Episode 1: Overcoming Sectoral Analysis
Dr. Akiko Maeda is a health economist with 25 years of experience in international development. She has held various technical and managerial positions at the World Bank, OECD, Asian Development Bank, UNICEF and UNDP, and was involved with policy analyses and investment programs on a wide range of topics, including: girls’ literacy and immunization in low income countries such as Yemen and Cambodia; health insurance regulation and fiscal policy analysis in middle income countries such as Egypt and Slovenia; and health workforce skills assessment for high income OECD countries. She joins us from Saanich, Canada.
She speaks to us about:
the limitations of single issue / linear analysis
the disconnect between research and policy making
the need for novel intersectional and complex system analysis in order to create a more just world - and much more.
Transcript
Intro: In dealing with the government as our primary client, there was an effort to make it client demand (based). But there was a lot of principles and things that the World Bank came with that you could say were imposed. Some of them were good and some were not good. On the ground level, I would say, the World Bank did not have much leverage or the ability to intervene — on occasion it did, but let’s say there was an environmental negative impact. And so either you have to do remedial work or some kind of additional investment or not do the project.
Safa: Hello and Welcome to the Rethinking Development Podcast. My name is Safa and I will be your host as we speak with and learn from development practitioners of all ages and affiliations around the world. Each week we aim to rethink ethical behavior and practices through the lived experiences of development practitioners. Our guest today is Dr. Akiko Medea. Akiko, thank you so much for joining us today.
Akiko: Thank you. It’s a pleasure.
Safa: Akiko is a Japanese Canadian health economist with a wide variety of experiences in the international development sector. She has held various technical and managerial positions at the World Bank, OECD, Asian Development Bank, UNICEF and UNDP and has been involved with policy analysis and investment programs on a wide range of topics. These include girls literacy and immunization programs in low income countries such as Yemen and Cambodia to health insurance regulation and fiscal policy analysis in middle income countries such as Egypt and Slovenia and health workforce skills assessment for high income OECD countries. However, over the years , Akiko has felt an increasing apprehension about the fragmented approach taken by international agencies in promoting development. Segmented by sector specialists and riven by inter-agency rivalries and political conflicts, she feels that the goal of creating a more just and equitable society seems to be slipping through our fingers. At the same time, she believes that exciting new discoveries in science, technology and human behavior are offering valuable insights into our emotional landscape and opening new opportunities for social development. Akiko will share her views with us and how we can strive beyond the social accountability paradigm and instead hone our collective faculties towards a social mindfulness approach. So, Akiko maybe we can just begin by you telling us a bit about how you first started working in the international development sector and what you had hoped to achieve at that time.
Akiko: Great. Thank you. I began, my interest in development really began as a child because my father was a Japanese diplomat and I grew up traveling and living in many countries around the world, including your country, Safa, Iran as well as Dominican Republic and Saudi Arabia. And that had always created an interest in different ways that countries operate and how different cultures really have different ways of solving problems. Subsequently I started my studies, university studies, in science and biochemistry, which I enjoyed very much - but halfway through my PhD program I realized that my studies in biochemistry was not really leading me to engage in international development work. So I switched out and entered into a study of political economy and then joined the United Nations and others to gain field experience - and hoping to dedicate my life to development work and, exactly as you mentioned, the goal of a more equitable society by engaging in economic development activities. We were all in the 1970s and 80s very optimistic about how these efforts would lead to more adjust society. So that was the beginning in which I skipped around different types of disciplines, which was very valuable - but I ended up working for various international organizations and, almost 30 years in that area, I have certainly learned a lot and have benefited. And for the first half I felt very committed and satisfied with the work. I thought we were making an effort with the best intentions and with the best tools. But I would say in the last 10 years is when I really, as you mentioned in the Intro, I really started to have serious doubts about the way things were being done and not just in a day to day way. There are always problems and there’s no perfect institution so you deal with it on a day to day basis. But I felt a much deeper misgiving and others shared with me their concerns and that is why I’ve decided to leave the World Bank and development organizations all together to rethink - as you were saying, rethink the way we’re doing things because just doing more is not going to solve the problem. In fact, we may actually be creating more problems, more divisions and sowing the seeds of destruction down the line. I felt quite alarmed about those prospects.
Safa: Right. Some of those misgivings or some of those challenges, could you perhaps give us some examples about what you noticed or what you experienced that caused you to feel dismayed at the way things were happening or the way agencies were set up or the way that projects were run?
