Accelerating Global Health Delivery

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

This session conducted by the leadership team of Partners in Health was scheduled for 7 am on the 10th of April. Hence by design it self-selected for individuals who were extremely motivated to learn from the experience of Partners in Health in Global Health Delivery.

Partners in Health (PIH) is a Boston-based nonprofit health care organization founded in 1987 by Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Jim Yong Kim.

The organization’s goals are “to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.” It provides healthcare in the poorest areas of developing countries. It builds hospitals and other medical facilities, hires and trains local staff, and delivers a range of healthcare, from in-home consultations to cancer treatments.

The session was led by Dr. Joia Mukherjee, and was facilitated by her colleagues Dr. Gary GottliebDr. Abera Lotha

The session delved into a nuance in global health delivery which are often ignored. Dr. Mukherjee asserted that the successful delivery of healthcare ought to be reviewed through three lenses.

  1. A justice framework
  2. Human rights framework
  3. Social determinants of health framework

The first two are not given their due share of discussion since perhaps as healthcare professionals we feel this is beyond our scope of work however, they are essential to an equitable delivery of good health for all.

The justice framework requires retrospective reflection. Many of the inequities we observe as global health delivery agents are not just because people who we aim to benefit do not know better or that there is lack of will to correct the structural problems that exist. Instead, the source of these issues come from a history of colonization, practices of slavery and exploitation of certain regions by others. The damage from these unfortunate parts of our collective history is immense. While these chapters of history cannot be undone, it would not be prudent to completely forget about these issues as important causative factors towards why certain regions struggle to this day with diseases that the developed world has long overcome. Hence, keeping them in our purview as we think about global health would ensure such injustices are never repeated.

The second framework is the human rights framework. Today we live in a world where almost everything we do, any service we receive or any item we own has input from many different regions. This is especially more applicable to the socioeconomic strata attending this forum or can read this narrative that I write today. When we live in a globalized world of commerce then a question that arises is why our human rights are different depending on national borders. What would be considered exploitation in one country would be considered fair trading practices in another. The world is much more comfortable with utilitarian notions of healthcare service delivery for the poor but not the same yardstick is applied to the wealthy. These are deep-seated, class-based biases that ought to be brought out in the fore and the repercussions of these biases need to be corrected or else the inequities we wish to overcome will always plague us in some way or form. This philosophy of healthcare delivery is reflected in the work of Partners in Health throughout the world. They believe all that they interact within their ecosystems are owed a similar chance towards healthcare services.

Finally, the social determinants of health were also discussed. This is an area quite often discussed and debated on in Global Health conversations. The impact of where you are born, your gender, your education and such all impact health outcomes. This has been researched and well documented. Dr. Mukherjee added a nuance to this conversation though. She proposed that instead of calling it social determinants of health we should label this effect the social forces of health since these socioeconomic markers are not just a correlation but have vector component to them as well hence the relabeling to a “force” would more accurately depict the relationship.

One of the key takeaways from this session was that healthcare is clearly a political and a social issue. And in our respective communities, to enable meaningful healthcare change we must interact deeply with the social and political forces. Meaningful change requires mobilization and that’s only possible once we put our skin in the game by operating beyond our healthcare facilities and embed ourselves intimately with the wider community.

About the Author

Mohsin Mustafa

Mohsin Mustafa is an Oxford MBA candidate, a Skoll Scholar and Weidenfeld-Hoffmann Trust Scholar. He is also an entrepreneur who is passionate about the provision of quality primary healthcare. He sees the provision of quality healthcare as a way of enabling social justice and that’s what fuels his passion for work. Mohsin is the co-founder and managing director of Clinic5, an affordable healthcare delivery service for communities in Pakistan. He is currently a Skoll Scholar, Weidenfeld-Hoffman Scholar and MBA candidate at the Saïd Business School.

Getting to the root of the problem: The myth of “AI for good”

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

“We have to move beyond talking about AI for good and AI ethics. We simply cannot build just, equal, and fair automated systems on top of corrupt toxic sludge.”

Tanya O’Carroll

Tanya O’Carrol’s mic-drop statement at the end of her talk brought on a raucous round of applause at the Artificial Intelligence (AI) and Human Rights panel at the 2019 Skoll World Forum. She had just addressed the major elephant in the room: the very business models of extraction of personal data at any cost that have brought on an age of surveillance capitalism need to be challenged.

The AI and Human Rights panel at the 2019 Skoll World Forum brought to light some incredibly pertinent insights surrounding the intersection of technology, society, and business. First, there was a questioning of “AI for good” and a plead for nuance while looking at what has already been done in human rights when discussing AI ethics. Second, there was the challenging of the capitalist structures in place that have even created a need for “AI for good”. Lastly, as is the optimistic nature of the Skoll World Forum, there were examples of the power of collective genius in addressing challenges of human rights in the digital age.

