Doing Development Differently, Again.

By Karl Hofmann, President and CEO, Population Services International

PSI was founded in 1970 to “do development differently.”  We worked in a handful of countries to the market for health products and services and used marketing practices to reach people in need.  We embraced an unconventional blend of sales and pricing to make products and services affordable and available, helping us better address some of development’s most vexing problems.

That was then.

I’ve recently returned from a trip to Rwanda and the Democratic Republic of the Congo and I was reflecting on our roots. We still work to understand the market for health products and services, we still use marketing as the backbone of our approach, but we’ve had to adapt, to learn new skills and the answers are as complex as the challenges we face.

Today, PSI is a network of 65 country-level organizations connected to a central hub that provides technical support, assistance with procurement, grants and contracts, financial management, and communications and advocacy support.

Unlike previous trips, this trip included no visits with donors and no calls on our host governments.  Instead, I spent my time focused now on how to make our network members work better and meet the highest standards.

In Kinshasa, I participated in the board of directors meeting for l’Association de Santé Familiale (ASF), the Congolese entity that PSI founded in 1987 to address HIV, malaria, child survival and family planning challenges.  Chaired by Professor Pascal Payanzo, the ASF board oversees the operations of our roughly $100 million annual program in the country, under the leadership of Congolese Executive Director Nestor Ankiba.

ASF remains linked to PSI, and our finances are managed jointly — which is the right posture given the complexities of a budget this size, and the number of donors supporting our work.  The Managing Director of ASF is an employee of PSI, appointed by the ASF board, and his day-to-day accountability is to the board as well as to our headquarters in Washington.

The topic requiring the greatest amount of discussion at the board meeting was the crushing weight of audits, about one every month.  With a budget of  $100 million from mainly government donors, it’s not surprising to have such a significant level of compliance and accountability. To manage this and run life-saving programs without interruption requires help. This is one of several areas where a network model pays dividends to donor agencies.

PSI’s Global Internal Audit team draws talent from across our multi-country network to help ASF address its risks.  PSI headquarters can deploy our malaria expertise from our regional office in Nairobi, our family planning team from Washington and other family planning poles around the network, and our marketing leadership from our West African hub.  Similarly, ASF technical leaders are deployed around the PSI network on short-term technical assistance visits to help us get better in other areas.

The challenges of managing a $100 million operation in the Democratic Republic of the Congo are innumerable – but banking is a particular challenge.  With programs that span the entire country and six regional offices, ASF confronts the particularity of the Congo’s banking environment, with only 300 bank branches in a country of 70 million people (roughly the size of Western Europe).  Michel Lusembe, President of the Congolese Banking Association, serves on the ASF board and helps us navigate the operational challenges that arise from working in such an “underbanked” country.

We’ve learned there’s no one-size fits all solution.

Today, “Doing Development Differently” means a sharp focus on governance issues, so that our network members operate at full capacity.  Within the PSI Network our national boards of directors are growing in sophistication, are providing greater oversight and delivering national-level accountability to national and international donors.  There is no higher strategic priority for PSI than a well-functioning international network.

Connected is better than disconnected.

In Rwanda, the challenges are different.  At the request of USAID, Society for Family Health (SFH) was created from the structure, vision and mission of PSI Rwanda.  Manasseh Wandera, Executive Director of SFH, has no reporting line to PSI, he is accountable solely to the SFH board of directors.  Colleagues from across the PSI global network that provide valuable skills and technical guidance serve on the majority Rwandan board of directors.

And, the network approach saves donors money in the short and long term.

Manasseh’s concerns are the opposite of Nestor’s.  While ASF in DRC wrestles with growth, SFH in Rwanda struggles with identifying new funding and keeping his small but talented staff fully employed.  When SFH’s primary donor, USAID, has a delay in payment, Manasseh has no cash reserves on which to rely for program costs.  Should the donor decide that some costs are unallowable, as often happens, Manasseh will struggle to find the resources to pay for much needed program activities.

SFH Rwanda is a small, scrappy, and a highly relevant player providing quality health services and products in Rwanda.  As the sole organization providing family planning products through the private sector, SFH plays an important role in Rwanda’s progress.

PSI assists SFH with technical support when donors allow, but the lack of an ongoing formal connection between PSI and SFH makes this tough and lessens health impact.

Doing Development Differently in Rwanda means doing development alone.  For the people we serve, it’s not ideal.

At ASF, at SFH, and at the dozens of other country offices across the PSI network, the work of building institutions that last, of optimizing impact, and of improving the lives of poor and vulnerable people is contributing to our collective work to end extreme poverty.  Each in its own way…..differently.

Photo Credit: Courtesy of PSI