Akiko: I think one of the more obvious discomforts I felt was the way the organizations I worked in - as well as the rest of the society, including the governments and education system as a whole, was rapidly moving towards narrowing the focus of our studies into various disciplines and expertise. In the 20th century, movement towards a deeper understanding of narrow and narrow fields was seen to be a natural progression because there was so much data, so much voluminous amount of information coming that a single person couldn’t obviously know it all. And so it made sense at that time for individuals to go into those various fields with the assumption that all these different expertise would somehow come together into a more cohesive knowledge and wisdom. And that was my belief too when I started out and studied health economics. But as I worked over the decades, what I saw was more and more of a deeper segmentation. The silo effect. And this is something in the behavioral sciences - there is better understanding, as we become committed to a certain group of people, professionals then we do become emotionally and behavioral attached to that. And it becomes very difficult to see out of that. And I saw that happening across all the institutions as well as in the work we do. And this is what I meant - this is harming the way we find solutions. So to give you a concrete example, the World Bank has just come out with a Human Capital Project, which is wonderful that they focus on human capital. But the way they’ve set it up is again, segmenting by topics, expertise into education, into health and survival, presumably with infrastructure and so forth. So again, the overarching statement, the goal is good, but the way you approach is back to separate groups coming together but not really coming together. It’s just a collection of solutions which we present to the policymakers. So I as a health economist , I can present very deep analysis of health insurance, healthful financing, health workforce, and present it to the Minister of Finance. So optimizing for the health sector is the solution that the health team provided from the World Bank. Now at the same time we have other groups from the World Bank — from the education group let’s say, and education skills groups. So they’re presenting their investment strategy, lets say. So a minister of finance for example, would get 17 different sector studies. What we didn’t provide was the, how do you do the trade off? It’s not just a collection of spending in 17 different areas and then somehow the budget is not enough. So something has to be cut. It was a very mechanistic way in which the chopping happened. Now the World Bank, we talk about optimizing and looking at the trade offs in a systematic way. Again, we looked at it mostly from the economic side, but it was a very dissatisfying process. Look at the poverty reduction strategy that the World Bank promoted for a number of years, especially under President Wolfensohn who was very much committed to poverty reduction. Again, an excellent goal. But if you look at the actual poverty reduction strategy, again, you see these enormous matrices, matrix of the health group and the education solution and the cash transfers and then commercial business and banking. It is overwhelming and the policymakers usually couldn’t handle it. And so they ended up making usually political expedience solutions. This happened over and over again. Now there was some development improvements in that. The political economy became appreciated as an important element of decision making. So a little bit of this political economy, behavioral sciences were starting to creep into policy design, but it has not gone far enough. And what I see happening more and more now as these fragmentations occur - in not just in international organizations, but it’s the same thing in the government side- is that this is reinforced by the overall education system that is being promoted globally, which is by subject matters, so you end up with a highly atomized and segmented society. And this is the model that we’ve been exporting from the so-called industrialized developed countries for the last, since the post war era, for 50 years. And the solution which is beginning to emerge has definitely not been the priority of the existing international organizations/ development organizations, because these segmentations are so deeply rooted. And I do not see enough leadership within the development community because the funding agencies, the bilateral and multilateral donors themselves want accountability within a short timeframe within those sectoral, measurable, frameworks. So you see this driving sort of a vicious circle and the driving force is not leading to solutions. So that’s one of the major concerns I’ve had. And I realize that just having different sectors and agencies come together to talk is not going to be enough because the problems are much more deeply rooted in the way we, the modern culture is evolving. And so that is something that I stepped back and wanted to reflect on and get back to school and learn some more to understand how behavioral sciences and the new evidence that is emerging as well as the use of technology could possibly contribute to solving these complex problems.
Safa: Right, so the fundamental structure, a system of agencies and organizations in terms of their specialization and segmentation and working in silos, it’s something that is evident in the educational systems of many countries. And it’s something that’s hard to overcome by working within these organizations. So it’s something that should be remedied by perhaps, stepping out and thinking of completely alternative ways.
Akiko: Yes. Exactly right.
Safa: And often when we think about social justice issues, people sometimes they analyze issues in a very single single issue format. But the complexities of everybody’s lives, whether it’s on an individual scale or a societal scale, is that there’s really no single issue. There’s so much intersectionality between the different challenges and the different social justice issues that people have to navigate on a daily basis, that it’s hard to address those and unpack those and overcome those if all you’re doing is relying on experts, specialists to address very small parts of the problem.
Akiko: Yes, exactly. Yeah. You’ve captured it well. Yeah.
Safa: So would you say that this perspective is something that more and more people are beginning to think about and reflect on or not enough?
