21st Century’s Emerging Inequality

By Gaurav Gupta

In the current discussion on rising inequality, it’s easy to overlook the fact that inequality was the norm, and simply expected, throughout most of history. Not until the 20th century did equality become a leading value. Last month at the Asia Society in Mumbai, Yuval Noah Harari delivered a thought-provoking lecture on equality, past, present, and especially future, followed by a Q&A with Dalberg’s Asia Regional Director, Gaurav Gupta.

Harari, author of a new book, Sapiens: A Brief History of Humankind, predicts a “new inequality” between an upgraded elite and a new “useless” proletariat. Through this discussion of the long-term view of inequality in the coming century, Gaurav and Yuval detail technology’s ability to act as both an equalizer and a replacer of human skill, and the role and evolution of belief systems in societies of the future.

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Presenting the USAID Community Health Framework and Toolkit

By Shruthi Jayaram

Integrating communities and families into healthcare is critical to help people live longer, healthier lives. Community health approaches which facilitate this integration have shown significant promise, especially in areas where access to hospitals and health providers is scarce. Such approaches can span, for example, community support groups to drive healthcare utilization and healthy behaviors, community health worker programs to bridge the gap between community members and the nearest available hospital or formal healthcare provider, and initiatives such as community health report cards to help communities hold their healthcare providers accountable.

Such measures have been shown to demonstrably improve health outcomes and can often be implemented at low costs. For example, a randomized controlled trial of a community monitoring program in Uganda showed a reduced death rate among children under 5 by one-third in the first year and an improvement in a range of health access indicators such as patient waiting time and absenteeism. Similarly, a significant body of evidence shows that community health worker programs can help encourage exclusive breast-feeding, reduce malnutrition, and provide vaccinations, often in a cost-effective way. Investment in community-based approaches can therefore take us far towards bridging gaps in key health indicators – this is a path towards not just the Sustainable Development Goals, but also towards stronger health outcomes for communities around the world.

Donors and governments have showed renewed interest over the past few years as the impact and necessity of community-based healthcare approaches has become increasingly apparent. To support ongoing efforts and catalyze new ones, USAID and mPowering Frontline Health Workers recently worked with Dalberg to create a Community Health Framework and Toolkit. This decision-making tool distills decades of USAID experience, and it was developed with the input of over 60 community health experts including USAID staff, implementing partners, donors, and academics.



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Back to School, On to Unemployment? Addressing the Global Crisis Facing Youth

This article originally appeared on The Huffington Post.

By Devang Vussonji and Faaria Volinski

It’s dark outside when Martin Kiptoo Kiyeng opens his eyes. He gazes at the concrete ceiling of the room he shares with his cousin’s brother in Rongai, Nairobi. He sighs. It’s 5 am on a Wednesday in September, his 700th day of unemployment since he graduated high school.

Instinctively, he reaches for his phone. Twitter lights up – this is his go-to place for news and, most importantly, job posts. Today, nothing. Today, he’ll have to search the old-fashioned way.

Martin throws on a collared shirt and slacks and grabs his backpack. With money scraped together from informal work, he rides a bus 50 kilometers to central Nairobi. He walks into office after office, writing applications for open positions in lobbies, handing his papers over into the void. His efforts are met by a suffocating, incomprehensible silence.

“Is it because I have only a diploma and not a degree?” he asks himself.

Martin is part of what has become a global crisis: seventy-five million youth around the world are unemployed, and the ramifications are lifelong. For every year Martin doesn’t work, he suffers a “scarring effect”, making him less likely to find work in the future and more likely to earn up to 20 percent less than his peers who found jobs right after graduation.

Navigating the Skills Mismatch

When Martin graduated from high school, it wasn’t long before he realized how unprepared he was for work.

“There’s a mismatch from what you are learning and what you get [in terms of a job],” he says. The job market had changed, but the curriculum he studied had not. New industries – retail, hospitality, and professional services – had become key job creators, while traditional sources of employment, such as agriculture and manufacturing, had contracted.

“There should be that transition when you’re moving out of high school, some sort of counseling.”martin

But counseling was too expensive. Martin worked overtime at his cousin’s hardware store in Rongai to make ends meet, pay for an affordable advanced diploma in project management, and support his mother when she got a stroke that permanently damaged the left side of her body. Between shifts, he negotiated with his aunt in Uganda to take over care for his mom, and he watched the only parent in his life leave.

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The Global Opportunity in Online Outsourcing

By Manpreet Singh

Global unemployment is expected to reach over 212 million by 2020. The unemployment crisis we face is complex, with lifelong ramifications that affect not only individuals – and especially youth – but also entire national economies.

However, today an online worker can access opportunities that were unfathomable before the Internet. Online outsourcing can help stem the world’s unemployment crisis by transforming where, when, and how work is performed. Online, workers can support their studies, their families, and even outsource work to others as they create their own businesses.

