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Key Findings from This Chapter
After planning an initiative, further opportunities for interaction or partnership may arise in the implementation, evaluation, and sustainability stages. Case studies suggested that federal agencies and foundations should reflect on the following issues as they roll out initiatives and consider partnerships:
Once a problem has been identified and a strategy to address it has been developed, implementing the strategy requires attention to concrete issues such as resources, but also to less tangible matters, such as the culture of the various stakeholder organizations. In cases where implementation will involve more intense types of interaction between the federal government and foundations, funders should consider the ways in which the collaboration itself can be supported. Depending on the situation, pooling resources may be more or less desirable. In some cases, a separate administrative or governance structure may need to be created. In all cases, it is important for public and private actors to recognize the constraints under which the various stakeholders must act.
There are many opportunities for synergistic use of USG and foundation resources, but recognizing and capitalizing on such opportunities requires consideration of the “strings” that might be attached to funders’ contributions. These strings may consist of funders’ expectations and requirements about disbursement, reporting, and the uses of funds they find most desirable—or unacceptable. USG brings to philanthropic work vast resources and personnel with high levels of expertise, but federal resources typically come with more requirements than those of private sector funding and usually are dependent on annual appropriations that are, to a great extent, outside of the agencies’ control. In contrast, foundation funds may be characterized by greater flexibility and/or fewer requirements, but contributions may be smaller or available for a more limited period of time.
Resources from stakeholder partners may be pooled and then allocated by a central authority or allocated directly by the partners. Within the federal government, both PMI and PEPFAR were designed so that the funding authority would be centralized in the Coordinators’ offices, a structure that seems to promote coherence among the different federal agencies and helps to avoid redundancy or contradictions among aid efforts around malaria and HIV/AIDS. Such centralization in USG efforts may be useful to foundations, since it provides a central funding mechanism for partnering with USG in addressing malaria or HIV/AIDS. Other collaborations, however, have eschewed pooled funding. RWJF has engaged in multiple collaborative efforts with USG—the Nurse Funders Collaborative, Cash & Counseling, and the National Health Plan Collaborative, among others—but does not appear to pool resources with partners. Instead, these projects include clearly delineated pieces funded separately by the various partners in the collaboration.
In some instances, there may be benefits to “partial pooling”—central allocation of federal funds, while private funding is allocated by the private partners. For example, government officials would not have the freedom to approve federal funds for programs not in line with the administration’s priorities. In some cases, however, private funding may be aligned via communication with these offices to supplement USG funding, for activities other than those that federal program funds can support.
Whether resources should be pooled appears to hinge on the limitations donors place on their contributions, and on donors’ roles in the initiative and their attitudes toward one another. Pooling of resources may be more acceptable to donors when one organization takes a clear leadership role in implementation and has administrative structures in place to handle the funds, or when a separate governing structure has been created for the collaborative effort. The Gates Foundation has created several such entities within which funds have been pooled (such as PATH and GAVI). Such a structure may help to build trust among donors, provided an initiative’s governance is transparent and the various donors have a voice in the leadership that they perceive to be commensurate with their contributions to the collaboration.
Given the challenges associated with partnerships, it is clear that resources must be devoted to maintaining the interactive effort. Interaction “on the cheap”—for example, without staff or infrastructure—can lead to difficulties in coordinating between organizations, loss of momentum, and the potential for turf wars (Amadou et al. 2007; U.N. Foundation n.d.)
Several examples of interaction at different levels of intensity illustrate the pressures to create structures and provide resources to support the interaction. Even though it was conceived to include a governing structure distinct from its founding organizations, the GAVI partnership began small, with only six staff members assigned to its secretariat, which was hosted by one of the partners. In response to annual governance studies (also part of the original conception of the partnership), which pointed to the need for greater administrative resources, the GAVI secretariat has expanded to about 80 staff members, and the organization is now establishing itself as a separate foundation. In its various collaborative efforts, the Gates Foundation has often dedicated funds for bringing partners together to enhance communication, collaboration, and the administration of the partnerships themselves. Examples of this include GAVI; Roll Back Malaria; and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Similarly, RWJF has funded national program offices (NPOs) to oversee efforts around their various national programs, such as those involved with nursing, health coverage, and childhood obesity.
