FROM a Great Canadian and World Statesman
Monday, 8 December 2008
PacificSci ~~~~~~~~~~~~~~~~~~~~~~~~~ FIFTH ANNIVERSARY OF A BUSINESS VENTURE WITH A SOCIAL PURPOSE
PREAMBLE: Fourth Sector Enterprises
Pacific Health & Development Sciences Inc. (PacificSci), a health systems consulting firm based in Canada, falls within a new class of organization known as “fourth sector” or “for benefit” enterprises. Such entities represent a new paradigm in organizational design, aiming to link two concepts which are held as a false dichotomy in other models: private interest and public benefit.[1]
Before telling the short story of PacificSci, we muse in this preamble on the emergence of “fourth sector” organizations. To place this in the contemporary context, consider the following observations regarding the conflicts confronting traditional organizations[2]:
• Private companies have always had to balance between achieving the largest possible profits for their shareholders and retaining trust and contact with their other stakeholders: the local community, consumers, sub-contractors, pressure groups, etc.
• The public sector for years now has faced enormous political pressure in favour of privatization of a wide range of functions - and then being forced to 'repurchase' the very same functions and institutions when private companies no longer find them profitable.
• Voluntary organizations: Due to fierce competition from other voluntary organizations and tight state financing, voluntary organizations are having to experiment with their independent income - the sale of services and new products. All of which - activities and financial priorities - can be at odds with the organization's main goals and mission.
As far as the private sector is concerned, one only has to look at the world financial crisis to recognize that some firms are simply too big to be allowed to fail, despite incompetent leadership e.g, even now the US is bailing out its once mighty banking industry. Clearly, western industrialized nations are capitalist when going up, and socialist going down!
Equally, it has become increasingly clear that neither public nor voluntary sector organizations really operate in the “pure” manner traditionally implied. Increasingly public enterprises compete with the private sector, while the voluntary sector has become more commercially oriented.
For example, the success of many voluntary not-for-profit organizations today is due to a fully funded core staff, supplemented by contract income, thus able to build handsome “working capital funds”, while remaining eligible for government grants, which conveys a competitive advantage over other types of organization. In effect, such non-governmental organizations or NGOs (once mostly charitable organizations) have actually become a good “business model”!
In the meantime, many public sector (government) entities have become so hollowed out that they simply must hire private contractors to deliver the expertise that actually belongs with their public mandate. In addition to consulting firms, much of that expertise (sometimes hidden) is obtained from universities, themselves having become “hybrid” organizations[3]. Even publicly funded universities now engage in industry partnerships while receiving government financing, and simultaneously contracting out services to government! For those wishing a more academic analysis, we refer to Claude Menard.[4]
In this increasingly complex scenario, for which the neat rules separating the traditional organizational forms seem increasingly less applicable if not actually quite murky, the emergence of fourth sector organizations is perhaps virtually inevitable: breaking with earlier conceptions of the relationship between the state, the private sector and the voluntary sector. Operating outside the world of grants, and inside the basic economic realities of surviving as a business, the bottom line is nonetheless one of social purpose: in many ways a modern renaissance of motivation to improve the human condition.
With this backdrop we now offer the short story of PacificSci as a fourth sector organization.
References:
1. FourthSector.net http://www.fourthsector.net/for-benefit-organizations.php Accessed Dec 5, 2008.
2. KaosPilot International - International School of New Business Design and Social Innovation. http://users.homebase.dk/~awi/Publications/fourth_sector.pdf Accessed Dec 5, 2008.
3. Lamb R. Hybrid Organization. University of Hawaii, Manoa. June 17, 2004. http://www.vfh.fh-brandenburg.de/vfh/gastvorlesungen/gastvortrag_05.pdf Accessed Dec 5, 2008.
4. Menard C. The Economics of Hybrid Organizations. Presidential address to the annual conference of the International Society for New Institutional Economics, MIT, September
27–29, 2002. Journal of Institutional and Theoretical Economics. JITE 160 (2004), 345–376 2004 Mohr Siebeck – ISSN 0932-4569
http://atom.univ-paris1.fr/documents/Menard_JITE_2004.pdf Accessed Dec 5, 2008.
