I appreciate that @Mo Putera but Im not at all that. Your 100% right that I’m sold out for getting good healthcare to everyone, but there are probably >5000 people in the GHD world who both have a better track record and more power to move the needle on access to high quality healthcare than I. You probably get the wrong idea from me posting too much on the forum :D :D :D , I run a smallish growing org that rolls out a decent model that may or may not get more traction.
Even our One Nurse in One room model as great as I might think it is, is only likely to be useful and perhaps the “best option” to provide remote healthcare in a handful of countries. Many Sub-Saharan African countries already finding (or have found) their own way to solve the problem which is great—even if its less efficient.
I think there are surprisingly few examples of “DRIs” who really own an issue in Global health. I actually wish there were more. There is the odd huge name like the late Paul Farmer would be the best example of what you are talking about. He helped move the needle and policy on a lot on many things, such as - MDR TB treatment rollout - TB directly observed treatment (along the lines of what Spiro—New TB charity raising seed funds does. - Community Health worker normalisation
On your systemic change question, I think systemic change in Global health is a multifaceted long-term grind. It takes a lot of effort, money, people working hard and good long term relationships and connections with the WHO and governments to make lasting change. The community Health worker movement is one of the best examples of successfully driven systemic change. It took 20+ years had a LOT of big names behind the campaign to get serious traction. This included Paul Farmer who I mentioned, plus big time advocates like President Sirleaf from Liberia. Plus tens of other people who are sold out spend their whole life on the issue. And they have a great advocacy org CHIC who co-ordinates and advocates led by another great woman Madeleine who recently posted here on the forum. There was no one Directly responsible” person—instead perhaps 20-50 hugely capable people co-ordinating and making this happen.
What I don’t think can work to create large-scale meaningful systemic change is funding a 3 year project through a big NGO which tries to do just that. Better to fund movements or organisations that already have committment and momentum. In some ways similar to your “DRI” idea, but unfortunately not as simple as funding 1 person.
Your “VAWG” example is a good one, because like with the community health worker movement there are hundreds of founders working on that issue who are dedicated to their work and as far as I know no one person who stands out as a clear leader of the movement Many of them are obsessive and brillian, but they won’t be directly responsible for the field in general. Maybe in their country or for their specific intervention, but not for the entire field.
I don’t know much about this field and I could be wrong, but I feel they haven’t yet co-ordinated and built a “coalition” of groups working on it with a super capable leader can be key to creating more systemic change
And I might be missing what you really mean by “DRI” here, but I’m just not sure that the principle applies outside of a handful of very niche interventions like the no-more-lead crew.
Very much appreciate the pointers and candour (and sorry for mistakenly calling you a DRI), much for me to chew on. In any case I was hoping you’d answer this on the podcast! But I suppose it just wasn’t a good podcast question.
Here’s how Holden Karnofsky describes the DRI idea just for your interest, I don’t have any other substantive thoughts on it, just “shouldn’t there be more DRIs in GHD?” (there’s more, I just picked the parts that struck me most):
“DRI” is a Silicon Valley acronym—“directly responsible individual”—referring to the idea that if you want something done well, you should designate a DRI for it. This person isn’t necessarily the person who is “in charge of it” from a power perspective (though Daniela and I think it usually should be, and in fact often dislike the term “DRI” in corporate contexts for this reason—we think DRIs should be owners/managers), but it’s the person who is “directly responsible” in the sense that the thing going well or poorly is on them. I chose this term even though I often dislike its use, just as an evocative shorthand.
The DRI-centric worldview in a nutshell is:
Serious impact in domain or task X is nearly always the product of a person who is obsessed with X and has spent a lot of time on X (relative to other people, and ~always over ~1000h even for very green-field X).
The rough mechanism is that any impact on the world requires understanding and dealing with a large # of little things. You need someone who is sharp and adaptive, but most importantly puts in the time and focus to deal with all of these things.
So if you are trying to have impact on X, you’d best either become that person or recruit/develop/manage them; other things are unlikely to work. If you’re noticing that X isn’t going as well as you hoped, your first and possibly last question should be whether the right person (or people) is working on it.
The game of figuring out who is a fit for what is a contender for “best thing to be good at.” This is a great thing to think about and build knowledge of.
…
The DRI-centric worldview advocates for a bit of an obsessive, often beyond-what-seems-reasonable dedication to the idea that everything that matters should have an unambiguous point person, usually someone who has a heavy concentration of both power and responsibility w/r/t whatever X they are working on. (This person is then held directly accountable for how things go.)
Interacting with tech founder types, I’ve often found it almost surreal the way they automatically go “Well X is in charge of Y and I’m not going to second guess them—we are going to do what they want.” It’s hard to say why it feels so surreal without actual examples, but like … a lot of times it seems really obvious that the person is crazy and doing a certain kind of thing wrong … and yet over time I feel like their attitude gets vindicated.
The DRI-centric worldview is really obsessed with commitment. Anytime someone seems like a sure thing to obsess over X for the next 10y of their life, the DRI-centric worldview is tempted to bet on them to succeed. Anytime someone seems like they’ve got one foot out, the DRI-centric worldview is like “This is going to suck.” (An exception would be when a person is on the way out of something they’ve already mastered—like a CEO leaving a company—and is helping transition.) I think the DRI-centric worldview is less surprised than other worldviews by how little mark various brilliant, competent, scattered people have made on the world.
The DRI-centric worldview really doesn’t like the idea of trying to “have an idea” that one hands off to another person to execute. It likes the hybrid visionary/executor.
In general, I feel (in a way that I couldn’t substantiate well without more work) that I’ve had a lot of surprises in my life that have updated me toward the above points. There are lots of times when other worldviews, and basic internal logic, is excited about some project because the idea seems so good. But when the key ingredients outlined above are lacking, it generally ends up bad.