Together with the World Bank Group and Rockefeller Foundation, Dalberg completed a study and built a toolkit to help companies, governments, and individuals connect to outsourcing opportunities. The findings show that the market for online outsourcing was worth $2 billion in 2013, and is estimated to reach between $15 and $25 billion by 2020, benefiting both companies and workers: online outsourcing will provide jobs for at least 30 million registered workers, and companies will benefit from better access to specialized skills, faster hiring, and 24-hour productivity.

Online outsourcing workers can earn $3 – $4 per hour for basic tasks like data entry and transcription, and an hourly rate of $20 – $40 for more skilled tasks, including software development. Online, workers also develop technical skills (IT proficiency, internet literacy), and soft skills (how to work with clients, working to a deadline, communicating professionally).

However, the story is not all positive. Online outsourcing does not fit into traditional employment legislation – online workers cannot unionize, do not receive social benefits, and are not covered by minimum wage laws.  The industry also has limited impact among disadvantaged populations. Workers must have access to a computer, Internet, and reliable electricity. They are also typically university educated and fluent in English.

To maximize the potential and reach of online outsourcing, governments must apply minimum wage and part-time laws for this new type of worker, and reliable infrastructure – electricity and Internet – is a must. As part of this work, Dalberg developed an online tool to help policy makers and investors understand how ready their countries are to take advantage of the growing online outsourcing industry. If all governments, businesses, and individuals can adapt to this new way of working, today’s unemployed will be able to support themselves and invest in future generations.

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Driving Smallholder Savings Through Digital Design in Senegal

This article originally appeared on CGAP.

By Ravi Chhatpar, Elyse Marr and Ashish Kumar

Financial inclusion initiatives for smallholders have often emphasized credit – whether through microfinance, group loans or commercial banking extensions. An alternative model emphasizes “little-by-little” savings, holding that savings discipline and prudent expense management may be a more compelling and responsible approach that doesn’t burden smallholders with the defaulter penalties and social risks that are associated with credit.

myAgro – a social enterprise in rural Mali and Senegal – has gained traction in applying this layaway model to the smallholder context. It works with smallholders to set a savings goal for the upcoming season to purchase inputs (e.g., high-quality seeds, fertilizer and tools) which are delivered once the savings target is reached. Smallholders contribute incrementally to their layaway account by purchasing mobile airtime-style vouchers from local vendors and sending in a code via SMS.

Working with CGAP, Dalberg recently spent seven weeks on the ground in Senegal, interviewing over 65 farmers and savings groups to understand savings behaviors in depth. The following are some of our key observations that are now informing our human-centered design (HCD) approach to designing of digital financial solutions for smallholder families

1. Smallholders struggle to access quality inputs, technology and training.
Smallholder farmers struggle with access to high-quality seeds and fertilizer for various crops, including peanuts, maize, beans and sorghum. Access to quality inputs also requires additional training around planting techniques. Simply planting high-quality seeds won’t guarantee higher farm productivity without specialized training. Similarly, tools and machinery – precision planters, for example – are also key to improved farm productivity, but are not available or too expensive for the farmers to buy with the income from a single harvest. Mobile-based financial tools could help myAgro customers save for greater quantities and more types of inputs overall, while also providing a means for myAgro agents and vendors to provide recommendations that simplify the menu of choices and that support farmers through the training process.


Mala, a first-time myAgro customer, is a farmer and housewife, taking care of her family of four in Sinthiou Gayo village in Tambacounda. She has been growing peanuts but has not been able to do so regularly over the past few years because she lacks access to quality seeds and fertilizers. She too often rushes to find them from wherever she can during the planting season (when the first rains arrive), rather than planning for them in advance.

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Changing the Definition of a Surgeon: GE Foundation launches Safe Surgery 2020, based on the idea that clinic leadership isn’t limited to doctors

This article originally appeared on NextBillion.

By Ashley Eberhart and Faaria Volinski

Each year, 1.5 million lives are lost in low- and middle-income countries because patients do not have access to essential surgical procedures. For those actually able to access surgical care, 48 million are impoverished yearly by the direct costs.

Photo courtesy of the GE Foundation

Photo courtesy of the GE Foundation

Last year at the first meeting of the Lancet Commission on Global Surgery, World Bank President Dr. Jim Yong Kim stressed that “surgery is an indivisible, indispensable part of health care.” However, safe surgery remains a great need. Health facilities lack infrastructure, equipment, people, processes, and measurement and feedback systems, and the economic consequences are startling: If existing access to surgery remains unchanged, low- and middle-income countries will lose $12.3 trillion by 2030. Lack of access, both physical and financial, to safe surgery is a burden for individuals, communities and countries alike.

