Selling Social Change

I recently read an article in the Stanford Social Innovation Review (SSIR) called “Selling Social Change” by Taz Hussein and Matt Plummer of the Bridgespan Group. It was a really interesting read that sparked a lot of thoughts for me especially around my own work right now. I wanted to share a few highlights from that article.

A summary of the article could read along the following lines; “Just because there’s a clear need doesn’t mean there’s demand…Rigorously evaluated evidence-based practices and programs alone cannot trump beneficiaries’ lack of awareness or interest… (Nonprofits and funders) must be prepared to actively generate demand for social change.”

I have found this idea to be especially pertinent in my work at CoreAlign, where we work to infuse the domestic American reproductive health, rights, and justice movements with the concepts of innovation and speaking race to power. The article details three steps nonprofits need to take when creating and implementing solutions.

  1. Recognize the limits of designing as service or program primarily for effectiveness and also design for “spreadability”.

Essentially, in our quest to deliver programs and products that deliver social good with maximum efficiency and effectiveness, we often overlook or undervalue whether potential beneficiaries will find the service appealing. In fact, sometimes we must look at how effective elements of our programs might actually hinder adoption and use. The examples cited in the article demonstrate that organizations that are able to make difficult decisions that may slightly reduce effectiveness or efficiency end up increasing the overall net use of services or products by beneficiaries.

  1. Go beyond identifying a broad group of potential beneficiaries and focus first on a subgroup most likely to participate.

The article shares an image of the “product adoption curve” and asks nonprofits better understand whom they are targeting “because different adopter categories have different needs and attitudes toward the programs and services created for their benefit.” This makes sense intuitively when we look at products like the iPhone and Facebook and consider the needs of early adopters, early majority, and late majority users. The same product may need to be marketed or pitched differently to different segments of users – and this can be a hard pill for many nonprofits to swallow.

  1. Develop and resource a sales and marketing capability from the outset, right alongside budgeting for program delivery.

Finally, and I love this point, nonprofits can fall for the fallacy that it’s enough to simply create a service or product that people want, and fail to spend the resources to inform and entice users to demand what they make. The article (somewhat boldly) uses a breakdown of Big Pharma spends on R&D vs. Sales & Marketing to demonstrate that it is not sufficient to simply have a great product – you have to get your beneficiaries to know that it’s out there, and understand how it might benefit them.

The author’s end by asking us all to consider three questions during our strategic planning processes:

  • How will you ensure that your program or service receives high scores from beneficiaries on these dimensions: better, compatible, simple, testable, and observable?
  • What segment of those you hope to serve knows that they have a problem and are looking for a solution?
  • Who will sell your innovative program or service to potential beneficiaries?

I found these to be very important and salient questions for my own work, and can easily imagine how it might spark new thoughts for others. Check out the article here and let me know what you think.

Source: Stanford Social Innovation Review, Selling Social Change, by Taz Hussein and Matt Plummer, Winter 2017

 

 

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Stunting in Brazil and India

Following up on the previous post about stunting, I wanted to mention two case studies I’ve come across in Brazil and India that are fascinating. I will need to investigate each one in more detail to really break out the shape and scope of the intervention plans, but I think these two case studies begin offering an optimistic insight into how other communities, countries, and regions can tackle stunting. Let’s begin in Brazil.

I hope to return to Brazil as a case study in a lot of contexts as this blog continues since it is a BRIC country that has made significant progress on several socioeconomic development factors (with room still for improvement). When we look at stunting rates in Brazil among children under 5 years, the results are dramatic. Over 40 years ago, that rate was a catastrophic 37.1%. Today, it is xxx% and declining still. Make no mistake – this is a dramatic and incredible accomplishment. Imagine the millions of lives that have inch by inch been improved over the last four decades.

A few of the factors that contributed to this tremendous human achievement include:

  • Improving the purchasing power of households through minimum wage increases and expanded cash-transfer programs;
  • Rising rates of female education and literacy;
  • Improvements and expansion of maternal and child health services;
  • Expansion of water and sanitation systems;
  • Improvements in the quality and quantity of food produced by small family farms.

