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Is “integrated development” the future or just a fad?

This post originally appeared here.

At the start of UNGA week, I attended an event called “The Next Generation of Development: Integrated Investments for Youth.” There was basic agreement among the illustrious panel of experts, which included UN Women Executive Director Phumzile Mlambo-Ngcuka, Founder and Executive Director of the African Institute for Development Eliya Zul and U.S. State Department Special Coordinator for the Post-2015 Development Agenda Tony Pipa, that integrated development is the wave of the future we all need to see and support.

But a lot of questions were also left unanswered and require the serious input of everyone working in development to try to figure out some answers.

In general, “integrated development” refers to attempts to work across development sectors to bring more holistic programs to resource-limited settings. Integrated development programs could include components dealing with education, health, governance, policy, human rights and other areas, rather than work in just one sector.

Notably, there was a lot of talk at the event about “evidence.” At one point, the moderator, journalist Femi Oke, asked the panel what the evidence on the benefits of integrated development says. When panelists tried to answer mostly by discussing the difficulties of collecting evidence on the benefits of integrated development and various attempts to do so, Oke was not satisfied and replied, “But you didn’t answer my question–what is the evidence?”

It’s no wonder the panel didn’t have a straightforward response to this question; the evidence for integrated development approaches isn’t terribly extensive. This is not surprising given the fact that most development work currently takes place within well-structured siloes in health, education, human rights, etc. FHI 360 conducted a literature review earlier this year and identified 25 interventions in the published literature that met their definition of “integrated development” and their standards for sound study design. Of the 25 interventions, 13 produced positive findings, 9 produced mixed results, and 3 suggested a neutral or unknown effect.

The authors note that part of the lack of evidence has to do with the quality of existing evaluations. In fact, they observed that the vast majority of integrated development approaches occur informally without properly conducted evaluations. In many cases, for example, a health organisation may tack psychosocial support on to HIV treatment programs, but not adequately measure the specific effects of integrating psychosocial support into the more traditional healthcare-only program. A proper impact evaluation would require several comparison groups, including one that received HIV treatment but not psychosocial support. Very few organisations undertake such rigorous evaluations, even though this is the only way to answer questions about whether and when integrated development approaches are appropriate.

Making sure rigorous evaluations on integrated approaches are conducted is just the first step. How to measure outcomes with multiple approaches and sectors involved is an important topic for discussion. Even within specific sectors, such as global health, indicators and outcome measurements are not standardised. Across sectors, they are even less standardised. The wider development community needs to have an in-depth discussion about how to standardizssendicators, who develops these indicators,and how they can be utilised in widely differing settings.

These types of complex questions are what led Mlambo-Ngcuka to point out that that integrated development is not easy. Bringing stakeholders from different sectors together can be extremely difficult, and it requires time, careful planning and sustainable funding.

As she also noted, “Integrated development is not a panacea.”

This was certainly the most important take-away from the evening. There are situations in which specialists alone are needed. Smallpox eradication is an example of a single-sector intervention that was absolutely revolutionary.

Integrated development is going to become more and more prominent as the SDGs unfold because, at least in design, the goals in the SDGs are very interconnected and often call upon multiple sectors to work together to solve each problem, one of the key differences from the MDGs.

As we work within this new development framework, it will be important to push for the strongest possible evidence to guide us in our efforts to identify the best approaches and best interventions to advance human development.

– See more at: http://www.whydev.org/is-integrated-development-the-future-or-just-a-fad/#sthash.nuf3IFTU.dpuf

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Does crowdfunding have a place in global health?

This post originally appeared here.

What does crowdfunding have to do with global health and development? The association between funding potato salad and improving the world may not be immediately obvious, but in an environment where sources of funding for health and development are dwindling, crowdfunding is increasingly becoming a viable option for non-profits in need of funds.

But what’s the actual benefit of crowdfunding for global health and development? It seems obvious how crowdfunding can help individual entrepreneurs and artists gain funding for their projects. Many of them may not have funding structures in place and need an outlet to pitch their projects and ask for money. But most non-profits already have fundraising programs.

So, why would anyone donate to a health or development project on a crowdfunding site rather than giving directly to a charity?

Crowdfunding sites offer several unique opportunities that attract donors and can even elevate the quality of projects. They usually offer a great deal of transparency to donors. Most crowdfunding sites require organisations to post a specific project and explain the breakdown of funds. A project with high overhead costs is usually not attractive to donors.

Rather than simply giving to an organisation as a whole and never being sure about where your money is going, crowdfunding sites identify a specific, traceable project and provide information about how precisely your money is being used. Project “owners” usually also follow up with donors with real outcomes so they can clearly see the impact of their donation.

In global health in particular, there are many small NGOs that work on the ground and have important knowledge about local communities but lack funds because they’re not very visible to donors. Because they’re small, they often don’t have the PR and marketing capabilities to be visible to most philanthropists. As a result, they can find themselves lacking crucial funds to finish a project. Since the traditional grant application process is so long and tedious, NGOs in this position may end up shortchanging their programs, at least in the short term, while they wait for new funds to come in.

Crowdfunding sites allow NGOs to gain visibility among donors in the general public, and they also allow for a relatively rapid and seamless transition of funds. Health seems like a particularly important area for a dedicated funding focus, since so many issues in international development are connected to health. And global health is a particularly good area for crowdfunding since many extremely impactful global health solutions can be implemented so cheaply, and crowdfunding is a way to mobilise the masses to raise small amounts of money for discrete but highly effective projects.

