Panel Including USAID’s Rajiv Shah Talks About Technology’s Place in Global Health
Some of us here in "the other Washington" got to hear a panel of political and development heavy-hitters speak this morning at an event hosted by Global Washington.
It was an interesting event because it brought together a diverse set of speakers, from NGOs to universities to private sector philanthropic entities to politicians, plus an audience of people working and interested in global development in various forms, all set in St. Mark's cathedral.
Rep. Adam Smith (WA-9) introduced Dr. Rajiv Shah, the new head of USAID who used to head up agricultural development programs and other initiatives at the Gates Foundation.
Dr. Shah talked about the moral imperatives of development, but also the national security interests that, according to some, make an argument for reducing poverty, improving education and health, and investing in women and girls. He gave examples of Feed the Future and the Global Health Initiative as two new U.S. programs intended to take a different approach to foreign aid. He highlighted the focus on whole-country investment and partnership, and in the case of the GHI, being more systems-oriented and coming up with innovations to solve the "last mile" problem -- getting services and supplies the final last mile to rural areas where they are needed. He reiterated what has been a clear emphasis since he started at USAID on evidence-based and results-oriented programs.
Dr. Shah then joined a panel which also included Dr. Prema Arasu, Vice Provost and Associate Vice President of International Programs at Washington State University, Akhtar Badshah, Senior Director of Global Community Affairs at Microsoft, Chris Elias, President and CEO of PATH, and Congressmen Jim McDermott (WA-7) and Adam Smith. Sylvia Burwell Matthews, President of the Global Development Program at the Gates Foundation, moderated the discussion.
(Photo: Tom Paulson)
What started out as a discussion of technology's impact on development quickly shifted when Jim McDermott was asked about the tension between health delivery and health technology.
He pointed out that specifically in the area of health, technology is all fine and well but that it's about human beings. He noted that the U.S. benefits from a massive brain drain of health workers from developing countries, leaving few people left to deliver actual care. Rep. McDermott pointedly mentioned that USAID has been reluctant to invest in human infrastrcture, plus our own domestic policies and shortages open the space for health workers to migrate here.
After Dr. Shah and Akhtar Badshah talked a little bit more about technologies, including things like using basic cell phone applications to deliver information, Chris Elias from PATH was asked to "ring a cautionary note" for technologies in development.
He outlined three areas of risk in looking to technology to solve development challenges. One is the risk of being too narrow-minded, "mistakenly equating innovation with technology." Gadgets are one thing, but innovations are also important in areas like service delivery, or bringing different sectors together to tackle problems.
The second risk is being too hung up on technology as a channel for delivering information, and forgetting that there need to be people too. He gave the example of a woman in a rural area in labor, needing help. She has a cell phone, but who is she going to call? Who will come and get her, and where will they take her for care? As he said, you can't perform a c-section over the phone.
The third risk articulated by Dr. Elias is that focusing on technology may exclude all the other talent and ideas that are out there to solve problems.
After these comments, several of the other panelists chimed in to agree that technology is not the answer, but just a means to an end. Nonetheless, as Adam Smith pointed out, federal money is tight for a lot of things, including global health. He encouraged the audience not to rely solely on the federal government, but look also to a broader pool of donors and become more efficient with the resources we do have.
Finally, Dr. Shah outlined a few specific ways that USAID plans to change to better embrace a results-oriented approach and prevent unintended consequences of its programs. First, he is implementing some comprehensive reforms called "USAID Forward," which will focus the agency on doing fast cycle assessments and making program adjustments. He also said that USAID doesn't currently do enough measurement of impact, instead focusing on outputs like the number of students taught, or the number of pounds of seed distributed.
Starting next year, USAID programs will collect baseline data so these impact measurements can be made. Dr. Shah also talked about doing counterfactual analysis, comparing communities that benefit from programs and communities that also received the program but didn't benefit. Finally, he mentioned having "Evidence and Failure" summits to get agencies and organizations together and talk about what worked, and what didn't.
It was nice to hear Jim McDermott and Chris Elias inject some reality into the discussions of the wonders of technology. All of us who work in global health can certainly find ways to improve and help our in-country partners to build their capacity, but it's important to recognize that people and systems are still required. There are no short-cuts. We should continue working on new vaccines and other technologies, but also continue investing in health workers, clinics, and the other systems needed to support delivery of those vaccines once we've got them.
You can read other coverage of the event by the Seattle Times, seattlepi.com and global health blogger Tom Paulson.
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