Akiko: Oh, I am encouraged that these concerns are definitely finding a lot of resonance even within the international organizations. Not all, but in many, which is encouraging. And I’ll give a couple of examples down the line, but I’m talking about stepping back — actually these kinds of complex problems , and we hear a lot in economics and in the development field that we have to move away from these linear mechanistic solutions to solving complex systems. There’s a lot of talk, but I think there is not enough understanding of what we mean more precisely by that. And here, I must say that my original training in biochemistry and molecular biology was very helpful because in those sciences you’re dealing with complex organisms. You know, a body is not just an autonomous simple automaton with linear commands. A body is very, very complex, lots of feedback loops and and yet it works. It has more or less the capacity to deal with very, very complex biological as well as environmental problems. And it offers a very good insight into how we may be able to reframe those as macro level development problems using the methods and knowledge approach that is very much more commonly used in biochemistry, biophysics and the more modern biological sciences 0 because the traditional, 19th century biology is about phylogeny classification, which is similar to what economics is doing, this linear model. But the modern biology is very much informed by the complex systems analysis. And I must say that that approach has not really broken into the more standard development project approach. The World Bank, the model is let’s say , a project in infrastructure where you have a clear, technology, we build a dam or a power station, build roads. You have very clear goals and the engineering that goes into it, the mechanical engineering and other engineering, works at that macro level and you put something in, something comes out the throughput analysis. They don’t look as much into the feedback mechanism, at least not the traditional infrastructure project. Now you move — that’s the traditional project model and you see all the log frames and all these projects operations manuals , these matrices, they’re very much in that line, in a way the Newtonian mechanics. You try to balance the inputs with throughputs but not realizing that within that mechanism , there are a lot of complex things happening. You kind of treat it as a simple machine. So the example in the economics fields is that for most of the 20th century economics was based on the notion of rational expectations. So you have a lot of data coming in and you try to interpret it on the assumption that humans would behave rationally, they would optimize, you know, the efficiency, optimize their own gain and let it happen. That’s where Adam Smith said, you know, that the invisible hand will guide it. Optimization. What Adam Smith didn’t say, what he assumed, is that this is embedded in a complex culture where social justice and all this are already in place. So that if you have a good social justice system in a society, in a culture, then you can let individuals optimize their goals. But what he didn’t realize is in many societies and systems outside of his Scotland, things don’t work so well and there isn’t a sense of social justice or there is not an education system that promotes ethics. So if you don’t have that, then you are going to have a very chaotic and adversarial system. So there was a lot of assumption about rational expectation in it, built into the economics. And so you built what looks like a complex statistical analysis, but basically they were relatively simple linear models. What the behavioral sciences, behavioral economics is bringing is a realization that human beings are not just points in a ball, a shapeless ball, structureless ball in this large macro system. In fact, human beings have complex reactions. So you push the person one way. It doesn’t necessarily just go out the other way. A lot of things happen and you may come up with a completely unexpected way. So I think that behavioral science is introducing a better understanding of the complex interaction at the individual and at the social level of human beings. Now the question is, yes, you got that human beings tend to be risk averse. They don’t look at long term risk very well, fine. But how do you build that into a more analytic system? This is where complex system analysis and more of a fractal chaos theory, those things are more appropriate than a more simple linear analysis would do. So there is not enough, I think, education of the general public in understanding, you don’t have to become a mathematician, but at least appreciating that the way that the world behaves, both physical and social, are based on complex systems and some understanding, better understanding of that would I think go a long ways towards the way which the projects are designed. But when you have 99% of the people who are on the front lines and in the management structure of these organizations, who have been trained for decades to see things in a linear way - it’s a very big a leap to ask them to step back and think in complex solutions. So we have to find a new way of both continuously educating but also explaining what this is beyond the mathematical models. We have to show through visualization and graphics , to present the problem in a much more accessible way. And this is where I think the, there’s a still a huge gap. But what I’m happy to see is that there’s a lot more, as I said, behavioral sciences coming in, but also more of these appropriate, more relevant models, mathematical models and other types of systems analysis entering into the field. What has not happened is that it is still in a very much academic area and it’s not translated to be more accessible, more easily understood — for those who may not be trained in mathematics- but you don’t have to be, this sort of deeper thinking can be achieved. Understanding can be achieved through other means. Particularly, I mentioned visualization and graphics could help and this is where technology could come and provide a much easier way to simulate what would happen in a complex system. And the costs are much cheaper now to present those simulated models. I think that’s one of the big missing parts, the big communication gap between those academicians and researchers who are beginning to present these and those in the field who are trying to design the appropriate research to show this. And then the policy makers who are too busy and you know, can’t be presented with these mathematical gobbledygook they don’t understand. And in the end you’re dealing with more urgent problems. So somewhere there’s a lot of disconnect and a lot of distractions. And what I’m trying to do is to figure out how can we do a better job of connecting these different bits.