The approach to supporting interaction can be designed to promote specific programmatic values. For example, RWJF selects outside organizations with expertise in each program area to house and operate its NPOs, coordinating the efforts of grantees and other partners. The offices remain distinct from the foundation, as well as from other funders and stakeholders in the national program. RWJF views the NPOs as important not only from an administrative stance, but also because they may catalyze new connections to better address problems. Another example can be found in the AIDS and Malaria Coordinators’ offices, which, given their substantial funding authority and political capital, are seen as having the ability to compel coordination among disparate programs across federal bureaucracies.
USG and foundations operate under very different constraints. In implementing health and social service agendas or initiatives, it is important that players from each sector understand the culture and constraints of the other. This is especially true of more intensively collaborative efforts, but such understanding supports all types of interaction around an issue.
The primary constraints that emerged in the USG case studies lie in the rules and regulations of public agencies, public funding mechanisms, and bureaucratic organizational structures. As respondents noted, the problems that federal agencies can address, the means they can use, and the resources available to them are circumscribed by legislation and federal policy priorities, as well as a host of rules and regulations, none of which is easily altered or bent. For example, a respondent from MCC asserted that USAID’s approach to many problems is limited by earmarks on funding—the legislation authorizing aid often ties it to a specific geographic region and/or programmatic area. Also, USG reporting requirements, typically meant to promote accountability, sometimes can pose challenges to collaboration. For example, the need to link spending to demonstrated results—as is the case, to varying degrees, for MCC, PEPFAR, and PMI—can, according to one respondent, serve as a deterrent to collaboration, since impacts could not necessarily be linked to one or the other donor’s efforts. Related to this, but not limited to the public sector, is the burden placed on aid recipients if they must comply with the many and varied reporting requirements of different funders (including various federal agencies, as well as foundations and others).
In several cases, USG funding mechanisms were cited as a source of difficulty for philanthropic efforts and as challenges to interaction with foundations. While the federal government has the resources to make long-term commitments to different initiatives, yearly appropriations processes introduce uncertainty. Moreover, one respondent lamented that USG funding decisions often are made at the last minute, making planning difficult. MCC’s multiyear compacts, relying on untied funds, were cited as a positive development.
The nature of some federal agencies’ organizational structures was cited by foundations and agencies alike as a constraint. Decision making and reaction to events on the ground were said to be slow because of bureaucracy. Moreover, the complexity of federal structures—coupled with the many variations in structure across agencies—can make it difficult for parties seeking to interact with an agency to know where the authority lies to make decisions and direct resources.
Foundations also operate under constraints that affect their ability to engage in some forms of interaction. The major constraints are their relatively short time horizons, and organizational cultures that view evaluation and accountability in terms quite distinct from those widely accepted in USG. The short time horizons probably are related to foundations’ focus on cutting edge, innovative programming, which case study respondents suggested may yield a self-image as “planting seeds,” rather than focusing on long-term cultivation of an initiative. This aspect of foundation culture may actually provide an opportunity for supplementary action or communication with USG, which typically lacks the degree of flexibility to innovate and tolerance for risk more typical of foundations. Communication could facilitate situations in which foundations support high-risk or experimental approaches, and if they prove feasible, USG then supports scaling them up.
