Four key questions facing the global development community

Today, as I take the reins as the new president and CEO of
Results for Development (R4D), a global development nonprofit focused on health, education and governance, I am excited about what lies ahead. But I also feel a great responsibility to ensure that R4D continues to make unique and meaningful contributions as we work with partners around the world to help people in low- and middle-income countries reach their full potential.

To that end, I've been contemplating four questions that have far-reaching implications not just for R4D but for the global development community at large. These are important considerations to stay relevant (and effective) in a changing world—particularly as we face the complex challenges of achieving more nuanced Sustainable Development Goals to reduce extreme poverty and prepare a growing group of middle-income countries to “graduate” from development assistance.

1. How can we learn what actually works and solve practical implementation challenges to ensure wide adoption of effective practices?

Many in the global development community are focused on identifying potentially game-changing ideas, through a proliferation of challenge funds and other platforms to source innovations. And we struggle with how to bring good ideas to scale and encourage replication. We are also focused on evaluating the effectiveness of new ideas. Yet all too often, the results of these evaluations come too late to inform design and do not provide would-be replicators with practical ideas about how to implement. We as a community could do more to integrate innovative design with real-time testing of what works, and smart adaptation to different contexts.

At R4D, we are cultivating a number of robust and iterative learning methodologies that rely on identification of new ideas, collective peer problem-solving and systematic field experimentation. We are working to find better ways to ensure that all of these methods yield practical evidence about what works that can be easily used by implementers.

For example, we are working with leaders of innovative water, sanitation and hygiene (WASH) programs around the world to understand the barriers facing communities in accessing WASH services, connect local innovators to each other for peer learning, and leverage learning opportunities to help them increase their reach. We are working with three local partners on a global literacy initiative in India to design an experiment that tests several different approaches to encourage parents to read with their children to see which is most effective. And we are conducting a large-scale randomized controlled trial of an intervention that aims to decrease maternal mortality by encouraging community leaders in Indonesia and Tanzania to develop their own local solutions to this problem. This quantitative evaluation is coupled with rigorous qualitative ethnographic research designed to explore why and how the program is or is not effective.

2. How can we better support local change agents?

We believe local leaders must identify and own the solutions to their challenges, and recognize the incredible amount of energy and talent in countries where we work.

Local leaders tell us that they want:

    • Easily digestible information about what works and practical tools for implementation.

    • Better information systems that produce data to tell them whether their approaches are working and help them prioritize their future efforts.

    • To connect with people around the world who are grappling with similar challenges, as a way to gain inspiration, motivation and practical ideas.

    • To be able to request direct support tailored to their self-prioritized needs from global organizations that work shoulder-to-shoulder with them, as peers, offering ideas and tools gleaned from successful efforts elsewhere.

    • We are learning that, with the help of a facilitator, implementers from different countries can collectively produce practical tools that can be adapted in their own countries and offered to others as global public goods. In addition, advances in technology have increased global social-connectedness, and this offers new opportunities for linking local leaders with information, data, tools, and each other to support their success.

At R4D, we are working to improve how we build lasting global human networks, led by local change agents and backed by digital technology, which promote the development and sharing of new knowledge. A good example of this work is the Joint Learning Network for Universal Health Coverage (JLN), which R4D helped launch in 2010. The JLN is a member-driven community of global health policymakers who work to remove barriers to achieving UHC. We also work directly with change-agents in specific countries when we believe we can help them achieve significant impact. For example, we are working closely with the governments of Ethiopia and Tanzania to scale up treatment for pneumonia, the leading killer of children under age 5 globally. With a small amount of support, these countries have the potential to save thousands of lives.