The problem with “AI for good” and “AI ethics”

The current discourse around “AI for good” and “AI ethics” stem from an understanding that left unchecked, new technologies can wreak havoc in society. However, the general consensus at Skoll’s panel was that AI is not that special — much like any other tool or technology, it can be used for good, for bad, have intendended and unintentended consequences. Furthermore, many corporate ethical codes for AI try to reinvent the wheel, without looking into existing human-rights based codes of conduct. Dunstan Allison-Hope of Business for Social Responsibility argued that “ human rights based methodologies offer a robust framework for the responsible development and use of AI, and should form an essential part of business policy and practice”. He continued on to say that the current conversation around ethics and human rights in technology only include tech companies, and that we need members of other industries weighing in on conversations surrounding human rights in the digital age, especially as AI and other technologies become a dominant force across sectors and geographies.

But why do we need AI for good or AI ethics in the first place? Promoting AI for good startups and regulating AI ethics don’t necessarily answer some of the most pressing questions that come with the rise of tech’s frightful five: Who is collecting our data? Where is this data going? What does consent look like? We need to look at the root of the problem: the big-tech business model.

Dissecting the big-tech business model

Shoshana Zuboff, an academic at Harvard, coined the phrase “surveillance capitalism” to explain power and information asymmetries that have enabled a new economic order that make those who hold our data far more powerful than us. Companies such as Facebook and Google have what she calls a “behavioral surplus” of digital data that allows them to be monopolists and market leaders in the trade of behavioral data. Everything we do online is tracked and able to be monetized. The monetization of this data is especially profitable in the aggregate, and as is Zuboff’s core argument, this data is far more valuable to the aggregator than to the individual.

The data that is extracted from us as we use tech products has such a disproportionate value to corporations that immense inequalities in power have emerged. Tanya O’Carrol of Amnesty International lamented at the Skoll World Forum that the way data is exploited and harvested is one of the biggest existential threats to society today. We need ethical codes for AI and organizations working on AI for good precisely because the tech business models of today prey on the raw material of our digital personhood. We need to challenge the system of data extraction that exists today.

What can we do? The power of collective genius

Systems change does not happen with an individual. It comes with the collaboration of a variety of different actors. Elizabeth Hausler of Build Change illustrated at the panel the need of collaboration between actors in her work in addressing infrastructure and architectural inadequacies resulting from natural disasters. Her organization uses AI to quickly assess buildings and rapidly come up with engineering designs that can then be implemented by builders and engineers with homeowner input. She also indicated that AI alone would not be the solution; we still need government officials to make the tough decisions to allocate resources to solve the right problems. Similarly, Babusi Nyoni, an AI evangelist from Zimbabwe discussed that without proximity to the perceived beneficiaries of an innovation, many technology projects fail. Communities and context can help determine which data is and isn’t useful.

Communities, governments, and businesses must bring together what Megan Smith, founder of Shift7 and moderator of the panel, calls their collective genius to challenge the existing power structures in the tech industry. Whether it is breaking up monopolies, pushing for an adherence to human rights conventions, corporate tax reforms, or accelerating positive community-led innovations, we must stop working in silos to challenge the status quo. Megan ended the panel by quoting William Gibson, “the future is already here, but just not evenly distributed”. Collective genius (and action) can help change that distribution.

About the author

Tulsi Parida

Tulsi Parida is a Pershing Square scholar at the University of Oxford, where she most recently completed an MSc at the Oxford Internet Institute, studying the implications of mobile learning technologies in emerging markets through a gender and political economy lens. She is currently pursuing an MBA at Saïd Business school, where she is focused on responsible business and impact finance/investing. In previous years, she has led teams at start-ups in the US and India working to reduce digital divides in literacy. Tulsi is committed to reducing digital inequality and promoting responsible/inclusive tech. 

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Shifting The Power Dynamics of Philanthropy

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

Philanthropy in and of itself is neither the solution nor the problem in international development. Rather, it is how we currently understand, utilize and govern philanthropy that contributes significantly to its successes and failures.

Panelist and author of Decolonizing Wealth, Edgar Villanueva, suggests that philanthropy is in a moment of reckoning. I hope he is right. The history of colonization and power dynamics inherent in today’s philanthropic system need to be recognized, grappled with and frankly, overturned.

