Robb Davis Interview

Today on healthtwine we have our first interview, and it’s a great inaugural post. We’re having a conversation with Robb Davis, a veteran of the development field.

He’s been Director of Health Initiatives at Freedom from Hunger, a nonprofit that couples microfinance with health education for women. He has decades of experience and has been a part of many other international non-profit organizations, and it’s very fortunate to be able to get some of his thoughts.

In this interview, we talk about the role of non-traditional health programs around the world, the role of advocates in promoting change , some examples of global policy impact , and some avenues for promoting the health of human beings .

Here’s a brief summary of his points:

• We know that global health is a very multifaceted issue, but we need to do better in reaching out across disciplines
• We need to not only supply health solutions, but also teach people how to use them effectively
• Advocates are essential! They connect the people and the stories on the ground with policy makers
• Many government policies, such as child labor laws or family planning rules, have a large impact on global health, positive and negative
• There are interesting things being done in health, such as direct legal action or battles over food sovereignty, and is bad to be too complacent, but we need to remember to be patient when tackling these large, structural issues

With that said, we’ll let Robb speak for himself:

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Non-Traditional Health Programs

healthtwine: Hi Robb, thanks for talking with me today. First, I’d like to ask you why you think non-traditional health programs are sometimes more successful or more comprehensive than the more traditional ones? In other words, what do non-traditional programs bring to the table that traditional ones have not?

Robb: I think the issue is that traditional health programs are very tightly focused. Health practitioners come, donors come, researchers come, and they’re all basically looking at it strictly as a health problem. They may be looking at a behavioral problem, they may have a primary health care focus, they may have a broader community development focus; but often, when the rubber meets the road, they focus narrowly on just health intervention.

When we talk about non-traditional programs, it’s more about an integration of health with other forms of intervention. A non-traditional approach, in that sense, would be to maybe say that health is wrapped up in issues of housing, in issues of women’s empowerment, in economics, in all those things. We know these things matter. We know all those things are true. But too often, we retreat to narrower, sectoral interventions.

“…health is wrapped up in issues of housing, in issues of women’s empowerment, in economics, in all those things.”

The area I’ve had the most experience in, obviously, is the intersection between health and microfinance, or health and economic development. In my experience, the struggle is not one where people cannot identify the multi-causality of health, but instead really dealing with intervention and dealing with the community. That’s because those of us in the field are trained in those sectoral areas. That’s what we know, and going outside of those areas are uncomfortable.

So in the area of microfinance, what’s been most interesting for me is to get the two sectors to talk to each other. I think that’s been hard, and I think what’s made it possible is that people on the business side — not on the health side, interestingly— say, “You know, our bottom line is affected by the poor health of our clients”. People on the health side know they need to do the economic development, but they don’t reach out to them. I don’t think they trust them. I think they’re wary. They don’t know the language.

healthtwine: Can you provide a few specific examples of how these non-traditional health programs have tackled a problem in a population differently and perhaps more comprehensively than the more traditional health program would have?

Robb: Yes, well I think there are a number. I think there’s value in Credit with Education, which is the strategy that Freedom From Hunger uses, utilizing microfinance as an agent to deliver education and increase health services. I’ll use malaria as an example.

Malaria is a huge problem, as you know, and it affects children, pregnant women, and whole communities in terms of lost economy. There were other health programs that were milling around, but they weren’t connecting services like delivering drugs with the instructions to help enable people to effectively use those services. For example, delivering malaria bed nets, but not instructing people on how to properly pitch them.

Well with Credit with Education, the credit services enabled women to engage in small business activities in a place like Burkina Faso. Meanwhile, the malaria education was immersing them in dialogue around causes, preventive actions, and then treatment once malaria hit. This way, we not only have businesses to help provide the nets, but also provide the women with the means to access and use them effectively.

Then there’s this guy over in the Bay Area, Chuck Slaughter, who has an organization called Living Goods and they’ve been working with a large, well-known organization called BRAC. BRAC has done some great work on poverty reduction in Bangladesh, and now the two organizations are working together in the Uganda branch helping women start small businesses, like franchises, to sell low-cost health products. They sell a variety of products, many of which are very focused on life-preservation, such as bed nets. And the franchise guarantees some level of quality control. So that’s another hybrid approach which is very powerful.

What I like about it is that you have people who really understand the issues of sales and marketing working with women and helping them develop sustainable businesses that are also in the women’s interests.

A lot of organizations are doing integrative approaches at the community level. They’re dealing with water, sanitation, finance…so that kind of approach has been out there for a long time. The question is, and it always comes up, are the development agencies leaving behind improved capacity?

Advocacy

healthtwine: What are some ways you’d like to see these programs improve in the future? Any developments points you’d like to see expanded or focused more upon?

