The following is a conversation between Emily Bancroft, President of VillageReach, and Denver Frederick, the Host of The Business of Giving.

Denver: VillageReach works to solve healthcare delivery challenges and low resource communities in Africa. Their approach includes developing, testing, implementing, and scaling new systems, technologies, and programs that improve health outcomes by extending the reach and enhancing the quality of healthcare. And here to tell us more about this work is Emily Bancroft, the president of VillageReach. Welcome to The Business of Giving, Emily.

Emily Bancroft, President of VillageReach

Emily: Thanks, Denver. Very pleased to be here.

Denver: You guys were founded back in the year 2000. How did this organization come to be, Emily?

Emily: It’s actually one of my favorite stories, Denver. I often say that VillageReach started on an airplane. We really started as a partnership between two people, Mrs. Graça Machel, who’s the former first lady of Mozambique… Also, at the time, she was married to President Nelson Mandela in South Africa.

She’s one of the elders; she’s a staunch women’s rights and human rights advocate, and she met the other founder of VillageReach, Blaise Judja-Sato, who was a Cameroonian-American businessman living in Seattle at the time.

And he was sent over to pick up Mrs. Machel and Nelson Mandela when they were coming to visit Seattle in 1999 as part of a tour that they were doing in the area to raise money for the Nelson Mandela Foundation, and Blaise and Mrs. Machel really hit it off and spent a lot of time together during that period that Mrs. Machel was in Seattle. And the next year, a major cyclone hit Mozambique.

And Mrs. Machel has a very active, very strong community development organization in Mozambique, and she was helping to coordinate response, and she called up Blaise. Blaise worked for a satellite telecommunications company, and she said, “Hey, can you come over and bring some equipment and come help with this cyclone response?”

And he went over, and while he was there, she asked him… or prompted him to start thinking. And she said, “What are you doing? How could you bring some of what you’re doing now, this education that you have, this incredible life that you’ve built, this knowledge that you built, how can you bring some of that back to the continent?”

And they started thinking about what they could do and how the challenges that they were seeing with the medicines and supplies and everything that was coming in to support the cyclone response and how hard it was to get that out to communities, that that wasn’t just an emergency response situation. That was something that needed to happen on a day-to-day basis if people in rural and hard-to-reach communities were going to get supplies. And so, they stepped back, said “Let’s look at vaccines. We know that kids need to get vaccinated. We know there’s going to be huge investments in vaccination programs.”

“How do we make sure that the systems that deliver are in place? How do we make sure that every child, no matter where they live, is going to have access to a vaccine? Let’s build that system, and let’s do it well.” And that’s what they did.

Denver: That is a great founding story. The other thing I love about foundings is that usually the culture of the organization is baked in right at the very beginning. Are there any elements of what happened then that are still alive and well at VillageReach?

Emily: Absolutely. I think, a couple things: one is one of our values and one of our organizational goals is around collaboration. And I think that collaboration between Mrs. Machel, her very deeply-rooted community development organization that really knew Mozambique communities was embedded with Blaise’s “Okay, how do we look around and see what’s happening in other parts of the world?” He went and talked to Starbucks. He went and talked to Microsoft. He came back to Seattle and talked to companies that were doing supply chain work.

And said, How do you do this? He went and met with UNICEF, right? So, he pulled and met with PATH, who had been around for about 20 years at that point in the Seattle community– another big, global health organization that was focused on developing some of these vaccines and technologies that were going to need to be implemented.

And so, it was that combination and that collaboration sort of spirit and way of thinking has really embedded into our culture. The second thing I think was around innovation and thinking differently about how to solve a problem. And I think this is something that is absolutely Blaise’s strength.

And it’s a big part of who we are today. And the best example of this is we needed propane. At the time, solar was very expensive. So, there weren’t solar fridges out… this is 2001 we’re talking about. And so, the fridges for off-grid facilities were propane refrigerators, and there was no source of propane in Northern Mozambique where we were working.

And so, instead of buying, using the funding that we had to buy propane during the course of this initial work that they were doing, they said “Why don’t we start a company that distributes propane because people need propane. This isn’t just a health sector problem, this is a broader problem, and there’s going to be development in Mozambique… we can see it coming.

