Arbie Baguios, (a former student, bio below) has been doing some serious thinking about aid. See what you think.
Imagine you’re ill and need to be taken to a hospital.
Would you rather go to one where the clinical outcomes seem good, but the way they treat patients is horrible?
Or one where they treat patients excellently, but the clinical outcomes are questionable?
How about where they’ve got the best staff and facilities, but clinical outcomes and their treatment of patients are not the priority?
I reckon most of us would want to be taken to a hospital where all three – clinical outcomes, treatment of patients, and staff and facilities – are to a high standard.
In fact those three indicators are exactly what’s used in the Donabedian model, one of the world’s most widely-used framework for evaluating healthcare quality
The Donabedian model looks at structure (the hospital buildings, the staff, the equipment), process (the transaction and relationship between patient and healthcare providers), and outcomes (the effect of treatment to patient and public health).
When it comes to our own health, we see all these as essential.
So why not in aid?
The coronavirus pandemic has reinvigorated calls for reform in the aid world.
Like in hospitals where structure, process and outcome are all important, all these are necessary changes we need to make if we were to move beyond business-as-usual.
But to date there has been no compelling framework that brings all these together. And in this instance, the usual critique within our sector of ‘working in siloes’ seem to apply.
On their own, these calls for reform aren’t new – some are decades old. But the sector’s lack of framework to address all these at once is making us “change for the worse, not the better”: rigour and evidence, but without regard to power; radical approaches but resistant to effective methodologies; and adaptive – but in the wrong direction, where feedback loops reinforce the bureaucratic beast, instead of heralding real change.
We need a model to re-imagine aid.
The Re-imagined Aid model
I launched Aid Re-imagined last year with the aim of helping to usher the next evolution of aid towards effectiveness and justice in our rapidly changing world.
And to this end, I developed the Re-imagined Aid model.
It sees development and humanitarian aid as also having essential components much like healthcare’s structure, process and outcome.
We may call these an aid programme’s logic (how it is designed), management (how it is implemented), and values (what characteristics, outcomes or behaviours it finds desirable).
We can think of these components as the main ingredients for baking an aid cake. If one is missing, it wouldn’t work – without flour, you’ve got a sweet omelette; without sugar, it’s just savoury crepes.
The quality of the aid cake largely depends on the quality of ingredients. And those calls for reforms outlined above are helpful in determining what high-quality aid ingredients look like.
The Re-imagined Aid model offers an alliterative heuristic. For high quality aid programmes:
The logic must be robustly analysed.
Is the evidence base or theory of change well-founded?
Will the aid programme be able to demonstrate its effect compellingly?
Does it utilise pluralistic science, able to accommodate for different knowledge systems, such as local or indigenous knowledge?
The management must be relational and adaptive.
Does it treat all its stakeholders (from staff to communities) humanely?
Does it prioritise embedded and equitable ways of working?
Is it oriented towards a clear true outcome, and does it allow for experimental and improvised approaches by stakeholders close to the ground?
And it must embody the values of radical accountability.
Is it decolonial and does it not give undue privilege to Global North ideas, thoughts, norms, behaviours, etc?
Is it self-determined, where local people are able to find solutions to their own problems?
And is it enabling people and communities to pursue their own interests?
Careful and balanced baking
So it seems baking – whether an aid cake or an actual cake – is easy. Just put all the ingredients together and stir, right?
Despite good intentions, the most recent and comprehensive evidence show that aid’s track record is mixed: sometimes it does good, sometimes it causes harm.
So another novel contribution of the Re-imagined Aid model is its emphasis on care and balance when it comes to aid.
This is particularly so because the model, taking inspiration from the environmental justice movement’s advocacy for the rights of future generations, recognises not just aid’s potential to cause harm at present, but also in the long-term.
Re-imagined Aid calls for aid implementers (specifically those from the Global North) to choose to act carefully. This procedural framework goes further than the conventional “do no harm” – which seems to imply that aid workers have already chosen to act, and that the prevention of harm can be guaranteed.
It starts with exercising precaution, which means “restraining ourselves” instead of leaping into action – something that might take some getting used to, especially for those of us conditioned to respond rapidly.
This is followed by preparing to minimise harm and maximise care (i.e., our typical application of “do no harm”), and then pragmatism (where limitations are weighed against need and urgency).
Baking a balanced cake
If a careful choice to act is made, aid implementers face further constraints. This includes time, resources, and the uniqueness of their aid programme’s contexts.
Such constraints make it nearly impossible for an aid programme to score perfectly against all essential components of a robustly analysed logic, relational and adaptive management, and radically accountable values.
So just as in baking a cake – where, for instance, too much sugar makes it overly sweet, while too little might make it unpalatable – balance is key.
At a higher level, however, the blockage to baking a balanced aid cake is, well, a lack of recipe.
It took a long time for advances to be made in the various aid frontiers of evidence/effectiveness, adaptation, and accountability. So naturally it’s also taken a while for a framework, which encompasses them all, to appear.
And our own personal biases and affiliations (i.e., our inclination to belong to one frontier ‘camp’), as well as the way agenda-based advocacy works (i.e., these camps limited to having one ‘ask’) certainly doesn’t help move things along.
That is why the Re-imagined Aid model is valuable: like a checklist, it enables us to see all that’s essential, past our own affiliation or agenda-based blinkers, and to ask “What is missing?” and “What is too little or too much?”
Checklists are helpful – just ask any surgeon or pilot who rely on them to save lives. Through this, the evidence-based policy folks can check if they have overlooked power or politics; those wanting to shift the power are prompted to think about robustness and rigour; and relationality and adaptation do not become an afterthought.
Out of aid’s pre-pandemic mess
Models won’t solve all aid’s problems. But they can profoundly shape the way we see and understand our world. (Take for example economic models – how some have led to our planet’s present state, and how new ones are trying to undo the damage.)
The Re-imagined Aid model helps us see the things differently (e.g., how aid can be evaluated like hospitals). Our post-pandemic world demands we do so.
Good examples of projects that closely adhere to this model are few – one is Local2Global’s work in the Philippines, which prioritises a locally-led response, utilises evidence, and applies adaptive management.
But that is exactly why this model is needed. It charts a clear way out of aid’s old mess: by going further than “do no harm” through choosing to act carefully. And by moving beyond only looking at either an aid programme’s logic, management or values, and instead urging for the right balance between robust analysis, relationality and adaptiveness, and radical accountability.
Arbie Baguios is the founder of Aid Re-imagined, an initiative that aims to usher the evolution of aid towards justice and effectiveness through deep, radical, and evidence-based reflection and research. Follow him on Twitter @arbiebaguios and contact him at email@example.com.