Robb: There are three areas I would like to see more attention focused on: advocacy training, leadership development within NGOs, and the whole issue of cross-sectoral problem solving.

I’d like to see more done with advocacy organizations, and for health organizations to do more public policy advocacy. Louis de Gama, an activist for Global Health Activists, has worked on advocacy around AIDS, tuberculosis, and malaria.

The thing I like about the Global Health Activists is that they’re basically focused on getting more resources flowing to health.

“…it’s about how to help people in different sectors come together and work together to solve problems”

They’re doing it a number of ways: they do the public policy advocacy in the [global] North, but they’re also helping the organizations in the South do advocacy. I think a greater focus on advocacy organizations helps southern actors to do more local advocacy. That’s one sector.

Another sector is the burgeoning civil society in the South. They’re weak in a governance sense because they’re organizationally very young, but they’re doing important work, including advocacy and grassroots development. The pleas for leadership development and nonprofit management have come from the leaders of NGOs in the south, saying there’s a whole lot that needs to be strengthened and whole areas for leadership development for NGOs in for civil service. That’s a huge area.

And finally, we have to help develop different approaches. This means helping different actors in resource-poor environment by bringing government and civil society together to do good regional planning around health and other things. The leadership development sector has given us a whole set of learning and visioning processes. Ultimately, it’s about how to help people in different sectors come together and work together to solve problems.

healthtwine: You mentioned advocacy as an important part of these non-traditional health programs. What do you think is the role and the importance of advocacy on these global health issues?

Robb: I think it’s incumbent on certain bridging-type organizations or inpiduals possessed with the gifts and the skills needed for advocacy to take these compelling stories to the politicians - the policy makers. That’s the role of the advocate: that at the end of the day it’s about connecting people; connecting policy makers with the people on the ground. I’m looking more and more at those connecting people who see it as their role and, really, as their responsibility to make those connections.

“That’s the role of the advocate: that at the end of the day it’s about connecting people…”

Policy makers are busy people and activists are busy people. I’ve done some advocacy in Washington and I’m amazed at how the policy makers feel disconnected; or if I’m at the UN, how they feel disconnected. I’m not saying it completely turns their policy thinking around, but it certainly confronts them with a different reality than they’re used to dealing with in their bubble. So I’m more and more interested in preparing people to work in the realm of connecting.

healthtwine: Do you have any examples of how advocacy or advocacy groups have been effective in bridging that disconnect between the policy makers and the people in need of help?

Robb: I’ll use Justapaz as an example. They’re a church-based organization in Columbia that basically connects the stories of Columbian peasants to policy makers in Washington. They document and connect stories of human rights abuses in Columbia, and with another partner organization, they have days of action in Washington. They’ll have days of prayers, reflection, and meditation.

And what they’ll do as a group is span out over Washington and visits congressional offices and talk about their realities. And at times, they’ll bring Columbians into Washington. Now has it changed US policy in terms of the war on drugs, and all that? No, maybe not yet. But it’s there, as a reminder, and it definitely brings the reality of policies into Washington.

Another example was a number of agencies around the UN led by the Quaker United Nations Office. The Quakers decided that they were going to focus on forgotten conflicts around the world that were off the radar screen of a lot of people in the U.N.; so they started documenting and getting involved in Northern Uganda, where the Lord’s Resistance Army resides. They started doing policy briefs and conducting information sessions; they started bringing in Northern Ugandans. So that was instrumental in actually getting much more attention focused. Unfortunately, that has been an intractable conflict, but there has been some progress made.

That’s a development-practitioner role, because it takes a development practitioner to sit and understand the realities of poverty or violence or whatever the issues are they’re dealing with, and translate that into language that addresses policy makers.

“India’s a great example. India has a number of large programs that help the poor.

Policy Impact

healthtwine: I’d like to focus the conversation now more on that connection between policy and global health. We’ve talked about business and education in terms of public health intervention. I want policies, and in a larger sense, law, to be brought into that same discussion. What I want to explore are how governmental and international policies and laws impact global health. Can you think of any examples from your experiences of how policies and laws have directly, or indirectly, impacted health?

Robb: Well, there are lots of those examples. India’s a great example. India has a number of large programs that help the poor. The issue then becomes how to interact and connect to those people in the government programs; how to enable them to have access to the services that they need. They’ve got a billion people, and a rural employment program available to people, but people don’t know how to access it.

Another example would be the West African governmental changes to drug policies. Ten years ago, all countries in West Africa were using chloroquine to treat malaria, so we were getting resistance rates of 15-20%, and that’s not acceptable. You have to switch to a new drug.

“…whether it’s laws related to female genital mutilation or domestic abuse, those are public health issues to me.

Now it’s one thing to promulgate that policy and it’s another thing to get the drugs into the hands of people in a way that won’t increase resistance. Those policies are an opportunity to get drugs out, but they also present enormous challenges in how do you do it.

