Going from a high-level intervention concept to the reality of implementing it on the ground in an unfamiliar country very different from one’s own is a massive leap.
First of course it’s necessary to choose which country makes sense for the fledgling charity to start with. In Clear Solutions case, we used a geographic assessment weighted-factor model, with under-5s mortality rate and total deaths from diarrhea, and current ORS usage rate as major factors in shortlisting countries. This really narrowed the field to ~ 10 countries in sub-Saharan Africa. Looking at stability, recent coups & wars, removed Chad, Somalia, Sudan, South Sudan and Niger.
Language was another significant factor: while countries of sub-Saharan Africa commonly have many local languages, it is much more practical for us to have English as one of the primary languages, vs French as the main European language alternative in our shortlist. We seriously considered French- & Malagasy-speaking Madagascar, even identifying a promising implementation partner, before it became clear that even not-bad English on their part, with our weak French, was going to be too much friction for our first country. Selection between our final 2 countries of Nigeria and Ethiopia, both having English spoken primarily/commonly in government and healthcare settings, isn’t final yet, but we benefit from several other Charity Entrepreneurship incubated charities operating in Nigeria to kickstart our network and on-the-ground knowledge there.
Focussing down to just 1-2 countries is a start, but with Nigeria especially, it’s necessary to look more closely. Nigeria’s population of >200M is ~1/6 the population of the entire African continent, and its 36 states are like small-medium size countries in scale. Revisiting the public health data at a state level shows that Nigeria’s northern states have ~2x the under-5 diarrhea mortality rate of those further south, pointing our charity in their direction. Security considerations also differ state-to-state, narrowing the options somewhat.
With neither Charlie nor I having been to Nigeria before, and all indications pointing to work on the ground being difficult for many reasons, our natural choice was to find local partner organisations to work with. We wrote-up a Request for Proposal (RFP) for potential implementation partners to respond to, outlining our aspirations for country/state visits (meet the requisite officials, learn about the local communities that serve) and initial thinking for our pilot projects. Happily for us, several CE organisations had gone before us in Nigeria, so we were able to tap-into a set of recommended local NGO partners, without needing to advertise the RFP heavily through other fora. RFP responses trickled in, we had intro calls with them, and gradually iterated on more detailed plans, budgets, etc.
As well as helping us with the partner approach above, Marshall, founder of CE-incubated HealthLearn, also gave us a valuable introduction to the Nigerian National Primary Health Care Development Agency (NPHCDA). Their growing Community Health Influencers, Promoters & Services (CHIPS) program aims to unify disparate Community Health Worker (CHWs) groups/organisations into a coherent whole; CHWs in this context specifically focused on house-to-house work, serving their immediate community (vs eg. working in a clinic). It seemed like CHIPS agents were a strong match for the CHW network that we hoped our ORSZ intervention would piggyback upon. An introductory zoom meeting with the NPHCDA CHIPS team went well, and we agreed to meet in person when in Nigeria.
All the pieces were falling into place, with potential partners across up to 6 Nigerian states, plus still keeping options open for Ethiopia, so we set about itinerary planning – familiarising with Nigeria’s domestic airlines and routes, booking slots with government & partners, etc. Happily for the charity, Charlie is very flexible on travel and living location for the coming 10 months, so he’s setting out with the expectation of living in Nigeria for several months. I have rather more commitments (and a desire to be) back at home, so planned just a 2 week trip. We both booked onto Ethiopian Airlines London to Abuja via Addis Ababa (Ethiopia) for 11th November and kicked-off visa applications: we were committed and the trip was happening!
G2CE 