Comments

There has been plenty of work done on capacity development approaches which has delved into these issues more deeply (e.g. the major research undertaken by the European Centre for Development Policy Management, reported in <a href="http://ecdpm.org/publications/capacity-change-performance-study-report/" rel="nofollow">Capacity, Change and Performance</a>, by Heather Baser and Peter Morgan 2008). My work in this area (<a href="http://leadershipstrategies.com.au/Capacity_Across_Cultures_Global_Lessons_from_Pacific_Experiences.php" rel="nofollow">Capacity Across Cultures: Global Lessons from Pacific Experiences, 2014</a>) suggests that if you look in Pacific countries for the institutional capacity that we value in western countries, you won't find much evidence of it, because that kind of capacity is not what is generally valued in those national cultural contexts. That is how you end up with a judgement about 'weak capacity' which I believe to be fundamentally flawed. But if you looked for the kinds of capacity that are valued in those cultures, then you would find there is enormous capacity (it's just that it's the kind of capacity that donors don't value as much). For example, in cultures where benevolent and autocratic leaders are valued, then it doesn't make sense to have flat-structured public sector institutions for example - they won't work effectively. In cultures where collectivist values underpin decision-making, then it doesn't make sense to build performance systems built on individualist values. In cultures which value the maintenance of harmonious relationships over the delivery of tasks for the sake of ticking boxes, then it doesn't make sense to think that action plans can drive an institution at the cost of harmony between people. And in cultures where uncertainty and ambiguity are seen as threats to well-being, then it doesn't make sense to introduce high levels of rapid innovation and expect them to stick. So from my perspective, having worked on these issues in the Pacific for 30 years too, it's the frame of reference of donor agencies and aid programs that is the biggest challenge, not Pacific capacity. My book includes case studies of Pacific Islanders who have thoughtfully reflected on their involvement in capacity development processes. It also includes some approaches for how aid programs can do things differently, if there is a genuine interest in contributing to Pacific capacity for developmental outcomes.

Jim, I couldn't agree more with your concern. For the Pacific check out the results of ADB's 2006 to 2008 <a href="http://www.adb.org/publications/series/capacity-development-series" rel="nofollow">capacity development study</a>, most especially the summary publication entitled: <a href="http://www.adb.org/publications/learning-success" rel="nofollow">"Pacific Choice: Learning from Success."</a> Steve Pollard

Although this is not the focus of our work at the moment (we'd be very happy for someone else to take this on!), we think that this existing distribution channel (ie the one 'owned' by small community-based entrepreneurs and shop keepers that runs from district centres to remote rural communities) could be used to courier basic medical supplies to trained health workers serving remote rural communities. Please see: <a href="http://www.colalife.org/2013/03/08/could-the-private-sector-supply-remote-rural-health-posts-in-zambia/" rel="nofollow">'Could the private sector supply remote health posts in Zambia'</a>. We believe that this would be far more efficient and would have a bigger development impact (money in the pockets of local entrepreneurs) than trying to set up a parallel public sector system to do the same thing. Even if this could be done it will take many decades and would be massively costly and in striving for this we are asking the already overstretched public sector to achieve something that even Coca-Cola (or any other producer of fast moving consumer goods) can't do and prefers to leave to others.

@Benjamin - this is right. Coca-Cola does not do 'the last mile', it's the small entrepreneurs serving those communities at the end of 'the last mile' that do that and they do it for many other products too (cooking oil, talk-time, salt, torch batteries, washing powder, etc) not just Coke.

Dear Jim, Very interesting blog and something we are definitely working on in the context of developing countries. Outside of capacity building for government officials, we are looking at the role of the private sector to also engage their employees in capacity building and technical assistance initiatives. The problem is not so much...the opportunity that is in front of us but the system that is needed to allow for smooth, efficient, and effective capacity building programs to take place (with measurable outcomes). Not sure if you are following the FfD3 event but in the draft final report "capacity" and capacity building is mentioned 40 times. Technical Assistance is mentioned six times - knowledge (sharing) is mentioned 14 times. Now....it's how do you turn this into opportunity and measurable (successful) efforts. Saludos cordiales,

The evidence from Colalife proves that the MOST robust supply chain is one where micro-entrepreneurs are incentivised and make money from the process. If I interpret your wording 'robust' to mean that which occurs typically in the Western world then this won't work to benefit players along the supply chain, isn't inclusive of small players and will suffer failure to reach the last mile.

I agree Max - this should be essential reading/podcast listening for policy makers and anyone designing interventions.

How refreshing to hear such confronting statements from a person who understands the problems of capacity building. I enjoyed Jim Adams' full address very much.

