Leadership Effectiveness

Hello Friends,?

Allow me to share preface to Emergencing: Discovering the Tacit Dimension of Global Health, I? wrote more than a decade ago. Reading this again helps me to understand the road ahead toward achieving global health. Here is the preface to Emergencing.

This book is about some of the insight that I gained in my quest to understand how we can do things differently in global health. Many people have asked what drives my passion in this area. I cannot put a finger on a specific event that occasioned my profound desire to understand about how we can change our approach to global health and human development. I am certain, however, that we are not doing a good job at reaching the people who need care the most around the world. In fact, many attempts at reaching out are followed by disastrous unintended consequences. Increased effort to combat malaria, for example, is systematically followed few years later by a resurgence of a more aggressive and multidrug resistant form of the disease, spreading to even wider geographical zones.

Growing up on the slopes of Mt. Kenya in 1970s, I witnessed, firsthand, the devastating effect of abject poverty and disease on life on earth. I also witnessed the devastating effects of poorly thought-out intervention programs geared to eradicate poverty and disease. On the slopes of Mt. Kenya, we tended for coffee trees, harvested, and sorted coffee beans which were shipped to a destination unknown to village folks. Months later, the village folks could receive measly payments from the coffee they sold. The money was contemptibly small in amount and neither enough to feed the family, nor to pay for education for their children. Life was hard in the village.?

Workers from international organizations, concerned about the plight of the poor people would gather quantitative data, analyze it, and make recommendations to governments and donor agencies, about how to reduce human suffering caused by severe poverty and diseases. What would follow were large scale campaigns to distribute food and medicines in the worst hit places.

Many of the programs lasted one or two years. Project withdrawal was always followed by an upswing of the problem that the project was designed to solve. This was a curious problem christened by folks in the international development community as development trap—a euphemism of massive failure and severe negative consequences resulting from the project implementation. The truth about development traps is that they resulted in massive human suffering, spiraling poverty, widespread increase in severity of epidemics, and a massive proliferation of urban slums throughout out the developing countries.

I was fortunate to come to Boston, and face-to-face with the vanguards, or experts of international development. The conversation among the experts of international development was shocking to me: they tended to blame the poor people living in underdeveloped countries for lack of skill, imagination, education, or any qualities of a complete human being. A quietly celebrated understanding pervaded among this group of thinkers, that people in Africa and other underdeveloped parts of this world are hopeless. In their hopelessness, Africans are waiting for a savior to jet in with a solution to the interminable problems of poverty, disease and death.

So, the experts spent much time on their laptops typing away prescriptions for Africans and African governments. I am sure something of a similar nature is happening elsewhere in London and Paris, or some other big old city in this planet.? I was intrigued at the ease with which the experts of international development could crank out solutions for country governments in developing countries without ever having set foot in any one of those countries. Many of the experts who did visit an African country, preferred to stay at the Hilton Hotel, or the like kinds of places in the city center; they did not consider it worthwhile to go out to the villages to meet the people for whom they developed the prescriptions.

Instead, they relied on reports by the heads of government from various ministries. Because of this pattern of behavior, the experts of international development gained the distinctive tile of development tourists. Unfortunately, development tourism is responsible for the Third World as we know it today. The problem with development tourism is that it created greater problems than it solved; the cure was worse than the disease it was intended to cure!

One cold winter evening of 2003, while browsing books at Barnes and Nobles in Prudential Center, Boston, I came across the Peter Senge’s book, The Fifth Discipline: The Art and Practice of the Learning Organization (1990, Currency/Doubleday). As I scanned through the pages, I could not believe my eyes. Dr. Senge, page after page, had described what I thought was the fundamental solution to the problem of international development. It quickly dawned on me, as I leafed through the Fifth Discipline that the problem of international development and global health was a problem of learning. People (and organizations) involved in international development and global health did not learn from their actions. They kept on doing the same thing over and over again, all the time expecting different results. I learned from the Fifth Discipline, that this is a certain kind of organizational learning disability in which organizational leaders did the same thing over and over again expecting different results. When they fail, they push harder. According to Senge (1990), the second Law of the Fifth Discipline states: “The harder you push, the harder the system pushes back” (p.58).

I was so certain at that point that leaders of organizations concerned with global health did not have access to the disciplines of the learning organization. If they were aware of the theory of the learning organization, they would use it to inform their practice, I thought. I bought the Fifth Discipline, and read it every day on my train home. I wondered why Senge had not offered advice to the experts of international development.