Feature Story - FIFTH ANNIVERSARY OF PacificSci
Pacific Health & Development Sciences Inc. (PacificSci), was incorporated precisely five years ago, on December 8th, 2003, as a health systems consulting firm. Our mission is “seeking solutions to health and social impacts of economic development”.
PacificSci is a joint venture of principals Franklin White (FW) and Debra Nanan (DN), President and Vice-President respectively. It was conceived primarily as a vehicle for our continued involvement in the field of public health, within which we had accumulated some 50 years professional experience. FW having worked outside Canada for the previous 15 years, and DN also experienced in both developed and developing countries and now a new resident of Canada, it was clear that –having been out of sight and out of mind for so long – one way to sustain our involvement in mid-career at appropriate levels of philosophy and responsibility would be to set up a private entity with its own mission.
The act of incorporation was carried out without professional legal assistance, using a simple “how to” guide. Within the first year, we became listed on various public sector registries in Canada, and launched our first website using freeware. In 2006, "PacificSci" was approved as our registered trademark. We upgraded our website in 2007 using the basic package from SiteCube.com, again without assistance[1]. See http://www.pacificsci.org/
Since incorporation, PacificSci has engaged in a blend of contractual and pro bono activities, mostly with an international focus, and with an expanding domestic portfolio. Without attempting to be comprehensive, the following is a selection from our portfolio.
Revenue Generating Activities
As a fourth sector organization, contractual work has been our primary source of corporate income. In this we have had reasonable success in attracting both international and domestic assignments, all of which reflect our social mission. In carrying out this mission, we commit to the same level of rigour and professionalism as we previously applied to our former careers in both academia and government service.
International Contracts
Foremost in this category has been Health Project Monitoring in Pakistan: In 2004 PacificSci participated with Universalia Management Group to bid for this Canadian International Development Agency (CIDA) role. A 5-year contract was awarded in 2005. Since then we have conducted M&E tasks in relation to four CIDA-supported initiatives:
- Family Planning Association of Pakistan (FPAP)
- HIV/AIDS Surveillance Project (HASP)
- Systems-Oriented Health Investment Programme (SOHIP)
- Lady Health Workers Programme (LHWP)
We are currently engaged in continued monitoring of both SOHIP and the LHWP. In addition, at CIDA’s request in 2006, FW carried out a review of a World Bank evaluation on a primary health care initiative in Pakistan, duly acknowledged by the bank.
We were also contracted by Sweden’s International Development Cooperation Agency (SIDA) to represent them in a joint donor evaluation of the African Medical & Research Foundation (AMREF). From October 2005 this entailed site visits to headquarters and field operations in Kenya, Uganda and Tanzania; the assignment was completed in March 2006.
NOTE: Links to each of these projects are supplied on our website: http://www.pacificsci.org/
Domestic Contracts
Domestic contract have also been a significant source of revenue, compatible with our mission. Over our first 5 years, PacificSci has engaged in several contracts, the most significant of which have been:
. Royal Roads University, Centre for Health Leadership & Research (CHLR): In April 2008 DN, PacificSci, contracted to support CHLR research; concluded Sept 2008. In July 2007, both principals delivered a review of process evaluation for population health initiatives. In Sept 2006, White co-developed with Dickson of CHLR a concept paper to support the ActNow-BC initiative, Ministry of Tourism, Sports & the Arts.
. EDS Canada: From December 2005 to February 2006, PacificSci was retained for our technical expertise to assist EDS in developing disease surveillance and management solutions, in response to an RFP to develop a Pan Canadian system. While EDS did not win this competition, out of 10 bidders it ranked second in a final run-off with IBM Canada, and ruled eligible if IBM did not complete the initial contracting requirements.
. British Columbia Ministry of Health: in 2004 PacificSci developed (complete draft) the Provincial Health Officer's (PHO) 2003 report. "Every Breath You Take..." This cites ~200 references and presents original analyses of air quality and morbidity data, including the first analysis of health services impact of 2003 forest fires. It was presented by PHO Dr Perry Kendall to the BC Legislature.
NOTE: Links to each of these initiatives are supplied on our website: http://www.pacificsci.org/
Pro Bono and Academically-Associated Activities
PacificSci’s voluntary activities have included many hundreds of hours in mentoring individuals and groups abroad and in Canada, participating in e-communities and in health policy groups, and reviewing for scientific journals.
