When I meet people working in development and tell them that I’m doing monitoring and evaluation, I usually get a knowing, pitying smile in response. “Oh, that’s interesting,” they say. “Lots of spreadsheets, huh?”

M&E doesn’t exactly have the most glamorous reputation. Mention the word “data,” and all but the biggest nerds tune out. Even I admit I was a bit surprised to find myself working in this field, since I spent most of my time in college reading novels and writing essays.

Well everyone, listen up. Evaluation is cool – and the field is undergoing some big changes. We’re already seeing a growing number of economists and statisticians who are approaching development effectiveness research with the serious methodology it deserves. And rather than evaluation being a burden to innovation and experimentation, I think this developing sense of rigor will spur a new generation of ideas that truly has the potential to chip away at poverty.

A recent paper by Andrew Natsios published by the Center for Global Development summarizes why M&E has such a bad rap.

The “regulatory apparatus has created an incentive structure that has led to an emphasis on process over program substance and, in so doing, has produced a perverse bureaucratic result … Essentially, measurability should not be confused with development significance.”

Let me cut through the jargon with an example. You’re an NGO that wants to improve childhood nutrition in, say, Malawi. Your big-name donors – like USAID or the Gates Foundation — want to make sure you’re not taking their money and buying yourself private jets or Parisian shopping sprees. So they want proof. Cold, hard, numbers.

But “improved childhood nutrition” is really, really hard to measure. How do you quantify that? The number of kids who live to be older than 5? How do you know it’s your program that’s helping them survive? Is it ethical to withold your intervention from certain populations in the name of a scientific control?

So rather than track the outcomes of their work, many NGOs instead track their activities. We fill up spreadsheets with indicators like “number of healthcare workers trained in infant/young-child feeding programs” or “number of breastfeeding support groups formed” but we often have no clue if those activities actually do what we hope they’re doing. The tragedy of the current system of accountability is that it doesn’t measure things that matter – but it’s so bureaucratic and intrusive that it doesn’t allow us to try new things, either.

Cue the new evaluators.

One camp that has gotten a lot of media attention lately are the “randomistas,” economists who run randomized trials to test the effectiveness of different “poverty-fighting” interventions. (For a good overview of their methodology for those of you who, like me, have no background in economics, check out this article about MIT economist Esther Duflo in a May issue of the New Yorker.)

This school of thought borrows from medical research, doing meticulous follow-up on populations that receive a particular intervention and those that don’t: the control group. Like a big clinical trial for a new drug, this kind of thorough research is costly and time-consuming. But just as the FDA would never approve a drug that “we’re pretty sure works and is safe; it’s just really hard to figure out,” I think we owe it to the populations we serve around the world to make sure our projects are effective, too.

As much as I appreciate the rigorous methodology in medical research, it’s clear the analogy to development can only go so far — after all, we have a million versions of blood pressure and erectile dysfunction medications, but no real progress on a malaria vaccine or affordable HIV drugs. If you’re a pharmaceutical researcher, the big bucks are in drugs for rich people. And in development, the big bucks are in easily quantifiable activities. That leaves a lot of uncovered ground. Randomized trials can help us understand what works, but unless the incentive structures change, neither will the interventions.

I was interested to read a recent blog post by Owen Barder, the director of aidinfo.org, about the use of prizes to spur innovations that benefit the poor. In rich economies, Barder says, patents are the ultimate prize: temporary monopolies that ensure the developer reaps the rewards of a product people want to buy. But what about in poor economies?

“Nobody will invent a vaccine against malaria, or a cassava plant that resists mosaic virus, based on the possible rewards they will get from charging high prices to its consumers.  So the patent system is a prize for people who invent cures for baldness, but not a prize for people who invent ways to prevent the spread of malaria.

For these reasons, other incentives, such as prizes, Advance Market Commitments, and similar mechanisms, may be effective either as alternatives or complements to the patent prize of a temporary monopoly, especially for technologies that would have benefits in developing countries.”

If we want to see new projects that truly help the poor, I think we need to look at our work as one big do-gooder clinical trial. Foundations and governmental aid agencies should develop rewards and prizes for creative interventions that address old problems in new ways. That’s the equivalent of a National Institutes of Health or National Science Foundation grant, the money for basic science research that may or may not help develop a new drug. And we certainly shouldn’t just look to Western NGOs for those solutions – I would be willing to bet that the truly game-changing innovations will come from an extremely local level.

