Setbacks in Public Health - When a program doesn't work
By: Alanna Shaikh
Lately I’ve been thinking about failure. Specifically, global health program failures. The health programs that don’t do anything, or don’t do what they’re supposed to. I’ve always thought of that kind of failure to be embarrassing – shameful, even. But maybe I’ve been thinking about it all wrong.
There are a lot of kinds of program failure. There is failure that happened because of badly designed programs, for one. They’re not tailored to the community it works with, they’re not based on actual evidence, or they don’t have the time or money to actually achieve their objectives. And those failures really are embarrassing. This walking group proposed for Somali refugees in Australia seems like a good example of that kind of failure.
But then there are the more inexplicable program failures. Good-looking projects, based on good research, with plenty of community input into their design. And they just don’t work. Some factor comes up that no one took into account and people don't react the way they have reacted in the past. All the research and planning in the world can’t account for every single possibility. (Even, it turns out, with Somali refugees and walking groups. This research among Somali refugees in New Zealand implies that women there like walking groups.)
So, your well-meaning, carefully created program just failed. Maybe it had no impact at all. Maybe its impact was well below what you had hoped for. Or maybe your program had an effect for exactly as long as the project survived, but as soon as the project ended, so did all of its impact. It’s all failure.
Here’s what I have been thinking lately: maybe program failure – the failure of good programs – is simply inevitable. Maybe it just takes ten programs designed and implemented to get four or five that actually succeed. If we look at it that way, failures are not embarrassing anomalies. They are part of the price of running successful programs. You pay your staff salaries, you pay your office costs, you pay for the programs that didn’t work. Basically, a form of overhead.
In that case, you don't mess around feeling shame for the programs that don’t work. You just dissect them to learn why they failed and incorporate those lessons into your future work. It would save time and energy, and it would vastly improve the quality of data and case studies that come out of global health efforts. Right now, if you study a successful program because you want to use it as a model, you spend a long time figuring out if it was really a success or just packaged that way for donors. If you’re bad at reading between the lines, it is easy to accidentally emulate a failed project.
Imagine if, instead, failed projects just identified themselves that way?
This is not a perfect perspective. We don’t want to reward badly designed or stupidly executed health efforts. And some failed projects actually damage the communities they work in; it’s hard to stomach that as a cost of finding success. But being more honest about what works and why some things don’t could go a long way in improving the work we do in the future.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not necessarily the views and opinions of the Global Network.