How can we make a dynamic and fundamental impact on the lives of people in South Africa?
As a grant-making foundation, the answer seems quite obvious: “By funding good projects”.
Yet the common story of the donor world is that the initial excitement about great project proposals is often followed by disappointment as they fail to live up their promise. The projects “do OK”, they make a difference, but they’re not often ‘game-changing’. It would be a good exercise to get funders to list the projects they have funded that have really made a dynamic and fundamental impact on people’s lives.
Maybe the starting point is for funders to gain a better sense of perspective about their potential influence. We hold a privileged place in terms of our ease of access to policy makers and other prominent people. Often, they are looking for the quick wins – the gains at the margin – that funders can sometimes achieve by bypassing bureaucratic sludge. So it’s often a symbiotic relationship, but it could give donors a false sense of influence and effect on people’s lives.
A more fundamental reason why we’re often a bit disappointed with our investments is that we never fully understood what was required to make the difference. Perhaps a less sweeping generalisation is that we appreciate the various factors that affect social outcomes, but we just can’t hold the whole picture together – because it’s so multi-faceted and changing all the time. Let me explain further.
Our starting point is usually a problem that we want to address, or an outcome that we want to achieve. For example, a quarter of children younger than four years of age in South Africa are nutritionally stunted.((Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P,Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M & the SANHANES-1 Team (2013) South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press.)) We know that stunting leads to poor educational, economic and social outcomes that last throughout life. In fact, we know from the emerging science of epigenetics, that foetal and childhood adversity can change our very DNA, which primes itself to survive and downplays the ability to thrive.((Shonkoff J, Garner A (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics 129(1): e232-e246; doi: 10.1542/peds.2011-2663)) These changes are transmitted from one generation to the next, and even the next. You can’t get more fundamental than that. For these reasons, we all want to achieve zero stunting among children. To do this, we might seek to support key strategies that have shown to be effective in programmes in other countries. “Problem – intervention – outcome”. But the experience of human development is that the answer is never as easy as that. Institutional, societal and individual factors either hinder or help implementation.
Weak institutions of Government, including poorly managed health, education and social development departments, can stymie the best intentions; which is why many foundations committed to social justice place such emphasis on holding institutions to account for their use of public resources.((Chang E (2007). Political transition, corruption and inequality in third-wave democracies. Working paper 79. Afrobarometer Working Papers. Institute for a Democratic South Africa, Cape Town)) The political scientists Acemoglu and Robinson argue that institutional weakness is the main reason why nations fail.((Acemoglu D, Robinson J (2012). Why Nations Fail: the Origins of Power, Prosperity and Poverty. Random House, Inc, New York))
Obviously, making up any institution is its people, and economists and political scientists have helped us understand why people running the institutions (as ‘agents’) often fail to act in our best interests (as ‘principals’). If we could better align the interests of principals and agents, it is argued, carrot-and-stick incentives would be sufficient for clean government and effective programmes. Butthe reality is more complicated than that. Think of the ongoing litigation to ensure provision of textbooks in Limpopo. Despite numerous court rulings, schoolbooks are still not available to all children. There are other factors that inhibit the effectiveness of institutions.((Teorell J (2007). Corruption as an institution: Rethinking the Nature and Origins of the Grabbing Hand. Working Paper. The Quality of Government Institute, Department of Political Sciences, Göteborg University. ISSN 1653-8919)) Dare I call them ‘cultural’?