And so, this is going to be something that’s going to be needed by households, by hotels, businesses; everyone’s going to need propane. And so, they started a company, FTC, and VillageReach started a company… it’s called Vida Gas. It became the largest propane distributor in Northern Mozambique, and the health sector was its anchor client.

So, they used philanthropic dollars– innovative, creative, these days you’d call it, probably more impact-oriented funding. But, at the time, it was philanthropic dollars from a forward-looking organization that seed-funded that company. And it’s a Mozambican-owned-and-run company. VillageReach actually sold our shares in it in 2018.

And so, I think that’s just such a great example of: How do you think about what different ways are there to solve a problem? Where does the private sector come into play?  Where does the public sector come into play? And how do they work together?  And how do different sources of capital work together as well to make this happen?

Denver: Yeah, so often we stay within the frame that we’ve been given, particularly as a non-profit, and sometimes you can’t figure it out if you just stay embedded in that frame. So, delivering quality healthcare, what are some of the major challenges you encounter?

Emily: We’re really focused, as I said and you said as well, on those systems that deliver. So, obviously there are a lot of constraints within the health system– whether or not people want to access services, whether those services are offered in an accessible, convenient, acceptable way to an individual.

And then there are also these constraints around:  Are the medicines and supplies and products there when they’re needed? Is there good data coming from the community level and the health facility level, that primary healthcare level to really feed and define what health care services need to look like?

So, that lack of data, sometimes the missing products, and then healthcare services that sometimes just aren’t always designed in a way that puts the client or the person who’s accessing the services at the center of them. Those are some of the things that we see every day in our work and that we try to design solutions around addressing.

Denver: And one of the things you do is tech-enabled pathways to primary healthcare now. So, that’s something which everybody has rolling off their tongue but doesn’t necessarily fully understand. Give us an example of how that really works.

Emily: I think, you can see, and I think COVID has accelerated this a bit, that the health system of the future is going to continue to be more and more technology-centric and technology-enabled.

And we do see real potential in how technology does help to expand the reach of primary healthcare services. So, when we talk about tech-enabled primary healthcare, we’re talking about: How is it that you can use technology to shift that reach and expand that reach?

So, the best example in our work right now is working with governments and the private sector to integrate hotlines, text messaging, and now also that really provides personal, accurate, and timely medical information for free to people by phone in the convenience of their homes.

And we saw during COVID that the governments that had these platforms in place were able to quickly use them to get information out to communities and to get information back from communities about what they were, what questions they had, what they were struggling with, what the unknowns were for them, and then able to feed and shift the messages and the information and the education going out based on what we were hearing back from communities.

And so, we feel very strongly that every government should have a platform like this. It should be part of how we think about a piece of the healthcare system, and it doesn’t replace healthcare workers; it doesn’t replace physical facilities, but it expands and enhances what’s available to communities.

Denver: A real amplification, I can see. You mentioned, a moment ago… supply chain. So, all I hear about the supply chain are the ships in Long Beach and things of that sort, but we have some challenges with the supply chain obviously in getting life-saving health products, particularly to that last mile. How do you go about doing that?

Emily: Yeah. Let me just start with saying I agree with you. For the first time, I feel like since I’ve been working with VillageReach, and I’ve been with VillageReach over 12 years: Supply chains are actually a topic of conversation, but that has not always been the case.

And I think that feeling that many people had when they saw supply chains fail and all of a sudden weren’t able to get… I know for us, it was flour for a while that was unavailable or very hard to get. Toilet paper, obviously, was the example that was very commonly used… face masks in the early days of the pandemic.

That’s the reality every day for a lot of the people that we work with. You don’t know when you show up at a health facility or interact with a community health worker, whether or not they’re going to have the vaccine that you need, whether they’re going to have the test kit that you need, whether they’re going to have the malaria medicine that you need, whether they’ll even have something to treat a fever.

And so, what we’ve really focused on are: What are the people that need to be in place?  How do you actually professionalize and make supply chains a discipline that is understood, that’s professionalized where people have a job description that includes supply chain activities?

So, the people, the transportation systems, so you need some way to get those medicines and supplies out. It needs to be reliable. It needs to be routine. It needs to happen regularly. And the data, you can’t know where to put products and make sure products are in the right place if you don’t have that data.

