'In 23 countries in Africa and expanding rapidly'

Jeffrey Sachs is widely known to the development community as a luminary and a lightning rod. Since helping to turn around struggling economies in Bolivia and Poland in the 1980s, the famed economist (a tenured Harvard professor by the age of 28) has become among the world’s most prominent advocates for development aid. His tireless advocacy and firm views have gathered both powerful allies — among them the U.N. secretary-general and Bono — and persistent critics. He is among a small group of development leaders who have broken through to mainstream attention: Just two years ago he nominated himself — only partly to make a point — as World Bank president. From his perch as the director of Columbia University’s Earth Institute, Sachs continues to serve as the spiritual guide of the Millennium Villages Project, which he founded in 2002 to prove that rural poverty can be eradicated through a targeted combination of international expertise and subsidized seed, fertilizer, medicine, bednets and the like. Following a visit to the first Millennium Village in Sauri, Kenya, I caught up with Sachs to talk about the $25 million-per-year project, its critics and where development is headed. The sort of popular understanding of the Millennium Villages Project that I get when talking with people in the global development community is that they know it’s something you initiated, they know it’s village-level and integrated development, and they’e heard there are some critics out there or controversy around it. That’s about it. If there were just one or two things that you could communicate to the community of development professionals that they ought to know about the MVP or that they would be surprised by, what would they be? You’ve got to appreciate that it is in 23 countries in Africa and expanding rapidly, so it has found tremendous success and support by governments across the continent, and for a real reason, because it is bringing practical approaches to local development, especially in rural areas, and doing it in a way that is tapping into advances in technology. So I’m very gratified that not only has the concept proven its worth, but it is spreading very rapidly. And what are the plans after 2015? As I understand it, the project was designed to focus on the Millennium Development Goals — those end at the end of 2015 — so where do you see the project going afterwards? I understand it’s meant to close down and be transferred to government, but what does that mean in practical terms? There are two senses of this project. One is a specific ten-year project to help poor communities achieve the MDGs. That will end at the end of 2015 and, based on extensive survey work during 2015, we’ll release the report on the results of this ten-year effort in the middle of 2016. There is a second sense of the project which is the idea of developing new, low-cost, effective tools for integrated rural development, and that work definitely continues past 2015, and at national scale in many countries in Africa. We have very active work underway, especially using IT in health, in education, in agriculture, in data management and information systems, in infrastructure, and that work is scaling up in general. So, the Millennium Villages as a specific project will finish at the end of 2015, but the Millennium Villages as a concept of integrated rural development tapping into the best of new technology will continue to grow and operate with governments across Africa and indeed in other parts of the world as well. This has been and continues to be a wonderful platform both for demonstrating what can be accomplished with the things that are known, and also devising new approaches, especially as technologies evolve. We’ve been in the forefront over the last eight years of the scaling-up and increased capacities of community health workers, for example. As new technologies have come onboard, like rapid diagnostic tests for malaria, this has enabled a change of health delivery of great significance. And, just to continue with malaria, it used to be that basically one needed to get to a clinic for diagnosis and treatment, and now you can do the diagnosis and treatment in the community. This is life-saving, it’s transformative, it changes the whole delivery system for a crucial threat to human health in Africa and we’ve devised very effective ways for community health workers now to bring malaria control into the communities. And we’ve championed, as a result of that, the scaling up of community health worker programs and indeed the Earth Institute is spearheading a large campaign to have continent-wide scaling up of community health workers. I am working with key agencies, including the World Bank, the Global Fund, and UNICEF, to mobilize the resources and expertise for the rapid scale-up of CHW programs. We have lots of government and corporate partners and NGO partners in that effort right now and it’s based on learning and developments from the Millennium Villages. So this is a learning base and it has been a very rich learning base for health care, for education. We have a lot of breakthroughs in Muslim communities where children were not in secular education but through arrangements with the Koranic or the Madrasas schools, we now have expanding educational activities and a lot of community satisfaction with this. We have some very important breakthroughs in information technology and how it can be used. Of course this is something that has been one of the most important surprises of the whole project. There were no smart phones at the beginning of this project and there was essentially not even mobile phone coverage at the start of the project. As mobile phones have spread and as smart phones have developed, it’s enabled us to do a lot of things that were not possible before, for example providing electricity through solar microgrids supported by mobile telephony. I sit on the United Nations Broadband Commission and I chair the Subcommittee on Broadband and Health, and we’re trying to use the Millennium Village platform as an effective way to develop many of these technologies. We have an important telemedicine project that is very successful underway in Ghana right now in partnership with the Novartis Foundation, for example. We successfully migrated from a cell phone to a smart phone-based support system for community health workers. We have a pre-pay, off-grid, electricity system. So these are examples of why so many governments are excited by this project. They’re also an illustration of why so much of this outside criticism such as it happened has been completely beside the point and very uninteresting for us, because these critics never even went to a site, they had little understanding of what this whole project is all about and I didn’t have too much interest in them because they didn’t take the time to actually learn about it. I want to get to the critics, but just for another moment I’d like to talk about the 11 villages where the MVP is working [the other dozen projects are run by partner organizations using the MVP model]. I assume they’ll be at various states of success at the end of the project: Some will be doing very well and meeting all the goals you had set and others perhaps not as well. For those that are not where you want them to be, will they also cease to get funding, or will there be some kind of transitional plan? The project is not going to continue to fund these sites. This is a 10-year project to support these communities to achieve the Millennium Development Goals. We’re still hoping that all the goals will be achieved in all of the sites, but whatever occurs and however far they get, the project itself will not continue directly financially supporting them after 2015. The project is working with the host countries for a smooth transition