Ruth Levine, director of the Global Development and Population program at the William and Flora Hewlett Foundation, will leave her position at the end of May, as her term-limited eight-year tenure comes to an end. How has the program evolved under Levine’s leadership, and what does her exit mean for its future? These questions have wider implications for global development philanthropy, given that Hewlett is one of the top U.S. funders working in this space—awarding $106 million for its global initiatives in 2018 alone.
Levine came to Hewlett in 2011 from the U.S. Agency for International Development, where she served as deputy assistant administrator in the Bureau of Policy, Planning and Learning, and notably led the creation of the agency’s evaluation policy. Prior to USAID, she spent nearly a decade at the Center for Global Development as a senior fellow and vice president for programs and operations, shaping the center’s approach to global poverty and inequality. Although Levine was the consummate D.C. policy wonk, she decided to leave it behind (even during the liberal glory days of the Obama administration) and enter the new frontier of west coast philanthropy.
Hewlett initiated its global development program in 2004. In its early days, it focused on reforming international trade rules, especially in agriculture, as well as improving learning outcomes in Africa. The 2008 financial crisis—and its impact on the endowment—spurred a re-prioritization of goals, resulting in the closure of its trade and agriculture grantmaking. In 2011, when Levine arrived at Hewlett, the Global Development program merged with the foundation’s Population program in order to facilitate greater collaboration. The integrated Global Development and Population program created a new strategic framework encompassing two primary lines of work: Women's Choices, which focuses on reproductive and economic choices, and Citizen Voices, which addresses citizen-led efforts to improve access to basic services.
A Key Funder on Reproductive Health
Hewlett’s work on reproductive health dates back to the 1960s, reflecting William and Flora Hewlett’s strong belief that all women should have access to contraception and safe abortions. But under Levine’s leadership, the foundation embraced a more ambitious agenda on gender. It now aims to “expand women’s choices about whether and when to have children and how to earn a living,” focusing on East and West Africa, especially Francophone West Africa.
One of Hewlett’s core goals is to ensure that no woman has an unwanted pregnancy or dies from an unsafe abortion. Francophone West Africa and East Africa are the geographic focus, because in these regions, “progress on family planning and reproductive health has been slow or stalled,” according to the foundation. The strategy explicitly targets two critical groups: poor rural women and young women.
In recent years, the program has pursued some innovative approaches, such as interventions rooted in behavioral economics and design thinking. One example is its support for a recent partnership between the nonprofit IDEO.org and Marie Stopes International to use human-centered design thinking to help young women learn about and access contraception in Zambia and Kenya. The result was the Future Fab model in Kenya and Divine Diva in Zambia. In the Future Fab approach, “Diva Connectors” encourage young men and women to attend events with music, talent competitions and fashion, and find innovative ways to talk to Kenyan teens, community members and healthcare providers about contraception. In Francophone West Africa, Hewlett has supported the Ouagadougou Partnership—a group of nine Francophone governments, joined by public and private donors, promoting collaboration in the reproductive health sector.
Even as the U.N. predicts that global population will rise to 9.8 billion by 2050, with much of the growth concentrated in Africa, Hewlett is among only a small handful of major private funders of women’s reproductive health interventions, along with the Gates Foundation and Susan Thompson Buffett Foundation. During Levine’s tenure from 2011 to 2019, Hewlett disbursed $337 million in its Choices program, directing most of these funds to reproductive work. Top grantees include international NGOs such as Marie Stopes International ($18.5 million) and Ipas ($17.5 million), as well as the Nairobi-based African Population and Health Research Center, with grants of $9.5 million.
Hewlett’s long-term investment in this sector seems to be producing results, although progress is slow when it comes to high-level impact. According to program officer Margot Fahnestock, a recent evaluation of the Divine Diva and Future Fab interventions showed that in Zambia, the percentage of 15- to 19-year-olds using Marie Stopes services rose from 7 to 12 percent. In Kenya, the total number of contraception services provided to adolescents increased from 225 to over 1000. Some recent data from the Ouagadougou Partnership shows that in 2016, there were 4.7 million women using modern contraceptive methods in the nine Francophone countries, an increase of 1.3 million since 2011.
When it comes to the larger battle to slow Africa’s rapid population growth, the picture is more mixed. On the one hand, in many countries where Hewlett is engaged, there has been significant long-term progress in lowering the rate of unmet need for contraception. For example, according to World Bank data, in Kenya, the rate decreased from 38 percent in 1988 to 15.6 percent in 2016; in Zambia, it decreased from 30 percent in 1992 to 21 percent in 2013.