Safa: Right. So it’s a process of unlearning the assumptions that we have or the, the, the ways that we commonly approach an issue or design a program and, and really think of a completely new, new way of, of doing the work in a different way. But you mentioned these three groups in terms of academics and researchers, practitioners on the ground, and perhaps managers or policy makers. Um, do you believe, or in your experience, do these kind of three different groups people communicate with each other enough? And what do you think are the barriers that prevent that?
Akiko: My answer is simply, no they don’t. I find that, uh, there’s really an alarming level of disconnect. It’s been, well almost 30 years since I left my graduate school in biochemistry, where there was some really exciting research that, promised to, solve a lot of the medical problems. And that is happening — that I see on the biomedical side. Enormous strides and better understanding, also enormous strides on neurosciences. Incredible. And since I left, the World Bank, and started listening in a lot of great podcasts, I’m amazed how much I had missed out. So that, that’s what I’m saying is that on the one hand there’s some great research being done, but, uh, one, they, they, they have become more segmented and perhaps, although there is a growing number of people, especially like these podcasts try to bring in these sciences to other lay people, which is great. So that’s improving. But generally I’m just amazed the last 30 years, how much things have moved away from being connected more. And then on the side of the practitioners, whether they’re researchers or myself working on projects, we are so overwhelmed and you know, increasingly more and more is demanded — we have to multitask. So I would say the last 10 years, with the World Bank with so much multitasking and especially with the IT coming on board — and designed not in a way that is biologically friendly. You know, so much data. So many things can be done. But it’s designed without understanding of the human ability to absorb and manage those data. So everyone’s feeling inundated, burnout, and as a result, and when you multitask, you know that you actually don’t do deeper thinking, your thinking gets shallower, your IQ actually goes down. And I felt that there’s so much multi tasking, I had stopped being able to reflect deeply on any problem. I was getting stupider. So on the frontline you have people overwhelmed, the academicians doing their thing but also isolated. And then the policy makers again facing all this problem with the political economy issues and they themselves overwhelmed with so much new data and so many new problems coming up that they are unable to digest it. And also you find that the advisors are getting fragmented. So instead of coming to more deeper, more sophisticated models and tools for policymaking, all we did in a way was just go and do a core dump and have a huge amount of data, undigestible. And so people will pick and choose. And at the same time people feel discouraged. And so this is what I saw happening in not just the field of development, but the same thing when I was at OECD for a couple of years. I saw that — the OECD is a think tank for the 35 high income countries. And so they’re supposed to do these analytics, which was great, but you have academicians coming in who often, I saw a number academicians who don’t really have a feel for the policy side and I saw a disconnect there. A lot of research. The policy people, they don’t have the time to learn and try to guide. So again, a miscommunication. I mean, OECD would have been an, in some cases where there are good leadership, there are efforts to really tie in research, really cutting edge research with policy. But it’s not easy. It’s bucking the trend. And OECD I clearly saw — I went there because I wanted to well go beyond health and work on health and labor. So people working on labor and people working in health sector, we need to work together. Well I tried but it was exceedingly difficult. Not because people were against the idea, everyone was just too busy with their own assignments and so they had very little time to work on issues, outside of their field of expertise. So you see the repeated problem. So yes, practitioners, policymakers, academics, we’re also just as much in the silo and it is not because people don’t want to, it is structural, structurally built into the way that we do our work, that we do our learning.
Safa: Yes, as you say to it’s a structural issue, but do you think this lack of time, this overload contributes to practitioners also not having the time or the mental space to reflect on the ethical issues related to the work that they do on a daily basis?