3. How can we break down 'sectoral' barriers that prevent us from effectively addressing key challenges?

Increasingly, I hear our partners around the world considering how to break down traditional silos that impede progress. For example, to support the comprehensive success of young children or adolescent girls, we need to recognize the interconnectedness of the problems they face—in nutrition, sanitation, health and education. These challenges often beg cross-cutting solutions. To that end, health systems can be an important first point of intervention on nutrition and education in early childhood, and schools can support adolescent reproductive health and menstrual hygiene programs that keep girls in school and learning. However, implementing multi-sectoral programs is a challenge when local governments and global development partners tend to organize funding and institutions by sector.

At R4D, we are working to break down our own barriers by bringing together our health, education, nutrition, and WASH teams to co-create ideas.

Another barrier is the disconnectedness between the public and private sectors. By definition, these two groups act independently and development partners often create separate programs to support governments and private innovators. Strong systems, however, are usually “mixed systems,” where governments engage private actors to achieve public goals. As a community, we need to focus more on this crucial intersection.

At R4D, we are committed to pioneering ideas for improving “mixed systems.” We support government health financing agencies to improve how they purchase care from private clinics and hospitals and promote better quality private provision. We also work with global private health provider networks to help them better address the goals of governments. We recognize that similar challenges and opportunities exist in other sectors, like education, where private schools proliferate and governments are starting to consider ways to harness private actors to ensure good outcomes for kids. We hope to develop “mixed systems” approaches that can be applied in health, education and beyond.

4. How can we ensure that lessons from what works in the field inform global development actors who make decisions about allocation of resources?

Most global development partners are in the process of evolving their approaches to a changing world, whether they are considering how to promote innovation and learning, or how to support countries transitioning away from aid. So it is crucial for our field to consistently synthesize the learning about what is working, and not working, for local implementers. This knowledge and experience of local change-agents needs to be front and center as global development institutions make key decisions about resource allocations, policies and development approaches to pursue.

R4D works both with networks of local practitioners and with consortia of global development institutions. We are working to increasingly find opportunities to translate lessons from the field to groups of development policy practitioners. For example, we have worked with a group of development partners to launch the International Development Innovation Alliance (IDIA), to support learning about how development partners can better promote the scale-up of innovations. And we seek out opportunities for our analytic work—economic analysis, policy analysis, and implementation research—to influence global agendas, as well as the policies and priorities of specific partners. Last spring, our analysis of global nutrition spending was used as evidence to argue for more resources to end childhood malnutrition. All of us in the field of global development can do more to ensure that global decisions reflect what will be most useful and effective at the local level.


Reflecting on these four questions, it appears that the field of global development can work to create better virtuous cycles, where networks of peers from around the world identify common challenges, co-design replicable solutions, systematically test them to see if they work, codify the results, and then widely share this new knowledge through human and digital networks. Ideally, local implementers and global development partners alike will use this knowledge to facilitate impactful results.

At R4D, as we work together with our partners to develop a cohesive vision for our next phase, we will consider how to create this type of virtuous cycle to achieve even greater results for the goals that we have prioritized, such as achieving universal health coverage, ending childhood malnutrition and pneumonia deaths and preventable maternal mortality, improving early childhood education, ensuring that every youth has the skills to succeed in life, and improving governance and accountability in countries around the world.  


Congrats! Fill Dave's shoes nobly! Two thoughts: nothing works unless you have experientially trained leaders for whom constructive risk-taking (after analysis) is the norm and comfortable. Outward Bound, etc. Some can be trained, most learned by doing. Feature this re creating entrepreneurs - not only business but social programs too!

I am new to your list and although i have some ideas about global development i am only now becoming engaged with it. Please ask me again in the future and i will hope to have a more to say.