Very soon after the first democratic elections, a national survey of public perceptions of health care was conducted.((Hirschowitz R, Orkin M (1995). A national household survey of health inequalities in South Africa. The Community Agency for Social Enquiry (CASE) for the Henry J. Kaiser Family Foundation, Menlo Park, CA.)) The vast majority (>80%) of black African respondents rated the quality of health care as ‘good’ or ‘very good’, whereas services for Africans were actually generally quite poor. People had come to expect poor services. You could call that a ‘culture’ of low expectations. A culture of corruption has also grown, as institutions fail to hold corrupt officials to account and the public becomes increasingly resigned to it. Other forms of ‘culture’ can also undermine the effectiveness of programmes. A high tolerance of destructive risk is manifested in the rates of HIV, crime and traffic accidents. These cultures are not defined by ethnicity, but are shaped by the circumstances in which people live.((Lynch J, Kaplan G, Salonen J (1997).Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse.Soc Sci Med 44(6):809-19)) “Culture”, said the anthropologist Mary Douglas, “is a dynamically interactive and developing socio-psychic system…”– interacting not least with the economic circumstances in which people find themselves.((Douglas M (2004). “Traditional culture – let’s hear no more of it”. In Rao V, Walton M (eds). Culture and Public Action. Washington DC: The World Bank))
To an outsider, it may seem crazy that a person would put him or herself at risk for HIV or domestic violence. But it turns out that individual choices may not be as arbitrary as it would appear. Slovic and Weber have studied people’s attitudes to risk in a number of hazardous situations.((Slovic P, Weber E (2002). Perception of risk posed by extreme events. Center for Decision Sciences (CDS) Working Paper, Columbia University.)) They’ve looked at the way that people perceive risks to their personal health and the environment, to financial security, the risk of technological failure and the threat of terrorism – and reach remarkably similar conclusions. They consistently find that, under conditions of risk, people make subliminal choices that they perceive to be the least risky. People don’t look at risks in isolation, but in relation to the other risks they are experiencing in their lives. In other words, we take risks because – all things considered, at least subconsciously – we think the risk is worth taking. An important factor in our decisions is how we value potential future benefits. If we feel that there is little to live for, we are likely to be far more tolerant of activities that give us immediate gratification, but put us at long-term risk.((Economists call this the hyperbolic discounting of future benefits.)) If people do discount future benefits because they’re generally pessimistic, then one could argue that interventions that build hope and optimism could have positive economic effects, by encouraging people to place greater value on long-term gains. For instance, it might encourage them to expose their children to early learning opportunities and keep them in school.
But the reality is not as simple as that! The behavioural economists Lowenstein and Prelec have shown that people actually do place value on future benefits, but make choices based on their perceptions of imminent possibility.((Lowenstein G, Prelec D (1992). Anomalies in Intertemporal Choice: Evidence and an Interpretation, The Quarterly Journal of Economics, 107: 573-597. [They showed that utility curve for choices over time are inverted parabolic, rather than hyperbolic.])) Picture yourself standing on the edge of a ravine on a hot day. On the other side is an item of desire, let’s say an ice cream parlour. You greatly value the ice cream; its value is not discounted simply because it’s on the other side of a ravine. But whether it’s really worth it for you to go get some depends on the steepness and rockiness of the ravine. In other words, your ultimate choice is influenced by your perceptions of the journey that’s involved in getting there, step by step! By implication, we could incentivise behaviour that leads to positive social outcomes if we help build a sense of real and imminent possibility in life.
But even this analysis does not provide us with a complete enough picture as to why programmes may or may not work. It’s not enough that people see sufficient value in the programme outcomes to want to participate fully. People also have to see sufficient value in themselves to be able to derive maximum gain from development programmes! In his book, Outliers, Malcolm Gladwell refers to studies where gifted African-American students perform worse when they are identified in racial terms ahead of the tests. His explanation is that they are self-stigmatised by perceptions of inferiority, and perform accordingly. The anthropologist Arjun Appadurai refers to this as their ‘terms of recognition’ in society.((Appadurai, A. (2004). ‘The Capacity to Aspire: Culture and the Terms of Recognition’, in Culture and Public Action, V. Rao and M. Walton (eds). The World Bank, Washington DC, pp. 59-84.)) Where people feel affirmed, they are able to make the most of opportunities that present themselves; when they feel devalued by others, they lack intrinsic motivation. Bourdieu coined the term ‘cultural capital’, the ability to ‘move up’ in society by repositioning yourself in the eyes of others, effectively gaining social status which can be used to improve your life.((Bourdieu P (1986). The forms of capital. In Richardson J (ed). Handbook of theory of research for the sociology of education. Greenwood Press: Burnham)) Appadurai refers to this as the capacity to aspire.