Akiko: Oh, of course. Of course. I mean, ethics is a huge part that’s very much neglected because if, if you’re under pressure- let’s take the work I was doing on health insurance reform and the government wants, government x wants to provide, special, higher coverage for, the wealthier group, let’s say the civil civil servants and, you know, that these people can afford better and the poor would need more, and then they say, well, we’re, we’re not a wealthy country. We don’t have enough budget and this is our priority. Now I remember I could have done more digging, do analysis to show that the costs, additional costs for extending basic coverage to the poor is well within the percentage limit of their, their budget framework. But I was too busy, so I didn’t have the time. That, I mean it just, I was just overwhelmed with another crisis somewhere else. Some terrorist attacks some where else. So because of that, no one followed up on it. And they may not have done it anyway, but it was worth the effort. But these things drop and it’s accumulation of all these things, that really amounted and, no, I would say most of us at the World Bank really believed in pushing for poverty reduction, for equity. And yet, you know, we get criticized for all the wrong, the structural reforms in the 70s were bad, but there are other things have been done that are better, well-intentioned, but the a, the way, all the structures, not just of international agencies, but they reflect the governance structure of all the governments in the postwar era because this is the model we’ve all exported, right? There’s a Ministry of Finance, the Ministry of Health , the Ministry of Education, right? All these things are segmented and budgets are done in a certain way. Guess what? It is a global expansion and a model. And the education system. Why is it that you have so many grades and children and same age and a classroom with one teacher and 20, 30, 40 students sitting in a row facing forward? Is that a natural way to learn? Of course not. And yet it was an efficient way in the 19th century Victorian England and somehow it’s persisted and it’s built into our culture. This tendency to, to be part of a hierarchy — to exceed hierarchical relationship and not to question, but to be an efficient worker within that — we’ve been acculturated and we’re exporting through education. Yes, girls education is very important but you realize that in the course of doing it, you’re also exporting this very subject matter oriented education — which has its good parts but it’s not adequate. And you may be undermining that country’s important social, social capital, the, the connection with the family, with your brothers and sisters and cousins and putting them in a, in a separate classroom away, children of different ages, different generations. You see there’s a whole accumulation of things that are happening that we need to rethink. And what I’m glad to see is that there are a number of countries as well as researchers that are questioning and moving forward and addressing beginning to address these issues. That’s why I’m feeling much more optimistic and excited that it’s not just me. I think everyone is feeling it to some extent. And so I think there is a willingness, more openness than let’s say 10, 20 years ago to listen to this kind of discussion and to be more open to trying out new ways. And there are a couple of new exciting things like in Finland — education in Finland I think is important. Or the OECD’s efforts to, develop a wellness index, a wellbeing being the goal, not economic growth. And that I think is, is a good mission. I should mention that one thing that attracted me to OECD and made me want to work there and learn a bit is that OECD’s mission statement is better policies for better lives. It’s not better policies for economic growth or income redistribution. It says for better lives, keeping it fairly open. It is lives, lived well, not just long , or not just with wealth but it is lives lived well. And so the wellness index tries to, redefine our goals more in alignment with what are probably are truer values, which includes ethics and values of social justice. Because the behavioral aspects of that is important. So I think that OECD’s mission which reflects by the way what the OECD governments generally are thinking, which is encouraging, is recognizing that the economic goals, the pursuit of economic goals, including poverty reduction, unfortunately poverty reduction has become defined as we reducing that income disparity or low income — when in fact wellbeing goes way beyond the income issues. And by using income as a proxy in a way, once again, tunnel vision, we’ve made that the goal and forgotten about the human wellbeing. So I’m very glad that OECD is coming back and pushing the agenda for a better measurement, which is more aligned with this more holistic view of human being in the way Amartya Sen and others are describing. But also it’s got the human index, but also there is the social human as an individual wellness and then the social wellness index because as a group it’s a different set of measurements, and the environment of course. And it also includes the economic because it’s not that you throw out the baby with the bath water, you don’t throw out economics because it’s, it’s bad. No, it’s useful. You still want to know whether what you’re producing is done efficiently and well, but it’s absolutely insufficient. You need the other indices. So I think OECD’s wellness index starts to provide some of the more integrative measurement that will hopefully lead to incentives, drive the others to work towards that. But, the other one I mentioned about Finland — a couple of years ago made a major change to their secondary school curriculum for a topic based curriculum rather than subject based curriculum- difference being that, you know, a lot of the, most of the topics and subjects that education received are by subjects like English or mathematics or geography and so forth. But the, the topics, the term topics is used to, present a complex problem, let’s say climate change problem or a, a civics problem with elections or some such thing about fairness within a social context. And, and then the students are expected to work in teams and groups to try to find solutions. So it’s not about using math or geography or, social studies. It’s using all your knowledge. Also, people come with different views, so you have to learn to argue and put up with conflicts. Some people get very upset, they’re getting emotional. How do you deal with that? So it’s a very holistic way, approaching complex problems. And I see a real hope in the future. If Finland is moving in that direction, think of the next generation of graduates coming out of that. These are, students graduate who’d be more open to these more intersectorial analysis, but they are already trained in, be able to cross those divides and, and be more aware. Also be familiar with more complex systems analysis and that starting from before universities in ,secondary school. In my country, Japan is also pilot piloting these new curriculum. They haven’t gone for a major reform yet, but they’re doing it in pilot schools so that they’re moving in that direction. So I see these more systemic moves being important, but these are the kinds of lessons that ought to be going much more quickly into the development field. I found that in OECD there was a lot of discussion and engagement on that and very important. And I, when I moved back to the World Bank, there was very little discussion in this area. So- although I must say that the World banks education team is really moving towards learning, not teaching. And so they have some of the good metrics and appreciation of that, but it’s not going outside of that education field. So I think the development agencies have a long ways to go and I hope they work more not in silos, but also work with OECD countries too, to share the lessons.