after 2015, in order to keep the strategies and facilities operating effectively. Got it. And when we visited just one site and obviously just for one day, a big part of the theme was around this transfer to government — and trying to build the capacity within government to take on a lot of what was built during the ten year phase of the project. Will there be ongoing evaluation of any kind to see how well government is taking this up and what learnings or best practices could be gained from that experience? Right now, our plan extends to very detailed and thorough analysis of what these 10 years have meant, and on July 1, 2016, we will release quite an extensive report, probably in several volumes actually, describing the project, evaluating the progress to the MDGs, making comparisons with other places in these districts where we’re operating. What will happen after that is not set yet. I am discussing with a number of possible partners the establishment of a longer-term monitoring and learning process, to continue to reap benefits of the learning in these communities. I think you predicted one of my questions with your earlier reference to critics of the project: Is there some kind of underlying theme that the critics are getting wrong about the project? They don’t understand it at all. And those people that go to the project understand what this is about — the critics are generally people who put process before reality, and they don’t understand. They seem to think that if it’s not a randomized clinical trial, it’s something that they should attack. This is not a randomized clinical trial, it’s a completely different mechanism for developing solutions to development problems, one that’s highly successful and highly congenial for the host countries. And the critics, by and large — there aren’t that many of them, but they’re persistent — they never went so they don’t understand what this is about. The critics often seem to know about only one kind of project: randomized controlled trials. The MVP is not a randomized controlled trial for many reasons, but most importantly because the RCT strategy is not effective when the scale of the key interventions is not at the individual or household level (such as when testing a new medicine) but is at the community or even district level, such as when introducing a new kind of health system, or water system, or strategy for malaria control. We therefore observe the outcomes of only one intervention site per country. Even so, we can still compare the situation in the MVs with the situation in comparable areas outside of the MVs. That is part of what we will do in 2015. Even then, there are inherent challenges in making and interpreting such comparisons, such as the obvious fact that the MVP has influenced policies at the national scale in many of the host countries. This means that some of the progress outside of the MVP (such as with malaria control) is actually the result of the MVP itself, even though the precise role of the MVP at the national scale is hard to measure. In any event, the detailed evaluations of the project in 2015 will teach us a lot about the achievements and limitations of the project. I of course look forward to that detailed work of assessment. If the critics had actually gone to the sites, they would have understood the situation much better. I think one who did go is Nina Munk who wrote the recent book “The Idealist.” Is there anything specific about what she is getting wrong? She’s just way out of date, that’s all. She had a superficial view of the project — mainly visiting two sites a few times during the first half of the project. The reporting is very limited and way out of date. Moreover, whenever things didn’t work fully at first, Munk describes the outcomes as “failures,” when in fact they are just part of the dynamics of a 10-year project. She had no feel for the active learning and adjustments that always take place, and should take place, in successful development work. I don’t want to harp on the critics too much, and I wanted to ask one more practical question: You talked a lot about the connection between the Millennium Villages Project and local governments and getting governments to pick this up. I know you had some development agencies like Islamic Development Bank, the U.N. Development Program and U.K. Department for International Development pick up parts of this model as well. What about the NGO community? We haven’t talked about them yet. Is there a way that Millennium Promise can or will interface with the NGO community to spread some of these ideas to the many projects that they run? Sure, I speak to the NGO community very frequently and to boards of organizations all over the world. We share openly the technologies, we help give advice on building community health systems where we have a lot of expertise, and a tremendous amount of achievement. And then, at the local areas, NGOs are all around, but that depends generally on the NGOs being present in these local communities and then there are lots of partnerships that develop organically on the ground. So I think the one thing that is probably the case is that we’re very busy, very satisfied and, moving forward, our main partner is the community and the host government. We’re generally very happy to share ideas and results with anybody but most of the time we’re focused on doing our work. The industry is changing, we’re about to reach the MDG deadline and we talked a little about NGOs and the transition to local government. Where do you see the sector broadly moving? There’s a lot of excitement and a lot of activity underway. I’m pleased to have watched and in some ways helped the scale-up of this activity. I think it’s very exciting. I hope that people don’t get trapped in very narrow ideological lines. Some people say, well, it has to be business, it has to be financially one way or another, or it has to be a randomized clinical trial, or it has to be something or other. For those of us who have spent our lives working on the ground in developing country contexts, you know that there isn’t just one way to make progress, or to learn, or to demonstrate. And some things are for the public sector, some things are for the private sector, some things are true public-private partnerships. One of the great arts of good economics — rarely practiced, but good economics — is what I always emphasize as differential diagnosis — to be able to understand the context you’re working in, and in that context the right things to do — and this to my mind is the key to success. Not landing on one narrow perspective either methodologically or by sector or a particular approach or technology, but to understand that we’re in a rapidly changing world, though our underlying goals are persistent and that is fighting poverty, hunger and disease. How you do it, what tools to use, what methodologies to deploy, depends a tremendous amount on context, and that’s what I hope people learn. I think it’s been one of the biggest weaknesses of this field for a long time — is that it has been in the grips of various ideologies: “It all has to be private,” “aid is bad,” “it all has to be clinical trials,” it all has to be something or other, and most of this is just silly — it’s a very, very weak perspective on a very complex set of challenges. And I think that more and more people are working in the field aiming for practical things, and as they do that, then they begin to understand the true complexities of this work, and the multiplicity of approaches. Stay tuned for more of our special coverage on localization, including a feature on Nuru International and Millennium Villages Project’s work in Kenya, an exclusive interview with Nuru International Founder Jake Harriman by Devex President and Editor-in-chief Raj Kumar, and a #DevTrivia section on the Millennium Villages Project.