We have also engaged in communications work. In 2006 the firm launched this monthly blog (PacificSci Global Perspectives) to present an independent view on current affairs, emphasizing the social determinants of health and social well-being. We were also a Communications Partner for the World Urban Forum (WUF) 2006, Vancouver.
On January 10, 2006, we launched PacificSci GLOBAL HEALTH DATA LINKS [2], a free subsidiary website developed primarily for students of international and global health providing annotated links to the following sources:
. UNDP Human Development Statistical Reports
. WHO Statistical Information Systems
. US Census Bureau International Database
. Population Reference Bureau Data-Finder
. WHO's Global Health Atlas.
Academically, PacificSci has been active in various (mostly honorary and voluntary) roles with: the Aga Khan University (Community Health Sciences), Dalhousie University (Community Health & Epidemiology), Kuwait University (College of Medicine), Royal Roads University (Centre for Health Leadership and Research), and others. The roles have included serving as: thesis supervisor; research advisor; external examiner; visiting speaker; curriculum design advisor; co-grantee; and co-author. In addition, Franklin White serves on an Advisory Board at the University of Victoria, Faculty of Human and Social Development, and Debra Nanan recently held a research post under a PacificSci contract with RRU. In May 2008, Franklin White was an invited by the University of Wisconsin to help launch the Survey of the Health of Wisconsin (SHOW), supported by the Wisconsin Partnership Fund for a Healthy Future.
Since incorporation, PacificSci principals have reviewed various scientific and professional articles for the following leading international journals:
. Anthropology & Medicine
. Archives Medical Sciences
. Canadian Medical Association Journal
. Evidence-based Complementary and Alternative Medicine
. Globalization & Health
. Medical Science Monitor
. International Journal Quality Health Care
. Journal of Public Health
. Qualitative Health Research
Since incorporation, as an expression of ongoing commitment to the population health sciences, PacificSci principals (in addition to numerous contracted technical reports) have themselves authored or co-authored 19 articles in peer-reviewed journals, 2 book contributions, 4 conference abstracts and 1 on-line video. Franklin White served as an Associate Editor and Debra Nanan as a contributor in: Dictionary of Public Health. JM Last (ed) Oxford University Press 2007. [Oxford Reference Online Series.] We also completed a major book chapter: White F, Nanan D. International and Global Health. Chap 76. In: Maxcy-Rosenau-Last, Public Health & Preventive Medicine. 15th Ed. McGraw Hill 2008. Full citations are available on a free website PacificSci NEWS & REPORTS [3], where we maintain a cumulative public record of our work. Unlike the contributions of most of our university and government colleagues, these contributions are of a pro bono nature. We see this as essential in staying in touch with and maintaining leadership in our field, while growing PacificSci as a fourth sector organization.
NOTE: Links to many items noted above are on our website: http://www.pacificsci.org/
Discussion
The most significant discovery in growing our enterprise, is that, despite working outside the formal system, we are able to make a unique and valued contribution to the public good, perhaps even “above our weight”. While less personally remunerative than working in either the public sector or in a university, this is offset by more “intellectual freedom” than most full time academics, and more control over professional time than persons working in a health service. Our third party independence, especially in monitoring and evaluation roles, and in our greater opportunity to “think outside the box”, frees us to speak out and write on issues as we see them, and make pro bono contributions out of choice, according to our best judgment. A significant disadvantage however is that, not being part of collective agreements that provide for professional networking and development, we must either dip into our own pockets or be invited as a resource e.g., conferences. This is the price to be paid for a different way of working: the fourth sector approach – in striving towards our social mission, we must also deliver on our skills, or go out of business. As we enter our sixth year, so far this has not happened.
Envoi: This has been a brief and candid account of the experience of Pacific Health & Development Sciences Inc., during its first 5 years or operation. During this period, PacificSci has managed to deliver reasonably well on its mission while being a “business venture with a social purpose”. Our “fourth sector” model has facilitated flexibility in what we, as principals, choose to do professionally. We can recommend this form of organization for anyone who wishes professional freedom of choice, within a strong social mission, and with the discipline to ride through lean inter-contract periods.
