NB Health Care

Saturday
May 9
2015

Kyle Poplin

Weekly Roundup – The Obligations That Come With Trading in Trust

More than most endeavors, global health trades in trust. Trust that drugs are safe and will do what manufacturers say they’ll do; that money given to worthy causes will actually be used to support those causes; that high-profile benefactors are seeking solutions rather than positive public relations and adulation; that contracts are awarded based on solutions rather than relationships.

The best way to earn that trust is through transparency, or making sure an organization’s intents and procedures are open and easily understood.

The consequences in global health are huge – millions die every year because health services fail them, even as trillions of dollars of taxpayer money are spent on those health services – and the work itself is daunting. Add in the need for all that work to be done in a transparent way, to guarantee that trust remains part of the equation, and some failure seems inevitable.

On that front, we’ve recently seen some questionable moves, if not outright failures.

Consider the excellent report by Michael Igoe on Devex this week about a partnership of government contractors protesting the U.S. Agency for International Development’s decision to award a contract worth $9.5 billion over eight years to the development consulting firm Chemonics International. It’s the agency’s largest-ever single award.

One obvious issue is that Chemonics has a spotty record in Haiti’s post-earthquake reconstruction. USAID owes the public an explanation of why that record didn’t prevent the awarding of the contract.

Another, perhaps deeper issue is that this is an “indefinite delivery, indefinite quantity contract” that could could eventually be worth $10.5 billion to Chemonics. As Rick Cohen asks in Nonprofit Quarterly, “What could cost that much?”

That’s a serious question. USAID defines itself as “the lead U.S. government agency that works to end extreme global poverty.” Its billion-dollar contracts should not be “indefinite.” They should detail what is expected to be delivered, when and where, along with spelled-out consequences for failure to perform. It’s about embracing transparency and earning taxpayer trust.

Another transparency/trust dilemma involves Hillary Clinton, her family charity, the Clinton Foundation, and its Clinton Health Access Initiative (CHAI). As Clinton prepared and then announced her run for U.S. president, serious questions arose about whether donors to her namesake groups had inappropriate access to her when she was U.S. secretary of state.

CHAI was forced to admit that it never provided the State Department data on foreign donations – tens of millions for foreign donations – when Clinton served as secretary of state. The matter is now a political football that has CHAI in a position of defending itself for what it didn’t do rather than the good work it has done. Who knows how that will affect future donations.

Then there was the World Health Organization’s bungled effort at transparency. The organization issued a press release in which it candidly admitted it “simply could not cope” with the Ebola outbreak, fessed up to its shortcomings and urged the public to “hold us to account.” It was a refreshing acknowledgement of failure, some said, and an important step in the learning process. Few people, after all, think WHO has the resources it needs to do the job it’s assigned.

Then, a day after that press release was issued, WHO’s moment of transparency grew opaque. A new press release was distributed that used weaker words, admitted lesser accountability and failed to address why the braintrust had altered its outlook overnight. If the first statement was the unvarnished truth, the second statement had several coats of varnish.

Clearly, transparency in an effort to earn trust isn’t simple. It can slow processes, increase workloads and, put simply, become a headache. But as recent cases show, it can also help avoid lingering questions that turn into migraines.

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