We didn’t look for it, and we sure as hell don’t condone how it happened, but the era of Big Aid is over. The callous glee with which our own administration choked off aid is something I will never forgive or forget, but sadly we’re not alone. Other rich countries have tacked to the right, decided to spend the money on defense, or simply lost sight of generosity. The fix is in.
Where this matters most is Africa. India declared itself independent of Big Aid years ago, and our own India portfolio is largely unaffected. The governments there—federal and state—have the will, the dough, and the capacity to scale up good ideas. Countries in East Asia and Latin America are in relatively good shape, with tax bases that can power government action. In Africa, governments have little to spend, and—in the short run, at least—these cuts are really going to hurt.
Whether they’ll have a long-term negative effect on development is debatable. The truth is that in 30 years of trying to figure out how the ideas of social entrepreneurs go to scale, I’ve seen very few instances where Big Aid proved to be a reliable and realistic player. There are a lot of ways that Big Aid plays an essential role in humanitarian work, but scaling up big ideas? Nope. It was mostly hopscotch projects and way too much stuff that just plain didn’t work.
Big Aid has always been an expression of rich-country power, and it has not escaped the notice of many Africans that GDP per capita has remained flat despite it. Georgetown professor Ken Opalo has argued that African countries must urgently start the process of ending aid dependency; he—and a lot of other people better-informed than I am—believe that the present moment provides an opportunity to make something happen that has needed to happen for a while.
Maybe. Beyond my pay grade. All I know is that Big Aid has badly needed reform, and it’s mostly gone for now. Maybe it will come back in some more useful form, but I doubt it, and certainly not tomorrow. Imagining a development future without Big Aid is hence the wisest—and paradoxically the most optimistic and creative approach we can take.
We need interventions and strategies designed for what African governments can and will do—without Big Aid. We knew that governments needed to be the doer-at-scale—what’s become clear is that they, not Big Aid, will have to be the payer-at-scale too. At Mulago, we’re thinking about the changes it will take in these terms: What, Where, and How.
What
We need to design stuff that African governments can afford, and that means designing toward one critical number: “the marginal cost per beneficiary if the government delivered your intervention.” Most organizations hoping to scale up via government don’t have that number, and we are a long way from a standardized way to get it.
A good example of getting that number is Healthy Learners, scaling up their idea of teachers as health workers in Zambia. After start-up costs, the government will need to spend just a buck fifty per school kid per year to run the program as their own—something Healthy Learners figured out early in the process. Given that this represents less than 1 percent of the current spend per kid, it’s almost certainly cheap enough for government ownership and implementation.
This program is “cheap enough” because it represents a reallocation of the time of existing salaried employees—a few teachers per school—and because those teachers are armed with tablets that run ThinkMD’s clinical decision-making software, a tool that helps them do something they could not do otherwise. Healthy Learners exemplifies two themes that will need to dominate future thinking in Africa: Solutions that involve the reallocation/reassignment of existing people and resources and the use of emerging technologies to empower existing people to have more impact. Tech is no panacea—technology in service to a bad idea is just lipstick on a pig—but the right tech in the right hands can drive impact at a cost unattainable just a few years ago, and we’re only beginning to understand what well-conceived applications of AI can do.
“Cheap enough” depends on who’s paying, and with all due respect to our effective altruism buddies, “cost-effective” does not necessarily mean “cheap enough”—somebody has to be willing to pay. Ferreting out who in government makes decisions about costs is an essential part of determining out whether something could in fact be paid for by a particular government. There is plenty of stuff that RCTs have proven is cost-effective in terms of DALYs or dollars—like Give Directly’s big cash transfers—but is still way too expensive for African governments to ever scale up.
There are a lot of things that African governments do competently, and there are affordable ideas within their reach. What we’ve not done—because the prospect of Big Aid has allowed us to avoid it—is design interventions to hit well-informed cost targets. We mostly design (if we design at all) without cost targets, then shave costs and look for economies of scale, hoping for some threshold of cost-effectiveness that is not based on anyone’s willingness to pay. Cheap-as-we-can-make-it is often not cheap enough, and cost targets are a great driver of the kind of ingenuity and creativity we really need right now.
