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Integration in development aid

Patrick Fine explains integrated development

Problems like malnutrition, child mortality and illiteracy have many causes – but the development sector often offers only one solution. The head of one of USAID’s largest contractors wants to change that.

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Chief Innovation Officer, International Rescue Committee
Director of Innovation Strategy, International Rescue Committee

It’s the understatement of the century to say that development is complicated. Addressing illiteracy could mean tackling not only teacher absenteeism, but also childhood malnutrition, gender norms and poverty. That’s why it’s so strange that the development sector silos challenges into fields like health, education and economic development, says this week’s guest on Displaced, Patrick Fine.

Fine is the CEO of FHI 360, one of USAID’s largest contractors, implementing programs in over 60 countries. His organization wants to change how we think about solving development challenges: Instead of working to solve discrete problems in different sectors, we should focus on building a suite of integrated services that serve people’s diverse needs. “It's not trying to do everything all at one time across an entire community,” he tells Grant and Ravi. “It's looking from a person-centric way, and a more holistic way.”

The promise of integrated development is that it weaves together development solutions across sectors to attack problems from more angles than just one. The peril is that implementers wind up trying to do everything all at once.

Patrick Fine, CEO of FHI 360

Some of integrated developments’ largest successes have been integrating maternal and child healthcare services with HIV treatment. One of the largest barriers to effectively managing both HIV and routine healthcare for women and children is the cost and location of clinics.

“There was a young woman; she went to the clinic on Tuesday. Her child was sick. It cost basically all of the money she had to pay the clinic fees,” Fine says. “But it was [an HIV clinic], so they tested for HIV but they didn't treat the child. They told her, ‘Now you have to come back tomorrow, because that's maternal and child health day,’ and she would have to pay again.”

Service fragmentation like what Fine described is part of the reason that most infants don’t immediately receive HIV testing or antiretroviral drugs, and why people living with HIV often present at clinics only when their illness has advanced to the point of being virtually unmanageable, according to the WHO. But when women’s health clinics integrate HIV testing and treatment, transforming them into a “one-stop-shop” for multifaceted health care, the proportion of women taking lifesaving retroviral medications is consistently higher. That means more people with HIV are getting the care they need, and fewer children are born with HIV. And conversely, in countries receiving support for targeted, HIV-only programs, infant mortality rates have increased.

It's not trying to do everything all at one time across an entire community. It's looking from a person-centric way, and a more holistic way.

Other successes include integrating nutritional counseling with education – and FHI 360 has recently launched an investing arm, FHI Ventures, to support social impact entrepreneurs spurring advances in healthcare, energy and the business of development.

This discussion gets into the weeds about a recent study comparing cash transfers with an integrated program to improve childhood nutrition in Rwanda (that sort of broke “Development Twitter”). And we talk about Fine’s favorite unorthodox tool for development, which he talks about on his podcast, A Deeper Look.

Related resources

The small study in Rwanda that could change the way the US does foreign aid – Vox, Dylan Matthews

Benchmarking a WASH and Nutrition Program to Cash in Rwanda – Innovations for Poverty Action

The specter of segregation haunts global health – Devex, Patrick Fine and Leith Greenslade

Facing Complex Challenges: Innovating through Integrated Development – CSIS

Opinions and views expressed by guests are their own and do not reflect those of the International Rescue Committee.