking strategically about how our experience and skills best complement those of country partners. For example, we are partnering with Nairobi-based AMREF to develop the Strategic Purchasing Africa Resource Center. (The practice of strategic purchasing enables health system managers to use public health funds more efficiently to deliver high-quality health services to more people.) AMREF brings its own network of partners and deep roots in communities in Africa to the relationship while R4D brings significant expertise and global experience in health financing — which will ultimately strengthen AMREF’S ability to advance universal health coverage, one of its key organizational goals. The Strategic Purchasing Africa Resource Center (SPARC) — which we’re building together — will identify and engage key players and stakeholders within local government agencies, academic institutions and NGOs to build a cadre of regional experts. SPARC will connect these experts to one another to share real-time implementation experience and to provide peer support and learning, while also offering coaching, mentoring and access to global resources to broaden and strengthen expertise.
In the coming weeks, we’ll share an exciting announcement on a new global initiative that builds on these concepts to strengthen health systems and the capacity of local change agents and institutions to do so over the long haul.
We sense a sea change coming in our field, and although we are excited to be part of this change, we recognize that we don’t have it all figured out, and we need to be prepared to learn from our mistakes. In addition to exploring our own new models, we hope to learn from our country and regional partners, other international NGOs and funders who are exploring new models and charting a new path. Please share your comments below or on R4D’s Twitter, Facebook or LinkedIn pages.