Tag Archives: developing nations

A brilliant rural development specialist shares his ideas on ending poverty in the world

A review of Out of Poverty: What Works When Traditional Approaches Fail, by Paul Polak

@@@ (3 out of 5)

Paul Polak is an extraordinary man. A Czech Holocaust refugee as a child and a practicing psychiatrist throughout the 1960s and 70s, Dr. Polak turned his attention to the challenge of ending global poverty in 1981. In that year, he founded the International Development Enterprises (IDE), a Colorado-based nonprofit organization distinguished by its successful launch of the treadle pump that enables farmers to irrigate very small plots of land at minimal cost. IDE’s mission more generally is to fashion and develop new tools to help poor farmers and other “dollar-a-day” families in developing countries work their way out of poverty. Now nearing 80, Dr. Polak has relentlessly pursued this mission for the past three decades.

In Out of Poverty, Dr. Polak interweaves the IDE story and the principles that guide it with that of one Nepalese family who moved from poverty into the middle class. The fundamental precepts of Dr. Polak’s work are clearly laid out in the introduction:

“1. The biggest reason most poor people are poor is because they don’t have enough money.

“2. Most of the extremely poor people in the world earn their living now from one-acre farms.

“3. They can earn much more money by finding ways to grow and sell high-value labor-intensive crops such as off-season fruits and vegetables.

“4. To do that, they need access to very cheap small-farm irrigation, good seeds and fertilizer, and markets where they can sell their crops at a profit.”

Much of Out of Poverty deals in detail with the challenges entailed in implementing these principles. Irrigation, including the story of the treadle pump, gets the most attention. Dr. Polak describes himself and the staff of IDE as what might be called catalysts rather than experts: from his perspective, the first step in any venture in rural development must be to talk to the people who will be affected by whatever is done — and listen to them. The IDE approach is resolutely bottoms-up, because “To move out of poverty, poor people have to invest their own time and money. The path out of poverty lies in releasing the energy of Third World entrepreneurs.”

IDE’s work over the years has tightly focused on farmers. As he notes, “most of the poor people in the world live in remote rural areas that will likely continue to be bypassed by successive waves of urban-centered industrial growth.” However, in the concluding chapters of Out of Poverty, Dr. Polak also shares a number of ideas for helping slum-dwellers (“43 percent of the urban populatioin in developing regions”) move out of poverty, too. The book is chock full of great ideas for small-scale entrepreneurs.

Dr. Polak and IDE were pioneers in the bottoms-up development model that is fast emerging as the only approach likely to make a dent in the endemic poverty in so many poor countries.

Regrettably, Out of Poverty is not well written. It is endlessly repetitive, with the same phrases and anecdotes appearing in chapters throughout the book, and it fails to deliver on its promise of sharing many examples of families that have moved into the middle class through IDE’s work, since the only story told in any detail is that of one Nepalese farm family. That’s a great pity, since this is a message that needs to be disseminated far more widely among policymakers around the world. A second edition, reorganized and with additional examples, would be a boon to the development community.


Filed under Nonfiction, Poverty

Aravind: A social enterprise with scale and impact to match Grameen Bank

A review of Infinite Vision: How Aravind Became the World’s Greatest Business Case for Compassion, by Pavithra Mehta and Suchitra Shenoy

@@@@@ (5 out of 5)

“At first glance, it seemed a venture far too quixotic to be effective. But when intuitive goodness is pitted against unthinkable odds, it stirs the imagination and awakens possibility.”

This is the spirit in which Pavithra Mehta, with co-author Suchitra Shenoy, approaches her history of the world-famous vision care center her great-uncle founded in South India 35 years ago. It is a truly astonishing story — one with profound implications for development throughout the Global South.

“Today, the Aravind Eye Care System is the largest and most productive blindness-preention organization on the planet. During the last 35 years, its network of five eye hospitals in South India have treated more than 32 million patients and performed more than 4 million surgeries, the majority either ultrasubsidized or free.” Equally important, Aravind also serves as a global resource center for opthalmology, training one out of every seven Indian eye doctors, consulting on management and technical issues with eye hospitals in 69 countries, and operating a state-of-the-art research center.