Crossing our way over to South Asia, let’s take a look at India for a moment. Due to the sheer enormity of its population, India has the most stunted children under 5 years in the world at an estimated 62 million. Progress in the country to fight stunting and malnutrition is varied across state, regional, and social lines. However, there is hope in Maharashtra where a broad-based government technical, advisory, and training body has seen significant improvements due to its efforts.

The Rajmata Jijau Mother-Child Health and Nutrition Mission has a three part mission:

  • Advocate for the importance of the first 1000 days (see my previous blog post here for more information on what this is),
  • Provide policy advice to the government on evidence-based interventions, and
  • Act as a platform to foster convergence among different departments with a common objective of reducing malnutrition.

Launched in 2005, this body has contributed to a magnificent reduction in child stunting rates in Maharashtra. At the time of its launch, the state was looking at an overwhelming 44% rate of stunting; by 2012, in just seven short years, that number had been cut in half (22.8%).

Three things strike me about these two case studies that I am sure will be relevant to the implementation and adoption of broad-based interventions to combat stunting and malnutrition:

  1. Strong, proactive, and persistent political leadership combined with active, engaged, and adaptive civic society organs created and facilitated the processes to understand and tackle stunting,
  2. Emphasis was placed on building sustainability of these interventions by empowering community leadership and community management of these programs,
  3. Multisectoral approaches were used to address stunting, understanding that policies in education, labor, and agriculture all impact nutrition

These seem like the bedrock of some fairly exemplary best practices in generating and rolling out interventions across broad geographic areas.

What is Stunting?

In today’s post, I wanted to revisit stunting. Over and over again, stunting emerges as one of the most critical hurdles to achieving full economic and social development in a global context. The condition affects over 162 million children under the age of 5 (Stunting Policy Brief, WHO and 1,000 Days). There is a significant amount of research into the causes and effects of this state of malnutrition, and a growing body of evidence-based interventions to combat it. So what is stunting?

 

Technically, the condition of stunting is defined as “a height that is more than two standard deviations below the World Health Organization (WHO) child growth standards median.” (Stunting Policy Brief, WHO and 1,000 Days) As any statistician might tell you, that’s quite extreme. It is important to recognize that so many hundreds of millions of children persist in this condition despite the extremity of its definition. However, the real tragedy of stunting is the irreversible long-term damage it inflicts including “diminished cognitive and physical development, reduced productive capacity and poor health, and an increased risk of degenerative diseases such as diabetes.” (Stunting Policy Brief, WHO and 1,000 Days)

Research has demonstrated the correlation between stunting before the age of 2 with diminished cognitive and educational ability later in life. Stunting is associated with fewer years of school completed, and significantly lower academic performances compared to non-stunted peers. In addition, stunting in women is associated with lower age at first childbirth and a higher number of total pregnancies. Stunting has been estimated by economists to reduce a country’s GDP by up to 3%. Furthermore it is associated with lower household income and a greater chance of living in poverty. One of the most shocking data points I came across is that stunted children earn an “estimated 20% less as adults compared to non-stunted individuals”. (Investing in Nutrition, World Bank)

Think about that for a minute – in India, the average GDP per capita in 2015 was roughly USD 1,581 (World Bank). If you were unfortunate enough to be stunted as a child, something that you had no control over, you can expect to earn on average USD 316 less every year, a truly significant amount of money at the margins. If you take into consideration the mean individual income of only the bottom 50% of income earners, you can imagine how disenfranchising that 20% diminishment in income really is.

One of the most important developments in the fight against malnutrition, including stunting, occurred in 2012 when the 194 member states of the World Health Assembly (WHA) endorsed six global targets to improve nutrition by 2025. (Interestingly enough, the world is currently not on track to meet even a single one of these targets…more on that later). The nutrition target for stunting is a 40% reduction in the number of children under 5 who are stunted. This translates roughly to at least 65 million fewer children who are stunted in 2025 and an estimated 2.8 million child lives saved. (Investing in Nutrition, World Bank)

As part of the effort to successfully reach the target goal for stunting, the WHO recommends the following actions to drive progress:

  1. Improve the identification, measurement and understanding of stunting and scale up coverage of stunting-prevention activities.
  2. Enact policies and/or strengthen interventions to improve maternal nutrition and health, beginning with adolescent girls.
  3. Implement interventions for improved exclusive breastfeeding and complementary feeding practices.
  4. Strengthen community-based interventions including improved water, sanitation and hygiene (WASH), to protect children from diarrheal diseases and malaria, intestinal worms and environmental causes of subclinical infection.

