Remaining on the high ground or descending into the swamp: the ultimate choice in our development world
I have just returned from yet another trip to Kenya (in fact my seventh over the last 19 months) where I was visiting and working with our project staff and health sector leaders to monitor the implementation of the innovative Emergency Hiring Plan. But this trip was different – very different. I came away feeling not only really energized and marvelously inspired about our work there but also quite optimistic about the future and promise of transformational development activities that challenge the mind set or entrenched ways of doing things. I have had an opportunity to reflect on some of the site visits and people that I met and all the incredibly rich discussions and exchanges that I had on this trip. As such, I am on reflection mode – as you can tell – and some of the observations in this paper are from my rather disorganized and infrequently kept travel diary – by the way, most of it is also normally kept in my head!
In most Ministries of Health where we work, including Kenya, the organizational ethos is often described in the following terms: “the way we do things here….this is what the policy says…we have always done it this wayâ€. The result is an elaborate set of do’s and don’ts and assumptions that are not necessarily visible to outsiders (people who don’t work for the organization). To understand and successfully navigate the overall experience of this organizational culture, behaviors and practices with all their complex nuances and meanings, and still present an alternative approach or strategy to overcome a persistent challenge has been the hallmark of our Emergency Hiring Plan (EHP) experience with health sector leaders in Kenya.
On Friday 22 September, 2006, I joined senior MOH and USAID Kenya leaders as well as AMREF, Deloitte and other local partners to witness a remarkable project accomplishment – the graduation ceremony for a class of 112 new hires who had successfully completed their two week training and orientation course at the Kenya Institute of Administration in the leafy suburb of Lower Kabete in Nairobi. On the same day, other groups were also graduating in seven other venues across the country, bringing the total to 392 new providers who were recruited and trained under Phase 2 of the EHP. For the first time, I was able to witness the incredibly complex logistics that our Capacity Kenya team and local partners were able to assemble in order to successfully mount such a rapid training program for hundreds of the new hires.
Inspirational speeches were made, certificates were handed out, pictures were taken, drinks and snacks were served and a celebratory mood was in the air. The entire hall was buzzing along in an atmosphere of hope, possibility and optimism. Seeing all those young faces in that hall and listening to some of them share their personal stories, perceptions and feelings about the recruitment process, the training course itself and their new places of work, triggered all sorts of emotions for me and the Capacity Kenya staff, especially Mr. Kimani Mungai, Project Coordinator for Kenya (he couldn’t hold back his emotions). Why? What was considered undoable even six months ago has now encroached, albeit in a small way, into the language and practice of the Ministry of Health. A project that had been characterized by seemingly endless spots of trouble and tension was now a cause for celebration! This particular event was positive and left a strong sense of accomplishment and hope that change is indeed possible – no matter the nature and complexity of the situation at hand.
When the ceremony came to a close, scores of young new hires came up to me – a few were from Northern Kenya (my birthplace). Being such a small community, most of them obviously knew of me even though we had never met – they were aware that I was “somewhere†in the US but they didn’t know that I was actually associated with a project that had just given them jobs in the health sector!
One of them, Jarso Diba Guyo, a laboratory technologist, had completed his Diploma course three years ago but remained jobless. He was posted to Sololo Catholic Mission Hospital (a modern, well run FBO facility) ensconced in a small, dusty border town near Ethiopia. Jarso asked me, “Is it really true that we now have jobs and we will be paid a salary at the end of each month – are you sure that this project will not let us down?†Before I could provide a response, a young Somali female Enrolled Nurse posted to Garissa Provincial General Hospital in the remote N E Province piped in with yet another caution of her own, “this whole process was so fair that we sometimes feel like we have been connedâ€, and she laughed.
Njeri, a Registered Nurse from Nyeri in Central Province, who was standing at the back of the group also chimed in, “I also completed my RN course 4 years ago. Although I attended many interviews, I was not able to find work. You know the way things work in our country. You either have to know someone, pay a bribe or even compromise your dignity in ways that you don’t want to…." (I knew what she meant). All these exchanges took place in Kiswahili. People’s stories and life experiences, when told in a language that you really understand – carry such deep meanings and they touch you at a deep personal level.
Being Kenyan, I knew perfectly well what these young men and women were talking about. But the fact that we were actually doing something to change all that, albeit in small ways, filled me with a deep sense of pride, hope and accomplishment. Through this small project we had taken on some real demons in a system that had crashed people’s hopes and dreams. Here we were – bringing equity, openness, merit and social justice to a social order that was plagued by decades of bad governance, cronyism and lack of due process.
This was not just a workforce mobilization project to strengthen services in the health sector – it was indeed morphing into a governance project. It was a project that made people make genuine connections and even some fundamental shifts – moving from despair and a deficit approach to life to hope and possibility. I just stood there, listening to this small crowd of new hires – completely overwhelmed. I asked myself, “why do they tell me all these things, why do they feel that I am credible and trusted, they hardly know me – we have just met?†At that point, tears welled up in my eyes. That was an unforgettable moment in my development career.
Finally, as Donald Schon writes in the opening paragraph of his book Educating the Reflective Practitioner:
In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solutions through the application of research-based theory and technique. In the swampy lowland, messy, confusing problems defy technical solution. The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of the greatest human concern.
The practitioner must choose. Shall he remain on the high ground when we can solve relatively unimportant problems according to prevailing standards of rigor, or shall we descend to the swamp of important problems and non-rigorous inquiry?
With the EHP in Kenya, we are in the swamp. But we recognize that this swamp cannot be drained in a day, week, months or even years. It does take time but you just have to roll up your sleeves and walk right in. And once it’s drained out, there are no guarantees that it will not fill up again. But, we can no longer remain on the high ground and keep on pretending that we are ‘saving lives' by using standard tools and conducting more research studies. As the saying goes, if you keep on doing what you have always been doing, you will keep on getting what you have always gotten. International development, especially in Africa, is crying out for difference – a different approach, a different mind set and a different but simple paradigm. And we must step up to this challenge – through programs that are genuinely innovative or even different – we should not fear because, fear of difference is dread of life itself!
Ummuro Adano
Senior HR Management Systems Advisor (Point Person for Capacity Project/Kenya)
Management Sciences for Health (MSH)
Capacity Project, Chapel Hill, NC
[September 2006]
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