lessons from partners in health #1: don't half-ass

There really isn't much money in the development business. To stay alive, non-profits have to appear efficient (or cost effective, as their grant requests say) to the donors who give them money. In turn, the people who manage donor organizations (like USAID and the World Bank) have to be able to brag about their efficiency to the people who employ them.

This means that non-profits can only get money to do things if they are cheap and reach lots of people. In developmentspeak a cheap thing to do is a "scalable intervention."

I'm a good economist and MBA, so this makes great sense to me. Scale. Leverage. Efficiency. Cost-effective, high-beta, hard-edged, chest-pounding stuff.

Partners in Health taught me that this is dead wrong. The value of the half-assed solution (er I mean, scalable intervention) is zero. Or less.

Let's say instead of spending a year with a hundred farmers showing them modern farming techniques, you decide to hand out fertilizer to a thousand farmers. So they burn their crop or pollute their drinking water or (most likely) just throw the stuff away because they don't know how to use it. Highly efficient, zero value.

Or you want to put 1,000 kids in school instead of 100, so you triple the class sizes and hire cheap, illiterate teachers. And your thousand kids learn nothing.

In public health it's even worse. If you hand out drugs for TB or AIDS but don't make sure your patient can get those drugs every single day, the bacteria or virus will mutate until the drugs have no effect at all -- then that "drug-resistant strain" gets passed on to their neighbors. Not long ago, people assumed that this meant that poor people with TB or HIV were doomed to die. PIH was one of the first groups to figure out that people with serious illnesses didn't have to die if you treated them the same way you treat rich people. Said another way, they didn't have to die as long as you didn't half-ass (= pursue a scalable intervention).

So if you give money to a non-profit, learn from Partners in Health and look beyond the metrics. Give to organizations that do good work, not cheap work.

(Caveat: this is my pragmatic MBA analysis of the Partners in Health method. They don't care one whit about my analysis -- they do it because they believe good health care is a human right and lousy health care is an injustice. Either way, they’re doing good work.)