To this end, there is a new crowdfunding site dedicated exclusively to global public health that seeks to address some of these problems. The site, CaringCrowd, was created by Johnson & Johnson and allows global health NGOs to post campaigns and receive funding from anyone who wants to contribute. It provides a space to donate to real, active global health programs that have been vetted by an advisory panel of distinguished global health experts. To be on CaringCrowd, projects must clearly benefit health and have health outcomes as the focus, and must not violate internationally accepted medical principles. Public health projects are presented in a consistent format to allow for easy comparison, and all projects operate on an all-or-nothing model, meaning that if projects do not reach their funding goal by the time the campaign ends, the project owner receives no money.

Perhaps most importantly for NGOs, the site operates on a non-profit model and is thus free to use, leveraging Johnson & Johnson’s resources to support and sustain this effort. As part of this effort, the site also includes educational materials, news about global health, first-hand accounts of working or living in resource-limited settings and career advice for people interested in entering the field.

Crowdfunding sites like CaringCrowd give small NGOs a voice as they seek essential funds to address specific health needs in resource-limited settings, and they give potential donors a way to rapidly understand a variety of projects in order to make giving decisions.

– See more at: http://www.whydev.org/does-crowdfunding-have-a-place-in-global-health/#sthash.oMh0j3NE.dpuf

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Ebola has Taught us a Crucial Lesson about our Views of “Irrational” Health Behaviors

This post originally appeared here

As Ebola rears its ugly head in the U.S., there has been a lot of discussion about how afraid we really should be. While health officials have remained relatively calm, insisting in a tense congressional hearing that there is no need to panic, some members of the American public have gone in the opposite direction, proclaiming a state of emergency on social media channels such as Twitter and Facebook. Donald Trump has been an especially noisy voice on the topic on Twitter, demanding that Obama stop all flights to and from West Africa and proclaiming that Ebola is actually much more contagious than the CDC says it is. At the end of September, with the announcement of the first suspected case of Ebola in the U.S., Trump expressed panic on Twitter, writing:

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Trump’s comments suggest not only a distrust of health authorities but also a kind of hysteria, with the use of the word “plague,” that is reminiscent of the infectious disease panic seen in many other outbreaks in American history, including SARS in 2003 and bubonic plague in 1924, the latter an outbreak that famously led to the frantic firing of thousands of Latino workers and destruction of homes in low-income Latino neighborhoods because they were seen as the “source” of the disease.

At the same time, a good deal of the coverage of the Ebola crisis in West Africahas focused on the “irrationality” and “ignorance” of West Africans, choosing to visit traditional healers instead of doctors and ignoring warnings from health officials that traditional burial rituals can hasten the spread of the disease. Indeed, this “lack of faith in Western medicine” is now being addressed by local and foreign health officials who are running educational programs in places like Liberia and Sierra Leone in order to ensure that the people exposed to the illness have the correct scientific information.

But while certain cultural practices and lack of education have certainly played a role in the rapid spread of Ebola in West Africa, the amount of attention we have paid to the “ignorance” and “irrationality” of people living in these developing countries has not been balanced with an equal amount of attention to our own developed nations’ manifestations of similar irrational health beliefs. Are we really that much more knowledgeable and rational than our West African counterparts, or do our irrationalities and psychological missteps simply take different cultural forms? And do our ignorance levels and irrationalities have the potential to be just as dangerous to our health as seeking out a local healer instead of a trained healthcare professional in response to a life-threatening viral illness?

Some recent news articles have focused on the need for anthropologists in the response to the Ebola outbreak in West Africa. These anthropologists have noted that the response to any disease outbreak or epidemic is fundamentally social and cultural. In this same vein, our response here in the U.S. to Ebola (and likely in other developed nations) is similarly prone to social and cultural inflections, psychological influences, and misinformation.

For one thing, responses to “exotic,” novel infectious diseases seem to incur a kind of panic in the U.S. that is often out of proportion to the actual threat of the illness. This leads to a situation in which people worry about these illnesses to the exclusion of other, more serious threats, like the seasonal flu, a highly infectious airborne virus with no reliable cure that is known to cause many deaths every year. Misunderstanding the relative risks of Ebola and the flu is not only irrational but also misinformed. Because we are accustomed to the flu but not to Ebola there may be a temptation to think the former is less of a threat than the latter when in fact the opposite is the case.  What is the most effective treatment for Americans to protect themselves from early death by an infectious pathogen? A flu shot.

In the U.S., our responses to infectious disease outbreaks can also sometimes tap into embedded racial tensions. For example, the widow of the first American citizen to die of Ebola has noticed that many members of the sizeable Liberian community in the Twin Cities are being ostracized because of fears of the disease. One Liberian friend of the widow—an individual who had not had any contact with an infected person–even had a doctor refuse to examine her.  This kind of behavior among healthcare providers is not only irrational but also potentially dangerous, since it tends to foster distrust of the medical community.

Finally, distrust of government and a tendency toward conspiracy theories also seems to become a particularly popular trend in response to infectious disease in the U.S. In early October, a doctor strolled through the Atlanta airport wearing a hazmat suit reading “CDC is lying”. Needless to say the idea has gained traction and is now circulating around the internetoften alongside a series of other “lies” fed to us by the government. This is particularly dangerous, since it leads to a general erosion of the public’s trust in our nation’s public health authorities and it tends to spread false information. A recent survey by the Kaiser Family Foundation showed that 25% of Americans believe that Ebola can be transmitted through the air and 37% believe that Ebola can be transmitted by shaking hands with someone who has it but is still asymptomatic.

So are some of the views of West African citizens on Ebola irrational and misinformed? Yes, and this is a dangerous problem that needs to be rectified. Yet, and I would argue in many ways equally as dangerous, some of the views of people in developed countries such as the U.S. on Ebola are also irrational and misinformed. This is also a serious problem that needs to be rectified. Perhaps anthropologists are also key in the developed world’s fight against the Ebola virus.

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