In 1958, Dr. Govindappa Venkataswamy reached the mandatory retirement age of 58 in his government post and retired to Madurai, a celebrated city of one million people in the South Indian state of Tamil Nadu. Inspired by his guru and the deeply felt spiritual values he had long held, he enlisted his brothers and sisters (virtually all of them opthalmologists like him) to help him found an 11-bed eye hospital. Dr. V (as he was widely known) set the fledgling nonprofit hospital on course to provide cataract surgery to all who needed it, regardless of their ability to pay.

He and his family implemented a staggered fee schedule, charging market rates to those with the ability to pay and a heavily subsidized rate to those with limited means, but worked free of charge to those who could pay nothing — allowing every patient to choose his or her own level of payment. (A future President of India once received free care.) Miraculously, this approach allowed Aravind to earn a profit from its earliest days until the present. Surplus funds permitted Dr. V. to build first one new eye hospital, then three more, and later to fund a manufacturing plant for intraocular lenses and a world-class opthalmological research center.

The quality of Aravind’s eye care services and of the lenses produced in its factory match or exceed the standards of the West. In fact, a recent study compared Aravind’s surgical outcomes to those of the members of the Royal College of Opthalmologists of the UK — and “found Aravind’s complication rates to be less than those of its British counterparts.” Similarly, when one senior Aravind surgeon lectured on corneal ulcers at the New York Eye and Ear Infirmary, “the faculty adviser told his residents, ‘The amazing stuff you just saw — don’t try it here. We don’t have that kind of expertise.'”

Today, Aravind employs 3,200 persons. Dr. V passed away in 2006 at the age of 88, but his younger brothers and sisters remain involved in Aravind — although they have passed the reins of management to first one and then a third generation of this truly remarkable family. (Aravind currently counts 21 opthalmologists in Dr. V’s family among its staff.)

Aravind’s business model is unique in many ways. It’s a nonprofit that consistently turns a profit. It subjects the most modest and obscure processes at work in the hospital to exacting statistical analysis — everything from the manner in which custodians clean the floors to the number of sutures its surgeons employ — and as a result has attained a level of efficiency that would bring smiles to the faces of the most demanding Japanese plant manager. It shares its management secrets (and they are many) with all comers with an openness and a willingness to train competitors that is simply extraordinary. It pioneered the use of eye care “camps” — one-day events staged in towns and villages throughout the state of Tamil Nadu to generate large numbers of surgical patients, busing them into the nearest hospital in the Aravind system.

Dr. V’s daily journal, assiduously updated throughout his days at Aravind, reflects the breadth and depth of the questions he never stopped asking. For example, “How was Buddha able to organize in those days a religion that millions follow[?] . . . How did the disciples of Christ spread their mission around the world[?]” Yet Dr. V also frequently spoke of his dream to bring efficiency, consistency, and low cost to eye surgery the way McDonald’s did to hamburgers. Aravind remains today a pure expression of the vision and the spirit of unending inquiry that he brought to the venture from the outset.


Filed under Business, Nonfiction

Third World development: A reading list

To my mind, the emergence of new nations out of a colonial past was one of the most significant developments of the 20th Century, and their uneven struggle to attain the comforts and possibilities of life to be found in Europe, North America, and Japan continues to loom large in the 21st Century. As a consequence, a fair proportion of my reading bears on these issues.

Much of what is written about development in what is variously called the Third World, the Global South, the under-developed countries, or the developing nations is self-serving and less than useful as a guide to understanding the true issues involved. The underlying reality is that since World War II the countries of the “West” have invested a total of nearly $2.5 trillion in “foreign aid” (as it’s popularly known in the USA) or “overseas development assistance” (as it’s termed elsewhere). You might think that investments of that magnitude would have produced dramatic improvements in the quality of life for the billions of people who live in poverty. However, the truth is appalling: there is precious little to show for this outpouring of aid other than the most obvious advances in education and public health.

Here are some of the books I’ve read in recent years that cast light on this reality. Some of them directly address the issues surrounding foreign aid. Others illuminate the backdrop to those issues. But I don’t pretend this list is comprehensive in any way. It’s simply a starting-point. I’ve listed these books in alphabetical order by the authors’ surnames.

Bornstein, David, How to Change the World: Social Entrepreneurs and the Power of New Ideas. Oxford University Press, 2007. Much of the social change taking place today in the world’s poorest countries is a result of the work of the venturesome folks called “social entrepreneurs” — and Ashoka, the USA-based organization that supports them by the thousands. This box profiles nine of the better-known Ashoka Fellows, demonstrating the role of local leadership in making the world a better place.

