Development and the HIV Epidemic: A forward-looking evaluation of the approach of the UNDP HIV and Development Programme 4. UNDERSTANDING THE APPROACH IN THE CONTEXT OF EVOLVING NEW DEVELOPMENT PARADIGMS AND PRACTICES
The time is ripe for a thorough rethinking of development theory and practice. The costly mistakes based on the conventional modernisation paradigm and a top-down approach to development have to be rectified, and the right lessons must be learnt.
Stefan de Vylder, development economist and practitioner (de Vylder, 1995, p.57) These pleas for revision, made as concluding remarks to a recent UNDP discussion paper, provide a useful starting point for considering the association between the new approach to development and the HIV epidemic. The HIV and Development Programme explored the relevance of new development practices to the response to the HIV epidemic and, in turn, contributed to a better understanding of development practices generally, and specifically of UNDP's evolving approach to human development.
4.1 Key lessons learnt This section is based on a review of selected literature on development practice and the nature of social change, and on interactive discussions which were held between evaluation team members and staff of the HIV and Development Programme. Consideration of what is now known about sustainable human development, capacity building and the role of UNDP led to deeper understanding about the way in which the approach of the HDP fits within the evolving framework of development practice and, in turn, has been able to contribute to development of this framework. Discussions were informed by publications on the need for reappraisal of traditional approaches of technical cooperation in development, along with a recognition of the nature of the HIV epidemic. The HIV epidemic epitomises the need for new approaches to development practice because of the close association between the epidemic and human development, the continually changing nature of the causes and impacts of the epidemic in specific local settings, the fact that traditional approaches have mostly failed to reduce either the spread of the epidemic or to minimise its impact and, most importantly, because no one can claim to have expert understanding of what will work in all contexts to address the challenges of HIV and development. The evaluation found that the work of the HDP is clearly situated within the conceptual and operational framework of UNDP's work, and that its approach is consistent with concepts used by UNDP. The Programme is contributing to the development of understanding of UNDP's evolving approach through learning more about what works in practice. In particular, the Programme has put into practice the challenges of working in a way which catalyzes analysis and action by the people whose lives are affected. It has explored the implications of working to develop capacity through approaches based on partnership rather than dissemination of pre-conceived knowledge, it has learnt how to act as an agency which mobilizes people, and it has learnt how to be self-critical and self-evaluating. The Programme's approach is situated within theoretical frameworks which help to guide these new approaches, and draws on understanding of social learning, strategic questioning and process consultation. Each of these frameworks emphasises the central role of transformation: transformation of individuals' perceptions and sense of personal empowerment, transformation of institutional approaches, and transformation of the roles of development practitioners. In these ways, the Programme has contributed to understanding of how sustainable human development works in practice, and of how such practice can contribute to more effective responses to the HIV epidemic.
4.2 Recognising the need for new approaches to development and to the HIV epidemic Many development agencies, including UNDP, are re-considering what types of development practice may be effective in the context of current crises in meeting development needs (Banuri, et al, 1994). The imperative for change arises from a recognition that traditional forms of technical cooperation have been less than effective in meeting their objectives. The report of a recent High-Level Seminar of the OECD's Development Assistance Committee, UNDP and the World Bank notes some current problems with technical cooperation (OECD/ UNDP/World Bank, 1994). Though referring to development in general, some of these problems apply also to the field of HIV and development: Technical cooperation is donor driven ... Any single donor may be marginal, but in the aggregate, donors exert a powerful distorting influence on national processes of priority setting and resource mobilization and allocation. Technical cooperation has supported the monopolization of resources and power by governments ... (which) has not been compatible with social and economic progress. Within donor agencies there are short time horizons and pressure to deliver resources. In facilitating responses to the HIV epidemic, top-down approaches based on what has been learnt in a few wealthy countries, and based on the need to be seen to produce quick results, are often the norm in developing countries. Many programmes are funded by donors in a manner which assumes that people in various contexts simply need to be told "the truth" about the HIV epidemic; that the only sensible responses are use of condoms and treatment of those who are ill using expensive modern drugs which do not in fact save lives; that measuring the numbers of people infected is possible and is an essential component of an adequate response (at no matter what cost); and that tradition, especially religious beliefs and traditional medicine, is a hindrance in dealing with such a new phenomenon as the HIV epidemic. The net result of such programmes, as widely acknowledged, is that responses to the HIV epidemic in many countries are ineffective in slowing down transmission rates, in reducing stigma and discrimination against those infected and those close to them, and in generating effective responses to the challenges the epidemic presents to human development. The inadequacy of the application of classical approaches to technical cooperation to the HIV epidemic is further highlighted because so many of the problems which need to be solved are not yet fully understood by anyone, no matter how expertise is defined. For example: - the epidemic in one country may be very different to that in another; - the problems at one stage of the epidemic may be different to those at a later stage; - the way the epidemic spreads is influenced by different development strategies, economic systems, and political situations; - the possible range of responses to the epidemic depends just as much on personal and community-wide commitment to their resolution as on what may be externally viewed as necessary; and - there are no obvious technical solutions, or even models of programme design, which are either entirely effective or readily transferable from one context to another. How, then, can this be changed? What is required to generate effective responses to the challenges presented by the HIV epidemic in the context of development, or to the challenges of development in the context of the HIV epidemic?