Safa: Right. As you say, there are some encouraging examples, but it’s, it’s taking a longer time for it to become more widespread. But in your experience, for example, in designing programs, have you, how have you been able to navigate the challenge between offering expertise based on best practices and research while at the same time respecting and incorporating local or community based ideas about what the best way to learn is or what the best way to approach a certain social issue is?
Akiko: I must say, in none of the agencies that I worked in that includes UNDP, UNICEF, Asian Development Bank, and the World Bank, I don’t think in any of them there’s been a very, in my experience that we’ve done a good job. I’m not speaking for all the agencies, it’s, I’m just talking about my personal experience in all these agencies. Now I’ll start with UNICEF, which has made community engagement and all that a priority in presumably. But my experience with UNICEF has been disappointing in that it has, again, my experience, okay, this is not condemning UNICEF as a whole, but my disappointment was in the way the immunization programs were developed and pushed. I worked in Yemen where sadly things are just terrible right now. But I was there in the 80s and, when the country was separated North and south and I was in the South, the Soviet side, communist side where they had quite a good dedication towards literacy and immunization. So that was very good, but in order to reach, at that time it was the Universal Child Immunization 1990. It was the 1990 goal that we were aiming for. So there was an effort to increase immunization. Now of course I’m not against immunization. We know how important that is and it’s really essential that children, Yemen get immunized, but, and the targets are important, measurement is important. But what happened was in order to get the immunization goal, there was so much resources, efforts put into that that is skewed the whole very limited fragile health system towards immunization. And I think it undermined a lot of the other like maternal health services and others where the incentives went to immunization. The workers went in that direction. Now you could say that’s a short term effort and it’s, it’s fine as long as you get back to a more regular system. But it was a pretty severe skewing to the point where, the health systems approach was abandoned. You know, there was, if we want, had looked towards a more longer term, slower solutions in which you work with the education group for example, literacy and explain the value of immunization, it would have been more sustainable instead of having to do mass campaigns every five, 10 years, which is what ended up with doing, they end up doing. But in other parts of the world we see also the anti-vaxxers that , there was a certain, I would say an arrogance about saying, well, immunization- of course scientific evidence is obvious. So it, we’re all guilty of that. Yeah. There’s strong eye scientific evidence and therefore you assume everyone must therefore follow suit because evidence is there. Now from behavioral sciences, we know that we don’t, we’re not necessarily motivated by scientific evidence that we move where, you know, we are emotionally, we feel safe and we have to have trust. And so having skipped that, you know, doing evidence-based policy, it’s not going to be enough. And this is where I think , institution like UNICEF — which does very, very important child, survival, child safety issues could do a better job — and reflect on also the kinds of negative impact that their campaigns and approaches could produce. I think a lot more deeper understanding of social behavior, of modeling, of opinion surveys, a lot more investment in that would help. So that was my not so good, experience in UNICEF. And I’m not so sure there’s a lot of talk, but I wonder how much they have moved since then on that. At the World Bank there was always talk about it must be client oriented. You know, clients , must be demand based, especially because World Bank is giving up, credits and loans, credits, interest free credits, just very low, low cost financing. But it means that the governments have to persuade their parliaments if they had a democratic system, otherwise the dictator that it’s worth taking out the loan. So, so clearly we talked about demand oriented. Well there are two different, clients where the World Bank is dealing with its main client, which is the government and usually the Ministry of Finance. As opposed to the clients, the population at large. And we had not figured out a way in which to do a more systematic analysis when these diverge. Many countries I worked in were not democratic. I worked under, in Egypt for many, 15 years, under Mubarak. So it was Mobarak and his team, what one can persuade them. And , it’s one thing to work towards persuading them. And I thought this was an important job to persuade them that health insurance coverage, especially including the poor but not just the poor, the middle income is very important and we, that I felt was an important part of creating that demand. And, in that, yes we were being interventionists, but there was a,, at the board level an agreement that this poverty reduction and social equity and economic equity is a goal for the World Bank to which we can advocate without feeling that we are interfering on the sovereignty of the country. Now, this is not a trivial thing because when you look, look at it, look at the United States. Had we in the World Banks headquarters in Washington DC , if we had advocated that for the United States, we’d be kicked out for interfering in the, the sovereignty of the country — definitely now under Trump. But before Obama, you