Most of us are now familiar with stories of failed aid, and critiques of the Western philanthropic system in which wealthy or otherwise privileged people in one place make decisions about funding, development, and projects for people or organizations in a completely different place, of which they know little. The gap is in having no substantial understanding or experience with the context. “Failed aid” isn’t only applicable to the relationship between developed and developing countries – the disconnect could be continents away, or mere minutes away. Rodney Foxworth, Executive Director of BALLE, referenced the median net worth of a black American household in Boston, which is $8, compared to $247,500 for a white household. Read that again. $8. Compared to a quarter of a million dollars.

Foxworth proposes that we need to shift capital to “advance the economic interests of communities who have been excluded from, extracted from, and marginalized for centuries.”

There is a growing recognition that this kind of extreme disparity and inequality is neither logical nor just, and that it drastically fails the communities and people on the negative side of the power and wealth balance. But how can those with power begin to shift it?

Some tangible actions to rebalance power and capital seem straightforward: creating more diverse boards and teams, putting more decision making into the hands of the people who are living with the problems directly or working on the frontlines, and spending more time listening and co-designing solutions that meet the self-expressed needs of the people themselves. These principles are often at the heart of how social enterprises and non-profits seek to do their work, and yet even with these as stated goals, we often fall short as well. It is easy to skip over the time and effort that true inclusion require; it is convenient to sacrifice deep understanding for perceived efficiency and output.

Achieving a significant shift of capital, or de-colonizing wealth, requires first understanding why and how power dynamics of wealth are where they are to begin with, and admitting the injustice of how the system was built and is still maintained. More difficult, of course, is actually changing, letting go of power, and building new systems on foundations of trust. It seems clear that someone living with or working directly with a problem day in and day out will have better insight and expertise than someone who has never experienced it, and yet we often ignore or overlook this expertise in favor of those who hold money and therefore decision-making power, or even in favor of our own ideas and self-acclaimed expertise.

Trusting in other’s direct expertise, and investing in that expertise, will be key in shifting the power dynamics of philanthropy. Ultimately though, how this plays out will rely heavily on who has a seat at the tables of philanthropic and stakeholder powers. It is the responsibility of everyone in the impact and development space to create a more diverse and representative table.

To top it off, we should probably all read Villaneuva’s Decolonizing Wealth – I’ve already ordered mine!

About the Author

Julie Greene

Julie Greene is passionate about tackling issues of social injustice, with a focus on educational and economic inclusion for women. Julie has come to believe that business is one of the best tools for achieving social impact and sustainable change, and is co-founder of The Women’s Bakery, a social enterprise that trains and employs women in East Africa. 

Photo source: Skoll Foundation

What’s The Role Of Men And Boys In The Gender Equality Movement?

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

As a global health nurse with over a decade of experience in gender based violence I will admit a healthy bit of skepticism when I was invited to document a session at the Skoll World Forum on the role of men and boys in gender equality.  Why would we waste precious resources and energy on men that could be spent on marginalized women and girls? What is the role of men and boys in preventing the violence they themselves have created?

My skepticism was greeted in an open and frank dialogue at the Skoll World Forum, a global community of social entrepreneurs and changemakers from over 65 countries, gathered in Oxford for four days to accelerate a future that is fair, inclusive, and sustainable.

Katya Iverson, a personal ‘shero’ of mine, and the CEO of Women Deliver opened the dialogue tackling this tension head-on and provocatively asking the panel to share their personal motivations for involving men in gender equity.  The panel was a powerhouse of gender advocates from Sri Lanka, the USA, Denmark, and Zimbabwe who shared their innovative solutions for tackling gender inequality.  The following key take-aways really resonated with me and I hope they might be useful in your own work:

  1. Elizabeth Nyamayaro, UN Special Advisor, reminds us that revolutions are never built on consensus. To achieve gender equality we need measurable commitments from male leaders like the IMPACT 10x10x10 campaign, comprised of 10 Heads of State, 10 global CEOs and 10 University Presidents.
  2. When you invest in gender equality everyone wins.  Challenging existing gender norms and inequalities means confronting the attitudes, behaviors, and power structures that uphold them and improving the sexual health and reproductive rights of women AND men.
  3. Globally we hide behind the phrase “violence against women” but Gary Barker of Promundo reminded us it is actually “male violence against women.”  Men need to confront their power and privilege and the root causes of toxic masculinity in order for us to make meaningful societal change.
  4.  Dakshitha Wickremarathne, founder of the Youth Advocacy Network Sri Lanka, encouraged men to come forward as feminists and take personal action. Elizabeth further echoed “Don’t underestimate the power of one. If you think you’re too small to make a difference, try spending the night with a mosquito.”
  5. Judith Bruce from the Population Council reminded us that investments in women and girls go further in communities, arguing that not to invest in them is “planned poverty”. She implored the audience to “disrupt planned poverty and replace it with planned parenthood.” and offered tools and a community of practice for our work.
Elizabeth Nyamayaro speaking to a delegate

Ultimately, I left the panel inspired as a mother of two young boys that there is a role for them in this movement and challenged to broaden my own advocacy efforts to better involve everyone in preventing gender-based violence.