Where
Organizations often try to scale in a given country for one of two reasons: They happened to start there, and/or they are compelled by the profound need for their solution. Neither is the right one. If you have a solution that you believe should and could be scaled up by governments, then your choices should be driven by potential, not need. The critical ingredient in the drive to scale is momentum, and a fatal error I’ve seen way too often is to get bogged down in a country that can’t or won’t own the solution and scale it. Need is everywhere, but potential varies a lot from country to country. You’ve got to drive toward potential.
A simple first-approximation tool that we find useful is something we call “should/could/would.” You start with the countries that, given need and stated priorities, should be interested in your solution. Of those, you identify those that, by dint of resources and capacity, could deliver the solution if they wanted to. Could isn’t enough, though—you have to then figure out within that group (if there are any) who would, meaning who would make the solution their own and commit to do it well. You got to find the would-dos, and if there aren’t any—and anything less than gut-wrenching honesty could lead you to waste huge amounts of time, effort, and spirit—then you’ve got the wrong solution and it’s time to go back to the drawing board. And for funders, I’ll just say this: Your geographic restrictions make even less sense now than they did before—you’ve got to let organizations move toward potential.
How
I was talking to my friend Nithya Ramanathan (the founder of Nexleaf) the other day about working with governments and she said something that nailed it: “No more of these transitions to government.” Yes! The government needs to own it from the outset. Too often we try to back into government adoption and implementation, taking comfort in bullshit “evidence” like token government payments and “in kind” contributions. It almost never works. We end up with incomplete, half-assed scale-ups that accomplish god-knows-what fraction of the original impact of the intervention. Often—too often—the NGO thinks the government is scaling their idea and the government just thinks they’re getting free services.
Another friend of mine, Rakesh Rajani, has any number of wise things to say about working with governments. He told me about a conversation with a senior Indian bureaucrat who said that NGOs wanting him to do this and that were like flies buzzing around his head, distracting him from the job he was supposed to be doing. I can’t get that image out of my head: it applies even to organizations I consider to be world-class.
We need a whole new approach toward helping governments achieve their ends in their way. Doers should be partners in joint ventures where they use philanthropic money to make stuff happen that the government will do and pay for. As an NGO, once you find the right place to work, you actually have a pretty potent value proposition: You bring ideas and know-how to help the government do something it wants to do—and you do it for free.
Scott Roy, a renowned sales expert, has written a very useful book about sales and impact called Sell Well, Do Good. Done right, sales boils down to this: Your product needs to be the solution to the customer’s problem. If you can’t get there, you don’t have a sale. When working with governments, your idea must be the solution to the problem they think they have, not the one you think they have, and if you can’t get there, don’t even bother. And remember that governments are people, and people are individuals. If you don’t come to know and respect them as such, you’re doomed from the start.
There is much more to say about working with governments, but I’ll just add this: Send in the A-team. Too often, I see organizations engaging governments with B-team talent (if that). If you’re serious about scale, assemble the best. These are the people who will make the difference between linear impact that depends on the eternal growth of fundraising or exponential impact with a flat budget. Send in the pros.
To approach what, where, and how differently—and differently enough—is going to require some big pivots on the part of a lot of great organizations. Too many people are still wasting energy on figuring out how to keep doing what they were doing before the world changed. We—along with other serious funders we know—want to encourage fresh thinking and doing by making available the money to make these pivots possible. Our own Mulago board just approved a $5 million set-aside to provide nimble capital for organizations already in our portfolio to take on this challenge—just for fun, we refer to it as the “Rise To The Occasion Fund.” If we want to see these changes happen—and we really, really do—then we need to fuel them. If the doers are up for it, we funders had better rise to the occasion.