know, this issue of making universal health coverage as a national policy would have been definitely seen as interference on sovereignty. So where do you, where do you make sure that you are aligning? This is where a deeper thinking of social justice and ethics- we have to reflect on that and have the full support of that institution in going forward with it. So at least on poverty and economic equity, there was these nominally very, strong, strong support and we advocated for that explicitly with the Ministries of Finance and Health with the government of Mubarak. So that is where there wasn’t such an appreciation on the importance of this by the government. But yes, we felt that it was correct to push and advocate for it, if not impose, we cannot impose , but advocate for it. And I think that an institution like World Bank could play an important role. Now at the project level — so when we do projects and let’s say more of a primary health care community health projects, the World Bank was required to do a lot of community interviews, stakeholder analysis. In fact, it was a requirement to do stakeholder engagement in building projects. But here again, I think it was rather marginal. If you really thought of stakeholder engagement. I mean that’s, and less controversial as maybe in health, but let’s say if you’re building a road, a road construction or major infrastructure and a noise issues of what happens to the environment and to the people living in that vicinity. I think the World Bank has explicitly made an effort to engage people, but it has often now ended up well because just talking to the stakeholders on the ground, is not sufficient because there are other interest groups, the local politicians, the vendors, the suppliers, there are a whole group of people who influence the final decision. And as an outsider coming in, even if you have ground staff, it’s not always possible to see and understand. In many cases, if you saw everything, you may say, no, this is, we have to stop the project because the project will then get siphoned off to this, or it may cause something else. In a very complex system I think in many cases we did not understand or could not understand or some combination of being manipulated, so forth. So what I’m trying to say is that in dealing with the government as our primary client, there was an effort to make it on client demand, but there was a lot of principles and things that World Bank came with that you could say was imposed. Some of it good, some of it not good. On the ground level I would say World Bank was not designed — given that you’re already struggling at the central government level -, World Bank did not have much leverage or the ability to intervene. It occasionally did. But let’s say there was an environmental negative impact. And so either you have to do remedial or some kind of additional investment or not go to the project. Occasionally I think World Bank has managed on the environmental front do a better job, but it came at a cost. And so we were seen by the government as very expensive, very condition driven and so and therefore imposing on our sovereignty our freedom to act as we want. So that became a huge issue of, you know, World Bank imposing their views of environmental righteousness. Well we are a poor country. And how come us and others get away with it but not us. And that is true, that is how things have happened. The garbage from Canada being sent to Philippines, you know, so that was, ironic, but these are, what goes on behind our backs and the staff at the front line, thinking they’re doing the best, don’t always see all these games being played behind their backs. And so we did not win that. We were not in a position to win the trust of those people on the ground. If you cannot build trust, then are you the right person? I think we tried to do too many things and be good to everyone and to put a good front. We need to be honest. If we cannot do that, don’t pretend, do your job well at one area, but then work through other teams. Again, you can’t do it alone. You’ve got to bring other players into it. Some efforts to bring in NGOs, but it, it has definitely not persisted in Jim Kim presidency. And I don’t think it will under Malpass presidency, but I think it’s a very, very challenging proposition where our business model hasn’t thought through these issues deeply enough, it is a complex problem. We try to have a simplistic problem, not simple, but I mean, it’s still relatively simplistic project model and say, well, you know, it’s the client’s responsibility. Well, sorry. Yes it is, but it is, it is much more than that and it’s beyond our control so we can’t deal with it. So yes, but you know if you’re in a leadership role, you’ve got to care about these complex problems. If not you, who else? Right. So this is where I think the World Bank for me has failed to play that important platform in bringing out these complex issues and not running away from it and tried to paper it over in order to get projects going. But, but to be brave enough and for that brave enough to be up front. But for that you really need a strong leader who can persuade not just Americans but Russians, Chinese, Brazilians and others to say let’s get together. That kind of leadership is rare and we don’t, I think World Bank missed the opportunity to get such a leadership. We haven’t had one.
Safa: Right. As you say, a big part of professional integrity is the ability to be honest, even in spite of interest groups and the political will of others — in order to really gain the trust of the people who you’re trying to serve. Can you speak to us about the concept of social accountability versus social mindfulness and your thoughts around those?
