After a Peace Corps stint in Honduras during the late 1990s, de Anda was set on a development career in Latin America. But given the dearth of entry-level development positions in the region, de Anda pursued a graduate degree in public health, worked on an anti-smoking campaign in New Orleans and lived in sub-Saharan Africa for several years before returning to Central America as PSI Nicaragua’s top official in 2008.
Today, de Anda manages a full-time staff of 42 and dozens of consultants carrying out PSI’s public health programs in Nicaragua. Devex spoke with de Anda to learn more about PSI’s operations and collaborations with local partners in the country as well as details about de Anda’s international development career path.
Partnering with PSI in Nicaragua
What projects does PSI focus on in Nicaragua?
We work in reproductive health and HIV prevention and family planning, promoting sexual and reproductive health. It’s a fairly narrow portfolio.
I worked in East Africa for three and a half years in HIV treatment before coming here [Nicaragua]. Coming back to Latin America with an [HIV] prevalence rate of 0.2 percent in Nicaragua compared with Tanzania statistics of 7 to 12 percent, it’s a very different epidemic. Sometimes it’s hard to use the word epidemic here. It’s a localized epidemic, and we try to keep it out of the local population. We’re focused on high-risk groups.
We have had some significant growth in the last two years in our family planning [programs], [but] HIV prevention is growing just a little bit. Family planning has got some support here and has allowed the PSI Nicaragua office to quadruple its size in the last year. Family planning is the big engine of our work.
Who are your local partners in Nicaragua?
We have a lot of local NGOs, and that’s fitting with our strategy. We are switching into a subgrantee model and trying to bring the capacity up [for grantees]. We want to transition to doing less of the implementation ourselves. More than 50 percent of our activities are being implemented by local partners. We also collaborate with the Planned Parenthood affiliate here.
The capacity is very high here. There are a lot of well-educated people, lots of clinical resources here, doctors and nurses. And because of financial challenges at the public sector, a lot of them are looking for opportunities for better benefits [with international development organizations]. When you have positions, it’s fairly easy to fill them, particularly compared to Africa.
Many of the development problems are less acute than in Africa, but we still struggle with a lot of chronic issues. Still, there are less AIDS deaths, less malaria deaths. We don’t have huge numbers of orphans. It’s more stable.
[How we partner with local entities] depends on the project. For youth projects, we will look at groups that already have existing youth work and see if they are interested in collaboration. [Then, we] train them in the use of our models and methodologies. Our goal is about 20 percent are supervised by our folks to make sure that the quality is consistent and that they are using the models as they were meant to be used, and we document what is being done.
What are the prerequisites for partnering with PSI in Nicaragua?
Their perceived ability to access the population. Can they get to the population? [Our understanding of the quality of these organizations] comes through our own presence on the ground. Historically, we do a lot of the street outreach. We’ve been doing it for 12 years now. We’ve helped to start organizations that now have their own outreach. We see the work that they do. If we see an area that has no active presence in HIV programming, we might talk to a group that is doing something similar and approach them to see if they might want to expand into that area.
We’ve made partners along the way. Seeing the work that they do, we help them build capacity and provide the training. Small local NGOs can get themselves started though these micro-grants. [At first, they receive] reimbursement for services provided, but later they become full-fledged partners and, ideally, they move onto the next step where they build their own capacity and look for their own funding.
A public health career in Nicaragua
What career advice would you give to those seeking to enter the public health sector of international development?
Funding is tight here in the region [Latin America] historically. The burden of disease is not comparable to sub-Saharan Africa. There are not as many programs, and the programs that are here are smaller in scale. There are not many programs I know of that have more than two or three expats. Catholic Relief Services with a $14 million program [in Nicaragua] has three expats. There are just not too many international positions.
Public health generalists kind of need something else [in addition to a public health degree], and I say that being someone who is a public health generalist. It’s only because I’ve got that public health, plus the Spanish, plus about 10 years of program management, so now I’ve got that finance and the administrative part, too. To be honest I tried to get back to Latin America after doing the Peace Corps here in the late 1990s for a couple of years and I couldn’t land a job. There’s a lot more opportunity, relatively more jobs, more funding, just more going on in sub-Saharan Africa and South Asia.
Can you tell us a bit more about your career path?
I paid my dues. I did it the long way. I was a Peace Corps volunteer and went abroad, lived abroad for the first time with Peace Corps. I went to Honduras. It so happened that a major hurricane happened during my time there - Hurricane Mitch - and that was after I did one year of service.
And then all these NGOs started pouring in. All of a sudden, there were NGOs, and funding, and all kinds of things happening there. By the time I had finished, I had linked up with an NGO through a Peace Corps program called Crisis Corps that recruits Peace Corps for an additional year. So I did that for an NGO in another part of the country. My first experience with an NGO was post-disaster in the same country where I was working.
I realized I enjoyed the work and got a master’s degree in public health. My focus was international and health systems management. I had realized that a lot of people that are smarter than me loved the programming part but didn’t want to do the financing part, but without the financing nothing happens - the proposal development and, after you win the money, how to allocate the money, how to manage that, how you report on that.
I heard enough people that said they hated that to know there was an opportunity. So I didn’t particularly enjoy it, but I refused to come out of the program $50,000 in debt and not know how to do anything in particular.
After Tulane, I stayed in New Orleans working for a nonprofit in public health for two years. It was a statewide anti-smoking health policy advocacy project. It was enormously frustrating in New Orleans and in Louisiana as you could imagine!
I tried to get a job overseas back in Latin America and applied, and applied, and applied. But two years of Peace Corps and then a short gig didn’t get me anywhere, so I bit the bullet and took the fellowship option with Catholic Relief Services, where I went to work in Equatorial Guinea and Cameroon.
I did that for a year and then went to Tanzania for a little more than three years and a half. Then I came over to PSI. I’ve been here for [a] year with PSI.
What’s it like living in Managua?
There’s a lot of positives that came out of social revolutions during the ’80s. There were a lot of people that were educated.
Capitalism has not been given free reign here. There is poverty, and there is a segment of very wealthy people. But there is a broader segment of middle-class people than I’ve seen in Africa and Guatemala. It’s actually a fairly cohesive society. So much is still influenced by the politics of the ’80s. We are still sort of in the ’80s here. The politics can be kind of disappointing when you see squandered opportunities. The perception that there is increasingly more centralization of power in the government and nepotism [is also troubling].