Dear Gina, congratulations to your election at the head of R4D. I am really pleased that you ask the right questions that were occulted since a whole generation of development cooperation; occulted by the impatience of good willing developers that were haunted by saving lives, quick wins and visibility of their actions and often accountable more to their headquarters and sponsors than to the suffering patients in countries that they should serve.
I'll try to give some hints very shortly in answering the questions after nearly 4 decades of development work in the field of health. Further discussion may deepen these positions.
1. How can we learn what actually works and solve practical implementation challenges to ensure wide adoption of effective practices?
Action research and accompanying operational research together with the actors in first line and referral health services is key. When GIZ developed the Centre International pour la Formation en Recherche Action in Ouagadougou, Ian Hughes from The University of Sydney analysed it in a "case study of international cooperation in teaching action research as a process example that may facilitate the construction and distribution of international resources for learning that could be used or adapted to varied local curricula" ( When leaving the Global Fund, Richard Feacham too insisted on operational research: "The opportunities for operational research in AIDS, TB and malaria are large and varied. They range on a spectrum between the simple systematic collection of data to allow program managers to make improvements during the life of the programs, right through to ambitious randomized controlled trials." (
Unfortunately, most decisions were directed to the "easy" and quick win part of develoment aid: input of hardware and consumables, parallel accelerated money flows, hightec data experiments. Too few attention was given to the rather difficult process improvements: quality improvement, human resources development and active community participation. It is not too late to work with the country staff and people instead of working for them and in their place.
2. How can we better support local change agents?
Capacity development through peer-to-peer networking, coaching and mentoring are key. Knowledge Hubs are one example how to address the question ( One aspect is often neglected: local change agents are confronting risks (financial, societal and security) and have to be secured and protected. They are the real heroes of (health) development. They need to protected and rewarded with real career options.
3. How can we break down 'sectoral' barriers that prevent us from effectively addressing key challenges?
Barriers are first of all a matter of mind set. With a fragmented view on "patENDsolutions" (Paul Watzlawik the "solutions may become the problem". We have to learn again to apply systemic views and understanding; to oppose advocacy for isolated solutions driven by specific interest and to challenge them against the concrete needs and hopes of patients through a constructive dialogue (Bruno Dujardin Dialogue is not a donor driven event but a continuous process on an equal footing!
4. How can we ensure that lessons from what works in the field inform global development actors who make decisions about allocation of resources?
This again adresses the mind sets of global actors. In the nineties of last century we were told: Think globally, act locally! Now we have to inverse this thinking: Think locally - centered on patients and communities needs - to inform a healthy policy and global decision makers. In a practical manner, global decision makers have to return to the field regularly challenge their convictions aganist the reality, to harness non filtered views by staff and population - and not be limited to tightly scheduled meetings in climatised offices with decision makers often deconnected from reality.
An inspiring word may help to find an answer to this question: During a an IPPF seminar in 1993, former WHO director Halfdan Mahler reflected on Lord Actons opinion "Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men." Halfdan Mahler then said: "Believe an old man who has seen much in his life: Charity also tends to corrupt, and absolute charity corrupts absolutely!"

your four questions and the issues you describe are precisely the key questions and challenges facing global development. My sense is that we are far from finding good solutions, which would require some deep macro and micro changes to the way development "assistance" is organized. However, engaging on the right questions -as you do above- is a good way to start!