But then, rather than crossing our fingers and hoping those interventions work, we need to dedicate serious time and money to our own version of Phase 1 trials, the kind of randomized evaluation we take for granted when we pop a Pepto-Bismol in the United States. If they are effective, then we can expand.

One new trend in evaluation that I think has a lot of promise to address some of these issues is looking to the target population for feedback – not the M&E teams or donors. With such widespread availability of mobile phone technology, some aid agencies are asking their beneficiaries to text in their answers to a simple question: “Did you actually get what we tried to give you?” When the services get more complicated, that kind of crowd-sourced feedback also gets trickier, but I think it’s an exciting trend with a lot of potential. Shouldn’t the community evaluation be valued just as much as what the consultants and donors think? They’re the ones we’re trying to help, after all.

It’s raining in Newark and I am going to write a blog! So much for an attractive blog title, but yes, after a couple of torn pages that hosted my effort to come up with something that is good and resourceful I have figured this is the way to go! I think I am going to write about my experience of transition to US, about being awarded for emerging leader in Global Public health (yes, that’s what I think we all are) and a bit of health literacy (without which I think I should not finish this post), but, hey who knows?

Speaking of transition, it was quite a journey for me to travel both hemispheres of the globe (Australia and US). I love people, diversity and different mix of cultures and this was just the perfect thing for me to study in Sydney and do fellowship in Newark. I should probably tell at this point that both the cities have been great hosts and I am looking forward for the days ahead. I shall write about a comparison of my experiences of Sydney and Newark once I get to know Newark better but the start is amazing, I must say. None the less, I have started working as a Global Health Corps Fellow and that is for me, professional works in three (including my very own Bangladesh) different countries! This surely is pretty exciting for someone who wants a ”Global” career in public health.

Thinking of the word “Global”, I sincerely believe an important step toward changing the world starts with building partnership and collaboration across the globe. It is as they, “leading to inspire, aspire to change” which should constitute people of similar mind frame who have exceptional qualities in them. It is unfortunate that I did not meet all of you, but I am sure we are young and enthusiastic representatives of different cultures with a vision of ”doing something” if not changing the way this world deals with its people and obviously, their health.

Now, “Health” my friends, can be a more complicated word than you think it is. Surely, I’m not going to quote WHO here to bore you with all the technical aspects of it. However, the word health goes beyond than just being “free from diseases”. We live for it yet are we entirely responsible for our own health? Yes? How about institutions that teach “Health”? What about governments that makes “health” more accessible? What about health services that render care? Your community where you belong? And finally, important people who plan for your health? To suffice, these are the five major keys to good health: 1. To develop health skills, 2. To create supportive environments, 3. To reorient health services to become more ”user-friendly” (if you like!), 4. Strong community action, and 5. To build healthy policy!

“Developing personal skills”: this is where the Health Literacy Fellows come in! Yes, we are carrying on from the initiatives of our predecessors. We are working on to improve the skills, i, e; Health Literacy of the patients and care providers alike. While this may sound curious of the prospect of ”teaching” the doctors/nurses, believe me, that’s not what it is! We are enabling them to “teach”, to educate patients they way they understand. Similarly, materials to help patients understand their condition and possibly to prevent conditions from happening which goes far beyond than saying “Quit smoking, eat healthy, always exercise”. Remember the golden rule: Health is not solely one’s own responsibility.

Contemporary economic challenges and solitary life style have rendered the extended family irrelevant and “backward”, hitherto the pride of many communities especially in Africa. Many young folks out there even with in the contemporary African family structure may not appreciate the love, care and guidance of aunties, uncles, cousins and grandees. I bear in mind the love of my late grandees with passion ensured my proper up bringing and nurtured me to what I am today. Unfortunately, with modern education, individualism, crazy busy schedules, mobility, such kind of life is history even with in Africa especially among urbanites. Folks, you missed and only lucky ones like me can reflect on the good times. Thus far, slowly but surely the extended biological and social ties have dwindled: I empathize with the young and generation to come. Even historical literature is inadequate to express the kind of sociability that existed.

However, lo and behold, time and space has rekindled the great memories of my extended family. When I joined high school and college far away from my family, it was not at first easy to cope up with such kind of life estranged from my aunties and uncles, of course my beloved grand ma. I thank God for creating humans as social animals. I have met different people, at work, college, cyber space and in the social cycles whose love, care and guidance is invaluable: once strangers now friends and colleagues. The integration of technology and social life through network sites like Face book, Yahoo, Google, Skype among others are bridging the gap too.

