Making Change Happen, on a Deadline

The PreFabricated Building Parts Production Enterprise in Addis Ababa is a state-owned company that makes concrete walls and other structures, mainly for the Ethiopian government’s low-cost housing program.  Public-sector construction companies in the third world are not generally known for energy, flexibility, risk-taking or creative thinking.   PreFabricated, in other words, does not seem like the kind of business that would or could do astonishing things in a hurry.

Like many companies in AIDS-wracked Ethiopia, PreFabricated had an AIDS policy, which included extra pay for its H.I.V. positive workers so they could buy more food.  In March, 2008, the company decided to do more.  It set a goal of persuading 70 percent of its employees — 700 people — to get tested for H.I.V. in 100 days.

This was a startling idea.  “Employees do not like to get tested at work because of privacy concerns,” said Seife Mergia, the company’s head of planning and information.  Most of the employees did not work at headquarters, but were scattered around various construction sites.  They were mostly contract day laborers — a workforce few companies invest in.  Yet by day 40 the company had built a clinic. It set up a lab and hired a technician.  It gave people credible evidence that their H.I.V. status would be confidential.  At the 120-day mark, 900 people had been tested for H.I.V.

PreFabricated surpassed its goal using a strategy called Rapid Results, in which a group of people choose a project and carry it out in 100 days.  Companies in Addis that used Rapid Results got their H.I.V. testing rates up to about 75 percent — triple the norm.   The same method has been used in Nicaragua to help pig farmers raise fatter pigs and to improve dairy farms’ milk quality. In Rwanda, two villages doubled the number of attended births in less than 100 days, and the Rapid Results team went on to work on other projects to protect mothers’ health.  In Madagascar, four districts quintupled the use of family planning services in 50 days, and the Health Ministry then began the program on a national scale.  Kenya is using Rapid Results in virtually all its ministries;  one campaign in the province of Nyanza circumcised 40,000 men in two months —  a crucial achievement for AIDS prevention.  Rapid Results has made Kenya by far the leader in Africa in scaling up circumcision.  Villages in Ghana, Sierra Leone, Sudan, Eritrea and other countries have used Rapid Results to improve local infrastructure as well — digging wells, constructing bridges and roads, building schools.

Rapid Results is an eccentric idea.  Nadim Matta, a management consultant who is president of the Rapid Results Institute in Stamford, Conn., likes to say that what’s missing to turn poor places into rich places isn’t more information, money, technology, workshops, programs, evaluation or any of the other things that development organizations normally provide.  What’s missing are motivation and confidence.

At first glance, this seems crazy —  can we cheerlead our way into the middle class?

What Matta means is that usually the obstacle to development is not that we don’t have the tools, but that we don’t use the tools we have. People drag their feet. The next step is someone else’s problem.  Budget approval takes forever.  The money disappears.  People won’t try because it never works.  The goal is too pie-in-the-sky. The parts aren’t available.  The bricks get stolen.  The project gets started and then the leadership changes and it sits, abandoned.   Every villager fumes:  nothing gets done around here.

“The biggest issue is that people don’t actually mobilize,” said Matta.  “The last mile is where solutions need to come together in specific ways.   We think we have part of the answer to the last mile problem.”

That list of complaints may sound familiar to anyone who manages a business, and in fact, Rapid Results was designed to help large corporations.   It was invented about 40 years ago by Robert Schaffer, a management consultant.  Five years ago, Schaffer’s company spun off a group as a nonprofit to train people all around the world to use the same method.   Rapid Results has spread, well, rapidly, because it has a champion in the World Bank, which is teaching people to use the method in various countries.  So are other groups, such as the African Capacity Building Foundation.

It works like this:  A trained facilitator sits down with people in a business, organization or village to decide on what to do.  They vote.  Now, if we had some money from the government or the World Bank — say, $5,000 or perhaps $30,000 — how could we spend it to accomplish that goal in just 100 days?  The village chooses its goal and how to get it done. The facilitator only talks about what other villages have accomplished in 100 days.

To build confidence, before they make decisions the teams play a pass-the-tennis-ball game.   The first time through, a team of eight will pass the balls in about 15 seconds.  “Then we share with them that we’ve done it hundreds of times with different groups around the world, and every one manages to do it in under three seconds,” said Ronnie Hammad, a World Bank senior operations officer who has been using Rapid Results programs for 10 years.  “At first they try to do the same thing faster.  Then they begin to question the rules.  Inevitably, after seven or eight  tries, they get it.  It happens with senior managers at the World Bank and with commercial sex workers in Eritrea.   Leadership emerges.  It unleashes creativity and innovation.  It’s an experience of what might be possible for them.”

At first, the 100 days seems ridiculous.  Groups that turn to Rapid Results have usually had the repeated experience of nothing happening in three years.  Who can accomplish something significant in three months?   But this is exactly the point — it takes a project out of the realm of business as usual.

With the facilitator offering coaching — for example, she will require that by the halfway point in the project, the team have a plan for how to sustain it — the team members meet, often weekly, to talk about how to get around setbacks and what worked elsewhere.

Frannie Léautier, the executive secretary of the African Capacity Building Foundation, wrote in an e-mail that Rapid Results initiatives are a “bite-sized approach to complex problem-solving.  Communities will get confidence to tackle problems that may seem insurmountable.”  The tight deadline “forces a degree of prioritization and focus which leads to results, avoiding white elephant projects which tend to be grandiose but not implementable.”

The deadline creates an ethos of doing whatever it takes.  People aren’t sitting and waiting for the district official to come out.   They go buy the materials themselves.  Women sleep on the bulk cement bags to make sure no one steals them. A village in Sudan needed bricks for a school, and the contractor wasn’t producing enough.  So the Rapid Results team organized a competition in the community to make bricks, and the project stayed on schedule.  “You can’t control what happens 10 years down the road,” says Mats Karlsson, a senior World Bank official who used Rapid Results in several West African countries when he was country director in Ghana.  “But 100 days everyone can control.”

Hammad said that when he arrived in Eritrea and surveyed World Bank activity, “there were lots of workshops, lots of ground being prepared  — but nothing you could put your hands on to demonstrate real results.”  With Rapid Results, he said, “you saw the same people, the same resources, the same conditions — and an order of magnitude difference in terms of performance.”

While Rapid Results can produce dramatic changes in 100 days, questions remain about day 101. Sustainability has always been the weak point of development work, whose symbol might well be the lonely water pump, abandoned for lack of a $3 part. Even a successful Rapid Results team is going to move on to other priorities after 100 days, and it will always be tempting to cut corners — or whole sides — to make the deadline. Next week, I’ll respond to reader comments and discuss how Rapid Results’ architects are grappling with the challenge of not just achieving results, but making them last.

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Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and now a contributing writer for the paper’s Sunday magazine. Her new book is “Join the Club: How Peer Pressure Can Transform the World.”

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An excerpt from this article appeared in print in Oct. 2, 2011.