Akiko: The reason why I wanted to distinguish those two terms is that the social accountability is certainly very important. I’m not downplaying its importance, but behind that concept it’s still the notion, it’s important that there is a social contract. What is not measured is not accounted. So you act, you definitely do have to measure and be accounted for. So you have to have those systems in place. Another sophisticated way of bringing to surface any problems along those. However, as with, with the, what I mentioned, all the sector or agencies and specialization, the, the fear I have is the construct of social accountabilities to find a measurement and make the organizations accountable and have a governance structure. That’s fine. But what is missing from that is to be, the ability to step back and to have a much more holistic view of how all these different accountability measures are driving the system towards. Let’s say you have social accountability on equity, which is fine, let’s say another one on wellbeing. But if the equity part in the selection, you’re going to have some proxy selection of equity. Let’s say you, you know, there’s accountability shows good progress, but in doing so, it created an imbalance somewhere else. Let’s say so much towards equity, like in Japan, where there then the, the role of the, outliers of those who break the iconoclast, break the rules and go outside. They become suppressed. So much equities. So where do you allow for that? So that may be getting missed. You’re not going to get that, if you’re only looking at the equity indicators. So what would probably be needed is for all of us just to look at these different metric numbers, but the ability to use all of our senses, our emotional senses, our visual, our artistic and other senses to create this, um, sensitivity and mindfulness, not just as an individual cause there’s a lot of literature on mindfulness in the West which is focused on individual wellbeing. But to extend that much more to a sense of social wellbeing. It’s my community doing well. Is there something unhappy , toxic? Is there bullying going on behind the scenes. That , you may do some social accountability metrics. But having that, um, because a society and human beings are complex, it’s a constantly evolving and changing. So if you don’t have the broader social mindfulness skills on which gets into, gets back to education, not just about subjects of academia, but also the importance of art, music, dance, drama. Because theater, it’s a human endeavour that creates a better understanding of how your projection of emotions resonate with others. And it gets magnified when you perform in front of an audience — because human beings are in a way social animals that, that resonate very much. So that kind of awareness, the ability to sense and feel and notice not just the individual body language, but the social signs, of distrust of signs of as I say, disarray of, of trauma. I think that, and to be able to create more joy, you cannot do that on this you yourself practice it. How can you talk about creating trust when you don’t understand what it is to live in a trusting society? The comfort and the love and the sense of safety you get from being in a community is something that you cannot just create by numbers. You have to have a broader understanding. And that’s what I meant by the importance of educating and for all of us training ourselves to be more socially mindful, not an easy thing. I’m very bad at it. I have to sort of step back because I have been in these bureaucratic institutions where you are in a very narrow sense, narrow community. Even if I traveled a lot, in many ways, you’re in a bubble. So I’m having now to undo that and develop my sense of social mindfulness from scratch. And I think all of us would benefit from being more , but humble but because we’re too busy in making a living and running from one commuter train to another. Right? It requires a very different design that allows the space, I think people are willing and open. There’s more willingness, but the design of the cities, the transport, the classrooms, the whole infrastructure is not yet conducive to that. And so this is where we all have to come together, the architects, the artists, and everyone to think, rethink how we do our, our work on, rebuilding trust. And I just, one word I have to add is it’s not just humans. You know, I’m very much an advocate for animal welfare and all this. It’s not just humans. We are part together with trees and, and other animals, human beings on their own — we can become quite a toxic species. We need a balance of other, other creatures around us to balance out the way we behave. And, and it’s not just the mammals and those charismatic mammals, it’s also the trees themselves have their lives. We need to reconnect with a balance. And the social mindfulness, I would extend not just to humans, but all living things and that’s something that is in a way nothing new. Its what a lot of people have been saying for a long time, but we need to revisit with a new set of eyes, with science opening up. And technology opens up a whole vast way of reconnecting. But it means also that it can amplify the toxic side of our behavior as we see happening. So technology is not the solution, it’s another instrument. But now that it’s in our hands, we really, really, really have to work on social mindfulness and become deeply, deeply engaged and rooted in that. Otherwise we’re creating so much toxicity that we will be having centuries of trauma down the line. That’s what I’m afraid.
Safa: So in terms of social mindfulness, the task at hand really is deeply engaging with our senses, our surrounding, our communities to really, really be able to speak from a place of engagement.
Akiko: Yes.
Safa: Thank you so much for speaking with us today and sharing your experiences and your reflections. We really, really appreciate it.
Akiko: Yeah, no, thank you. It was a pleasure to speak with you Safa.
Safa: To our listeners, thank you for tuning in. To keep up with our weekly podcast, please subscribe on iTunes, Spotify, and Google podcast platforms, rate and review our episodes, share it with friends, and follow us on instagram where our handle is @rethinkingdevelopment. If you have any listener questions that you would like me to ask our future guests, please feel free to email them to us. I look forward to continuing this conversation with you all next time. Until then, take care.