And then, of course, the financing because you always need the financing and the sort of political will to implement these systems. So, it’s really pretty simple. Those are the things we focus on. It’s just a question of how we bring innovation into some of those pieces that might shift that a little bit. Are you using a truck or motorcycle or are you using a drone?

Denver: Yeah. Tell me about that drone for health. I was going to get to that transportation part there. Tell us about that.

Emily: Yeah, I think that we’ve been actually really looking at it and thinking about the way to integrate drones into the transportation options for supply chains really since about 20… probably 13 or 2014, I think we started talking about it. And at that time, it was completely out of reach, right? The technology wasn’t there. It was expensive.

Denver: Yeah.

Emily: People thought we were crazy. Governments weren’t interested in talking about it. But as things have progressed, we’re seeing a really increased understanding, and I think it has to do with the way that in a lot of African health systems, but also just African countries in general, there’s been so much leapfrogging of some of the infrastructure. We saw this with the rise of cell phones, the rise of mobile money in Africa. So, there’s a real history of thinking differently about how to solve an infrastructure problem than maybe the way that it was thought about in the US.

And so, drones have really captured the imagination of a lot of governments around if we have this more responsive component embedded into our supply chain, think about what we could do around hard-to-reach communities or very-expensive-to-reach communities, around being able to rethink maybe how our blood donation network runs because we have limited blood.

So, instead of having to position it all over the country, if we could move it more quickly, we can think differently about what that whole network looks like. Lab sample transport systems, another area where you need really responsive ways to get sample specimens back from facilities to labs. Traditional transport means aren’t always the best for that. And so, we’re seeing this really strong interest.

So, in Democratic Republic of Congo, Malawi and Mozambique, we are working directly with governments to set up the regulatory systems and to bring drones into their supply chains and look at how to integrate those and to look at the best ways to integrate it. And then, we see some national-scaled models of that done by other partners in Rwanda and Ghana right now.

So, there’s still a lot of work to be done to get the pricing to a point where it makes sense and to really create the workforce needed to support it and that whole enabling environment. But the potential for integrating drones into traditional supply chains and augmenting land-based transport, I think, is very real right now.

Denver: Yeah, I love your point about leapfrogging, too, because like in the United States, as you say, we have legacy systems, which have vested interests that are going to try to stop any kind of advance that’s going to hurt their bottom line, where in Africa, as you say, it was just ” Oop!” You know what I mean?”

Emily: Right!

Denver: Right to the modern age here.

Emily: And real! I mean, there’s a drone academy that’s been set up with one of the technical colleges in Malawi that is training drone pilots and people who want to be contributing to this part of the economy moving forward. And I think we’re going to see more of that.

We’re trying to help the government in Democratic Republic of Congo set up a Francophone drone academy as well right now. So, we’re going to see great pictures of kids holding models that they’ve created of drones, right? Like there’s a lot of really interesting technology I’m thinking that I think is just on the horizon.

Denver: Yeah, it sounds very exciting. You guys have worked to mitigate the impact of COVID-19 in these under-resourced communities in Africa. In fact, you’ve also been doing it in your state of Washington where you’re based. Tell us a little bit about that work.

Emily: This has been, I think, one of those unforeseen but really exciting aspects of how you can change and pivot during emergency times. So, we were approached actually when Washington State was starting to roll out. So, we’ve always had a base of operations in Seattle… as I said Blaise was living here; I’m based here.

Many of our technical staff are in Africa, but we do still have a small technical team here in the US, who have worked throughout Africa and really understand African health systems and understand immunization and immunization supply chain programs very well… and data systems.

So, we were asked if we could help King County here in the Seattle area with the rollout of the COVID-19 vaccination. At that point, it was an all-hands-on- deck, and they knew through our work with the Gates Foundation that we had done a lot in immunization and said, “We need an immunization partner. Could you join us?”

So, we put two people on their team. Our team helped to set up their high-volume vaccination sites here, so the mass vaccination sites that were drive-through sites and big-stadium sites here in South King County. And it then led to a really great discussion with the Washington State Department of Health about, okay, now, the problem isn’t as much getting lots of people vaccinated, it’s about really understanding the undervaccinated populations throughout Washington State.