 

To learn more about stunting, please visit and donate generously to 1,000 Days.

Malnutrition and the First 1,000 Days

Let’s start with the big picture – every year, nearly 7.6 million children will die before they turn five years old (UNICEF). That’s 7,600,000 children, just shy of the total population of a country the size of Israel, or Honduras, or the entire combined populations of Kansas, Nevada, and New Mexico. Imagine the scale of this problem. Imagine if EVERY year, these countries or states saw their entire population wiped out – each and every year, over and over again. Except it’s not an entire population, but exclusively the most vulnerable members of human society – poor children who aren’t even five years old yet.

This is, unfortunately, the world we find ourselves currently living in hard as it may seem. It is worth pausing here to note that the under-5 mortality (a measure of the probability of dying between birth and five years of age per 1,000 live births) is at its lowest ever, historically. We have a lot to be proud of in terms of how far we have come in the past half century below as the graph below indicates:

mortality-rat

According to Save the Children’s State of the World’s Mothers 2012 (and can be found here), malnutrition is an underlying cause of death for nearly 2.6 million children each year. Malnutrition is a significant problem, not just because of the mortality rates it induces in young children and mothers but also because of the morbidity and suffering it causes to those who survive it. Every year, 20 million babies are born into this world with low birth weight, some because they are born too prematurely and others because of inadequate growth and nutrients while developing in the womb.

There are also economic factors impacted by malnutrition – adults who were malnourished as children earn an estimated 20% less on average over the course of their lives than those who weren’t. Imagine how quickly that adds up, and how cyclical that poverty trap becomes. Malnutrition can also cost developing countries an estimated 2-3% of their GDP every year, a significant amount for any country let alone ones grappling with severe poverty.

As might be reasonably inferred, malnutrition disproportionately affects the poor and disenfranchised. Across South Asia, “the poorest children are almost three times as likely to be underweight as their wealthiest peers.” That number becomes a lot more alarming in Latin America, where in countries like Honduras the poorest children are eight times as likely, or El Salvador and Peru where they are 13 and 16 times as likely to be underweight.

The report compares what a typical girl can expect between the highest and lowest ranked countries on their Mother’s Index list, which compares the well-being of mothers in 165 countries. The difference is stark:

“A typical Norwegian girl can expect to receive 18 years of formal education and to live to be 83 years old. Eighty-two percent of women are using some modern method of contraception, and only 1 in 175 is likely to lose a child before his or her fifth birthday. At the opposite end of the spectrum, in Niger, a typical girl receives only 4 years of education and lives to be only 56. Only 5 percent of women are using modern contraception, and 1 child in 7 dies before his or her fifth birthday. At this rate, every mother in Niger is likely to suffer the loss of a child.”

That level of suffering is beyond difficult to read – it is almost impossible to comprehend. The report goes on to state, point blank, that “Persistent and worsening malnutrition in developing countries is perhaps the single biggest obstacle to achieving many of the Millennial Development Goals (MDGs).”

Fortunately, Save the Children and other organizations have begun focusing on a set of interventions that could significantly improve the current malnutrition crisis. These are focused around a concept known as the First 1,000 Days, which is the period between conception and the start of pregnancy to a child’s second birthday. Research shows that adequate and sufficient nutrition in this window of time “can have a profound impact on a child’s ability to grow, learn, and rise out of poverty.” The report goes on to lay out the foundation for why we should focus on the First 1,000 Days:

“Mothers and babies need good nutrition to lay the foundation for the child’s future cognitive, motor and social skills, school success and productivity. Children with restricted brain development in early life are at risk for later neurological problems, poor school achievement, early school dropout, low-skilled employment and poor care of their own children, thus contributing to the intergenerational transmission of poverty.”