4.3 Possibilities for reform, and implications for addressing the HIV epidemic Partial answers to these questions may be found more readily in recent discussions about the nature of development than in discourse about the HIV epidemic. The OECD/UNDP/World Bank seminar suggested the following as part of an "Agenda for reform":
(OECD/UNDP/World Bank, 1994; see also OECD, 1991) UNDP has responded to the challenges of this "Agenda for reform" through the development of more complex perspectives on human development:
(Banuri, et al, 1994, p. 21) The UNDP discussion paper in which this definition first appeared suggests that sustainable human development will result from new approaches within what it describes as "a new development paradigm". The HIV and Development Programme has explored approaches consistent with these suggestions. Working within the framework of sustainable human development, the Programme has been based on a commitment to ensuring that solutions to the problems of HIV and development arise from: - an enhanced capacity of individuals, communities and nations to understand the nature of the epidemic in their own contexts; and - an enhanced capacity of individuals, communities and nations to find effective means to address those problems; which in turn depends on - an enhanced capacity for people and organisations in all sectors (government, NGOs, the private sector, health and development agencies, religious organisations, and others) to work cooperatively and communicate with each other about problem definition as well as resolution. No amount of technical cooperation can, on its own, enhance these capacities but it can facilitate necessary social change: - change in people's perception of their own roles and capacities in enhancing human development; - changes in the ways individuals and institutions relate to one another; - changes in the focus of analysis (from virus to people and their inter-relationships); - changes in the nature of what needs to be done, who needs to do it and where and how the impetus begins. For these changes to be sustained, there needs to be a strong and widespread willingness to respond to the epidemic, and an external environment which enables such responses: an environment which encompasses cultural, policy-making, political and legal factors which influence people's abilities to understand and to act. What, then, is the most useful role for an international development agency? How can effective development practice be applied within the HIV epidemic? Such questions cannot be explored independently of advances in understanding of development practice, nor of advances in understanding of the epidemic. The UNDP HIV and Development Programme complements the roles of many other UN, bilateral and NGO donor agencies working in development and in response to the HIV epidemic. The HDP therefore deliberately focuses on exploration of the association between HIV and development, and how more effective development practice can generate more effective responses. The Programme is thus situated within the overall conceptual and operational framework of UNDP's work. Its approach is consistent with concepts used by UNDP, especially the concepts of sustainable human development, capacity building, social learning and partnership (Banuri, et al, 1994). Discussion about the new paradigm of sustainable human development has led to suggested guidelines, or starting points, for practice within this paradigm. The Programme contributes to this new discourse through having learnt more about what works in practice.