And local health jurisdictions don’t have a lot of resources to do that. They are short on staff. They still have to carry out the regular work. And we’re now working with 14 different counties across Washington State, helping with things: What do we understand?  Doing interviews with Latinx communities about why they’re not accessing vaccinations.

You’re helping to dig through data and visualize it in different ways to help the county understand: Where are there pockets of undervaccinated? Where are there vaccine deserts within the county? We’re trying to help bring them back into using the skill sets and using the knowledge that we built and that we have through our work in Africa and seeing how relevant that is to the situation in a lot of rural counties here in Washington State.

Denver: Cool. We talked about problem solving, and you’ve been talking about how you’ve come up with these solutions for so many of the challenges you face, but also you recognize that sustained impact is really the key. What are some of the things you do to assure that first?

Emily: Yeah. So, one of the things I always say is that what I love about VillageReach is we put as much thought and attention on what it takes to sustain this work as we do on the development of the innovation itself, and we’re very deliberate about it. We actually start from the beginning anytime we’re implementing something new or starting out a new piece of work.

We’ve now built in a system where we start to think about: How are we actually defining what we’re doing, and how are we actually documenting what we’re doing, and how are we having conversations with our partners, the government, other large technical partners about what are the actual components that make this work, and how do we understand those over time?

And it evolves sometimes, where we may start with something, and it will evolve, but then: Who’s doing what now?  And who should be doing that in the future?  And how do we start to actually create that pathway so that, let’s say, if VillageReach… a great example is we’ve been helping the Mozambican government implement a strategy they have around bringing in private sector transporters to help transport their medical products.

Sounds pretty simple, but there’s a lot to do around: How do you manage a third-party logistics provider?  What data do you ask them for?  How do you manage the contracts? And so, we did some of that at the beginning, but then built this model to say “Okay, what do you guys want to be doing in the future? Do you want to be driving trucks, or do you want to be managing third party logistics providers?”

“Okay. You want to be managing providers. Then here’s all the things that need to be done. What does that look like in a year, or what does that look like in three years?” And then build that plan with them. And so, we put coaches on each of our teams that have actually been through these sorts of transitions who have actually helped a government take on something that we were doing.

We work on the financing of that. We have economists and a costing expert on our team. And we really deliberately try to build strong, hand-over plans and embed technical assistance into the governments to make that possible for them. And we’ve seen it work.

We’re one of, I think, the few examples of where a sort of innovative platform… and this health center by phone platform that I was talking about, this phone platform where we actually developed in partnership with the government, tested it, got the evidence there.

Built the stakeholder group within the government who’s going to take it over. The government then decided where to fit it into their system, which was not an easy thing to do. Did that, we handed it over; it’s in their budget. They took over all of the human resources of this just before the pandemic hit.

And therefore, it was their COVID-19 hotline and their primary health care hotline, starting in February of 2020, and they continue to operate it today, and that took nine years. It was not as slow, and it took very, very deliberate, thoughtful work on the part of both sides to make that happen.

Denver: Yeah. That’s part of your transitioning initiative, I assume.

Emily: Exactly. So, we’ve actually named it. Our team knows that this is something we have to think about. As I said, we give them coaches; we take somebody like the woman, Upile Kachila, who was really involved in that transition with Health Center by Phone. She now coaches other teams on how to think about that and their work.

Really trying to say this is part of who we are. And it causes some discomfort sometimes for our teams because: What does that mean about their jobs? And so, we try to embed a culture where we want to be moving on to the next problem.

 Our job is to be thinking about what’s the next innovation, what’s the next solution that can be brought in, but we don’t want to leave our government partners; we want to do this in a responsible way, but there’s going to be the next thing to work on. So, this isn’t about holding on to something because it’s your job and your livelihood… like get excited about moving on to that next thing once we transition well.

Denver: That’s a cultural element about the organization. You know what I mean? That we’re going to do it. We’re going to set it up where somebody else can take it. And it really just takes that upfront thinking so often that organizations don’t have because they’re so anxious to solve the problem immediately. They don’t have that long-term view saying “Who’s going to pay for this? How is this going to continue?”

Emily: Yeah.

