What Does “Long-Term Commitment” Really Mean?

The modern global enterprise is networked for the long haul

By Karl Hofmann, President and CEO of Population Services International  

The New York Times’ op-ed columnist Nicholas Kristof used to christen every year “the best year ever” for most of the world’s population. Kristof used to be right.  

Afterall, reductions in global extreme poverty, progress against disease – these have been steady truths for many years. Until COVID-19.  

The pandemic has stalled development. Adding to natural disasters – COVID-19 and the Haiti earthquake, for example – 2021 has also featured man-made disasters: Afghanistan, and Myanmar come to mind. 

As global development organizations partner with countries to confront these crises, many are also wrestling with democratizing development, decolonizing global health, and generally reexamining the effectiveness of international NGOs.  

Are we doing a good enough job? 

At Population Services International (PSI), we’re focused on this fundamental question and these underlying critical issues, and have been for years. PSI operates under a set of values, one of which is: “Long-Term Commitment to the People we Serve.” This value calls us to consider our relevance to our health consumers today, as well as 25 years from now. Led by our Board of Directors, PSI has expanded our self-inquiry to examine the advantages and gaps in our operating model—our global network of national NGOs, PSI corporate branch offices and PSI commercial entities. 

Philanthropists Jeffrey Walker and English Sall have recently written in the Stanford Social Innovation Review about the concept of “locally directed, network supported.” Specifically, they touch upon how this approach has helped U.S. domestic social progress efforts gain better scale and resiliency. We see parallels here to our own approach in the international context.  

We want to play our part in rebalancing power, from donors and funders to consumers in the markets where we work. We must ensure our global network responds to the expectations of ALL our stakeholders: host governments, health markets, our health consumers, our funders and our global staff of 5,500 people.  We aim to be “locally led; globally connected.” 

Instead of an “international NGO,” we’re working to be the Modern Global Enterprise that meets those stakeholders’ needs. Our vision for this network model over the next 25 years rests on four key pillars: 

  1. A global and holistic view of our talent.  

We employ people in many different jurisdictions with many different labor rules—yet we strive for an environment in which all are members of a global talent network that represents diversity, connectedness, and inclusion. We’ve committed to meeting certain diversity objectives by 2025, including a global leadership cadre comprised of 50 percent under-represented gender identities and 50 percent under-represented groups. We are surpassing the objective for gender identities, and our current country leadership staff far exceeds the goal for underrepresented groups (currently standing at 62 percent), but overall, we still have a way to go. Meanwhile, like the best of the transnational private sector value creators, through our “Work from Almost Anywhere” philosophy we hire talent where they reside. Our global office in Nairobi housing most of our digital health work is a concrete example. That’s how modern global enterprises succeed. 

  1. Constantly testing and adapting our approaches.  

We are not the PSI of 1990. Our work has evolved as our stakeholders’ needs have evolved. PSI is known for large-scale product and service delivery, using social marketing channels and the supply chain experience we’ve built over 50 years, for example as one of the largest providers of contraception and one of the largest distributors of insecticide-treated mosquito nets in the world. Now, national forces largely lead these efforts and PSI is called on to respond to different market gaps or to contribute in different ways. Our “Strengthening Consumer Powered Healthcare” strategy calls us to help speed the growth of other, diverse actors into the space we use to dominate and, by extension, inspire locally-led innovation that can be taken to scale. To do so, we work closely with national governments to steward their health markets as they drive toward Universal Health Coverage.  

  1. Adapting our institutional structure. 

A modern global enterprise should stand for certain things in the marketplace; in our case, we want to be known for quality, standards, cost-effectiveness, efficiency, measurable impact, and knowing the consumer.  But how we achieve those things shifts constantly over time. PSI has been the proud founder or co-founder of multiple global health institutions that now operate independently from us, and with which we are proud to partner. These include the Society for Family Health in Nigeria, Population Services Kenya, and the Social Marketing Company of Bangladesh, among others. Having helped to establish them, we now learn from them. In the case of Greenstar Social Marketing (Pakistan), Ltd., PSI has been a partner since co-founding it, although Greenstar has always been independent.  

But the institutional evolution of PSI’s global network is not unidirectional.  

In some cases, to protect some of the hardest and most sensitive aspects of our work – when the people we serve and the health workers supporting them are both dealing with unjust discrimination and risk —PSI has moved from local NGO implementation to a branch office structure, because sometimes it is better to house this work under the protective umbrella of a US-based organization. This is the case with HIV prevention work involving men who have sex with men, and also with women seeking safe abortion services where politics sharply curtail their access. A modern global enterprise must mitigate the risks to its work from all sources, which may include host country stigma as well as punitive US Government policy shifts. 

  1. Embracing sustainability of impact, as well as finances. 

The needs of PSI’s health consumers will certainly shift over time, but they will not disappear. A modern global enterprise needs to chart a pathway to sustainability that involves more independence of action, and less reliance on the agendas of outsiders. Let our health consumers guide our work! Let host governments dictate priorities to advance UHC! Yes, we are a non-profit that sells things—for many years with heavy subsidy from donors, as part of a social marketing approach to health challenges. But increasingly, as some donors abandon this approach, we are faced with the question of how to sustain our impact. Because the needs persist. Already, PSI’s third largest source of funding is Sara, our archetypical health consumer in the markets where we work.  Increasingly, we are working directly for her. 

Our Social Business Unit pays taxes in the countries where we operate, as we accompany the consumer who we’ve spent decades coming to know, but for whom available donor subsidy is no longer enough to meet her needs. A modern global enterprise in our space will increasingly see financing as a blend of sources: traditional donors, new socially motivated impact investors, host governments contracting for service, and direct-to-consumer marketing and sales. 

Is today’s PSI global network meeting these and other aspirational aspects of a modern global enterprise? Not yet – we still have a long way to go to achieve the more perfect network that we seek. Governance challenges are real, our global talent journey is incomplete, our finances are still heavily donor-dependent, and the power imbalances inherent to our work remain vibrant. The focus on these issues by our Board and staff will help ensure PSI continues to meet the health needs of ALL our stakeholders 25 years from now – and beyond. 

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