References
1. Pacific Health & Development Sciences Inc. MAIN WEBSITE http://www.pacificsci.org/
2. PacificSci GLOBAL HEALTH DATA LINKS http://www.webspawner.com/users/globalhealthdata/index.html
3. PacificSci NEWS & REPORTS http://www.webspawner.com/users/pacificsci/index.html
Saturday, 1 September 2007
THIRD WORLD AID TO FIRST WORLD COUNTRIES... The “Brain Drain”
Also in the main section below we elevate an item previously presented in our sidebar: on "Corporate Hybrids". Your host, Pacific Health & Development Sciences Inc. (PacificSci), is an example of such an organization, now in its 4th year of operation.
In our sidebar: Once again we focus on Canada's political scene, with a brief capsule on Prime Minister Stephen Harper’s limited popularity, as revealed in a recent poll. We then focus on a troubling police action that may have been politically directed. Whether or not one agrees or disagrees with opposition on any given policy issue, the legal and democratic right to protest is supposed to be protected in our society. However, the recent undermining of a legal protest in a designated area adjacent to the “Security and Prosperity Summit” (involving the leadership of Canada, Mexico and the US) through use of agents provocateurs has alarmed our civil society. That Canada’s police forces were used to discredit the use of this right is cause for serious concern, and it is disturbing that the Honourable Stockwell Day, Minister for Public Security is ignoring calls for a public inquiry, issuing statements designed to diminish political accountability.
BRAIN DRAIN FROM SUBSAHARAN AFRICA
Significant numbers of African-trained health workers migrate every year to developed regions, leaving severely crippled health systems in countries where life expectancy is only age 50 and 16% of children die before age five. However, the critical shortage of health care workers in many parts of the world is beginning to receive attention from donors and international agencies. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, funding projects will not have the desired effects.
The population of sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Africa suffers more from brain drain due to economic conditions, wage differentials, rapid population growth among young people and conflict than any other continent.The worker shortage derives from a combination of underproduction, internal maldistribution and emigration of trained workers. Sub-Saharan Africa needs approximately 700,000 physicians to meet the Millennium Development Goals. Many African countries cannot meet widely accepted basic standards for health care coverage by physicians, nurses and midwives. An additional 2.4 million physicians, nurses and midwives are needed, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.
Fewer health professionals from African countries than from other countries work in the US, according to the Least Developed Countries Report 2007. Data from the report demonstrate that the percentage of doctors practicing in the US relative to the total number of doctors back home range from 43% in Liberia to 10% in Zambia. This would not be a problem if the number of doctors remaining in their country of origin was sufficient to meet the needs of the population, but this is not the case. For example, Zambia has only seven doctors per 100,000 people, compared with the US level, which is close to 300. Even though the absolute number of professionals from the poorest countries working abroad may be small, the impact on professional services back home can be severe.
Efforts to retain workers focus on health care systems. For example, Swaziland provides HIV/AIDS services for health care workers who, practicing in high-prevalence areas with minimal resources for safety measures, are at an increased risk for occupational exposure. Other efforts build on the belief that providing workers with needed resources for care motivates them to stay and work in their home countries.Improved wages are also a key to retention. Salary support can help motivate health care workers to remain in their countries, even if it means working with fewer resources. Other types of inducements have been offered, such as lunch allowances, care loans and affordable housing.Some countries have begun to recruit trainees from rural areas. In South Africa, local students can receive scholarships for health care training on the condition they agree to return to their home district to practice. A study of the program found that trainees from rural areas were three to eight times as likely as those from urban areas to practice in rural regions after graduation.
The documented shortage of health care workers has inspired the American Public Health Association to pass a policy statement on "Ethical Restrictions on International Recruitment of Health Professionals to the United States." The policy addresses the role of the US in exacerbating the international crisis, calling on employers to adopt voluntary codes for ethical recruitment and on the government to contract only with employers who have done so. The future of global health and development in the 21st century lies in the management of the crisis in human resources for health.