Denver: And you’ve really got to start it from day one. You can’t get to year four and then begin to say “We have to think of a scalable system.” And it seems that you’ve really done that.

Emily: Exactly.

Denver: What are you doing to shift power and influence to the people in the communities that you serve? It’s a challenge, I think, many non-profit organizations have right now. What are some of the things that you’ve done specifically to make that happen?

Emily: Yeah. I think about it in two layers. I think about: What are we doing within our own organization?  Then, what are we doing about the work that we do and the communities we work with and our government partners as well?

So, I think, internally, we set a target about six years ago, and this sounds really simple and basic now, but we would hire positions in Africa, unless there was a really strong business reason that they needed to be hired outside of Africa. And so, that really started us on a path towards interrogating each of our roles to say: Why is this role where it is, and is that really the best place for it?

And so, now our senior management team is 80% in Africa. I was our vice president of programs. When I became our president, absolutely hired that position in Africa moving forward, so that’s been five years now that that position has been in Africa.

So, really systematically looking at: Why do we think certain things have to be in certain places?  And let’s make sure that we’re being really thoughtful about that. and that has fundamentally shifted the look of our organization, the feel of our organization and the leadership and decision making within our organization.

On the community side, one of the things I’m really excited about right now is our current strategy, the shift that we made, and we launched it just before COVID. So, a few things have been slowed down more than we would like, but the shift that we made was we had really thought about the health worker as the center of our strategy. What does the health worker need to do their job well?  And that’s still very important.

But we shifted our focus to say, “What does the person who is accessing health services or, even better, the person who is not accessing health services, what do they need from the health system? What do they need from these systems that deliver? And how do these systems that deliver adapt to their needs?”

So, with that shift, our teams have started doing a lot more community-based participatory research, and we’ve got a couple of great examples. We did some work with adolescents where we trained adolescent researchers; they did a lot of work with… we’ve written up some of these super interesting things around using photo voice and journaling and different tools to get adolescents to pull from their own friends and colleagues: What it is that they need from the health system.

And one of the things that changed for us was we actually recognize that these hotline platforms could be a really powerful tool for adolescents because they wanted the ability to be in a group and talk to a healthcare provider. They wanted the ability to be in on in their communications with healthcare providers; they wanted to be able to ask questions that they might not feel comfortable asking in person.

They wanted high confidentiality, which walking into a health center didn’t always give them. And so, by marketing then that hotline service to adolescents, and training the hotline workers to be responsive to adolescent questions, and changing the data system a bit that we used with the hotline because it required first that you gave your name, and it was hard to move forward… for the hotline worker to move forward if you didn’t give your name, so making these shifts, adolescents became 50% of the callers to the hotline in Malawi. So that’s one great example.

And then the other one is right now, we’re working with caregivers who are either dropping out of vaccinations or, in some cases, not accessing vaccinations. And again, doing that same, we’ve trained that peer facilitators who are pulling the information. And now, I’m super excited that we’re moving into the phase of actually helping them now come up with some interventions and helping them support trying out those interventions in their communities to see if it does make a difference in more people bringing their children in for vaccinations.

“If we work together, we can do something at scale. And VillageReach never would have been able to do that on our own. None of these individual partners would have been able to do this on their own. And so, for me, that is the power of real collaboration and really coming together in saying: What can we do that we cannot do on our own?”

Denver: Yeah. I love you putting them at the center like that because I think one of the problems sometimes is that we want so much information, we create friction, and they sign right off. I even find that sometimes on donor sites when people want to pull all this information, I talked to some younger donors and they say, “I’m not going to give all this information, I just want to make a gift.”

So, kind of just a sense of who they are and where they’re coming from, and you’ve really have adapted. Let me return to the beginning of our conversation, which was about collaboration.

Emily: Yeah.

Denver: And I know that’s so central to you, but how has that impacted your ability to leverage, if I may say so, a relatively small organization against a Herculean problem, and really have greater impact?

Emily: Yeah, it is so critical, and there are a couple examples I would give. One is, I knew you said this very well in your introduction of who we are: We think about our work in terms of these phases, where we co-develop these solutions; we help to build the evidence around them, determine if they really are making a difference in increasing access to healthcare for the most underreached.