If perceptions of opportunity are shaped by both material realities and perceptions of social status, then social and economic inequality makes things worse. Inequality makes it harder for programmes to have real impact on those who need them most. It creates a vicious cycle that worsens inequality. An example is the effect of implementing Grade R in South Africa, which improved the maths and home language performance of the wealthiest 20% of children in Grades 1 to 6 (by the equivalent of about half-a-year’s schooling), but showed no benefits for lower quintiles.((Van der Berg S et al (2014). The impact of the introductionof Grade R on learning outcomes. Research on Socio-Economic Policy (ReSEP), Stellenbosch University)) The wealthier children will thus grow up to have better jobs and be able to provide better for their families. Their children will not be nutritionally stunted and will develop in an environment in which they are primed to thrive. On the other hand, the children of today’s poorer learners will be genetically disadvantaged at the time of conception, and their environment will simply reinforce the divides. They are more likely to be nutritionally stunted, and will be unable to contribute fully to the country’s socio-economy. So we come full circle.
These interactions – between the economy, biology, society and the human psyche are so complex – that we might despair of being able to have any fundamental impact. Not so! The more we understand of these complex dynamics, the greater our prospect of effective intervention. The child psychologist Jean Piaget said that “to understand is to invent”. Through our understanding, we will be able to ‘invent’ responses that have far greater prospects of fundamental impact. Often, through randomised controlled trials, we know the effects of singular interventions on the individual parts of the system. We now need to bring this knowledge together to design multi-faceted responses to complex social problems. (These are sometimes referred to as ‘wicked problems’)((Buchanan R (1992). Wicked Problems in Design Thinking. Design Issues, Vol. 8, No. 2 (Spring, 1992), pp. 5-21, www.jstor.org/stable/1511637))
Because of their complexity, the inputs that shape social outcomes are often stacked up like bricks in visual representations of the problem, divided into ‘meta, meso- and micro-factors’ or ‘proximal-distal determinants’. A web of directional arrows often connects them. In practice, they have little real meaning and could give rise to unnecessarily convoluted programme designs that slowly strangle the life out of the project. Theories of change often stop there, which is fine for academic purposes. But for programme designers, the challenge is to go the next step – to be able to prioritise the most significant drivers of impact and simplify programme design accordingly.
It is useful to think ‘human body’, rather than ‘facebrick wall’ when developing a theory of change that is to be implemented. In that way, we will understand that systems are ‘alive’ and dynamic, and pay more attention to the interactions between different components. There is no right format for a theory of social change, but they will almost certainly need to take into account programme efficacy, economy, relevant institutions, societal perceptions and behaviour, individual motivations and the effects of human biology – and how they relate to each other.
The following diagram may assist in thinking through some of the relationships between structures and institutions of society, their impact on human perception and behaviour, and consequent effects on people’s health, education and general well-being. Interventions don’t have to try and break every link in the chain, but choices of intervention must be purposive and based on where it is likely to have the biggest effect. Programme designers may have to accept that their intervention alone will not have fundamental impact. On the other hand, critical interventions can be game-changing, and the size of the problem is insufficient reason for pessimism.
The importance of this diagram is in demonstrating that structural interventions could achieve ‘cultural’ shifts, and pro-social interventions could affect economic fundamentals. The latter is scarcely researched, and some of DGMT-supported projects seem to be breaking new ground.((Keswell M, Burns M (2014).Impact Evaluation Report of Activate! 2013. Prepared for the DG Murray Trust. Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town))
How can we make a dynamic and fundamental impact on the lives of people in South Africa? By understanding the levers that could change the trajectory of people’s lives, and designing interventions that can achieve such leverage. Some of these levers are well-understood and are part of a familiar lexicon: economic incentives, health services, education, social security – and recourse to the law when public institutions fail to deliver. Some of the levers are far less well understood, and we don’t have a common language for them. They relate to societal culture, perceptions of power and powerlessness, collective and individual motivation, and their impacts on our very DNA. This is where much of the new action is. This is where the DG Murray Trust should also be.