Child labor laws are certainly another example. There also have been more and more laws written for women’s rights; so whether it’s laws related to female genital mutilation or domestic abuse, those are public health issues to me.

An example from the microfinance world would be consumer protection laws that require truth in lending. Again, that’s not health that’s microfinance.

An area with a lot of potential is the area of basic human rights

Generally, the younger countries that I’ve worked in around the world have less developed set of public health protections in place because they may be weaker in their ability to develop laws.

healthtwine: What are some policies and laws that have been enacted you find to be promising? And what is an area in policy and law that you see has a lot of room for progress in the future?

Robb: I think a number of south Asian countries are putting child labor laws into place. India is a country that has made a lot of progress and their labor laws are actually being used to keep people from being enslaved.

An area with a lot of potential is the area of basic human rights, women’s rights, child labor, and women’s abuse. We’re starting to see more effective things put into place. But broader sort of issues like smoking or water and air quality standards are still being neglected. A lot of countries have bigger challenges they have to approach before they tackle those issues. China and India are putting those into place now, but in terms of those broader things, I think there’s still a long way to go.

healthtwine: Can you think of any recent policies that have had a significant, and negative ramification on global health?

Robb: The classic one in this country has been the policy in funding for family planning overseas and in the US. Another one has been the policy of this current administration around AIDS prevention and education. Those to me are just examples of policies that have been disastrous.

healthtwine: And what do you think has been the result of those policies?

Robb: I think the result is missed opportunity to engage people in discussion. I’m all for talking to young about abstinence, but the reality is that people aren’t going to abstain from risky sexual behavior. So it’s necessary to talk with them in a dialogue and make sure other things are available to them to prevent and to treat AIDS. Family-planning gag rules, which keep people from talking about certain family planning approaches, limit the opportunities of women, who especially need a broader understanding of their choices for family planning. The gag rules limit their ability to be in control of their health.

healthtwine: What are some factors you think lead policy-makers in government to create bad policies?

Robb: I think one factor is self-interest. For example, the United States government links their policies to their very narrow political interests and national security interests. That is potentially very dangerous. These policies are not based on need or where the potential problems will arise, but where we currently have some kind of national security interest. So lots of money goes to certain countries and many countries get neglected. I think that that aid gets tied to and become easily co-opted by the national security strategies of the countries, rather than trying to meet the greatest need. And I think that’s really unfortunate.

The Way Forward

healthtwine: Can you think of any organizations that are actively discussing how to change policies and maybe even trying to change the laws they feel have an adverse effect on global health?

Robb: Well, if we go out more broadly and if we think about violence against women, there would be a number of organizations. I’m thinking of one I know about: the International Justice Mission.

What they’re doing is taking a direct action approach. They take a direct legal action approach to free people from slavery, and they do this both with child slavery, sex slavery, and labor slavery all around the world. And those things to me are public health issues.

Another group, a whole other sector, is food sovereignty. Organizations like Food First, the Oakland Institute, and others doing policy research like IFPRI, the International Food Policy Research Institute in Washington are against seed patents and they’re trying to develop legal protection for farmers to be able to use seeds. So, those are organizations I would look into. It’s fascinating, because they’re basically calling into question whether food should be treated as a commodity or a human right.

healthtwine: Thanks a lot for your time and your ideas. Do you have any final words on the future of these multi-faceted tackling approaches on global health issues?

Robb: I really think the key is partnership. I think it’s good to have organizations that have their niche that do things well. I don’t think every organization needs to be a big multipurpose organization. But what I’d like to see is more effort put into finding alliances that build on the strength of inpidual organizations. I know it takes time and effort.

We’re talking about long-term processes. These things, by their very nature are very complex; all of development is complex. So these are multi-faceted approaches that require time and patience and we don’t see results necessarily overnight.

Take racism, for example. That is a long-term structural issue. But we saw in this recent election that these long-term struggles can yield change. So I think we should be hopeful, but realize we’re dealing with some very powerful forces, that take a lot of effort and a lot of patience.

“I want people to be impatient about those who would say, “That’s just the way it is”.”

It’s a hard balancing act. I want people to be patient in terms of not giving up. We can say these are long-terms societal issues — that we just need to roll up our sleeves and engage in over a long period of time. In that sense, I want people to be patient.

Where I want people to be impatient is in accepting that reality as a given. To not say: well, you know, there’s only so much we can do; well, there’s only so much policy makers can do; well, there’s only so much time in the day; well, there’s only so many resources.

I want people to be impatient in not accepting that. I want people to be impatient about those who would say, “That’s just the way it is”.

But I do want them to be patient in saying that’s not just the way it is, we can’t just throw money at it, we can’t just devise some quick fix and it’s going to take a lot of people over a long period of time to fix it. So let’s roll up our sleeves, I mean what else is there to spend our time on?