Macro and Micro Perspectives of International Development Programs
As a student of International Health, I am well versed in statistics and lofty development goals. Public health campaigns are aimed at transforming health systems, educating entire populations, reaching the masses. Success is measured in achievement of quantifiable goals, improving rates. The United Nations develops the “Millennium Development Goals” and suddenly ministries of health focus on reducing the number of women dying in childbirth or increasing the amount of children enrolled in school, in a singular way. Achieving these goals becomes the sole end. Any program that will increase the stats is valued over improving the overall systems. Funding is shifted to programs that will achieve these goals, and while change is often successful, it is often inefficient or unsustainable.
On-the-ground work is absolutely invaluable for a student or professional of international health or development. They are macro fields, yet without the micro perspectives, individuals will be sacrificed for the greater good. And the means and ends get all jumbled.
For example, let’s take the role of women’s empowerment in two different fields- population and development. In population programs women are often reduced to wombs, while in development programs, women are often reduced to workers. Coercive population programs such as forced sterilizations under Indira Gandhi or the one-child policy in China may reduce total fertility rates, but increasing reproductive choice and rights or empowering women have been shown to be much more effective. Additionally increasing rights and empowering women are important in and of themselves. You want to stabilize population growth? Keep girls in school! Delay the age of marriage! Give them economic opportunities, thus increasing their power within the household and their say in reproductive matters, and giving them incentives to have less children so they can continue to be economically productive! You want to lift the impoverished out of poverty? Organizations like Ubuntu at Work empower these women through enhancing their skills, broadening their horizons, raising their confidence, and connecting them to markets. These are not only inherently worthy goals, but they increase the economic production of families, they capitalize on the most underutilized resource in the world (women), and they give women economic capabilities. Women consistently have been shown to spend more on their families, on their children, on health and education. Having a micro perspective allows an international health or development student or professional to keep their priorities straight, to develop sustainable programs, and to ensure efficiency by addressing individual concerns.
This week, when helping the women set up zero balance bank accounts, a number of women were initially opposed to the idea. If they had to travel to the next village to access their money, their husbands would know when they had cash on them, and would demand it. The husbands would either take their money and use it for alcohol, or beat them for refusing. Pretty much a lose-lose situation. However, if the women were paid in cash, they could hide their money and allocate it to their children or save it. Without a micro perspective, without involved staff, regular check ups, and consistent evaluation and assessment, such individual concerns would not be addressed. And these situations aren’t unique to Ubuntu at Work. All kind of development studies have shown that without assessing individual concerns, programs are often largely inefficient. For example, subsidizing school uniforms or having appropriate, gender segregated bathroom facilities have been shown to keep girls in school longer. With a solely macro perspective, it would not occur to most professionals living wholly different lives, that school uniforms could be a hindrance to a family’s ability to afford education, or that in a bathroom-less school, girls may stay home while menstruating.
After just a week with Ubuntu at Work, I feel that I have learned so much. In some ways it has been very reinforcing of what I’ve studied in high-tech classrooms thousands of miles away, but it also has been an entirely unique experience. I am learning to think beyond numbers and ends, to put a face to the stats, to keep an intimate, individual, micro perspective in order to achieve macro goals.