Hello Gina,
Congratulations on your new role! R4D is doing a great job around the world. I have always had an interest in your work and still look forward to working with R4D in Africa in the near future. I would like to share my thoughts on your concerns.
Re: How can we learn what actually works and solve practical implementation challenges to ensure wide adoption of effective practices? It is all about local capacity building – empowering the people to solve their own problems while providing for them the financial leverage and technical expertise to achieve the desired goals. What works is what creates the desired change in the target community or sector. It requires a deep understanding of the issues at hand, the interrelated cultural and social norms and behavioral practices and co-designing (with them) of practical innovations that can address the issues. The latter requires working closely with affected communities to co-develop (with their input) the solutions that they would be interested in adopting and implementing rather than developing a solution that ‘program experts’ think is ideal for solving underlying local issues. In brief: localizing program prescriptions.
Re: How can we better support local change agents? Consider increasing R4D footprint among affected communities, developing change agents among the community, capacity building local R4D agents to not only localize and integrate the R4D agenda within the communities, but also to experience and communicate first hand information on issues affecting the communities. From an organization perspective it will require that R4D establishes country office responsible for regional and sub-regional activities within the target country. The country office will be responsible for providing end-end roll out of the global R4D agenda, providing strategic guidance to the R4D global team, ensuring leadership, technical and financial support is readily available to the devolved units at regional and community level, managing key stakeholders including government, and for facilitating effective communication with country programs, R4D global team and stakeholders. Special emphasis must be put on facilitating change management and transformation, stakeholder management and motivating and retaining change agents.
Re: How can we break down 'sectoral' barriers that prevent us from effectively addressing key challenges? The key is to strengthen Public Private Partnerships in addressing the challenges – working hand in hand with (and facilitating participation of ) government and key stakeholders in public and private sector while focusing on R4D’s key goals, will circumvent imaginary and real ‘sectoral’ barriers. Identifying and working closely and programmatically with key opinion leaders from among the community, government, private sector and stakeholders, and sharing with them your strategic goals, establishing communication linkage with ‘sectoral’ players, organizing focused joint stakeholder workshops and events for information, knowledge and shared value exchange, will unravel the ‘sectoral’ barriers and create a sustainable environment for R4D program implementation. Supporting development of policy and legislative framework will not only enhance program sustainability but also assure the realization of desired impact.
Re: How can we ensure that lessons from what works in the field inform global development actors who make decisions about allocation of resources? Strengthen your advocacy and strategy unit to ensure there is effective communication and documentation of your programs. Working collaboratively with other global payers in the same area of interest as R4D and facilitating provision of joint reports and recommendations will positively attract the attention of global development actors. More radically: designing and executing high profile field based events that exposes the representatives of the global actors (GAs) to the real situations on the ground will result in positive review of resource allocation. Often the gap is in “experience based decision making” - let the GAs come face to face with the global health issue, let them experience (see) the girl child who has to sit in soil during her menses, let them hear from the community representative (in a community setting) about the WASH issues affecting them. When such experience is documented the result is often an accelerated sense of urgency and unprecedented resolve to deal with the problem with finality.
About myself;
Work experience: Five years of progressive experience as program logistician with Medicines Sans Frontieres (MSF) in Kenya and Tanzania, supporting Somali and South Sudan programs. Fourteen years of senior business management experience with Becton Dickinson (BD), a leading global US medical technology company including four years as Policy and Strategy Advisor for Africa and ten years as business manager. Two years of pharmaceutical distribution management experience (Twiga Chemical Industries East Africa Limited). Three years of pharmaceutical marketing experience with SmithKline Beecham (now GSK). Two years of cumulative project management experience as consulting project director with a US nano-technology company (OASIS), with an Italian dialysis equipment manufacturing company (Bellco Srl) under the Managed Equipment Services (MES) Ministry of Health Kenya Project, and with a Finish sanitation eco-technology company (Ekolet).
Expertise: Global Health | Leadership, transformation and change management | Policy formulation and development | Strategic planning | Project planning and management | Business management | Partnership development | Logistics
Education: Bachelor of Veterinary Medicine (BVM) degree, a Master of Business Administration (MBA) degree (specializing in Strategic Management), and a Master of Arts in Project Planning and Management (MA PPM). Several post graduate certifications including certificate in Monitoring and Evaluation for Population and Health Programs; Policy Formulation, Implementation, Analysis and Evaluation; Public Private Partnership; Leadership Development; and Emergency Logistics Preparedness (MSF Holland, Netherlands).
Cross cultural international work related experience and travel: USA, Mexico, Netherlands, Belgium, Spain, Germany, Switzerland, Turkey, Poland, Italy, United Kingdom, Czech Republic, Russia, Thailand, Vietnam, China, United Arab Emirates, India, Malta, Uganda, Tanzania, Ethiopia, Rwanda, Burundi, Djibouti, Eritrea, Madagascar, Sudan, Somali, South Africa, Malawi, Zambia, Zimbabwe, Botswana, Namibia, Angola, Nigeria, Ghana.