More information is available from these resources on brain drain:
* "Providing the providers-remedying Africa's shortage of health care workers." N Engl J Med 2007; 356(25): 2564-67.http://content.nejm.org/cgi/content/extract/356/25/2564
* The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada (3.5 MB):http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
* The Least Developed Countries Report 2007 (2.54 MB):http://www.unctad.org/en/docs/ldc2007_en.pdf
Source: Juan Ramos. ProCOR. Aug 9, 2007 Jramos3@partners.org
NOTE: To visit ProCOR, scan column at right to locate URL under “Recommended Links”.
CORPORATE HYBRIDS
“… organizations driven by both social purpose and financial promise that fall somewhere between traditional companies and charities…distinct from those operating in the government, business and non-profit sectors…Whatever participants call it, the fourth sector faces challenges. Current legal and tax structures draw strict lines between for-profits and non-profits… The social benefits that fourth-sector firm seek to unlock are not easily quantified and often take decades, not quarters, to attain.”
Reference: Stephanie Strom. The New York Times. May 6, 2007.
COMMENT: By definition, PacificSci is a hybrid or "fourth sector" organization. Ineligible for grants available to non-profits, nor driven by the bottom line as a purely business enterprise, nor financially underwritten by the tax payer as are universities, government bodies and international agencies, yet our contractual work, advocacy efforts and pro bono activities are all guided by our secular humanist mission: seeking solutions to the health and social impacts of development. Now in its 4th year, our philosophical model is proving operationally viable and productive.
Friday, 1 June 2007
OFFICIAL DEVELOPMENT ASSISTANCE AND GLOBAL HEALTH TRENDS
PREAMBLE: During our first 6 months, this report addressed the following global issues: climate change, child development, colonized minorities, food security, human rights, and other news and reviews. In most instances we also addressed the relevance of these issues to Canada, our home base. To locate these issues you may either scan down this issue to earlier issues, or Google search by combining the keywords just noted with the term pacificsci.
This June 2007 issue reviews the vexing issue of official development assistance from wealthy developed countries such as Canada, makes reference to a report on global social and economic trends, then selects reports from a discipline that is essential to understanding global health trends: Health Situation Analysis. This refers to information on health conditions, supported by vital and health statistics critical to strategic and operational development planning. Our selected examples include Africa, the State of the World Children, and Projections of Mortality and Burden of Disease to 2030.
Our sidebar addresses the emergence of “corporate hybrids”, freedom of speech and tolerance for intellectual opinions.
G7 OFFICIAL DEVELOPMENT ASSISTANCE (ODA)
The most recent confirmed OECD data for ODA (2005) reveal that, although absolute amounts are higher, G7 countries allocate proportionally less Gross National Income (GNI) for international development: 0.30%, compared with .50% for non-G7 nations. Of 22 OECD nations only 5 met the UN target of at least 0.7%: Norway, Sweden, Denmark, the Netherlands, and Luxembourg, none of which are G7 countries. The lowest G7 allocation is made by the USA (0.22%; among 15 non- G7 nations, only Portugal and Greece give less than this), while Canada comes in slightly above the G7 mean at 0.34%. Clearly, both individually and collectively, the G7 should show more leadership.
Note: OECD rankings do not include Russia, a G8 country (G7 + 1).
Reference: Final ODA Data for 2005. http://www.oecd.org/dataoecd/52/18/37790990.pdf
SERIOUS QUESTIONS ABOUT CANADA’s ODA
Questions are being raised about Canada’s ODA priorities eg., $30 million in 2006 to China, an emerging political and economic powerhouse. Parliamentarians urging increased aid to truly poor nations say the government’s refusal to support proposed new legislation to guide ODA reveals lack of commitment. “Canada used to be a leader and is now a… laggard” said Alexa McDonough, NDP foreign affairs critic. According to McDonough, the planned 2006 ODA of just over $3 billion represents 0.32 % of GNI, down from 0.34% last year and far off the 0.7% target that Canada helped set. Josee Verner, Minister for international aid, replied “spending in 2007-08 will increase by 8%, in line with the goal of doubling by 2011 the amount spent on ODA in 2001”.