Whereas USG has put great effort in recent years into developing accountability structures—albeit with results that may, as yet, remain unclear—foundations have less motivation for such procedures. Some even have argued that foundation culture is hostile to measuring outcomes, not to mention impacts. As Michael Porter and Mark Kramer point out in their seminal article, “Philanthropy’s New Agenda,” foundations’ own internal processes provide the wrong incentives for adequate measurement: “Failure risks censure,” they note, “but success adds no reward” (1999, p. 129). Cases like Ashoka and Hewlett illustrate a less rigorous approach to evaluation and a more qualitative understanding of impacts than at USG agencies, as highlighted below.
Public and foundation sectors’ views about measurement and evidence diverge. If funders of health and social service initiatives are to form deeper levels of interaction, they must jointly confront the feasibility and value of evaluation. They will have to consider questions about plausible effects and how these can be measured, the kinds of evidence they will accept, and the types of evaluation they are willing to support.
In their book, Money Well Spent: A Strategic Plan for Smart Philanthropy (2008), foundation leaders Paul Brest and Hal Harvey use a graphic model of a small cube within a big cube to illustrate the nature of different problems, the potential for philanthropic impact, and the potential roles for foundations and USG philanthropy. “Small cube” philanthropy seeks to address “near-term, non-life-threatening needs of a relatively small number of people” (p. 24). Such philanthropy lends itself to straightforward evaluation since the processes of change are direct and readily graspable; causal links between philanthropy and results tend to be clear; and results tend to be visible, tangible, and discernable in the near term. Such problems may be more appealing targets for USG, rather than foundations, given the federal government’s accountability standards. Moreover, such efforts also involve relatively low risks, which may also appeal to government (cf. Fink and Ebbe 2005; Sandfort 2008). Still, according to Brest and Harvey, such “small cube” philanthropy has less potential for big impacts and perhaps less leverage for bringing other organizations on board.
In contrast, “big cube” philanthropy can address issues that improve hundreds of millions of lives. However it requires that funders deal with ambiguity and complexity, both in terms of intervention design and impact measurement—something the authors claim foundations typically have done more effectively than USG. The Gates Foundations’ work—in particular, its Grand Challenges in Global Health program—provides examples of big cube philanthropy.
Brest and Harvey suggest that collaboration and interaction between foundations and USG may be much more important with big cube philanthropy. In particular, they suggest that such systems-oriented philanthropy “may play a special role in goading businesses and governments into tackling a certain problem,” (p. 26) which appears to have been the case with malaria. The authors observe, however, that “global, long-term problems, even though potentially catastrophic, do not align with the rhythms or boundaries of our political systems or the incentives of managers” (p. 26). In sum, Brest and Harvey’s argument suggests—and case studies appear to support—that USG may be more naturally inclined and structured to deal with immediate problems where results are measurable, whereas foundations may be better equipped for those initiatives dealing with ambiguous problems and the potential for hard-to-measure, systemic effects.
There are differences of opinion between USG and foundations, as well as among foundations, as to what constitutes useful evidence. Our study found cases in which funders sought and accepted relatively “soft” evidence of their programs’ impacts. Ashoka, for example, requires Fellows to submit reports that track their progress against benchmarks. Yet self-reports, benchmarks that vary across respondents, and biased response rates result in evidence that might not be acceptable to organizations with different evaluation standards. For example, it would be difficult to reconcile Ashoka’s approach with that of MCC or the many federal programs that encourage or even require independent, often experimental evaluation before programs can be reauthorized. The point is not that one approach to evaluating effectiveness or success is superior to another in all instances, but rather that, in interacting, stakeholders need to be aware of their potentially conflicting approaches.
Nor is the Ashoka example meant to portray the foundation sector as taking a “soft” approach to evidence in general. Indeed, the Gates Foundation has invested hundreds of millions of dollars in the development and dissemination of indicators to gauge the impact of its own and other philanthropists’ programs. Gates also is investing in rigorous evaluation methods. Moreover, several case study foundations show the development of particularly innovative ways to measure progress at different levels. Hewlett and RWJF both consider outcomes and/or impacts at the program, foundation, and societal levels. Similarly, the Rockefeller Foundation has developed (though not yet implemented) a monitoring and evaluation program to track changes at the user, provider, and funder levels.
