Health and Development in Africa: Health and Development in Africa: What are the Engines for Growth and What are the Engines for Growth and

Change?Change?

Anne C Petersen, PhDAnne C Petersen, PhDCenter for Advanced Study in the Behavioral Center for Advanced Study in the Behavioral

SciencesSciencesStanford UniversityStanford University

Global Philanthropy AllianceGlobal Philanthropy Alliance

Invited Lecture, Penn State, 4-23-07Invited Lecture, Penn State, 4-23-07

ACP BackgroundACP Background

Research: biopsychosocial Research: biopsychosocial development at adolescencedevelopment at adolescence

Experience in philanthropyExperience in philanthropy• MacArthur Foundation (3 years)MacArthur Foundation (3 years)• Kellogg Foundation (10 years)Kellogg Foundation (10 years)• Global Philanthropy Alliance Global Philanthropy Alliance

Consider development through Consider development through those lensesthose lenses

Development in general; Africa Development in general; Africa laterlater

Key Drivers of Development: Key Drivers of Development: PeoplePeople

Multinational development Multinational development enterprise (foreign aid) doesn’t enterprise (foreign aid) doesn’t workwork

Global philanthropy may work Global philanthropy may work (anecdotal evidence)(anecdotal evidence)

Money is not the solution to Money is not the solution to povertypoverty

Health & human development Health & human development centralcentral

Foreign Aid StoryForeign Aid Story

What is foreign aid?What is foreign aid? Who is involved?Who is involved? What is the problem?What is the problem? ConclusionConclusion

What is Foreign AidWhat is Foreign Aid

Western (Europe/US) countries Western (Europe/US) countries shifted post WWII in language and shifted post WWII in language and thoughtthought

Shifted from colonialism to: Shifted from colonialism to: • Foreign aidForeign aid• Benevolent military interventions Benevolent military interventions

West vs Rest: West decided Rest a West vs Rest: West decided Rest a “blank slate to be taken care of” “blank slate to be taken care of” (Easterly, 2006)(Easterly, 2006)

Some Quotes over TimeSome Quotes over Time

Nobel Laureate Gunnar Myrdal Nobel Laureate Gunnar Myrdal (1954): the answer to poverty is a (1954): the answer to poverty is a planplan

Cameroon lawyer & journalist Jean-Cameroon lawyer & journalist Jean-Claude Shanda Tonme (2005): “They Claude Shanda Tonme (2005): “They still believe us to be like children that still believe us to be like children that they must save,” with “their they must save,” with “their willingness to propose solutions on willingness to propose solutions on our behalf.”our behalf.”

Who is Involved? New InstitutionsWho is Involved? New Institutions International Monetary FundInternational Monetary Fund World BankWorld Bank USAID/DFIDUSAID/DFID Development Banks: Inter-American, Development Banks: Inter-American,

African, Asian African, Asian UN Development ProgramUN Development Program World Health OrganizationWorld Health Organization Food and Agriculture OrganizationFood and Agriculture Organization International Labour OrganizationInternational Labour Organization UN Children’s Fund (UNICEF)UN Children’s Fund (UNICEF) + others+ others

What’s the Problem?What’s the Problem? Trillions spent, little to showTrillions spent, little to show

• Some good programsSome good programs High level plans disconnected from High level plans disconnected from

intended beneficiariesintended beneficiaries Some funds misdirectedSome funds misdirected

• To bureaucrats who don’t partnerTo bureaucrats who don’t partner• To dysfunctional governmentsTo dysfunctional governments

Evidence of harmEvidence of harm Appropriate conceptualization and Appropriate conceptualization and

motivation?motivation?

Examples of Good WB ProgramsExamples of Good WB Programs Food for Education (Bangladesh) -Food for Education (Bangladesh) -

paid parents cash for child’s school paid parents cash for child’s school attendanceattendance

Rural Roads Project (Peru) – Rural Roads Project (Peru) – improved roads to get crops to improved roads to get crops to market in 1/10 previous time market in 1/10 previous time

Good health programs Good health programs • With WHO – directly observable With WHO – directly observable

treatment of TBtreatment of TB• With UNICEF – child nutrition (Tanzania)With UNICEF – child nutrition (Tanzania)

Foreign Aid and AIDSForeign Aid and AIDS

Devastating effects in AfricaDevastating effects in Africa• On women and menOn women and men• On workersOn workers• On families On families

Too little, too lateToo little, too late Many deaths could have been Many deaths could have been

prevented with early actionprevented with early action Still doing too little preventionStill doing too little prevention

Effective Health ProjectsEffective Health Projects Specific goalsSpecific goals Clear action in projects with outcomesClear action in projects with outcomes Examples: Examples:

• Vaccination campaign in southern Africa Vaccination campaign in southern Africa virtually eliminated measles 1996-2000virtually eliminated measles 1996-2000

