When Tedros Adhanom Ghebreyesus, now director at the World Health Organization, was Ethiopia’s minister of health, one of his priorities was reducing infant mortality.
Jamie Cooper, founding chair and president at the foundation Big Win Philanthropy, was one of the external funders who got involved in the effort. Because only 10% of women were giving birth in health facilities, she proposed a home birth checklist. But Tedros said that was not aligned with the government’s goal of increasing the percentage of women delivering in hospitals.
Within two years, the proportion of women giving birth in facilities with a qualified midwife, nurse, or doctor climbed to 66%, leading to a reduction in infant mortality. Now, Cooper and her team see it was the right call to develop a facility-based birth checklist with a post-birth home checklist.
The experience changed the way the foundation worked with governments, opening its eyes to the need “to be a trusted partner, not to undermine them myself in any, any way,” she said.
While it is often said that social innovation cannot go to scale without government support, not all funders understand the best ways to work with governments. That was the focus of one session at this week’s virtual Skoll World Forum, the annual event hosted by the Skoll Foundation. Focusing in particular on sub-Saharan Africa, it explored how to navigate the partnerships between funders and governments that can be critical for a potentially impactful innovation scaling in the public sector.
“When you feel that a funder or social entrepreneur or an NGO doesn't really meet your need, you need to exercise the power to say no.”— Malado Kaba, former minister of economy and finance in Guinea
Plan for scale from the beginning
Pilot projects are vital, because what works in one place may not work in another. But all too often, organizations pilot ideas that never go anywhere, said Deborah Malac, who formerly served as U.S. ambassador to Uganda and ambassador to Liberia.
“We … get pilot projects going, and then … towards the end of the life cycle, we say, ‘Here, take this, scale it up,’” she said. “If you’re talking … about taking things to scale ... you have to plan for that scale from the beginning.”
Malac emphasized the importance of working across governments, because while a ministry of health may get behind a program, it has to go to the ministry of finance to get the money to make it happen.
Work at the regional, national, and subnational levels
Dr. Paulin Basinga, director of health for Africa at the Bill & Melinda Gates Foundation, described a call last week with the government of Guinea about strengthening routine immunization in the Kankan region as an example of the shift toward closer partnership with governments at the regional, national, and subnational levels.
“If it was the old way of doing business, we will just go to Kankan, get an NGO, start working and then implementing a program,” Basinga said, “and we know that it will fail at the end.”
But in this case, the Gates Foundation began by working with the minister of finance, the minister of health, and local leadership in the Kankan region. It made efforts to understand their priorities and then signed a memorandum of understanding, with the Gates Foundation putting money forward in 2021 and government money to follow in 2022.
Be prepared to take no for an answer
Some donors think they can buy themselves a seat at the table of policy and strategy discussions, but government leaders should ensure they remain in advisory roles, said Malado Kaba, Guinea’s first female minister of economy and finance.
“I believe that sometimes funders can play too big a role, but only if you let them do so,” she said. “When you feel that a funder or social entrepreneur or an NGO doesn't really meet your need, you need to exercise the power to say no.”
Kaba offered the example of turning down the support of an international development partner that wanted her to use its diagnostic tool for auditing purposes even though it would have needlessly duplicated an audit her ministry had already carried out.
Acknowledge the power dynamics at play
Basinga said that when ministers set priorities, donors will align. But Cooper of Big Win Philanthropy disagreed, as did Patrick Mugisha, commissioner at Uganda’s Ministry of Science, Technology and Innovation.
“My brother, you are forgetting that particular national development plan could be funded by a donor,” Mugisha said.
Maternal death and stillbirths are on the rise, and philanthropic donors have shifted their attention to COVID-19. Entrepreneurs say new efforts to fill the gap may not be enough.
Mugisha and his peers in Uganda’s government are developing a program that decentralizes innovation work into clusters such as health, agriculture, and education so there is a place to direct interested donors.
He called for more forums that allow donors and funders to come together and make plans in partnership but cited the challenge that funders still have the upper hand in negotiations with governments.
Leaving egos at the door
Government control, effectiveness, and capacity vary from country to country, Malac said.
Often, philanthropists can make a greater impact in countries where bilateral donors have a harder time working, she added, because they can be more flexible with earmarked budgets.
But no matter the country, the conversation must begin with understanding government priorities and then identifying opportunities for collaboration, she said.
“We have to, to a certain extent, leave our egos at the door if we’re going to truly let governments lead. ... And it’s not easy for any of us ... because we all think we’ve got the plan and the solution,” Malac said.
Update 4/23/21: This story has been updated to clarify comments by Malado Kaba.
Update 4/21/21: This story has been updated to reflect Patrick Mugisha’s current job title.