There are six key solutions with immense potential to save the lives of our children in their nascence, and well beyond. It is the intention of the author and this blog to dive deeper into the weeds and study different programs around the world to assess where successful programs are running, how they are able to do so, and the impact that has generated. For now, let us highlight in brief the six solutions:

  1. Provide iron folate supplements to cure iron deficiency anemia, the most common nutritional disorder in the world. Anemia is a “significant cause” of maternal mortality and can cause premature birth and low birthweight. It is estimated that 25% of the world’s population, or 1.6 billion people, are anemic – the vast majority of whom are women.
  2. Improve knowledge and practice of exclusive breastfeeding in the first 6 months provides comprehensive nutrition and immunity development for newborns against common childhood illness. Breastfed children are 6 times more likely to survive the early months of their life than non-breastfed children
  3. Improve complementary feeding knowledge and practice, adding other foods and liquids to a child’s diet between the ages of 6-23 months of age.
  4. Provide Vitamin A supplements to bolster the human body’s ability to counteract the debilitating consequences of diarrhea. Vitamin A deficiency affects nearly a third of all preschool aged children, which is a major contributing factor to diarrhea and measles, and can cause irreversible corneal damage.
  5. Provide Zinc supplements along with oral rehydration solution to help children with diarrhea recover more quickly and protect them and their communities from recurrences.
  6. Improve knowledge and practice of water, sanitation, and hygiene (WASH) best practices to prevent diarrheal diseases at the source, the cause of 1.3 million children deaths each year.

What is most impressive about all of these interventions is their relatively low cost (cents to a few dollars per individual), their track record of successful scaling, and their long-term payback on investment. For these reasons alone, we should look more closely at programs, organizations, and governments around the world that are implementing successful interventions based on these solutions, learn from their successes and mistakes, and replicate or scale up with additional resources.

Women’s Economic Empowerment, and Education

On to the inaugural post! Today I’d like to broach the topic of Women’s Economic Empowerment (WEE). In the world of development, this is as close to the Holy Grail as we have come to achieving true poverty alleviation. Its worth pausing for a moment to dig deeper into we actually mean by WEE. I have been reading through a terrific research report by the Overseas Development Institute (ODI) titled “Women’s Economic Empowerment: Navigating Enablers and Constraints” (by Abigail Hunt and Emma Samman) which you can find here. In it, the authors state the definition of WEE as follows:

“Women’s economic empowerment is the process of achieving women’s equal access to and control over economic resources, and ensuring they can use them to exert increased control over other areas of their lives.” (Taylor and Pereznieto, 2014).

While I think this idea really broadly covers the aspirations of WEE work, I think it’s a little vague and begs for more detail over how exactly control and access lead to increased empowerment. Critically, what emerges is the ability control and access have to generate power for social and economic change. The authors go on to refine their definition of WEE as a,

“Process whereby women’s and girls’ lives are transformed from a situation where they have limited power and access to economic assets to a situation where they experience economic advancement.” (Taylor and Pereznieto, 2014)

In my opinion then, the true value of WEE is the ability to not only provide control and access but also to seed transformative power changes in society at the micro (individual, household, familial, regional, etc.) and macro (economic, state-level, international) levels. The report continues to expand on 10 “key factors” that can enable or constrain WEE. I hope to get into most of these factors in the future but for now I want to focus on the first, and in my estimation one of the most important – Education and Skills Development.

I have really positive news to start with – most people fundamentally believe in equal access to good education for both boys and girls (OECD, 2012b; Jones et al., 2014b;Purewal and Hashmi, 2015)! This is really an understated achievement of shifting cultural norms, and is worth its own moment of pause and reflection. While this may be self-evidently important, I think a powerful statistic shared in the report elucidates why we should be concerned with equitable access to quality education as a transformative social justice practice: “An additional year of primary school for girls can later increase wages by around 10%, rising to 15-25% for each extra year of secondary school, and nearly 17% for tertiary education.”

