A 15-Year Journey: What we’ve learned and where we’re going

Fifteen years ago, I was part of a small team led by David de Ferranti that decided to form a new organization dedicated to generating knowledge about how to do development better … and getting that knowledge into practice.

David thought I would be a good addition to Results for Development because of my work as senior health advisor to the Mayor of Washington, DC. I had been working to build a more equitable health system so that all residents could access high-quality, affordable health care — and leaders around the world had the same ambition with similar challenges.

Now, 15 years later, I’m reflecting on R4D’s journey to date — what we’ve learned and achieved — and charting our path forward for the next 15 years.

What we’ve learned

With no initial starter funding, we had to be nimble and opportunistic. But we always aspired to work at the nexus of thinking and doing, enabling leaders in low- and middle-income countries to put knowledge and ideas into practice.

From the very beginning, R4D excelled at co-creating programs with country-based partners and funders. For example, R4D, alongside the Rockefeller Foundation and leaders from low- and middle-income countries around the world, contributed to getting the goal of universal health coverage on the agenda globally (previously many global health initiatives had focused on specific diseases). Together, R4D and our partners led important research about how LMICs were moving toward universal health coverage and promoted health for all as a global aspiration. This collaborative effort led to the launch of the Joint Learning Network for Universal Health Coverage (the JLN) — a global network of policymakers and practitioners that work together to engage in peer-to-peer learning and address common challenges. The JLN still exists today and has grown from 6 member countries in 2010 to 36 countries in 2023.

These early successes fueled our growth. We began to support specific countries with their health system reforms. And we launched programs in global education and nutrition, including seminal work on advancing promising innovations in education and mobilizing global resources for nutrition. In our early years, we also experimented with what later became hallmark approaches, such as scaling innovation, market shaping, collaborative learning, and evaluation and adaptive learning.

After a successful start-up phase, in 2017 R4D underwent a strategy process that led to our current mission — to support change agents to build strong systems for healthy, educated people. We clarified our focus on the three key and interconnected human development sectors of health, education and nutrition, and our emphasis on locally-led, sustainable systems-change.

Through it all, we have remained entrepreneurial and committed to continuous learning. Here are a few of the lessons on how to do development differently that we’ve internalized along the way:

1. Be clear about who you are working for.

In the mission statement we adopted in 2017, we emphasized that our primary clients are change agents — government officials, private sector innovators, and civil society leaders — who are working to build strong systems for health, education and nutrition in low- and middle-income countries around the world. We made the intentional decision to put change agents at the center of everything we do.

2. Seek clarity on what they want from you.

After we adopted our new mission, we gave a lot of thought to how we support change agents. We asked them: What do you need? And what do you not need? Reflecting on their responses, we grappled with the question: What are the right roles for global organizations — especially, if our goal is to foster local leadership and strengthen local institutions? Here is what our country partners said they want from us:

• Sharing of knowledge and expertise. Country leaders want to access global experts, the latest evidence about what works, and to participate in cross-country learning. R4D’s global team of staff and fellows is responsive to country priorities, and our global networks and learning platforms generate practical knowledge about how to improve systems, while also supporting practitioners to apply what they learn.
• Support for country-led change. Change agents know that spearheading systemic change is an inherently political process — to be successful, it must be responsive to local challenges and priorities, it must include diverse stakeholder input, and solutions must be tested in an iterative way. R4D and our partners support change agents to navigate these change processes and co-create solutions that work. Our approach emphasizes coaching and building capacity along the way, to enable local experts and institutions to continuously improve for future change processes.

3. Be more than just a project implementer.

By virtue of how global development is funded (discrete, timebound projects from many different funders) the space is highly fragmented, and often driven by the priorities of donor organizations. To be truly impactful — beyond the project — organizations must:

• Provide continuous, cohesive support to country leaders. Systemic, large-scale change can take 5-10 years or more and yet many donor projects are only funded for 2-5 years. Often, just as local leaders have generated evidence about what works and are ready to adapt plans and/or scale up, donor funding ends. At R4D, we believe it’s critical to do more than simply execute a project plan and move onto the next project. We proactively work to provide cohesive support across various funders and over time — convening diverse actors working on a similar issue to coordinate action and strengthening the capacity of local partners and change agents to continue working on an issue after project funding ends.
• Foster local and regional ecosystems of expertise. Each country where global development projects are being implemented has a pre-existing ecosystem of experts and institutions that bring not only their expertise, but also a deep understanding of the culture, the context — and importantly, what’s been tried before. To achieve lasting impact, it’s crucial to work collaboratively across local, regional and global ecosystems. At R4D, we invest heavily in our relationships with our local partners — creating mutually supportive partnerships and working together to generate positive outcomes for local leaders. And our staff come from and contribute to local, regional, and global ecosystems and facilitate connections across them.
• Facilitate connections across development partners. Although every donor has its own priorities, they all want to maximize their investments and leverage investments being made by others in the field. R4D has been successful at building and maintaining relationships with a very diverse set of institutional funders, including bilateral aid agencies, foundations, multilateral UN agencies, and global partnerships, and strives to support these development partners to achieve more by working synergistically.

We’ve learned a lot along the way, and we aim to continuously consolidate and institutionalize these lessons to deepen and amplify our results.  We also feel compelled to share our lessons so we can support the positive development of our field, just as we eagerly learn from our peers. Our learning journey is far from over, and I am personally motivated by the lessons yet to come.

What we’ve achieved

Back in 2008, we decided to name ourselves Results for Development. And we’re often asked: What are your results?

We are an organization that catalyzes system-level change by working with and through local actors. We support change agents with their priorities and goals, including improving access to high-quality, affordable health care, improving educational opportunities for children, and reducing malnutrition. So our results are multiple, varied, and often indirect – and they can’t be translated into a tidy indicator.

Here’s just one recent example of results we are very excited about. We’ve supported locally-led change by working with the government of Tanzania to significantly increase access to amoxicillin dispersible tablets, a lifesaving treatment for child pneumonia. And we have evidence that suggests this effort has contributed to a significant decrease in deaths among children under 5. We believe these results will be sustainable because we partnered with, and strengthened the capacity of local agencies to effectively procure and distribute the treatment — and we helped them to channel their own domestic financial resources to purchase it, so they are no longer reliant on outside donors.

For more examples like this one, check out our impact page, which we continually update to reflect what R4D and our partners are achieving and — importantly — what we’re learning.

Meanwhile, we are very proud that over the course of our 15 years:

• We’ve facilitated locally led change and strengthened systems in 19 countries by supporting country leaders to strengthen whole systems for long-term impact.
• We’ve pioneered new thinking and gotten evidence into practice on 15 topics (ranging from integrating nutrition into health systems to improving the impact of EdTech on learning) collaborating with local leaders to generate evidence about what works then supporting their use of that evidence.
• We’ve helped to build 26 networks that connect implementers to learn from each other and get those lessons into practice in their own countries.

We recently launched a new Learning & Results Initiative focused on further understanding and measuring how the efforts summarized above are contributing to sustainable impact in the complex environments where we work. We’re excited about where this initiative is headed and look forward to sharing more in the future.

Where we are going next

R4D is in its teenage years. As the mother of two teenagers, I understand that teens have changed a LOT from the time they were born, but they still have some growing up to do.

From our roots as a small, mostly-DC based organization, R4D now has 6 country entities (Ethiopia, Ghana, Nigeria, Tanzania, UK and US), 180 staff across 11 countries, with dozens of government and NGO partners around the world, and relationships with more than 30 institutional funders of all types. And, for the first time, we surpassed $50 million in annual revenues last year.

But we are still evolving. And we are grateful to be evolving at a moment when the field around us is also shifting rapidly, so we can redirect ourselves to meet the needs of the future.

We have set a vision to become a truly global — and globally-connected — international organization that plays the role of connector, facilitator, coach, and learning partner across countries, regions, and the globe. To achieve this vision, we are transforming our internal structures, systems, staffing and culture.

And we are actively working alongside many peer organizations to combat inequities, power imbalances and racism in the field of global development. One way we do this is by supporting priorities and processes driven by local change agents — and working with and through local and regional experts and organizations. We are deeply invested in supporting the ecosystem of local and regional institutions that are well-positioned to help their governments continuously improve and address new challenges in the long run. We believe this is the best path to strengthen the systems that will make health, education and nutrition outcomes more equitable across the globe.

The past 15 years has most definitely been a learning journey. And the journey continues.