4.4 Learning to move forward, along an ever-changing path A central question being constantly explored through the SPR is, "How can we, together, move forward?" Answering this questions leads to choices in the types of processes used, with the ultimate goal of assisting social change. Interim processes include identifying people and organisations who are social change agents, working with them and supporting them through partnership, and the facilitation of their networking with each other. A useful framework to inform the nature of such social change processes can be found in a seminal work by Schon, Beyond the Stable State (Schon, 1971). Although written in response to crises in the welfare states of wealthy countries in the 1970s, the theoretical frameworks outlined by Schon have relevance for human development now. Schon explores the nature of social change. He notes that the dominant model for diffusion of new ideas is based on the concept that, "A communicates to B what B does not know but A does". Like classical technical cooperation in development, which is based on the same model, this is inadequate to facilitate the range of innovations which are required to meet the complex realities of modern societies. In what could now be seen as a forerunner to recent discussions on crises in development and in the international organisation of societies and nations, Schon notes that,
(Schon, 1971, p.182) The complex problems caused and/or highlighted by the HIV epidemic provide good examples of a proliferation of such problems. Just as the problems of human development are not solved just by the creation of good banking systems, so the problems of an epidemic driven by complex and dynamic social and behavioural systems are not solved by the improvement of medical or educational systems alone. Schon's central thesis is that as such mismatches between problems and institutions becomes endemic, so do all sorts of responses, which vary in effectiveness and can in turn create their own problems. The net result is the loss of "the stable state". The challenge, then, is to find productive ways to deal with the consequences of the loss of the stable state. The answers, Schon suggests, arise through processes of "social learning": a concept central to the newly defined human development paradigm. An imperative for effective change is the application of social learning to changing the nature of the state in general, rather than focussing on independent institutions. Failure to do so will result in endemic crises, as have now been identified in current discussions on development (Banuri, et al, 1994, pp.9-11; de Vylder, 1995, pp.8-11). Social learning requires an emphasis on process rather than forseen outcomes, and on the generation of autonomous yet networked responses akin to the characteristics of social movements, rather than on the restructuring of individual institutions:
(Schon, 1971, p.184) This is entirely consistent with the recent suggestion that, "UNDP must see itself as: (1) a catalyst and an advocate for social change; (2) an agency which mobilizes stakeholders in sustainable human development; (3) a supporter of potential partners; (4) a self-critical and self-evaluating body; and (5) a promoter of institutions that enhance accountability and responsibility of all partners" (Banuri, et al, 1994, p.7). It is also consistent with the approach of the HDP in that the Programme works in these transformational ways, is process-defined, and consciously works with, and promotes cooperation between, governments, NGOs, communities and individuals affected by HIV and by development. Practical suggestions on how to bring about the required changes can be found in three critical components of the new approach to development which have all been drawn upon to directly inform the work of the programme: the need to start with people's own perceptions of their realities and to promote more actively the role of expertise which arises from lived experiences (Chambers, 1994); the use of "strategic questioning" (Peavey, 1994); and the culmination of a range of new approaches in a method of facilitation developed by Management Development and Governance Programme of UNDP and called, "Process Consultation" (Joy and Bennett, 1994).
4.5 Who defines what is real, and what is needed? The first of these was suggested in a paper prepared as an overview for a recent UNDP roundtable discussion (Chambers, 1994). Under the title, "Poverty and livelihoods: whose reality counts?", the author draws attention to the vast differences between the perceptions of poverty held by professionals and the perceptions experienced by the people who actually live in poverty. He suggests that the most valuable expertise in both understanding reality and knowing what changes are needed is the expertise which arises from lived experience. This understanding of expertise presents major challenges to those working in development and requires major changes in approach: "If poor people's realities are to come first, development professionals have to be sensitive, to decentralise, and to empower, enabling poor people to conduct their own analysis and express their own multiple priorities" (Chambers, 1994, p.16). The author notes that these challenges are not simple:
(Chambers, 1994, p.20) Again referring to the need for a new agenda in development, this author suggests four pillars for a poverty agenda: - analysis and action by local people, and putting first the priorities of the poor; - the promotion of sustainable livelihoods (rather than simply economic growth); - decentralization, democracy and diversity; and - professional and personal change. Such changes, he suggests, demand, "... altruism, insight, vision and guts" (Chambers, 1994, p.28). The scope of the changes required in development practice as a result of starting with people's own realities should not be underestimated. People's realities include not just perceptions of the world as it is, but also understandings of the ways it can be changed. These can lead to entirely new ways of defining and reaching programme goals.