Source: Sue Bailey. The Canadian Press. March 27, 2007
EDITORIAL: an annual increase in absolute expenditures in the order of 8% will simply maintain the status quo with little movement towards the target of 0.7% GNI
REPORT FROM 8TH GLOBAL DEVELOPMENT CONFERENCE, Beijing. For up-to-date social and economic trends, visit the Global Development Network April 2007 newsletter. Topics include: the rise of Asia in the global economy; growth and poverty in Latin America; structural transformation opportunities in Africa and the Middle East. http://www.gdnet.org/pdf2/research_monitor/2007-April_conference%20edition_Research%20Monitor.pdf
HEALTH SITUATION OF SUB-SAHARAN AFRICA
The health situation of Sub-Saharan Africa (SSA) is the least favourable of all regions. Following steady declines until the mid-1990s, adult mortality sharply reversed, with the disease burden increasingly dominated by HIV/AIDS superimposed on already heavy burdens from endemic malaria, water-borne diseases, vaccine-preventable diseases, nutritional deficiencies, and other preventable conditions. In some settings, this was compounded by war and civil strife, with consequent increases in violent death, food shortages, poverty and displacement of people, further fueling a rural to urban migration for economic survival. In parts of SSA, adult mortality rates are at their highest in 3 decades; a rapid drop in life expectancy (LE) is seen in 38 countries (LE age 40 or less in 8 of these). Without HIV/AIDS, LE at birth would have been almost 6.1 years higher in 2002. The slippage is not only due to HIV/AIDS: for example, despite major gains in immunization coverage during the 1980s, these have reversed since, reflecting a loss of capacity to deliver primary health care. In the meantime, the health profiles of Africa and the world are not standing still: the pattern is shifting with a steady increase in Non-Communicable Diseases and injuries. Even given Africa’s preoccupation with infectious diseases, which still dominate the disease burden, planners must now be alert to this emerging and future disease burden.
Source: The foregoing brief report is a paraphrased extract from a health situation analysis carried out by PacificSci for an assignment in East Africa completed in 2006.
THE HEALTH OF THE PEOPLE: THE AFRICAN REGIONAL HEALTH REPORT: A fully comprehensive situation analysis has recently been published by the WHO Regional Office for Africa. http://www.who.int/bulletin/africanhealth/en/index.html
THE STATE OF THE WORLD’s CHILDREN 2007
This UNICEF report focuses on the discrimination and disempowerment experienced by women and girls. It discusses how gender equality will move the UN Millennium Development Goals forward, and how investment in women’s rights will ultimately produce a dual dividend: advancing the rights of women and children. Seven interventions are advocated:
1. Abolish school fees and invest in girls' education
2. Invest government funding in gender equality
3. Enact legislation to create a level playing field for women and to address domestic as well as gender-based violence
4. Ensure women's participation in politics
5. Involve women's grassroots organizations in policy development
6. Engage men and boys on the importance of gender equality
7. Improve research and data on gender issues.
For the full report as a PDF document: http://www.unicef.org/sowc07/report/report.php
PROJECTIONS OF MORTALITY & DISEASE BURDEN TO 2030
Revised global and regional projections of mortality and burden of disease by cause for 2005, 2015 and 2030 are now available from the World Health Organization. Principal investigators (CD Mathers & D Loncar) applied separate projection models for males and females, stratified into 7 age groups. The website below offers online access to the article, a working paper, and references to papers on data sources and methods. Detailed results for projected deaths and DALYs can be downloaded as Excel spreadsheets. The analyses were carried out at country level with aggregation into regional or income groups. The investigators used socio-economic projections to model future mortality and morbidity patterns, assuming slower and faster rates of development and population growth, taking into account independent variables: income, education, time, and tobacco use. The results suggest that, from 2002 to 2030, life expectancy will increase throughout the world, with an upward shift in the age of deaths, with considerably fewer younger children dying, while deaths due to cancer and heart disease will increase. Deaths from infectious diseases will decline overall, while mortality from HIV/AIDS will continue to increase. http://www.who.int/healthinfo/statistics/bodprojections2030/en/index.html
Acknowledgment: In constructing our summary, a review by Robert Goldberg on ProCOR (Recommended link in sidebar) was helpful, including his note of caution regarding the quality of data used to develop the predictive models and assumptions utilized.
THANKS FOR VISITING PacificSci GLOBAL PERSPECTIVES!