Designing Practical Interventions: The Case of Millennium Villages
After you’ve made the diagnosis, after you’ve mobilized the development aid, after the key concepts of investing in health and education, or in infrastructure, the real life of implementation of development programs becomes the most important issue. When the Millennium Development Goals were first enunciated and I was asked and very honored by then UN Secretary General, Kofi Annan to advise the UN system on how the MDGs could be achieved. I called on colleagues and professionals from around the world, from many different disciplines from agronomy, from public health, from the education sector, from urban and rural engineering. To suggest the most effective approach is the new technologies, the best ways to make an advance. That was the UN Millennium Project. And from 2002 to 2006 it prepared many, many studies. And in 2005 presented a long report and detailed information to the member states of the UN. And in a special session of the General Assembly in the fall of 2005, the UN member states adopted a number of Ideas of how to proceed in a practical way to achieve and implement the Millennium Development Goals. One of the very lucky things for my colleagues and me was the proposal that it would be a good idea to look in detail at a few places, some very, very poor villages around Africa, to see how these recommendations could work on the ground, in practice. And to use that experience to develop new tools for implementing the fight on poverty. To implementing pathways to saving lives through public health, to implementing new cutting-edge technologies such as the use of mobile phones or broadband for schools and for health systems, and for business development. This is how the Millennium Village project got started. If you look on this map of Africa it shows you where the Millennium Villages are located with each of the main village clusters shown on the map. But it also shows you Africa in a bright colored depiction that you haven’t seen before most likely because these colors on this map are not of the countries, or even of the features of mountains and lakes and so forth as a standard. But rather is a division of Africa into different kinds of farm systems. So the yellow areas along the east coast of Africa, the category shown in Kenya and in Tanzania and Malawi, and other places down the east coast of Africa is the maize production region of Sub-Saharan Africa. Or if you look in the horn of Africa up in northern Ethiopia where the village of Koraro is located, you see a highland area. In fact, in northern Ethiopia the main staple crop is something basically not known in the rest of world, a grain called teff, which provides a wonderful bread traditional in the Ethiopian diet. But its a distinct ecological zone because it is a highland zone. Or if you look across the brown shaded areas where you see cereal crops are mainly planted in, in very dry regions or the area just above that known as the Sahel of Africa, and a zone that from a farm system point of view is called is, is called agro-silvopastoral. So there’s some bit of crops there’s some tree crops grown and there’s pastoralism the goats and the sheep the camels that are herded in the very dry areas. Well we wanted to see how the Millennium Development Goals could be approached in each of these distinct agro-ecological zones. Because each one poses specific challenges. How to grow crops that are different. How to manage livestock, particularly important in the pastoral regions. The disease burdens are quite different as the climate varies. In the highlands it may be Malaria isn’t so much of a problem, but in the tropical lowlands malaria can be holoendemic, infecting just about everybody, unless it’s brought under control. And so the Millennium Village project identified ten very poor places with the help of the host governments. Each of these places was at the beginning of this project in 2005 a so called hunger hotspot. That meant that there was a chronic undernourishment of, of at least 20% of the population, and in many cases much more. In other words, not only would the villages in poor countries, but they were in the very poor parts of the poor countries. The idea was to apply the Millennium Development Goals as the guiding principle. The core of the project was a holistic approach. Remember that there are eight MDGs. Now applying the MDGs therefore means to design programs that aim to achieve all of those goals. Not just a health project, or an education project. But to achieve all eight of the Millennium Development Goals. There are two big reasons for that. One is that each of the eight goals is meritorious in its own right. Of course fighting hunger isn’t the end if there’s big disease burden,or fighting disease and hunger isn’t the end if children are not yet going to school, and so forth. Each of the eight goals is important in and of its own right. But the goals are also synergistic. Helping to provide safe water in a community can not only rid the community of a big part of the disease burden, but can help the children be healthy enough to go to school. And so to help meet the school objective. Fighting malaria, similarly, is not not only protecting the lives of the community but helping to protect the productivity of the community. So that people are not sick when it’s planting or harvest time, or the children are not so sick that they don’t get to school. So not only do we want to achieve the eight Millennium Goals because they’re each important. But by targeting each of them we actually help to achieve even the others as well. So the Millennium Village Project took a holistic and synergistic approach, aiming at a rather low cost of donor funding. In the first five years, $60 per villager per year to be matched roughly by the host country government and the local community, so a total on the order of about $120 per villager per year. To face the whole range of challenges, higher productivity agriculture making sure the children have classrooms, teachers, school supplies for effective primary education. Making sure that vaccines and bed nets protect the children from malaria to reduce the burden of childhood disease and to reduce sharply the death rates among young children. Ensuring emergency obstetrical care for mothers so that childbirth is safe, and even when an emergency occurs the mother doesn’t die of hemorrhaging or a obstructed labor which kills so many mothers if there’s no emergency care available. And using new