Building Leadership for Safe Surgery

Recently, GE Foundation launched Safe Surgery 2020, a $25 million initiative that aims to accelerate access to safe surgery and anesthesia worldwide over the next five years. “By addressing the surgical ecosystem, we aim to impact the greater health care delivery system,” said GE Foundation President Deborah Elam at the launch event. GE Foundation is not alone in pushing for safe surgery to take a higher priority on the global agenda; John Meara and Mark Shrime of Harvard Medical School recently wrote in a New York Times op-ed, “Improve a surgical system, and you improve the very things that are necessary for the delivery of health care in general.”

Based on three main pillars – leadership development, innovation and elevating ideas – Safe Surgery 2020 is rooted in the idea that safe surgery champions in operating rooms, hospitals and at national levels have the potential to drive cost-effective, systemic change. For example, training a doctor to empower other members of the care team to report and act upon clinical observations, or encouraging a hospital director to increase transparency in measurement and feedback mechanisms, can greatly improve surgical outcomes.
In practice, the initiative will provide a variety of support mechanisms, which may include face-to-face leadership training, on-the-job mentorship, and a diagnostic tool to help leaders assess the baseline quality and safety of their facilities and identify areas for improvement. In addition, a facility toolkit will be made available to provide targeted support to leaders based on their needs.

According to Dr. Harshad Sanghvi of Jhpiego, “Leadership is critical to overcoming a demotivated health care system. And it’s not just surgeons or anesthesiologists who will make the change – 70 percent of surgical need can be met by non-surgeons.”

Harnessing the Capabilities of Non-Surgeon Health Workers

The idea that leadership in a clinic is not limited to surgeons points to task sharing to the great number of other health workers, including nurses, technicians, community health workers and others. Take glaucoma: Close to 600,000 Ethiopians require surgery to prevent blindness from advanced glaucoma, and a trained nurse is fully capable of administering the needed surgeries in rural areas when surgeons are unavailable.

Ethiopia will in fact be the first to work with GE to implement the Safe Surgery 2020 initiative. According to Dr. Kesetebirhan Admasu, Ethiopia’s minister of health, the country has an ambitious goal to make safe surgery accessible within two hours’ walking distance from every Ethiopian home. This will require getting 500 new hospitals up and running in the next five years. Rural residents will pay a premium of $10 per year for access to health care services, while those below the poverty line will be covered financially by their local government. Task sharing will be a crucial component to making this happen.

Though task sharing has proven to be very successful, concerns remain. What is the career path for a nurse trained to perform C-sections in the absence of doctor or surgeon qualifications? As legal systems change, how can support-level health workers be protected, especially if they are administering surgeries on their own? Governance will need to keep up as task sharing increases, and improvements in higher levels of care need to remain top-of-mind. As Sanghvi stressed, “We do have to keep training everyone. The demand for surgeons is growing, especially as people have more and more disposable income and are demanding quality services.” The definition of a surgeon must change. It is imperative that non-physicians can also serve as surgeons.

Making Safe Surgery Context-Appropriate

Another challenge is ensuring that approaches to safe surgery are custom-built for the environment at hand. Infrastructure and equipment needs vary widely by country, state and even facility, which is often highly dependent on existing government involvement. One facility might have trouble finding biomedical technicians to repair equipment, while another nearby might find the same equipment unusable without consistent access to electricity. One hospital might have multiple surgeons, but no anesthetist with the qualifications to manage complex cases, while another might have no surgeons at all.

Partnership is key to fostering leadership and enabling surgeons, anesthesiologists and nurses to deliver safe surgery with the manpower, equipment and infrastructure they have available. This includes both hospital-to-hospital partnerships to share learnings and experiences, as well as partnerships with government and the private sector to ensure legal regulations and fund support leaders to build safe surgery ecosystems.

Safe Surgery 2020 is a promising start to foster the leadership development required to improve the success rate of surgeries in low- and middle-income countries. “Transforming surgical safety will require a multi-sectoral effort,” said Elam. “We are proud to launch this initiative, but we realize that we simply can’t do it alone. Safe Surgery 2020 must be part of a broader, global effort to put surgery on the agenda.”

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Infographic: What is the (Particulate) Matter in India?

By Kabir Nanda and Varad Pande

Yesterday, the Supreme Court of India announced a 4-month trial “Environment Compensation Charge” on all commercial vehicles entering New Delhi starting November 1. Poor air quality in India has been an ongoing issue, but the problem is coming to a head especially in the wake of global attention on pollution after Volkswagen’s falsification of pollution tests. In the world’s list of 20 most polluted cities, half are Indian, and regulation to curb pollution is more necessary now than ever before.

This latest Dalberg infographic analyzes the detrimental role of particulate matter: tiny particles suspended in the earth’s atmosphere and a key indicator of long-term air quality and health. 99.5% of India’s population resides in areas where particulate matter levels exceed the WHO standard, and the transport sector is one of the largest and most addressable sources.

