Part two of a two-part series highlighting how strategic philanthropy is making an impact on women and girls. Read part one.
“Creating sustainable social impact.” “Solving complex problems in the field of social change.” “Using systems levers for lasting scale.”
It’s easy to use these buzzwords with gusto, gumption, and the optimism required to change the world. We all like to live in these words, feeling the passion that working in this space can bring.
But in practice, it’s easier said than done. How do we define “sustainable social impact?” How do we know if we’ve identified a “systems lever for lasting scale?” It’s extremely difficult to operationalize these things, but an execution plan and measurement can turn jargon into impact.
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Systems Change in Zimbabwe
For a specific project in Zimbabwe, we at Maverick Collective/PSI have defined our “system” as the community health system and our scale level as the Zimbabwean government owning and operating the model we have proposed. However, the complexity of the two definitions above, in practice, take many different forms.
At the fundamental, grassroots level we have the Community Health Worker (CHW). She is the backbone of her community’s wellbeing and a pillar in her community. Ilene is one such superwoman. She carries a backpack full of binders, each to track and educate on a different healthcare issue (TB, HIV, family planning, and malaria.). She walks from house to house in worn out shoes with her government-issued uniform and satchel. She prides herself on the trust she has established within her community.
But the system is broken.
Ilene works for 8-plus hours a day, talking to her patients and looking after one of their most valuable assets, their health. At the end of the day, she has new data that she must integrate into a larger system. This data is then aggregated into a larger picture of health for the population of her country, but inefficiencies in the current system affect the bigger picture. First, the time it takes Ilene to manually enter data is time away from patients. This data is also collected and organized in a silo. In other words, if patient X has TB and HIV, they are viewed in the system as two different people, which does not provide the full picture of health that decision-makers need in order to do their jobs effectively. Finally, despite the effort exerted, the data may not make it to the health facility, government electronic health record (EHR), or District Health Information Software (DHIS2) in an accessible format for analysis.
Through the lens of HIV prevention, diagnosis, and retention on medication, we are attempting to address the gaps in the data and the system it lives within, offering the important benefit of empowering Ilene, her patients, the decision-makers at the facility and those at the government level.
These efforts require an understanding of many moving parts including how data is gathered and interpreted by various people, the data infrastructure and the translation of the data into action.
Ilene is one of the hardest workers I have ever met and she knows that she is tasked with one of the most important jobs in the world: to protect the health of the people that trust her to do so, but the system disempowers her and her community.
Addressing the complexity of a system, and the ambiguous nature of scale, requires the cognitive exercise of going from the micro to the macro within the same conversation. It requires patience from all parties and the ability to exist in ambiguity and uncertainty until you begin to see the small signals of change within each lever you are addressing. But, if we can bear with the pace, the risk, and the uncertainty we might be able to change the way systems work for the people they are meant to serve. We may be able to combat injustice in a holistic way instead of just tackling the symptoms created by an unjust world.
- Learn more about Maverick Collective’s efforts to improve the lives of women and girls.
- Find more information on the importance of electronic health records.
- Dive into research about healthcare systems in Africa.
Original contribution by English Sall, Maverick Collective, PSI.
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