Amazingly, mid this year, I joined another great extended family GHC. Thanks to the Global Health Corps fellow, life is just at ease. I regard it as a family, not merely a fellowship of one year. I am delighted to have ties beyond my extended family: different young professionals eager to reach out to the victims of the injustices of this world. I know space and time exist, but the spirit of care, compassion, change; mentoring and equity will linger for ever.

Welcome on board all 2010-11 fellows to this wonderful, exciting, and extensive family. The world is banking on us. Service to humanity is all that I can proffer.   Love you and miss you all.

Millions of people in this world are suffering and dying from HIV/AIDS and other preventable and treatable diseases such as malaria and tuberculosis. Young people are concerned, want to promote health equity and they have a right to health. If you are interested in young people, health risks and their solutions, visit the WHO website.

In Africa, many people suffer from tuberculosis, malaria kills many people, and two-thirds of all people infected with HIV live in sub-Saharan Africa. There are about 22.4 million people living with HIV in Sub-Saharan region and in 2008, about 1.4 million people died from AIDS in this region.

Rwanda is one of the countries in sub-Saharan Africa most severely affected by HIV/AIDS . In 2005 the adult prevalence rate was in the range of 4% to 11% among women attending antenatal care services, and 3% among general population.

Rwanda has developed national policies on testing and treatment for HIV/AIDS. The political commitment and leadership of the Rwandan government is highly remarkable, as demonstrated by the establishment of the National HIV/AIDS Control Commission under the office of the President and the creation of a Ministry of State in charge of aids, Tuberculosis and Malaria within the Ministry of Health. Rwanda has made significant progress in health infrastructure especially for Rwinkwavu and Kirehe hospitals in partnership with Partners in Health in Kayonza and Kirehe districts.

The connection and involvement of youth in promoting global health equity is the right choice.  During 2 weeks of orientation and site placement, I have visited chapters in Kirehe and Kayonza districts located in the Southeastern province. The youth are committed and determined to fight HIV/AIDS in their activities by sensitization, mobilization,  and giving informational messages to rural communities. But as you know HIV/AIDS is not only a health crisis in Rwanda, and for some time has been associated with other problems concerning socio-economic issues. FACE AIDS plays an important role by:

-Building a movement of youth leaders

-Providing socio-economic support to HIV-affected individuals living in impoverished communities.

FACE AIDS’ mission is to fight HIV/AIDS by building a movement of young leaders dedicated to global health equity and social justice. To provide youth with a social support network, empower them through income-generating activities and youth-led savings and credit cooperatives, and encourage them to become leaders in the health and development of their communities. Once many thought that the fight against HIV/AIDS, tuberculosis, malaria and other global health problems should be done by physicians and nurses , as Benjamin blogged about (scoring a goal for GHC!). As GHC has offered youth the opportunity to  commit to improve and contribute to global health equity, I encourage you to take the right choice, while thinking like Eva Koehler in her recent blog entry  ‘ Good intentions are necessary, but insufficient’. Huffington Post published a story of another young person who has been inspired to join our cause, who was influenced by his time with FACE AIDS! He made the right choice – the right one!

I just had a practical experience that helped me understand why monitoring is so important to a program. Second week of our fellowship was the first time to collect PMTCT (Prevention of Mother To Child Transmission) data. There were problems on how government hospitals and health centers report data with some gaps, which prompted the M&E team to ask for clarification from health workers. I must say some really did a very good job, making the data easier to follow. My colleague Mara and I were eager to lean what the data meant and how the Ministry of Health tracks and deals with errors in reporting.

The following day we were requested to enter data into the centralized system format. I took one district and Mara another. I like the team work we had. We kept exchanging our experiences with how data was entered. I didn’t know my colleague had found an easier way to enter data and the work which was supposed to take me the whole day only took me two hours to finish. In our local language we say ‘’ kuyenda awiri simantha” (translated as “when you walk with a friend, you support each other”)!! Thanks to Mara. The data was later verified by our supervisor. There are so many things to learn in this program. I see an exciting fellowship year!!!

The district of Ngoma is an administrative entity that is part of the East province of Rwanda, which has been created in 2006 with the administrative reform. The climate is temperate, the soil is sandy- argillaceous and the roads are very dusty.

The town now known as Kibungo unites the ex-districts of Ville de Kibungo. Ngoma district lies in eastern Rwanda between Bugesera, Kayonza and Kirehe Districts, and neighbors the Tanzania and Burundi borders. www.statoids.com/urw.html

The district has 14 geographic sectors. Ngoma’s health sector is comprised of 12 health centers and 1 district hospital (Kibungo). Stephen and I will be working in all 12 health centers as District Health Advisors mainly for capacity building.

