Lessons from Global Health Development: Relief vs Development

This is Part 2 of a three-part series 
Read Part 1.

“Help! I need somebody! Help! Not just anybody. Help!” – The Beatles 

When a cry for help begs a response, how do we assure that productive help, not just good intention, actually happens? 

When faced with failure, what does a responder do? As an expert/advisor, you have a choice: correct the specific failure or strengthen the system (Taylor, Just and Lasting Change). To make this decision, it is critical to discern: is this an event-induced “disaster” – Ebola, Tsunami, Hurricane – or is it a chronic, systematic, or lifestyle-induced failure? In medicine, the difference is how a physician treats a patient with emergency trauma vs a patient with a chronic disease. The global relief vs development challenge has a healthcare leadership parallel: rescue or strengthen.  

Why does it matter?

Diagnosis before treatment. This sounds simple, but when immediate relief is needed, the help reflex to correct or fix seems obvious. Yet, the best intended responses vary greatly in their effectiveness. Because often what helps in relief now, hinders development later – having the opposite of the intended effect. When dysfunction occurs, the temptation to intervene with mandated action may be warranted, but it can also compromise an organization’s culture or a community’s ability to evolve. This is a core dynamic of social change if local energies are to be harnessed. 

A nearly forgotten lesson of the 19th century, the Jevons Paradox, states that breakthroughs designed to advance civilization usually do the reverse. In 1865, William Stanley Jevons noted that increased coal burning efficiency led to more steam engines which, in turn, increased demand for coal and resulted in more soot and smoke. This is why technological progress in medicine is associated with iatrogenic (provider-caused) disease and why controlling one infection leads to the emergence of others. Because of unpredictability, as Taylor notes, whatever we do is likely to create other problems. 

Disaster relief often takes the form of an emergency or wartime response: a top-down, immediate, and highly paternalistic intervention. This type of relief is marked by high control and local structures and systems are often perceived as an impediment: they are more “in the way” and require a work around. Helping the “helpless” re-enforces a dependent relationship. While such help may be necessary in the short term, this approach is the opposite of empowerment. Development, of course, must be based on empowering and enabling local ownership. It can be independent or interdependent, but not dependent. 

So What?

At some point, a transition from relief to development must occur. When healthcare leadership confronts performance failure, i.e., significantly and/or chronically “off track,” then an intervention by board or management may result. When considering the intervention of choice, keep in mind that correction is more a product or transaction that is typically viewed with fear and disruption, while development is a process. The choice is the difference between doing it to or for others vs doing it with and through them. 

Performance acceleration is not disruptive when people own it. And as confidence and capability grow, so do trust and sophistication. This begs a question: what is the appropriate and agreed upon time interval for monitoring and evaluating performance success? Board and management need to be clear on the range and timing of acceptable performance in order to guide the choice of intervention. Both board and management need to appreciate that colleagues in the organization or community, in their emotional response to corrective intervention, likely will not share the same time frame. The emotional reaction to mandated intervention – other than clear disaster relief - is invariably resistance by at least some and requests for more time by most. 

The important lesson is to assure that the definition of success, progress and results explicitly includes the impact on current and future relationships. Because it is these relationships that produce and empower current and future success. Achieving long-term, i.e., sustainable, progress is ultimately about strengthening relationships, not merely disaster relief.