But don’t dwell there too long because unfortunately we don’t actually see this professed equity play out in the real world. According to UNICEF, in 2013 there were nearly 63 million girls of primary or secondary school age who were not enrolled respectively around the world. That figure is nearly the entire population of France. So what exactly are the barriers to female participation and access to quality education?

The short answer is there are a lot of reasons. It would take hundreds of pages to go into the details for all of them so I’ll just mention a few along a micro and macro split. At the micro level, some of the most important causes include young/child marriage. For example, according to ODI’s research report Gallup notes that in 29 Sub-Saharan African countries in 2015 “…married girls aged under 18 with a secondary education was 16% compared to 36% of unmarried girls.” While both numbers are starkly low, one is significantly lower.

Another important reason mentioned in the report is a lack of household resources. This can range from lack of financial resources to purchase school uniforms, textbooks, notebooks and pencils, and even tuition fees. Furthermore, in places like India where I worked for several years on issues of primary school education, there is a distinct and unfortunate cultural preference to send boy children to school over their girl siblings when resources are limited. (Author’s Note: A further blog post will provide more substantial data and research to back this up, as well as personal observations from my own professional experience). Conversely, programs that aim to alleviate these financial burdens have seen interesting and hopeful reduction rates in dropouts for adolescent girls (Duflo et al., 2006). A few other considerations at the micro level include “institutions that are inhospitable to girls who are menstruating, pregnant, or have children, curricula that reinforce traditional gender roles and a lack of female teachers.” (UNFPA, 2014)

At the macro level, data suggests that while most people are negatively impacted by external shocks (economic crises, wars, famines, natural disasters, etc.), girls’ lives and access to education are severely affected. One of the most interesting and disheartening consequences of economic shocks occurs when household mothers are driven to pursue more paid economic activities. According to the ODI research report, “girls are often the first to be removed from school to take on extra domestic responsibilities, including looking after younger siblings.” The disproportionate burden that is placed on women and young girls to manage household and informal sector care is evident in school dropout rates in periods of economic contraction (Stavropoulou and Jones, 2013). Even worse we find that “4 of the 5 countries with the largest gender gaps in education” are facing war or insurgency.

I want to end with a reflection on what this last piece of information tells me. Something I think is becoming abundantly clear through the data is the tremendous improvements to WEE gained through the modern infrastructure of multinational cooperation and stability. Rash wars, interventions, or escalations of tensions not only damage nation-states and the infrastructure of international stability – they disproportionately affect women who are often the first to be stripped of the progress and advancements of the 21st century.

More on that later…thanks for reading.

Ours is not a caravan of despair

Beginnings are always the hardest. Rumi says, “Come again to the Sema…even if you have broken your vows a thousand times, come again. For ours is not a caravan of despair”.

This is a great starting point for my approach to the work of development and poverty alleviation. The post-World War II history of development has been a complicated narrative at times built on foreign policy strategy, at times on human rights, and at times on pure spite. Recently we have come to view the work of development as our vow to fulfill a tryst with our brothers and sisters in the world community who are most disenfranchised and oppressed. While steady progress has been made in some serious respects, there have also been some truly terrible mistakes along the way. But we ask ourselves and others to come again and again to this work – because ours is not a caravan of despair.

With this blog, I want to explore the current state of development, the interventions and mechanisms that are being deployed on a micro and macro level, and the implications experienced by actual people and communities.

Specifically:

  • I want to focus on South Asia and Sub-Saharan Africa (SSA), although India will be of personal interest to the author as it is his ancestral homeland and love
  • I will start with a focus on three specific development areas
    • Women’s empowerment –  issues of women’s rights and justice, reproductive health, and economic empowerment
    • Early childhood education – issues of primary school education and remedial education
    • Hunger and malnutrition – issues of nutritional intervention policies, agricultural policies, and the link between food-based interventions and health implications

The course is uncharted, and my ambition is to remain loose, open, and malleable as this blog progresses. I will also try and incorporate guest bloggers and writers when I can to provide alternate perspectives on issues. My hope for this blog is primarily two-fold: first, to create a space for myself to reflect on the complicated and important world of development and second, to raise and continue the level of discourse in the online community about development.

Without further ado, let’s start the show.

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