In the health centers, we will be identifying areas of intervention based on the Access Project assessment tool. This task will require working closely with different district authorities on issues important to the healthcare sector.

The district hospital suffers the problem of doctors who leave (resign) their job for better salary in other towns or districts. This may cause some workforce mismanagement of the remaining hospital workers.

At the health center level, most of the posts have workers in charge of specific tasks but sometimes they are not qualified for their post or there is lack of training.

With GHC fellows, there will be sustainable, high-quality health care for thousands living in Ngoma District.

Day one at VHW as a Global Health Corps fellow, it’s a morning around 6 am; I don’t know yet the starting time of my daily duties; what I know is that it is the dry season, plants in the garden should be watered and this has to be done early in the morning, preferably before sunrise (before 7 am).

Thirty minutes of preparations are enough for me to get on the way to the garden. My first appearance to the community workers in the demonstration garden is that of a stranger. None of those who are in the garden know me. I approach three of them and start weeding a seed bed as they are doing too. None dare ask me who I am and why I am there. Suddenly, Mr Gerard (not me) is standing besides me; he asks one of the three to go and tell the rest of their group from the production garden and the 2 nursery cabins to come. A short introduction has been organized to welcome me. People come one by one and finally they are nine of them surrounding the two Gerards. The first Gerard introduces the second Gerard as the new agronomist in charge of the Food Security Program together with a lady who will report very soon without mentioning her nationality. Before he asks for their close cooperation with the new agronomists, he explains how the Program is so important that Global Health Corps has granted Village Health Works with TWO agronomists for the benefits of the VHW residence, the malnutrition centre and the whole clinic catchment area.

Now, it is the turn of the second Gerard to say a word in front of the team he’ll be working with throughout the year. Since my name is already uttered, my first statement is to mention my origin being within the catchment area without mentioning however my home village. I also have to request for their cooperation throughout my stay at Kigutu Village Health Works clinic reminding them I will need their field experience while they may need my training knowledge. I convince them that none will be independent of the other, but rather, we will be in need of each other.

Now it’s time for everyone of the community workers to introduce him/herself. The community leader, being the first one to introduce himself, has to go beyond and reveal his satisfaction that finally they have got someone who will assume responsibilities after two months without anyone in charge of the Program as the last agronomist left before the end of his term due to sudden health problems. Finally, the first Gerard has finished his job and he has to leave for other duties and that mark my very time to embark on these new duties for the coming one year period.

Yesterday’s NYTimes editorial about sending aid to Pakistan took a powerful and unabashedly tactical stance, concluding: “This is a battle for hearts and minds. It is one that Pakistan’s government, and the United States, must not lose.” The NYTimes acknowledges the calamitous effects of the floods on Pakistan’s people and the US’s obligation as the richest donor, but it focuses on Pakistan’s strategic importance to the US.

Though I consider myself a realist, or at least a pragmatic thinker, something about this message left a bad taste in my mouth. Perhaps it is simply the idea that Americans must be convinced to support aid to Pakistan. Whereas Haiti’s earthquake released a spontaneous outpouring of public support and attention, the floods in Pakistan have apparently left people unmoved, except when scared by the threat of spreading Islamism, diplomatic hostility, and nuclear war.

There’s also the worry, as Chris Blattman expresses, that Pakistanis will see right through our ostensible benevolence to our selfish motivations. Though Blattman calls this line of reasoning a “morality lesson,” it is nearly as tactical as the attitudes that inspired it. If we truly want to win hearts and minds in Pakistan, we should give “irrespective of [our] realist and nationalist aims.” Plus, it wouldn’t hurt for a sense of moral, rather than strategic, obligation to drive our actions.

The morals vs. strategy debate reminds me of the perceived dichotomy between “rights-based” and economic approaches to development and global health. Proponents of the rights-based approach assert that letting incentives dictate the provision of goods and services is immoral; instead, people have an inalienable right to basic health, and it is our (the first-person possessive in the most general sense) responsibility to provide it to the poor. The economic approach acknowledges the magnitude of deprivation in the world, and the need to do something about it, but emphasizes the economic benefits of improving health in the developing world.

I think that, increasingly, development practitioners would assert that these approaches are not in opposition, but rather two complementary approaches to “winning the hearts and minds” of donors and supporters. Some people are more swayed by convictions in social justice, others by what they and the world stand to gain from the fight against poverty and poor health. Why not appeal to both constituencies? Is this just a matter of messaging, then? Should we support both kinds of appeals, so long as they reach the right people?