If the efficiency and effectiveness of philanthropic efforts are at all a concern, it is in the interests of stakeholders to evaluate programs as rigorously as possible. If rigorous evaluation shows initiatives supported by philanthropy have achieved their goals, decisions on further investments can be made with greater confidence. Such evaluations, however, are not always feasible or appropriate. They are costly, and the context of many initiatives may not be suitable for experiments. In the developing world, there may exist little capacity to conduct such evaluations, and willingness among the various stakeholders may be lacking because of cost or objections to making people subjects in an experiment and denying services or other benefits to a control group.
With respect to collaborative efforts, it is important that donors have similar expectations for the evaluation of their programs—or at least that they can come to agreement about the evaluation approach. Given the costs associated with evaluation, it may be difficult to convince some stakeholders that the effort merits the expense, especially in cases where evaluations are not required or will not be used for further decision making.
Many of the initiatives examined in our case studies are still in progress, but sustainability over time is a consideration for many philanthropic initiatives.[1] Indeed, in some cases sustainability has been built into the initiatives from the beginning, while in others, it has developed over time. In general, there appear to be two approaches to sustainability: through mechanisms built into the initiative and through external mechanisms. These are by no means mutually exclusive and, in the best-case scenario, both are probably desirable. Still, the USG and foundation sectors may make different contributions to sustainability, and practitioners may wish to consider different roles for different types of funders as an initiative develops.
Both USG and foundation cases have taken sustainability into consideration when shaping their responses to health and social service problems. In some cases they have built innovative mechanisms for sustainability into their unique approaches to a problem. For example, Ashoka actively fosters relationships among Fellows so that they can draw on each other for support after Fellowship funding comes to an end. In addition to these networking opportunities, Ashoka Fellows are given lifetime access to communications and legal consultation through independent firms. In another example, GAVI’s IFFIm was designed specifically to keep immunization financing in low-income countries predictable and sustainable. IFFIm borrows against 10- to 20-year legally binding aid commitments from donor countries to ensure that financing is available when needed and over the long term.
Among some federal agencies, sustainability is intentionally linked to local ownership of initiatives, which, in any case, experts have agreed is critical to the success of development efforts (HELP Commission 2007). PMI, PEPFAR, and MCC all require that recipient countries take part in developing interventions and, in certain cases, co-financing programs. PEPFAR’s “harmonization” process requires that each country lead and take ownership of its own response to that nation’s AIDS epidemic. Similarly, MCC’s compact development process requires in-country identification of problems and development of solutions, while PMI engages local governments throughout the assessment, planning, and implementation phases of an in-country malaria control strategy. PMI also actively encourages recipients to diversify their funding sources, in particular through involving NGOs and private businesses.
USG and foundations bring different strengths and confront different challenges in their philanthropic efforts. Of particular importance for sustainability are the two sectors’ respective time horizons and attitudes toward their own roles in seeing initiatives through to full fruition. Foundations tend to accept risk, which leads them to innovative approaches but not necessarily to long-term commitment. Indeed, many private philanthropic funders—such as RWJF—limit the length of time or the number of times a grantee may receive support. In contrast, the federal government is more likely to fund proven strategies, which suggests the potential for USG to cultivate the growth of initiatives for which foundations “planted the seed.”
However, the sectors’ respective approaches to long-term commitment may be changing. Well-funded foundations, such as Gates, may be trending toward longer-term efforts than past foundation giving. Moreover, with federal budgets under extraordinary pressures, foundations may be in a better position than government to make such commitments (cf. San Francisco Chronicle, January 6, 2009). In any case, it is clear that the long-term solution of some problems will require long-term donor commitments, and more purposeful interaction from various donors might support such efforts. Both foundations and government appear to have embraced the philosophy of local ownership of their initiatives, which can also support sustainability.
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