Truman National Security Project

Innovations That Build Upon What Works


America’s bold foreign policy vision needs to be matched with a bold development strategy.  One recent idea published in The Guardian by Oxfam’s Jennifer Lentfer centered on the need to foster an entrepreneurial spirit amongst aid workers to achieve systemic change.  To balance welcome but complicated-to-explain initiatives like the 2015 30% Procurement Reform Target, Lentfer suggested that USAID give the 600,000 ex-pat aid workers a $1,000 slush fund that she called “a social change investment fund,” stating that [they] “could also be tasked to just have fun…develop a healthier relationship with risk.”  But in an era that calls for smarter aid, we should instead find innovations that complement existing US tax payer investments, while reinforcing the importance of making a meaningful impact in the lives of people around the world.

Compared to $1,000 for an aid worker to use as they please, training a Community Health Worker (CHW) is a real local strategy for global health.  I’ve seen firsthand how important innovation and problem solving are to a successful initiative, through my work with CHWs across the Millennium Villages Project in Sub-Saharan Africa.  In the Millennium Villages, CHWs are chosen from the community, rapidly trained, and paid to provide preventive and well-defined curative healthcare in households throughout a community.  When supported at large-scale, CHWs cost $6.90 per person served per year, or $3,750 to train a CHW in the first place (WHO bulletin).

The benefits, though, are immeasurable. In the process, we can sharply reduce child and maternal deaths from malaria, diarrhea, pneumonia and break the chain of transmission of HIV from mothers to their newborns.  Additionally, CHWs take care of their own community as part of a national primary health care system that will stay long after development aid has shifted elsewhere.  They are the ultimate ambassadors to local communities, and considered by WHO and World Bank criteria to be highly cost-effective.

One way to bolster our development strategy is finding ways for locally effective strategies like CHWs to complement successful development investments like the President’s Emergency Plan for AIDS Relief (PEPFAR).  To date, the program, which the Institute of Medicine called “globally transformative”, has provided way more bang for the buck than the $38 billion we’ve invested into it.  To follow on this success, PEPFAR should incorporate innovations like CHWs, a move which USAID already champions.  We already know CHWs work on their own.  Together, this move would have the potential to make PEPFAR an even more successful program going forward.

In contrast, Lentfer’s approach naïvely sells us a simple vision of unleashing the latent creativity of aid workers who supposedly know the local scene. Not only would we reckon with the question of who qualifies as an aid worker, but imagine the act of disbursing $6 million dollars in $1,000 chunks throughout the world! It’s certainly possible, and groups like Spark MicroGrants, Watsi and Kiva have built organizations to match needs or plans: that’s why we have social entrepreneurs.  But without a clear need or even a loose plan, encouraging an aid worker to develop a “healthy relationship with risk,” by expressing their personal preference for local programs in the name of the American people endangers the credibility of USAID.  Especially when there are clearly better uses of time, creativity and money.

Together, we need to make sure that programs like PEPFAR remain at the center of public and congressional attention.  Built into PEPFAR are ways to coordinate with the goals of countries where aid is being invested, while creating avenues for innovations to sustain and deepen the gains we have achieved.  This is why CHWs are a smarter investment strategy than trying to motivate aid workers who’ve lost their sense of purpose.  There is nothing wrong with making bold suggestions or calling for innovation.  But let’s make a concerted effort to build upon what works.

Prabhjot Singh is a Truman Security Fellow.