And then we work with others to scale them up. And so very early on, we realized VillageReach isn’t going to scale anything. Even if we were in 50 countries, I still would argue, it’s like the kind of scale that you’re looking for. It’s very hard for a non-profit organization to do that.

And so, we pretty quickly said “Who can do that?” It’s governments and, in some cases, it’s large technical partners, groups like UNICEF. So, especially, when you’re looking at immunizations, that’s a group that can change practices and really influence governments and influence government practices across a lot of countries.

So, where do we really align and find those partnerships? So, that’s one piece, is in how we just think about scaling. We’re not saying we’re trying to build an organization that can do something across 20 countries. We’re trying to say, How do we do something enough in a small number of countries around problems that we think are pretty applicable across a number of geographies?

And then how do we use that evidence and knowledge to influence governments and other larger players who can actually facilitate scale in a different way than we can. We also really look at where we work in coalition and this, I think, is what we’ve seen become so powerful.

We are a part of this incredible coalition called the Community Health Impact Coalition. And it’s a group now of, I think, there are 27 members now. When we joined, there were maybe only 13 or so. These are all relatively small organizations; it varies… relatively small organizations, all aligned around a very concrete problem, which is that we know how to build strong community health and community health worker programs that have really incredible benefits around under-five mortality, around true increases in outcomes for communities.

And yet when those programs scale, you don’t see that same benefit and quality continuing. So why is that? What is it that’s keeping those from scaling? And so, as a group, just getting very clear about what are the components of these small-scale models that need to be brought into larger-scale thinking. And then how do we influence governments and large players, UNICEF, WHO, to bring that into the guidance around community health programs?

And then when the pandemic hit, we realized the community health workers are going to be such a big part of pandemic response. We saw it in Ebola; we know it’s part of a strong and resilient health system, especially as people become afraid to go to facilities, which is what we saw happening.

And so, we came together, and we wrote an action plan for what’s needed for community health workers to really be able to be the essential tool and resource that they needed to be during the pandemic. And one of the things that we identified, and we wrote this action plan over on a long weekend, across 12 different time zones, was getting passed off, but came together and did this.

And one of the things that we realized was if health workers weren’t protected with PPE, protective equipment, if community health workers weren’t protected, they would not feel safe playing this role that they needed to play during the pandemic. And they also were likely to be the last on the list when you looked at where the larger disbursements of protective equipment that were coming from maybe the Global Fund or from WHO or where those were going to go, and what governments are going to procure was going to focus on isolation centers, hospitals with good reason, right? But yet if we wanted… so how could we help with this problem?

So, it was the first time we really put action behind what had been a policy, advocacy-oriented coalition. And we joined forces with Direct Relief, the largest purveyor of donated equipment in the world. They brought some seed funding to the table. They wanted to do something scaled in Africa and we said we can offer you scale.

And then we took these coalition partners and all the networks that they had in the countries where they worked and the governments that they worked with, and we said: Who’s willing to work with the government and their countries to quantify what’s needed for community health workers? And we’ll help you get the equipment.

And we were able to procure 122 million units of PPE for about 500,000 community health workers across 18 countries in Africa through 30 different partners.

Denver: Wow!

Emily: And we were actually, at one point, the third largest user of World Food Programme’s emergency transport system that they offered up behind WHO and UNICEF.

And this was this sort of scrappy coalition that just came together and said, “If we work together, we can do something at scale.” And VillageReach never would have been able to do that on our own. None of these individual partners would have been able to do this on their own. And so, for me, that is the power of real collaboration and really coming together in saying: What can we do that we cannot do on our own?

“Our whole strategy is built around not us doing that direct service, but influencing the uptake of that in the health system and other actors doing it.”

Denver: Yeah, it’s a wonderful example. And it also gets us thinking differently about the impact an organization can have because I think we’re into: we fed this many people type of mindset. And also, sometimes you have boards that are rooted in that, that you almost have to change the paradigm, I would think, in terms of letting those people know how you’re looking at impact, which is really different. It’s really impact against the problem as opposed to impact of what we’ve done, if that would be a fair way of putting it.