That depends on whether both approaches, when actually implemented and not just used as fundraising appeals, lead to real results. In the past few months, there has been a lot of buzz about rights – the UN recently called water a human right and India declared access to food a basic right. But do these declarations have any effect? You could argue that increased attention to these issues increases donor capital directed toward programs that provide these “human rights,” thus increasing the number of NGOs working in the space. This argument is fairly tenuous, though, and only exacerbates the problem of international development “trends” directing resources and attention. Even when rights are emphasized not as trends, but as consistent goals that should motivate donor action, the social justice approach is limited in its ability to capture wide attention and deliver deep, rights-based programs at scale.

On the other hand, the economic benefits of sustaining healthy populations have motivated a wide variety of private and public actors to contribute to global health. Though they are not fully devoted to aid (as in the philanthropic sector), enormous resources are at stake here. If efforts like corporate social responsibility and profit-motivated approaches are able to divert even a fraction of these resources to alleviating poverty and poor health, that could be a major win.

But when economic incentives drive donor behavior, quality is likely to suffer – both at the individual donor and aggregate landscape level. What happens when a corporation decides to shut down operations in a community and no longer has an interest in maintaining a healthy workforce there? What happens when the sum of many targeted interventions, all of which benefit poor people in small ways, fail to add up to a unified whole – to a population whose myriad problems are fully addressed? Advocates of rights-based programming would argue that it is not enough to celebrate the fact that the interests of the rich and poor are often aligned, which naturally leads the former to help the latter in some circumstances. Only the pure motivation of helping those in need will lead to a unified set of services – or rights – that actually stand to improve people’s lives.

Ultimately, I think that someone out there – and, hopefully, many people – needs to prioritize the comprehensive needs of the poor. But, realistically speaking, most people and corporations don’t, and they may be more motivated by the benefits they stand to gain when helping others. Should these people be shooed away from development? Doing so would leave behind only those proponents of the rights-based approach, which have good intentions and often deep knowledge of the communities they serve, but limited resources to address all of their constituents’ problems. Rather than try to do everything themselves, I think the social justice folks could fill the important role of connecting services and ensuring that people’s needs are met, from whichever sources are best equipped to provide them.

I found a really striking example of this in The Blue Sweater, by Jacqueline Novogratz. For years, development academics and practitioners have quarreled over the right price for malaria bednets. It was once believed that bednets should be sold for at least a small price, because people tend to value more dearly those goods that they paid for. Rights-based practitioners complained of the immorality of such an approach, and they were recently validated by studies by the Poverty Action Lab demonstrating that free bednets have a greater effect on malaria rates in the developing world. But the price of bednets is not so much the issue, Novogratz argues, as how to ensure that everyone gets one.

At present, not enough bednets have been distributed for free – so why not employ a variety of tactics to get bednets out to people? One of the Acumen Fund’s portfolio companies has worked on producing low-cost bednets sold both to individual consumers that can afford them and to companies that provide them to employees (out of their own interests). Here, organizations or governments that believe strongly in the right to bednets could help coordinate the actions of this company and donor organizations like USAID that provide them for free.

Neither the rights-based nor the economic approach to development is sufficient in isolation. Though there are some inherent philosophical tensions between the two, I believe that they can serve as useful counterbalances and complements to each other in the fight against poverty.

And as for Pakistan, I agree wholeheartedly that the US should step up to the plate and deliver more needed aid – but perhaps with more tact and genuine concern than that expressed by the Times!

One of the most ubiquitous buzzwords in the development and social entrepreneurship spheres is “sustainability.” Is your farming sustainable? Housing project? Green-tech eco-friendly carbon-neutral biodome? Eager to apply this concept to my own GHC post, I dove into my position intending to enhance management capacity in 12 different health centers in a sustainable way. But I all got was sustained silence.

Turns out that even though Rwanda has officially embraced English as an official language, this change happened only in late 2008, so virtually all the meetings I’ve had in my rural district are conducted in the indigenous language, Kinyarwanda, with a peppering of random French phrases (Rwanda being a former Belgian colony). Even when officials do speak English, this only means I’ll understand the introductions and formalities before everything inevitably switches after five minutes. Until Philippe, my Rwandan GHC partner, has the chance to recap the events for me, I sit mute, fascinated by this new exercise of plucking out whatever few words I can extract: Bafite! He just said, “They have”! Gukora! That means “to work”! But even after adding in a smattering of intelligible French numbers, I still end up failing this makeshift oral exam.

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