This is the third blog post in a weekly series from students enrolled in the course ‘Contemporary South Asia: Entrepreneurial Solutions to Intractable Social and Economic Problems’ co-taught by SAI Director Tarun Khanna. The course features several modules on issues facing South Asia: Urbanism, Technology and Education, Health, and Humanities.
This week’s focus: Health, led by Sue Goldie, Harvard School of Public Health
Public health constitutes one of the broadest and most rapidly globalizing fields in which social entrepreneurs are active. That said, many strategic initiatives have failed (and continue to do so) due to widespread failure to reconcile large-scale health priorities with local contextual issues, something that must be achieved to prevent new ventures from being poorly designed and potentially counterproductive, which is an especially grave concern in a field where human lives are at stake.
In our new set of lectures taught by Professor Sue Goldie of the Harvard School of Public Health, and Director of the new Global Health Education and Learning Incubator at Harvard, we have scrutinized both failed and successful attempts to achieve such a balance and have learned how cultural consideration and skillful emphasis upon local ownership may be difficult to manage but are essential to securing sustainable positive outcomes.
The enormity and diversity of major health threats have encouraged immense multi-sector investment in new ventures, but constant variations in the scale and nature of public health concerns frequently place pressure on practitioners to satisfy different stakeholders’ agendas, even as they must confront related problems that are specifically relevant to the context in which they are working. It is difficult to achieve firmly set targets unilaterally when local needs and the applicability of a project’s terms may not correspond to what investors view as indicators of large-scale success.
That said, while development experts are well aware of the prevalence of such dilemmas, Professor Goldie brought an intriguing perspective to the class discussion by highlighting the role that social entrepreneurs can play in addressing this conundrum. When stressing the importance of scalability, she encouraged us to design future interventions that did not try to confront a large-scale issue comprehensively, but instead focused upon addressing a context-specific impediment to the achievement of a larger objective.
Efforts to reduce maternal mortality in India form a case in point, as high rates have traditionally led health policymakers to prioritize prenatal care. However, a strategic approach oriented around such an issue (albeit one that is highly important) does not counter the deleterious effects of other contextually relevant influences upon maternal mortality, in particular the prevalence of birthing outside in medically unsafe areas.
Less than half of Indian mothers give birth in health facilities (where complications could be treated immediately) due to logistical, financial and personal reasons. Traditional policy planners did not recognize the impact of this problem on maternal mortality, inhibiting the overall success of broad initiatives aimed at reducing deaths in childbirth. Social entrepreneurs can play a critical role in addressing such context-specific issues that undermine the achievement of broader objectives. In the case above, a conditional cash transfer program for pregnant women was created so that expectant mothers not only received antenatal care subsidized by the state but were also incentivized to have their children delivered in safer hospitals run jointly by entrepreneurs, health care providers and the government.
In the course’s module on health, we have seen evidence of recurring tension between policymakers and investors’ prioritization of “globalized” health threats and contextual concerns held by intended beneficiaries of initiatives. If bold ambitions are to be achieved on a greater scale, contextual knowledge must be applied more effectively and local concerns must be satisfied.
Deft social entrepreneurs can catalyze promising ventures by remembering this, and can foster cross-sector collaboration and comprehensive success in fields where the cost of failure can include human lives.