About the Author

Meaghan Thumath

Meaghan Thumath is a global health nurse and policy maker. She is a Trudeau Scholar at the University of Oxford’s Centre for Evidence Based Intervention (CEBI) researching the impact of drug policy and child welfare systems on maternal mortality. For over a decade Meaghan has provided technical assistance to international organisations such as UNDP, UNAIDS and the Global Fund to End AIDS, TB and Malaria supporting improved access to healthcare for marginalised populations in Central Asia, Eastern Europe and West and Central Africa.

Follow Meaghan on Twitter

Scaling Health Solutions through Government Partnerships

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

Achieving universal health care through collaboration between funders, social entrepreneurs, and government

Frustrating. Slow. Fundamental. Scale. These were the words that came to mind to attendees when Erin Worsham of the Center for the Advancement of Social Entrepreneurship asked them to describe working with government. The balance between the challenges of working with government, and the potential impact and scale that could be achieved through collaboration was immediately apparent.

In the next hour and a half, we heard candid conversations from two partnerships between social entrepreneurs and governments. One was between Last Mile Health and the Government of Liberia. The other was between Partners in Health and the Kingdom of Lesotho. Through these conversations, there were three themes that kept coming up:

  1. Collaborative target setting and evaluation between social enterprises and governments
  2. Demonstrating impact to inspire scale up
  3. Funding for comprehensive primary health care, rather than particular diseases

Collaborative target setting and evaluation

Thabelo Ramatlapeng of the Kingdom of Lesotho kicked off this theme when she mentioned one of the major challenges for governments was working with organizations who brought their own missions, and their own objectives, and were inflexible about setting these objectives collaboratively. In both partnerships, there was a concerted effort made to understand the government’s priorities and ambitions, and design the work and evaluation according to these, rather than organizational agendas.

Lisha McCormick of Last Mile Health drove this home when she mentioned that in her experience, the Government of Liberia wasn’t concerned with RCTs, and evaluation; they had very practical questions- how do we implement, and how do we pay for it?

Demonstrating impact to inspire scale up

Another recurring theme was social enterprises demonstrating impact to government in smaller use cases, and government building on this momentum to scale up what is proven to work. Partners in Health by building seven comprehensive primary care clinics in the most isolated and difficult to reach areas of Lesotho, and Last Mile Health by implementing a community health worker model in three counties of Liberia. Each have now scaled rapidly in close collaboration with government, with comprehensive primary healthcare now reaching 40% of the population of Lesotho, and community health workers operating in 15 counties of Liberia.

This to me, seems like the ultimate theory of change around working with government. Innovators prove that work can be done differently and more effectively, and the value of government is in recognizing and scaling this innovation so that it has massive impact. The innovation would not have been recognized, however, if the respective teams hadn’t engaged government in setting the objectives and defining success at the very earliest stages.  

Delivering comprehensive primary healthcare

There was a third stakeholder in the conversation between panelists that wasn’t a speaker, but whose presence was felt- the funders. A major challenge emphasized by Abera Leta of Partners in Health was that funding for health is often in verticals, designated to treat HIV vs. malaria vs. a vaccination, rather than funding that can be used for comprehensive care that treats communicable and noncommunicable diseases, and makes true universal healthcare access a reality.

Again, the importance of following the government’s lead was emphasized. In countries like Rwanda that insist on autonomy in how they use donor money to fund healthcare, comprehensive primary healthcare can be prioritized. Just like with social enterprises, when funding reinforces and enables the government agenda around comprehensive primary healthcare, rather than trying to force its own, the potential of this collaborative relationship is realized. Every speaker, from the government and the social enterprises, was unanimous in calling for funding that could be used to build the primary healthcare systems that countries need.

As we think about these themes, it’s important to keep the individuals at the center, who are the reason that  all three players- governments, social entrepreneurs, and funders- do this work. S. Olasford Wiah of the Government of Liberia brought us back to these individuals when he shared what inspires him to work in community health. He shared the story of one of his former patients. A woman who had a healthy pregnancy, but experienced complications during the delivery. Her community came together to try and bring her to a health center, walking and carrying her for hours in a hammock, but by the time they reached the center, she had passed away.