I met Peter Senge two years later, through Jean MacDonald, his administrative assistant. Thereafter, Senge and I had one a many conversations about the problem of international development, global health and the five disciplines of the learning organization. I wanted to know how we could construct a theoretical model, grounded on the disciplines of the learning organization, to inform processes for international development and global health. I viewed health of the people as the true barometer of human development.

Senge spoke to me about leverage points. He would ask: where is the leverage point? What is the metatheory? During my doctoral coursework in economics, I learned from the works of Thomas Getzen of Temple University in Philadelphia, that economic development is by far the greatest cause of improvement in health. [Getzen provided much evidence about this theory in his book Health Care Economics, Wiley and Sons]

I was really intrigued by this seemingly obvious thought that had not worked in developing countries. We cannot fault the people in the international development community for not trying to implement projects for economic development in developing countries. Try, they did, and implemented many projects. Many of the implemented projects however, produced a paradoxically negative economic effect on the local people. Others had no effect.

If the theory that economic development is by far the greatest cause of improvement in health was true, then why was it not working in developing countries? Why was it that projects geared towards poverty eradication ended up causing more poverty? Why was it that projects geared towards eradication of infectious diseases ended up causing an upswing of a more virulent, and drug resistant form of the disease they tried to eradicate? I wondered how we could use the theory of the learning organization to inform this question. I posed the question to Peter. How can we apply the theory of the learning organization to evoke economic development in underdeveloped nations?

The conversations that issued from this question were to last another three years, and formed the basis of my dissertation project. In my doctoral work, I focused on the problem of leadership effectiveness in the practice of global health. I later learned about the work of Stuart Hart at Center for Sustainable Global Enterprise at the Samuel C. Johnson School of Business in Cornell University, Ithaka, NY. Hart had just published Capitalism at the Crossroads: ?The Unlimited Business Opportunities in Solving the World's Most Difficult Problems (Wharton School Publishing, Philadelphia, PA), at the heels of University of Michigan’s C. K. Prahalad’s Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits (Wharton School Publishing, Philadelphia, PA). Hart was in the midst of setting-up a learning laboratory at the Center for Sustainable Global Enterprise. Hart referred to his laboratory as the BOP Learning Lab, in which he hypothesized that multinational corporations are the greatest leverage point for environment sustainability.

Ultimately Senge, introduced me to the works of Michael Polanyi and the theory of knowing. Polanyi posited that “we can know more than we can tell,” and advanced the idea that the more that we can know and cannot tell, is tacit knowledge. This book is a report of the insights that I gained during the process of attempting to piece together the theory of global health and human development. The foundation of this theory of global health and human development is grounded on the works of Peter Senge in the theory of the learning organization, Michael Polanyi in the theory of knowing, Ikujiro Nonaka in the theory of knowledge conversion, and Stuart Hart’s idea of engaging fringe stakeholders for competitive imagination.

I used a qualitative method with an emerging grounded theory, to investigate the paradoxical increase in the incidence of diseases and poverty in sub-Saharan Africa that exists at a time when there is increasing investment for fighting the diseases and poverty. I learned that failure to acknowledge tacit knowledge leads to the emergence of unintended consequences and ultimate failure of projects, creating a relevance paradox. The underlying systems archetypes of failure to acknowledge the tacit dimension include fixes-that-fail and shifting-the-burden, and the tragedy of the commons.

I found that processual integrity emerged as the positive central phenomenon that allowed the emergence of relevant knowledge from a group of diverse stakeholders. Knowledge failed to emerge when decision makers alienated certain sources of knowledge. Thus, knowledge alienation emerged as the negative central phenomenon inhibiting the emergence of knowledge from a group of diverse stakeholders. Knowledge alienation ultimately results in the relevance paradox.

The emerging themes established that the effectiveness in global health leadership predicates upon the ability to reach into the tacit knowledge of the members from each of the five stakeholder groups of global health and human development through exploratory indwelling, and conversion of the tacit into codified, and formalized explicit knowledge through externalization. This theme resulted in a pentagon model of knowledge emergence and effectiveness in the practice of global health leadership. The results indicate the need for a community of practice for global health founded on the pentagon model of knowledge emergence.

Dr. Macharia Waruingi Doctor of Medicine

Doctor of Health Administration

Minnetonka, MN

March 5, 2010?

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