Notions of ‘measurability’ and ‘evidence’ are often based on concepts that are appropriate for clinical medicine but not for social change. Indeed doyens of the American Evaluation Association such as Michael Quinn Patton make clear that measures of progress have to be developed within an understanding of the unpredictability of change, and the impossibility of attributing change to single players. Rather than a linear approach that narrowly ties impact to input, strategies for social change need to be informed by complexity theory. While this poses challenges for measurability, solid investment in assessing and documenting the diversity of factors that influence social change would provide donors with more confidence to support such efforts.
Where does the problem lie? Rosalind identifies a tendency amongst some donors that certainly needs challenging. But not all donors, nor all of the corporate sector derived philanthropy initiatives, fail to promote a social change agenda. Indeed I have been struck by the great interest of US-based donors in supporting human rights, in their broadest terms − challenging inequities in distribution of resources, recognition of people as equals and the right to participation in social and policy decision-making. Given this, it seems paradoxical that the instruments that are used to measure change are unsuited to the task.
If just a tiny proportion of the money donors are willing to invest in finding quick fixes for HIV/AIDS, for example, were invested in testing interventions to shift the sexual cultures that are responsible for fuelling the AIDS epidemic in many countries, there would be more evidence available of what works well and what does not work well in diverse contexts. The desire for a quick fix is so dominant that even where there is evidence of the effectiveness of social interventions from evaluations using clinical models such as case controlled trials, few institutions or donors are keen to scale them up because this requires acknowledging complexity and that change takes time − interventions such as Stepping Stones, Inner Spaces Outer Faces, and Health Workers for Change come to mind. Institutions are more comfortable counting the number of people who have taken up anti-retroviral treatment, than counting and addressing those who subsequently drop out, let alone addressing causes of transmission including sexual violence, lack of sexual autonomy among women in particular and people’s use of sex in navigating poverty.
Another factor that limits the possibilities of a transformative agenda among many donors is the use of their resources to support people and buy goods from their own countries – whether out of comfort or obligation. This creates a situation where expats fill Departments of Health, coming and going over a few months or years, with de-contextualised solutions marketed by US and European Schools of Public Health. A transformative agenda would see donors endowing local Schools of Public Health in southern countries, with strong governance, and funding to build PhD programs and training for health managers so as to consolidate national capacity over the long run. We are starting to see some moves in this direction, for example with the Africa-initiated CARTA programme, where nine universities in seven countries are building their own PhD programme, initially for their own staff. The solidarity provided by some European and US donors and universities, willing to support this locally shaped initiative, offers an alternative option others would do well to explore.
We know enough about what makes for policy change and for changing social norms and values. Donors need the courage to acknowledge that it is only by supporting long-term capacity development and social interventions by and with those most affected, that ongoing dependence on donor funding can be ended.