This is the injustice experienced by the 50% of the world that doesn’t have access to essential health services. And addressing this injustice is what motivates us and demands that we collaborate to achieve a world with universal access to health care.

About the Author

Puja Balachander

Puja Balachander is a social impact designer following the lead of vulnerable communities to help solve their most intractable problems. Throughout her career so far, she has worked on designing sustainable, equilibrium-shifting solutions with end-users. Puja believes in working with end-users in their language and in their community, therefore she practices and teaches design in French, Hindi, and Tamil, and has worked all over the US, India, and Madagascar. Currently undertaking her MBA degree at Saïd Business School, she is also co-founding Devie, a social enterprise that aims to improve access to quality early childhood development.


Aligning Inner Wellbeing with External Impact

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

In 2014, I and my Indian co-founder started an ed-tech company in Bangalore to use technology and help teachers close early learning gaps and serve the 200 million low-income families who aspire for a better future for their children. After 3 years of struggle and one pivot we were under a lot of pressure to show potential investors we are worth it.

And then my partner’s mental health deteriorated. We burnt-out.

How many young entrepreneurs out there burn-out while trying to achieve their vision? A survey by The Wellbeing Project, a global initiative co-created with Ashoka, Esalen, Impact Hub, Porticus, the Skoll Foundation and Synergos, shows that 80% of Ashoka fellows and social entrepreneurs across the world self-identify as suffering from burnout. More than half of them are between the age of 25 and 34.

Daniela's Tattoo on her arm.
My arm tattoo reminder: “We are all human”

System change is about people and people can only work effectively when they are balanced, grounded and connected. It’s been almost one year since I stopped working in India and now, I am aware of my self-care. This session at the Skoll World Forum for Social Entrepreneurship 2019 was a great reminder of how important self-care is for everyone, but especially for change-makers.

Cheryl Fraenzl, Director of Programs and Terry Gilbey, General Manager for Esalen Institute, an alternative educational center in California, ran an incredibly powerful workshop, called: Aligning inner wellbeing with external impact, around wellbeing, connection and the practices that allow us to reach our human potential.

“Wellbeing does not mean happy-happy, it is about the inner alignment with what we do, the sense of presence and connection, it means being aware of how we do, it is a state where inner purpose matches outer purpose”, says Cheryl.

Lesson 1: Bring a discipline of wellbeing practices in your life

As participants, we were first invited to score our life domains (from 1 to 10) to see how aligned we feel in areas such as: growth and learning, love, career, money and sense of community. You can use the Wheel of Life to see the distance between where you want to be and where you are in your life.

The next step is to explore what works for us to achieve what the facilitators called a “life balance”. Meditation is one such “wellbeing practice”. “Meditation improves our ability to function particularly in stressful situations” says Terry who reminded us further about the benefits of meditation, such as slow aging and lower blood pressure. Other practices might involve yoga, breathing exercises or mindful walks in nature.

The Wellbeing Project works with change leaders around the world and takes them through an 18-month “inner development program”. So far, around 60 social entrepreneurs from 45 countries found and nurtured a deeper sense of wellbeing, through discovering what practice contributes to their “inner work”.

Lesson 2: Cultivate a deeper focus on relationships

According to a survey on loneliness and social isolation conducted by Kaiser Foundation and The Economist, 2 out of 10 adults in the USA and the UK report being “almost always, if not always, lonely”. Further, a study that follows different people across their life for the last 75 years, shows that, ultimately, happiness depends upon the quality of our relationships. Check out more insights from this study directly from psychiatrist Robert Waldinger:

TED Talk: what makes a good life? Lessons from the longest study on happiness | Robert Waldinger

Happiness is not about success or financial wealth. What’s crucial is to foster and maintain relationships. If we dedicate time to people in our life, we will feel supported and happy.

Evaluation programs of The Wellbeing Project show that every single change leader who goes through the inner development cycle reports as feeling more centered, more present, more aware of right now. Cheryl stated: “Their narrative changes from <<I am the sole solution>> to <<Change takes a momentum, a majority of us to create multiple solutions>>”.

Wellbeing of those working in the social impact space is about a celebration of the small steps, a state of being rather than doing, a presence in the moment and finally, about trust and collaboration. I argue this is one of the most important lessons at the Skoll World Forum this year.

About the Author

Daniela Gheorge

Daniela Gheorge is a social entrepreneur in education. Born in Romania, Daniela spent eight years working in India in business development, marketing and operations across four states with impact businesses. She started vChalk, a for-profit ed-tech company, in Bangalore in 2014. She is currently a Skoll Scholar and MBA candidate at the Saïd Business School.