There’s a surprisingly big category of problems that are ‘orphaned.’ By ‘orphaned’ I mean: you can’t point to a specific person or organization who thinks it’s their responsibility to deliver the outcome in its entirety. Lots of people talk about the problem, and often many work on slices of it. But if you asked: ‘is there a hyper-competent person waking up every day feeling accountable for making sure this gets solved?’—the answer is very often, ‘no.’
These problems exist across domains and at a variety of ‘altitudes.’ Indeed, some are perhaps better described as ‘things we want to be true’ rather than ‘problems.’ In any event, a few examples that have been on my mind recently:
Can we prevent infection from all respiratory pathogens (including the common cold)?
Can we make every new building in SF both serve its function and be beautiful?
Can we permanently fix the American west’s water problem?
Can we halve X risk?
Can we eliminate single-use plastic globally without making convenience trade-offs?
Can we make childcare costs so low that they’re a non-factor in deciding whether to have kids?
In my opinion, there should be ‘general managers’—GMs—for problems like these. These are founder-types who feel personally responsible for delivering a specific outcome (vs field-building generally); hyper-competent leaders who will pull whatever levers necessary to achieve the defined outcome. Most companies wouldn’t let an important initiative go unmanned or without a ‘directly responsible individual’ — why are we OK not having GMs for even more wide-reaching problems?
Nan gives the historical examples of D.A. Henderson “owning smallpox eradication” and Evan Wolfson “owning marriage equality”. I honestly forgot about this article yesterday, but your remark at the end there reminded me of it.
On this question “‘is there a hyper-competent person waking up every day feeling accountable for making sure this gets solved?’ for many Global health issues there are 30-50 people like that. Only with newer more niche ones like lead might there be 1 or a handful.
These are great examples from the past. I love the old-school “heros” you mention and wish we had more today. Even with those “DRI’s” you meantion of the past, I would imagine they were reall ymuch more part of a bigger global team, and in many cases the public figurehead rather than “the” responsible person.
I appreciate that @Mo Putera but Im not at all that. Your 100% right that I’m sold out for getting good healthcare to everyone, but there are probably >5000 people in the GHD world who both have a better track record and more power to move the needle on access to high quality healthcare than I. You probably get the wrong idea from me posting too much on the forum :D :D :D , I run a smallish growing org that rolls out a decent model that may or may not get more traction.
Even our One Nurse in One room model as great as I might think it is, is only likely to be useful and perhaps the “best option” to provide remote healthcare in a handful of countries. Many Sub-Saharan African countries already finding (or have found) their own way to solve the problem which is great—even if its less efficient.
I think there are surprisingly few examples of “DRIs” who really own an issue in Global health. I actually wish there were more. There is the odd huge name like the late Paul Farmer would be the best example of what you are talking about. He helped move the needle and policy on a lot on many things, such as
- MDR TB treatment rollout
- TB directly observed treatment (along the lines of what Spiro—New TB charity raising seed funds does.
- Community Health worker normalisation
On your systemic change question, I think systemic change in Global health is a multifaceted long-term grind. It takes a lot of effort, money, people working hard and good long term relationships and connections with the WHO and governments to make lasting change. The community Health worker movement is one of the best examples of successfully driven systemic change. It took 20+ years had a LOT of big names behind the campaign to get serious traction. This included Paul Farmer who I mentioned, plus big time advocates like President Sirleaf from Liberia. Plus tens of other people who are sold out spend their whole life on the issue. And they have a great advocacy org CHIC who co-ordinates and advocates led by another great woman Madeleine who recently posted here on the forum. There was no one Directly responsible” person—instead perhaps 20-50 hugely capable people co-ordinating and making this happen.
What I don’t think can work to create large-scale meaningful systemic change is funding a 3 year project through a big NGO which tries to do just that. Better to fund movements or organisations that already have committment and momentum. In some ways similar to your “DRI” idea, but unfortunately not as simple as funding 1 person.
Your “VAWG” example is a good one, because like with the community health worker movement there are hundreds of founders working on that issue who are dedicated to their work and as far as I know no one person who stands out as a clear leader of the movement Many of them are obsessive and brillian, but they won’t be directly responsible for the field in general. Maybe in their country or for their specific intervention, but not for the entire field.
I don’t know much about this field and I could be wrong, but I feel they haven’t yet co-ordinated and built a “coalition” of groups working on it with a super capable leader can be key to creating more systemic change
And I might be missing what you really mean by “DRI” here, but I’m just not sure that the principle applies outside of a handful of very niche interventions like the no-more-lead crew.
Very much appreciate the pointers and candour (and sorry for mistakenly calling you a DRI), much for me to chew on. In any case I was hoping you’d answer this on the podcast! But I suppose it just wasn’t a good podcast question.
Here’s how Holden Karnofsky describes the DRI idea just for your interest, I don’t have any other substantive thoughts on it, just “shouldn’t there be more DRIs in GHD?” (there’s more, I just picked the parts that struck me most):
Nan Ransohoff’s There should be ‘general managers’ for more of the world’s important problems is on my mind too:
Nan gives the historical examples of D.A. Henderson “owning smallpox eradication” and Evan Wolfson “owning marriage equality”. I honestly forgot about this article yesterday, but your remark at the end there reminded me of it.
On this question “‘is there a hyper-competent person waking up every day feeling accountable for making sure this gets solved?’ for many Global health issues there are 30-50 people like that. Only with newer more niche ones like lead might there be 1 or a handful.
These are great examples from the past. I love the old-school “heros” you mention and wish we had more today. Even with those “DRI’s” you meantion of the past, I would imagine they were reall ymuch more part of a bigger global team, and in many cases the public figurehead rather than “the” responsible person.