If the US and other countries with many government departments involved in managing aid can do this, then it should be easy for Australia with its much simpler aid management structures.

Terence, I want to clarify that Sam's article was not written on the premise that there has been a decision to partner with Coke. Coke has been used by donors elsewhere, it got a favourable mention from the Minister, and Sam was analysing whether the Australian aid program should partner with Coke in the Pacific, not critiquing a decision to partner with it.

Thanks for this well-balanced and considered article – much more constructive than some of the ‘kick-back’ commentary we see, which actually stifles proper debate. It is important to keep an open mind and be prepared to think the unthinkable when you are faced with stubborn global health challenges, as you never know where this might lead you. We have to acknowledge that some of the current approaches to improving access to medicine are not working and haven’t worked for many years. Access to diarrhoea treatment in Africa is one example. In these circumstances we have to ask: do we carry on doing what we’ve always done or do we seek to innovate and try other approaches? On the basis that it’s easier to act your way into a new way of thinking than think your way into a new way of acting[1], ColaLife did the unthinkable and designed a diarrhoea treatment kit – called Kit Yamoyo - that fitted in the unused space in Coca-Cola crates. The logic was simple: Coca-Cola gets everywhere so if medicines went with it, they would get there too. From a standing start and within 12 months we’d got diarrhoea treatment rates up from less than 1% to 45% in the two remote trial areas in Zambia. And this is for an international standard treatment that has been around for 10 years. The big surprise was that only 4% of the 26,000 kits sold actually travelled to remote communities in Coca-Cola crates. This was not the innovation we thought it was. It wasn’t the space in the crate that was important, it was the space in the market. What the folks at Coca-Cola taught us was how to design a product together with its value chain. That’s what they do with a brown fizzy drink. We learnt this and applied the same principles to a health product with potentially game-changing results. Following the trial, we are now working with the local manufacturer of Kit Yamoyo in Zambia to establish it in the market, while in parallel, and inspired by our work, the Government of Zambia have ordered 452,000 ‘unbranded’ kits to be given away free through health clinics in 11 of the most nutritionally deprived districts in Zambia. These alone will save 1,350 lives if the ‘lives saved’ modelling done for our trial holds true for the scale-up. The key points to note from our experience are: 1. We would not have made the progress we’ve made if we’d shut down the possibility of talking to Coca-Cola ‘on principle’. 2. During our trial and during the scale-up there is no association between our anti-diarrhoea kit and Coca-Cola. None of those involved in the marketing, distribution and sale of Kit Yamoyo have any idea that we are mimicking the drinks giant’s methods. Kit Yamoyo doesn’t even carry ColaLife branding let alone Coca-Cola branding. Coca-Cola’s involvement in Tanzania and Ghana with the national essential medicines distributors is also advisory. They are helping the existing organisations responsible for the distribution of medicines in the public sector to become more efficient and effective. They are building local capacity, they are not ‘taking over’ the distribution. And that brings me to my final point and a key area of general misunderstanding. Many fall into the trap of assuming that the Coke they see in remote places is taken there by Coca-Cola and therefore attribute Coca-Cola with having the most amazing global distribution system. The truth is that if you go to any of these remote places you will never see a Coke truck or van. Coca-Cola is brought to these remote communities by independent micro-retailers and entrepreneurs and they bring it because people want it and they can make a profit selling it to them. The system works by clever product design and marketing and the creation of a value chain which ensures that everyone who touches the product on its journey to consumers makes a profit and the target customers can afford it. Obviously, you can only apply these principles to a health product if that product can be ‘commoditised’. Fortunately, you can do this for an anti-diarrhoea kit but you couldn’t do it for the majority of medicines. However, that doesn’t mean that you can’t use existing private sector channels to get more complex medicines to trained health personnel in remote communities and you can read ColaLife’s thoughts on this <a href="http://www.colalife.org/2013/03/08/could-the-private-sector-supply-remote-rural-health-posts-in-zambia/" rel="nofollow">here</a>. Again, although this idea is inspired by the ubiquity of Coca-Cola it can be implemented with no reference to The Coca-Cola Company. Sure, let’s be aware of the ethical issues but let’s keep an open mind and consider all possible options when it comes to improving the health of some of the poorest people on the planet. Simon Berry CEO ColaLife

Thanks for the article. I'm not sure where I read the phrase "PR master move" in relation to the original "$1 a day" global poverty line, but it is definitely apt. The power of this statistic its that it is so easily understandable and communicable. The establishment of the new commission is a direct result of this success, and is very welcome. But as important as technical correctness is, I hope that simplicity will not be sacrificed for nuance.