1. How can we learn what actually works and solve practical implementation challenges to ensure wide adoption of effective practices? R4D is on the right track. We also need to understand what the beneficiaries actually want and need. Prescribing interventions that are not culturally, religiously or socio-economically unacceptable does not work. We tend to underestimate the end users' understanding of what they need and what can work for them. Shift from the development aid mentality to development partnerships. Encourage host countries and communities to contribute own resources for their benefits. For example, if supporting the building of a bore hole; have a community member donate the land and let identified community leaders guide their people to mobilize labor and other locally available resources. We need a better understanding of what the beneficiaries really need and have empowerment initiatives that are transformative.

2. How can we better support local change agents? In addition to what has been mentioned, we also need to cascade these learning platforms to the countries at the national, sub-national and community levels. We also need to work with the local champions and leaders at all levels from the national to the community/village levels. We need some recognition and incentive methods to appreciate the local change agents. The challenge has been that global best practices don't reach the lower levels. The socio-economic issues are more or less similar across countries and we need a system to support these local change agents to be able to learn from their counterparts in different countries/communities and then a system where they share these locally. The process needs to be continuos and across all sectors
3. How can we break down 'sectoral' barriers that prevent us from effectively addressing key challenges? Breaking silos is important. It is great R4D is taking the initiative to do this internally. We also need to advocate with the big donors such as the USG, UK Government, EU among others to start designing more integrated programs that are multi-sectoral. The challenge has been the way funding is structured and the demand for results from each project. We need to have a more holistic approach and look at the beneficiary as a person who needs all the key social services. We also need political commitment if we are to influence the way funding is structured and flows; how are country and donor budgets allocated? Do they encourage synergy across sectors or competition? Even within the health sector, there is still verticalization that needs to be addressed especially as regards the major disease projects such as HIV, TB, Malaria and now MNCH. This is a big challenge but it can be done with the right leadership and persistent global advocacy efforts for multisectoral approaches. The Sustainable Development Goals have provided an opportunity to start work on this if they are supported by how funding is allocated globally and locally
4. How can we ensure that lessons from what works in the field inform global development actors who make decisions about allocation of resources? R4D is doing a great job and we need more evidence based programs informed by implementation research. We need a leader who can create opportunities to bring various implementers and decision makers together on a regular basis. We also need a system that would ensure that such best practices are recognized and shared at all levels. Need global learning platforms like R4D is leading but also regional, country and community level platforms. For example, in Kenya, they have a great Community Health Strategy but the challenge is that different MOH department and projects design trainings that are vertical rather than having a more comprehensive approach. Implementing partners do the same because of the way the funding streams are structured causing burn out of the same Community Health workers who are volunteers! With such a scenario, unless there is flexibility in funding allocations and project designs it would be a challenge to solve it. Countries can be supported to have multisectoral planning processes. Different countries also need to leadership on multisectoral coordination, set their priorities and demand their partners: donors and implementing partners to work within what they have put in place.


1. How can we learn what actually works and solve practical implementation challenges to ensure wide adoption of effective practices? In addition mentioned is that presence of strategies that are working to ensure that supervisors of various projects becomes faithful in implementing all outlined works, also all projects should be transparent to the society to avoid favoritism.

2. How can we better support local change agents? to help development change local changes by helping them financially and by giving them education on establishment of their own entrepreneurship groups so as to raise their own income.

3. How can we break down sector barriers that prevent us from effectively addressing key challenges? Breaking down barriers is to provide education to the society to be aware of the specified ongoing projects, integrating the society before commencement of the specified projects will help to remove resentment within a society and also not to run the projects that are not needed by the society.

4. How can we ensure that lessons from what works in the field inform global development actors who make decisions about allocation of resources? working in a transparent way and keeping our activities records, also to ensure that all financial resources or all materials that have been sent to us from global development stakeholders are used as instructed by those stakeholders.