• National campaign for oral rehydration therapy National campaign for oral rehydration therapy Egypt cut infant death 82% 1982-1989Egypt cut infant death 82% 1982-1989

• Childhood trachoma cut 90% since 1997 in Childhood trachoma cut 90% since 1997 in MoroccoMorocco

• River blindness in West Africa virtually halted River blindness in West Africa virtually halted since 1974since 1974

• Smallpox eradicated worldwideSmallpox eradicated worldwide• Near eradication of guinea worm in 20 Near eradication of guinea worm in 20

Africa/Asia countriesAfrica/Asia countries

Conclusions about Foreign AidConclusions about Foreign Aid

FundFund• Individuals or groups (eg, social Individuals or groups (eg, social

entrepreneurs) not governmentsentrepreneurs) not governments• Projects not plansProjects not plans

Create feedback loops from the Create feedback loops from the intended beneficiaries to funders and intended beneficiaries to funders and performersperformers

Create marketplaces with choice; Create marketplaces with choice; people as customerspeople as customers

Global PhilanthropyGlobal 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? ConclusionsConclusions

What is This?What is This? Giving of time and moneyGiving of time and money Individuals: 76% of $ ($41 T)Individuals: 76% of $ ($41 T) Large enterprise in the US (and some Large enterprise in the US (and some

European countries)European countries) Most foundations do no evaluation/ Most foundations do no evaluation/

assessment of effectivenessassessment of effectiveness Many variations within philanthropy Many variations within philanthropy

in motivations/ extent donor drivenin motivations/ extent donor driven Live donor/ dead donor issueLive donor/ dead donor issue

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

US International GrantmakingUS International Grantmaking Rapid growth over last decadeRapid 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 Steady commitments from long time global foundationsglobal foundations

Increasing numbers of new foundations Increasing numbers of new foundations giving outside the USgiving outside the US• Since 9-11 funnel more through US-based Since 9-11 funnel more through US-based

organizationsorganizations

Who?Who?

GatesGates MooreMoore FordFord KelloggKellogg PackardPackard Many, many others, especially Many, many others, especially

small foundationssmall foundations

What Works? What Doesn’t?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->dependencyvicious cycle: donor in system->dependency

• African proverb: giver above recipientAfrican proverb: giver above recipient What Works?What Works?

• Supporting capacity building, ideas of Supporting capacity building, ideas of those who will benefit, technical those who will benefit, technical assistanceassistance

• Funding “with” (not “to” or “for”)Funding “with” (not “to” or “for”)

Examples of Effective GrantsExamples of Effective Grants CIDA – College in Jo’burg, SACIDA – College in Jo’burg, SA

• Free education, best business education practices, latest Free education, best business education practices, latest technologytechnology

• Initiated with Kellogg funds/business contributionsInitiated with Kellogg funds/business contributions• Sustainability through student commitments to support Sustainability through student commitments to support

student, high demand from students & companiesstudent, high demand from students & companies Sweet MozambiqueSweet 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, SABus 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), Sustained by high quality, feedback (no middle person),

continual improvementcontinual improvement

Conclusions from PhilanthropyConclusions 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 partnersLink with complementary partners Learn (improve)Learn (improve)

Hear Similarities?Hear Similarities? Same kinds of projects are effective Same kinds of projects are effective

with foreign aid and philanthropywith foreign aid and philanthropy Underlying principles Underlying principles

• For fundingFor funding Support individual’s (or small groups) Support individual’s (or small groups)

sustainable ideassustainable ideas Provide capacity building, technical Provide capacity building, technical

assistanceassistance

• For operatingFor operating Get feedback from intended beneficiariesGet feedback from intended beneficiaries Focus on what do wellFocus on what do well Partner with those who do other things Partner with those who do other things

betterbetter

Also Similar to Lessons from Also Similar to Lessons from Human DevelopmentHuman Development

For especially adolescents but also For especially adolescents but also adultsadults• Externally imposed programs don’t workExternally imposed programs don’t work• May get superficial “compliance” but not May get superficial “compliance” but not

sustainable behavior changesustainable behavior change• Change requires personal motivationChange requires personal motivation

Adolescents still have hopeAdolescents still have hope• Some adults have lost itSome adults have lost it

Working “with” requires Working “with” requires relationships, loverelationships, love

Remaining ChallengesRemaining Challenges

All require relationshipsAll require relationships• Partnership PrinciplesPartnership Principles

Mutual interestMutual interest Mutual benefitMutual benefit Mutual responsibilityMutual responsibility Mutual respectMutual respect

Scale upScale up InfrastructureInfrastructure Do no harm!Do no harm!

What about Africa?What about Africa?

Resonate with Africa – love Resonate with Africa – love everything about it!everything about it!

Work there becauseWork there because• Great challengesGreat challenges• Great rewardsGreat rewards

Thank

s!