——, The Price of a Dream: The Story of the Grameen Bank. Oxford University Press, 2005. Muhammad Yunus gained global fame when he won the Nobel Peace Prize in 2006, but the story of his decades of dogged efforts in Bangladesh — and of the immense organization he built — is much less well know. This book demonstrates how home-grown solutions to development programs are often superior to anything imposed on developing countries by the international community.

Clark, Gregory, A Farewell to Alms: A Brief Economic History of the World. Princeton University Press, 2007. Clark puts the question of economic development in historical perspective, dispelling long-popular myths about the supremacy of the West.

Diamond, Jared, Collapse: How Societies Choose to Fail or Succeed. Viking, 2005. A fascinating exploration of the historical influence of environmental factors in the failure of “developing countries” — and a sobering perspective on the prospects for development breakthroughs in much of today’s overpopulated world.

Easterly, William, The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good. Penguin Press, 2006. This is the best book that tackles the issue head-on and makes the clearest case for an explanation.

Guha, Ramachandra, India After Gandhi: The History of the World’s Largest Democracy. HarperCollins Publishers, 2007. In global perspective, the greatest challenges to narrowing the inequities among nations lie in sub-Saharan Africa and India. This history of the subcontinent after independence helps to convey the complexity of the issues faced by change agents in the world’s second most populous nation.

Hochschild, Adam, King Leopold’s Ghost: A Story of Greed, Terror, and Heroism in Colonial Africa. (Houghton Mifflin Company, Boston and New York, 1998). The most dramatic portrayal of the legacy of colonialism I’ve ever read.

Kamkwamba, William, and Bryan Mealer, The Boy Who Harnessed the Wind: Creating Currents of Electricity and Hope. HarperCollins Publishers, 2009. The astonishing story of a brilliant, self-taught young man who demonstrated the vast potential that underdevelopment leaves behind.

Kristof, Nicholas D., and Sheryl WuDunn, Half the Sky: Turning Oppression Into Opportunity for Women Worldwide. Knopf, 2009. It is impossible to tackle the issue of economic and social development without considering the central role of women: it’s become a truism in the field that the education and empowerment of women is the surest first step toward meaningful social change. Nick Kristof, a long-time New York Times columnist, is one of the world’s most incisive observers of the daily reality lived by people in the Third World. Previously, Kristof and WuDunn reported jointly from China for the Times.

Mehta, Pavithra, and Suchitra Shenoy, Infinite Vision: How Aravind Became the World’s Greatest Business Case for Compassion. Berrett-Koehler Publishers, 2011. The Aravind Eye Care System, based in the South Indian state of Tamil Nadu, has had an outsized influence on the treatment of eye disease throughout the world. Pavithra Mehta, a grand-niece of Aravind’s founder, tells the astonishing story of this extraordinary institution, illustrating the potential for indigenous development that shuns outside support.

Prahalad, C. K., The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits. Pearson Prentice Hall, 2004. In this paean to the multinational corporations of the world, the late C. K. Prahalad, one of the most celebrated management consultants of recent times, presents a host of case studies about the potential of business to foster development while increasing profits. Although the general proposition seems shaky to me, some of the case studies are impressive and thought-provoking.

Sachs, Jeffrey D., The End of Poverty: Economic Possibilities for Our Time. Penguin Press, 2005. Here is the cheerleader’s polyannish case for large-scale development assistance. Useful as a counterpoint to Bill Easterly’s White Man’s Burden, which far better reflects my own experience in developing countries.

Sullivan, Nicholas P., You Can Hear Me Now: How Microloans and Cell Phones Are Connecting the World’s Poor to the Global Economy. Jossey-Bass Publishers, 2007. Grameen Telecom is much less well known that the grassroots bank that spawned it. This intriguing story is a great case study of the long-familiar “leapfrog effect” that allows underdeveloped countries to advance rapidly by skipping over the use of technologies long dominant in the West.

Wrong, Michaela, It’s Our Turn to Eat: The Story of a Kenyan Whistle-Blower. HarperCollins Publishers, 2006. No consideration of Third World development is complete without taking official corruption into account. This story, which focuses on one courageous Kenyan man who tried to expose corruption, brings to light some of the complications it poses.


Filed under Commentaries, FAQs & Commentaries