Emily: We had that conversation with donors a lot actually, and it’s hard, right? We talked about influencing the health systems that serve 58 million people and, obviously, one of the questions that we get around that is: What’s your direct contribution to that?

And what I always try to say, “We can break down where we’re managing and running something, and it has this many users, but our whole strategy is built around not us doing that direct service, but influencing the uptake of that in the health system and other actors doing it.”

And so, I think it does make sense too; we’re not saying that we directly serve 58 million people, but we are saying that the solutions that we’ve worked on and helped to seed and helped to see grow and helped to see others take up are now impacting the health systems that serve 58 million people. But it does depend on how you look at success, and our strategy looks at success in that way.

Denver: Yeah, and I think donors will begin to change their frame over time, but it’s not going to happen overnight. It takes a while in that transition. This has not been an easy time to be in charge for anybody leading a non-profit or any kind of organization. What have been some of the challenges have you faced? Do you think the expectations of leaders are changing, and maybe how have you adapted to this new world of work?

Emily: Yeah. I think, again, I felt like we were lucky at VillageReach. We really started to bring in concepts of wellbeing and belonging into our work before the pandemic.

And I think part of this is my style as a leader. The only reason I took this job was because I had a leadership team that said to me, “You won’t have to do this alone, Emily. If you take this job, we’re going to do it as a team.” And so, that already is sort of embedded in just what I need in order to be a good leader, was that support network, and thinking about it as a group effort and not a solo effort. And so, we had also joined up actually interestingly with a group called The Wellbeing Project, who was doing a test around: How do you strengthen organizational wellbeing? How do you start to bring in concepts of wellbeing?

What is that balance between sort of individual wellbeing and organizational wellbeing?  And how do we think about building healthy organizations in a different way? So, we had started that work. We actually had started measuring for every year as part of our strategy, these various measures of wellbeing and belonging within the organization.

So, when COVID hit, it felt like we had to do more, but we had a framework already for having those discussions and bringing up these concepts within the organization that we could build on and utilize during this time.

Now, it wasn’t easy. I think my top priority was: How do we keep our staff in Africa on the front lines able to do their jobs, protected with what they need to continue working safely?

And at times, that meant that the US staff didn’t feel as secure maybe in their positions because it really was, if we have a choice, we’re going to really focus on making sure that our staff in Africa can continue doing their work safely in this time period.

And in the end, we were lucky. We didn’t have to make a lot of really tough decisions, but those were the types of conversations that we were having. I think I’ve learned a lot, and I still don’t do this as well as I could, but around communication.

And even just as a healthcare organization, our job in making sure that our staff were getting quality information about a very complicated and hard-to-understand, evolving pandemic and virus, and not making assumptions that our team understood it well, and really thinking about how we needed to educate ourselves and our teams in order to then be good and to support the communities in which we worked.

So, a lot more going back to the basics. I felt like, on communication, a lot more spending time on talking about how people were doing, what they understood about the virus, and none of our staff were untouched by this, especially in Africa; none of them were untouched by this pandemic.

And so, really giving people a lot of leeway, which is hard in a healthcare organization when you’re also expected to be on the front lines.

Denver: You are clearly passionate about this work. There’s no doubt about that. And maybe part of that happened as an experience you had in Haiti as a young lady. And, tell us a little bit about that and what is your driving motivation today? What drives you?

Emily:  Yeah, that experience, which I’ve talked about before was, as many people in this space do, I thought I’d be a doctor. That was the only pathway I understood if I cared about health and healthcare; the only option was to be a physician.

And then I had been to Haiti when I was in high school, which is part of what had inspired me to be a physician. And I went back when I was in college, and I volunteered in a clinic in Port-au-Prince. And it was so clear working in that clinic that the medical care being provided was not meeting the community need, and the sort of underpinnings of why people were showing up at the clinic were much more around poverty, inequity, injustice, security, safety.

All these things that it wasn’t that the health center wasn’t needed, but it just was so clear to me for the first time as a young person that this was not the full picture, that just healthcare access wasn’t the full picture.

And so, that really switched my trajectory. It switched to what I focused on for my studies. It switched some community development work that I did in the US when I first got out of college in terms of really understanding and learning about more community-based organizing and how communities aligned around these bigger issues of health and healthcare access, but also poverty, strength of community and relationships.

