Using examples of adaptive approaches in healthcare, Stanford GSB Lecturer, Steve Davis, shows how giving communities the tools and authority to shape their own destinies can be transformative in solving the world’s largest problems
I recently had dinner with a ski guide who also worked as a nurse in a nearby rural mountain town. She described the catastrophic toll that opioid addiction was leveling on her community and its health system. Solving this riddle is now her full-time job. ‘It all starts with the patient,’ she said. ‘Everyone is so different, in what they need, in the reasons they are there, in their approach to treatment.’
‘Yes,’ I said. ‘I see that so often in public health. One-size-fits-all rarely works.’
‘For sure. We’re not just treating these folks medically, but trying to address the reasons they found themselves in this situation in the first place,’ she said. ‘Each community – and each person – brings different circumstances and support systems, so we have to adjust our approach to match.’
I wondered if my nurse friend was merely acting the good soldier, repeating what she’d been trained to believe. So, thinking about the evolving trend toward community-centered approaches, I pressed a bit harder: ‘Does this idea of fine-tuning your approach for each patient really come from the community, or are you being told to implement yet another new programme developed by someone else, far away?’
She responded with the same steely calm I’d seen earlier that day as we skied a sheer cliff covered in deep powder snow. ‘I can assure you, I would not be doing this work unless we were permitted to shape the approach ourselves. These are our friends, families, neighbours. We know what they are experiencing – and hopefully, what they need. It wouldn’t work any other way.’
Adapting models to different communities
In such conversations, I think back to the lessons from the TB Control initiative in Mumbai – building partnerships and programmes focused on the patient and community. We conceived our game plan by focusing on the particulars of the community before us, being realistic about its customs and needs. We adapted our model to the habits of the people we wanted to serve – both the patients and private practitioners – rather than attempting to force behaviour change. The solution to an enormous public health problem, we found, required working with the community, rather than on it. Or from the community’s perspective: ‘nothing about us without us’.
What does a community-centred mindset mean for practical activists? A lot more listening. We need to hear from communities about how they feel, what they need, and what they want to do themselves. We must understand how they want to be helped and then conceive solutions with the patient or farmer or student at the forefront of our thinking. We need to support communities in building their own capacities, providing assistance as needed, rather than going in to do the work ourselves. We need to look for models that support the development of community voice as a foundational principle. Ultimately, we must support and serve the leaders and decisions of the community.
Ceding control
Easier said than done, of course. Each of these approaches means ceding control to some extent – trusting that people know what to do to take care of themselves – even as we provide financial aid. It is true that the global north still invents many of the ‘answers’ and sends them to the global south. But in 2020, there are innovators worldwide, and they need resources to develop and distribute their ideas. Practical activists must be alert to these opportunities for reversing the traditional flow of innovation.
Realising this trend will not be easy. I expect a long journey with many hurdles. Imagining a world where practical activism is truly community-centred requires a dramatic leap of faith, and it means big changes on many fronts – from rebalancing power relationships to navigating cultural barriers to reconceiving models for accountability.
Certainly, there will always be circumstances that demand a more top-down, supply-side strategy—for instance, during epidemic outbreaks, natural disasters, or violent conflicts. In such situations, we’ll need to mobilise a large humanitarian response, usually from outside. And some tools, like vaccines, are global in nature, so we should maintain global mechanisms for developing, approving, and purchasing them. Political and financial conditions associated with such aid and development programs will naturally preserve vestiges of the old-school model.
But when trying to solve the world’s largest problems, giving communities the tools and authority to shape their own destinies will be transformative. It doesn’t take much convincing when you’ve had the chance to sit in a large room watching young African leaders work together on building a new information exchange for continent-wide medical systems, as I did not long ago in Arusha, Tanzania. Frankly, it was thrilling. To see the people in this group – with their extraordinary passion, digital sophistication, collaborative spirit, and drive for leadership – taking the reins to improve outcomes for their communities was a testament to the horizon ahead.
This is an edited extract from Undercurrents: Channeling Outrage to Spark Practical Activism by Steve Davis (Wiley, 2020). AMBA members can benefit from a discount on Undercurrents courtesy of the AMBA Book Club. Please click here for details.
Steve Davis is a Lecturer in Management at Stanford Graduate School of Business and the former CEO of PATH, a global health innovation non-profit organisation.