4.6 Asking useful questions to the right people A second component of enhancing understanding of people's realities is the use of "strategic questioning" (Peavey, 1994). Strategic questioning is a process in which the person investigating and the person investigated become equal partners in a process of learning. One can find power in approaching a problem with the feeling of, "I don't know", or in allowing doubt into what is already known. Such attitudes open doors to new possibilities, through which both the listener and the person being questioned can realise change. Strategic questioning is the skill of asking questions which will make a difference. It is characterised by six key features. In summary, strategic questions: - are dynamic and create motion (for example, by asking, "How can we, together, move forward?"); - create options; - can be a lever to reveal in-depth information; - do not lead to "yes" or "no" answers; - empower the person being questioned; and - sometimes include "unaskable" questions which challenge assumptions and values.
4.7 The central role of process in building capacity Finally, a set of processes which have been adopted by the HIV and Development Programme is suggested in the guide, "UNDP Process Consultation: Systemic Improvement of Public Sector Management" (Joy and Bennett, 1994). This guide was developed to assist countries to face the challenges of building capacity for systemic public sector change and reform. It suggests that UNDP's role is to support that process by contributing resources and by, "... facilitating the sharing of experiences and insights in different areas of development" (Joy and Bennett, 1994, p.iii). In essence, the role of the external agency is to suggest issues to consider and processes which might be used to consider them, not to explain "realities" or to provide "answers". Suggesting issues and processes is exactly what the Programme did, for example, with work in the legal, ethical and human rights fields. It would have been inappropriate and ineffective for the Programme to determine exactly what changes should be made to the legal and ethical environment in each country, because each country is different, as highlighted in the UNDP guide to process consultation:
(Joy and Bennett, 1994, pp.3-5) Consistent with the general approach of sustainable human development, the guide suggests a strong emphasis on working with processes rather than endpoints. It suggests that a further aspect of the approach required now, as used by the Programme, should be to explore the nature of the new development paradigm through simultaneous practice and reflection, rather than through desk-top programme planning followed by action: "New roles, and the new relationships they imply, are worked out and learnt by discussion and interaction" (Joy and Bennett, 1994, p.37) Importantly, the guide to process consultation also recognises the importance of the view of reality of an agency such as the HIV and Development Programme, recognising that there is room for outsiders to bring their own perspectives to problems, so long as those perspectives are offered in dialogue, not as "solutions" to which funding is tied. Such an approach was typical of the Programme's work in capacity building for undertaking research which would contribute to better policy and programming responses to the epidemic (see Case Study 1). The Programme's central role in this project was to ensure that an adequate range of people was involved in determining both research needs and methods, rather than a role of indicating what should be investigated through research.
4.8 Transformation as an essential component of development The UNDP process consultation guide affirms that "transformation" plays a central role in the new development paradigm. The central concern of the guide is with transformation of structures and processes, whereas the HDP staff are more critically aware of the need to enhance the understanding and practice of social change agents as a means of working towards this. There is consistency between the guide and the Programme's approach in seeing transformation as something which will not happen overnight, in using processes which lead towards transformation rather than specifying the outcomes of that transformation, in recognising the central importance of developing relationships, and in continually grounding the programme in people's lived realities:
(Joy and Bennett, 1994, p.21)
4.9 The evolving nature of sustainable human development It is in this context that the Programme has worked, through developing, implementing and constantly evaluating new approaches through partnership with people in their own contexts. Indeed, the evaluation has been merely one more form of gaining the "feedback from actual experience" suggested in the above paragraph. Most importantly, both the Programme and the evaluation are elements of a necessarily ongoing process of experimentation and learning. While much has been learnt to date, the path ahead is by no means certain, and there is a need for continual questioning in the context of ongoing partnerships with those whose lives are directly affected by the challenges of HIV and of development. The promotion of better understanding and more effective action in response to the HIV epidemic and development is at a stage which is typical of the field of sustainable human development in general:
(de Vylder S, 1995, p.11) The Programme has incorporated the need for continual learning with the need for urgent practice. In so doing, it has enhanced understanding of what is needed and has demonstrated that it is both possible and desirable to continue questioning the value of approaches as they are being implemented. A final lesson, along the lines of what is now called "international best practice", may never be reached. This is because each country and each context within countries is different; the epidemic is evolving, and sustainable human development is itself a process, not an outcome. In the words of an evaluation participant from the Philippines, "International best practice is about starting a process." The most useful role for outsiders, then, may well be to help people to find their own effective processes. The development which results would then be relevant, sustainable and centred on people's most crucial needs.
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