clever ways to meet environmental goals of proper sanitation, safe drinking water, protection of the local environment. It really is the idea of the differential diagnosis, but not applied to one specific challenge, but rather applied across the range of the goals so that all of the goals can be achieved, and so that all of the synergies can be harnessed for success. The project is now in its eighth year and what we have seen is that even in the very poorest places it’s possible to help mobilize a very active community. Because across the world mothers and fathers want to ensure the health of their children, they want to ensure of course the survival of mothers in pregnancy and in childbirth. They want to reduce disease burdens. So by harnessing the energies of communities with a little bit of help, with best practices, with new kinds of information systems, tremendous things can be achieved. Have a look at some of the range of activities taking place in the Millennium villages. In Potou, Senegal a huge expansion of onion production to serve the national market has helped farm families to raise incomes and to raise living standards, to invest in the quality of their housing for the community to invest and improve health and education. And to upgrade agriculture more generally by introducing irrigation and introducing other parts of a high productivity agricultural system. In Rwanda with the partnership of government a village area that was bereft of just about everything and a place that had been a gathering point after the Rwanda genocide where refugees from all over the country came and gathered, but,meaning it wasn’t a, a tight knit community at the beginning. Was able to get power in, into the community, electricity, a, a new road connection new investments in health and in education, and a tremendous take off of business activity. In Sauri, Kenya, the very first of the Millennium villages you see the children on their way to school and a big step up of school programs including school meal programs throughout the whole community. In Ambola in Tanzania you see a new improved water source for safer water supplies for the community. We’ve seen that that range of activities is feasible. It was once thought that a poor community might be able to do one or two kinds of things, this is an old fashioned and poorly thought out idea. Communities necessarily live holistic lives they earn livelihoods, or they struggle to do so. They want their children in school, they need healthcare, bo, both to prevent and to treat Illnesses. Every community needs to have water but if the water’s safe the community stays healthy. And so the idea that communities can improve systems across the board has proven to be a viable and a correct assumption every day demonstrated within the Millennium villages. And gender equality has manifested itself by women’s leadership throughout the villages. And by new business development that women have taken on and that have greatly empowered them, given them their own source of income and a tremendous amount of pride. And here you’re, you’re looking at the Rwanda women’s cooperative in Mayange, the Millennium village in Rwanda where the women are producing wonderful artisinal goods of weaving and knitting. These goods have been featured in American stores. They’re being marketed online and the women are as proud as can be and their incomes and stability, ability to care for their children has absolutely soared. One of the most exciting developments in the Millennium Villages has been the development of the community based healthcare, and within that, the role of community health workers. A community health worker is a young person, very often a young woman from the community, maybe with ten to 12 years of schooling in total. Certainly no medical degree or no nursing degree. But with a bit of training over a few months a local village worker carrying a backpack with the right kinds of medical supplies can absolutely transform, improve the health of the community, save lives and help the community to get on its feet. One of the things that a community health worker carries is the combination of goods needed to fight malaria. In the backpack of a community health worker typically will be three things. First, a rapid diagnostic test which can diagnose malaria without the need for a microscope and a laboratory at a clinic. Second is a medicine carried in the backpack available right in the community. again, the mother doesn’t have to carry a very sick and feverish child febrile child to a clinic. But rather the community health worker can treat the child at home and very effectively. And third, in the backpack is a mobile phone, which changes everything. If you have to call an ambulance, it’s possible now, if you have to call the clinic for advice from the nurse that’s on duty or the doctor that’s on duty, it’s possible. And more and more these phones are also being programmed with expert systems to plugin a patient’s ID number or the results of a test, and then receive the information needed automatically by computer expert system that says that given the test results and given the age and weight of the child, here is the does of medicine that’s needed to address the illness. Absolutely wonderful, and just the beginning of what will be tremendous new IT-enabled public health applications that I believe will provide a kind of leapfrogging to improved heath in the communities. I’m happy to say that the Millennium villages have been an inspiration for many of the host governments to scale up large national programs in malaria control, or AIDS treatment,or help for small holder farmers, or electrification with off-grid solar based systems. And many, many other innovations that have been tested or demonstrated or pioneered in the Millennium Village. These projects are now spreading. What started as ten countries is now around 20, that in one way or another are drawing on the Millennium Village model. And within those countries, what started as individual clusters has now often expanded to national application. It’s exciting to see on the ground this kind of progress. It’s especially thrilling to see what is now possible through improved technologies to make working systems at very low costs for better health, for better education, for access to infrastructure. Because we know that if those systems can work effectively, they can be the key to breaking the poverty trap and enabling very, very poor communities to get on a path of self-sustaining economic development.