The proposed compensation charge in New Delhi is a good start, but we’ll need a more sustained and holistic thrust from the government, automobile industry, and citizens to curb air pollution. Our lives depend on it.

India_ParticulateMatterInfographic_final 2400px (2)

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Creating the Climate for Action: Lessons from the UN Global Goals Process

By Sonila Cook and Varad Pande

It took more than four years and skillful backroom negotiation to get to this week’s victory — the ratification of the next global development agenda, the Global Goals for Sustainable Development, that will guide the world for the next 15 years. This achievement is worthy of celebration and offers hope for the next set of international negotiations that have been nearly 20 years in the making — the upcoming climate talks in Paris.

Explorer Inge Solheim raises a flag that represents Goal 13: Climate Action in the community closest to the North Pole to support the U.N. Sustainable Development Goals. Addressing climate change will be even more difficult than agreeing on the 17 global goals, as climate change raises complicated questions. Photo by: United Nations

Explorer Inge Solheim raises a flag that represents Goal 13: Climate Action in the community closest to the North Pole to support the U.N. Sustainable Development Goals. Addressing climate change will be even more difficult than agreeing on the 17 global goals, as climate change raises complicated questions. Photo by: United Nations

If the path to the global goals was pocked with small potholes, however, the road to a climate agreement is lined with deep craters. Addressing climate change will be even more difficult than agreeing on the 17 global goals, as climate change raises complicated questions: Who is responsible for action? Who pays? Underpinning these questions are charged debates around the right to develop versus the right to pollute.

Yet the global goals and climate change negotiations are inextricably linked — the lives and livelihoods of those living in poverty are at the core of both. Failing in Paris would undermine the nascent global goals and development writ large. Thankfully, we’ve learned important lessons in gaining consensus around the global goals.

Here are four learnings from the global goals that the climate change process should incorporate in the run up to the 21st session of the Conference of the Parties in Paris and beyond. Continue reading on Devex >>

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Noodling on Kellogg’s African Deal: Why Global Investors Are Turning to Africa and What it Means

By Jude Uzonwanne

Last week, Kellogg Company announced a three-layer deal with Singapore’s Tolaram Group, including a $450 million deal for a 50 percent stake in Tolaram’s Multipro, a Lagos-based food sales and distribution company. This joint venture represents a remarkable step for Kellogg; the deal, priced at 15 times Multipro’s 2015 earnings before interest, taxes, depreciation, and amortization (EBITDA), is designed to give Kellogg access to Africa’s fast-growing 1 billion person consumer market. Think instant noodles, snacks, and breakfast foods: Kellogg is now one of the powerhouses behind a product whose name “Indomie” is to “noodles” what “Xerox” has become to “copy” the world over.

The Kellogg-Tolaram deal is just one of an increasing number of global acquisitions of African companies. The average African customer is on the rise with a rapidly growing willingness to spend. Naturally, global brand leaders want in. Take, for example, Wal-Mart’s 2011 $2.4 billion acquisition of South Africa’s Massmart, the owner of retail stores such as Game, Buildersmart, and Makro; Diageo’s 2012 $225 million acquisition of Ethiopia’s Meta Abo Brewery; and Marriott’s $200 million acquisition of South Africa’s Protea hotel chain in 2013, to name a few.

Why Africa?

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Partnership: Missing Ingredient to Mobile Money APIs

This article originally appeared on CGAP.

By Andria Thomas and Marcus Watson

If you chat with a group of software developers in an innovation hub in Africa, the conversation quickly and inevitably turns to mobile money and open APIs. Software developers are tremendously excited about mobile money and the potential for new apps, such as Wave for remittances or mjara for loans, to dramatically expand the flexibility and use of mobile money platforms. Accelerating mobile money innovation could expand the reach and benefits of financial services offered to the unbanked, which makes APIs exciting for anyone who cares about financial inclusion.

During recent interviews in East Africa, we heard the optimistic view that with open APIs “the possibilities of what could be done with this are endless,” together with the counter view that “Telcos need to open their mobile money platforms to developers if they want mobile money to survive as a payment method past 2020.” But despite the apparent demand from developers, and the six business rationales for MNOs to open their APIs recently documented by CGAP, there remain no real examples of widely adopted open APIs for mobile money. Of course, open or closed is to some extent a question of degree, depending on who the MNO grants access to, with what restrictions, and with what approval hoops the developer must jump through before gaining access to the necessary code. What is lacking are ‘fully’ open APIs where all the code for the API is published and accessible without weeks of negotiations and technical discussions with MNO integration teams to agree on protections and other specifics.

Photo Credit: Ken Banks, kiwanja.net/Flickr

Photo Credit: Ken Banks, kiwanja.net/Flickr

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