And so, it really shifted my direction and still continues to motivate me today. We talk about a world where everybody has the healthcare needed to thrive. And I remember when we started talking about that internally, a couple of the staff said “So hard though because health care is not the only thing you need to thrive.

And it’s like, absolutely, it’s not. But if we can think about it in that way, the world where everybody has the healthcare that they need to thrive, it’s like this is one piece of the puzzle that we can help to contribute to. And so, I think it’s that that motivates me. There are so many intersectional issues out there right now that are impacting the communities where we work. But if we can really be focused on this one piece, we’re contributing into this broader world that we want to see.

“We have to learn how to do more with less sometimes. We have to be creative about our infrastructure. We have to think about where new technologies can actually leapfrog. And those are things that I’ve seen the places where we work in Africa do a really good job of.”

Denver: A pretty foundational piece at that. No question about it. Finally, Emily, when you observe and examine the healthcare system in Africa, what can Americans, parents, policymakers and citizens learn from our African counterparts?

Emily: I think there is a lot of political leadership I see in Africa around the importance of healthcare systems and of health and science in making decisions. I think COVID is such a great example of this. I always tell the story that I showed up in DRC on February 1st, 2020, two days before COVID had been named a pandemic of international concern by the WHO. I showed up there, I got information on COVID.

I had my temperature screened. I had to leave my information about where I was going to be staying. And then I went and visited the COVID 19 response center that was being set up by the government. Got back to the US 10 days later; nobody asked me a single question. It was being talked about, but there was not yet real concern.

We were not on top of it. And there was super strong political leadership in Africa for the fact that they could see what was coming; they knew that this was serious, and they knew what they needed to do to set up to respond. And that was clear from day two of it being named a public health emergency of concern.

On day two, I got screened when I entered the country. And so, I do think there is this leadership that’s really come from seeing what a virus can do if you don’t contain it, and if you don’t take the steps needed. So, that’s one piece. And I see that, too, around immunization programs.

When Washington had a measles outbreak a number of years ago, I wrote an article about when there’s a measles outbreak in Africa, there’s mobilization, there’s community mobilization, there is government mobilization, there’s mobilization to go out and do something about it. And in the US, we don’t see that urgency sometimes to take on these issues the way that I see them in Africa.

And so, I think that there’s a lot that can be learned. And, again, we’ve seen that in our work in Washington State; there’s data system challenges here. We have to learn how to do more with less sometimes. We have to be creative about our infrastructure. We have to think about where new technologies can actually leapfrog. And those are things that I’ve seen the places where we work in Africa do a really good job of.

Denver: Yeah. They get ahead of the problem a little bit while we’re just trailing it. After it’s become a disaster, then we start to pick up the pace. For listeners who want to learn more about VillageReach or maybe financially make a contribution if they’re so disposed, tell us a little bit about your website and the kind of information visitors will find on it.

Emily: Sure. We actually just launched a new website last month, so definitely welcome feedback on it, but it’s, and I do encourage people to go. We post a lot of our resources; we try to write quite a bit, and so there’s a lot of great information on our site.

We also have this great partnership with a group called Focusing Philanthropy, which allows us to match donor contributions to specific strategic initiatives that we set up each year. So, in June, we’ll be launching a new one, which is around really combining this community-based research that I talked about, around how we can get more children in for vaccinations, taking that community-based research and really starting to put some of those recommendations in action. And so, there’ll be an opportunity to give to that work and get it a hundred percent match by Focusing Philanthropy. So, we’ll be launching that in June. So, I definitely recommend that people take a look at our site and pay attention to some of those opportunities that we have coming up.

Denver: Fantastic. Thanks, Emily, for being here today. It was an absolute delight to have you on the show.

Emily: Thanks, Denver, and thanks for doing this. I really appreciate that you tell these stories and get so much great information out about organizations.

Denver: Thank you.

Denver Frederick, Host of The Business of Giving serves as a Strategic Advisor and Executive Coach to NGO and Nonprofit CEOs and Board Chairs. His Book, The Business of Giving: The Non-Profit Leaders Guide to Transform Leadership, Philanthropy, and Organizational Success in a Changed World, will be released in the spring of 2022.

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