But on the other hand, the total fertility rate has been slow to decline in Africa, because of both unmet need and the fact that women still prefer to have many children. According to the 2017 Revision of the U.N.’s World Population Prospects, the total fertility rate in Africa has only fallen from 5.1 births per woman in 2000-2005 to 4.7 in 2010-2015. For the nine Ouagadougou Partnership countries, the rates range from a low of 4.69 (Togo) to a high of 7.4 (Niger).
Many expert demographers, including these authors, have concluded that the overall pace of fertility decline in Africa is slower than both Asia and Latin America in the 1970s, when those regions were at the same early to middle stages of the fertility transition. For Levine, these statistics reflect the reality that “both of these agendas—responding to unmet need [for contraception] and creating a wider range of options for women’s futures—are long-term, and we’re working on both, and are likely to continue to work on both.”
Embracing Women’s Economic Empowerment
Levine’s biggest contribution to shaping Hewlett’s global grantmaking was to move the foundation into the still-emerging field of women’s economic empowerment in 2015. She said in an interview that adding this component to the foundation’s work was “the next logical step” toward an “expanded understanding of choice and agency.” In a blog post at the time, Hewlett President Larry Kramer wrote that the new initiative channeled the foundation’s “oldest, strongest, and most enduring priorities,” which included helping women “gain control over crucial decisions in their lives.”
In taking on women’s economic empowerment, Hewlett joined a growing number of private and government funders that have come to see gender equity as a key—if not the key—to faster global development. What makes the program unique is that it is not focused on traditional issues such as microfinance and vocational training. Instead, its goals are more macroeconomic, such as finding new ways to measure women’s contributions to the economy, promoting analyses and models that examine the gender-specific impacts of economic policies, and influencing global economic norms and their application to sub-Saharan Africa.
In rolling out the new effort in 2015, Hewlett said that it aimed to fill a vast void in knowledge about women and the economies of the developing world. “We know little about the economic activities of poor women in low- and middle-income countries. We know even less about unpaid care and other household activities that, while not market-based, make an economic contribution.”
Hewlett has given millions in grants to develop better data in these areas over the past four years, but it has also backed advocacy to advance women’s economic empowerment. One of the foundation’s top grantees for this work, the U.K.-based WIEGO, describes itself as a “global action-research-policy network that seeks to improve the status of the working poor, especially women in the informal economy.” Another economic empowerment grantee is the Accra-based African Women’s Development Fund, which was awarded $1 million in 2017 to re-grant to African women’s grassroots organizations focused on economic security and justice. Hewlett has also supported Development Alternatives With Women for a New Era, or DAWN, to build a “feminist activist African network.”
While Hewlett’s grantmaking for women’s empowerment is still at a relatively early stage, Levine said she was encouraged by shifts in the approach of powerful economic institutions to gender-specific data. “We’ve seen a substantial increase over the past few years in the attention given to the problem of invisibility of women in economic statistics that are used for planning and policymaking,” Levine said. For example, the World Bank and the International Labor Organization are close to finalizing methods to measure unpaid work and subsistence agriculture.
The Push for Transparency and Accountability
Hewlett has long been known for its major role in supporting reproductive health around the world, and in recent years, Levine has been an important player in the growing community of funders and NGOs focused on women’s economic empowerment—an issue she’s clearly passionate about. In fact, though, the other branch of Hewlett’s global work, the Citizen Voices program, has commanded a larger share of grant dollars over the past eight years—around $447 million. This work now incorporates two distinct components: one focused on transparency and accountability, which dates back to the beginning of the Global Development program in 2004, and another strand on evidence-informed policy, which was created in 2013.
The transparency and accountability grantmaking aims to address the challenge that is basically encapsulated in the ambitious Sustainable Development 2030 agenda: In many low- and middle-income countries, large swaths of the population, especially the poorest, do not have access to quality healthcare, education, sanitation, water, and other public services.
Hewlett is part of a network of funders that has been instrumental in fueling the rise of a global movement that aims to address these service delivery problems by pushing for transparency and accountability in the receipt and use of government revenues in such countries, especially those dependent on extractive industries. The foundation has worked closely with a consortium called the Transparency and Accountability Initiative, which also includes the Open Society Foundations, Luminate, the MacArthur Foundation, Ford, as well as the United Kingdom’s Department for International Development (DFID). Over the years, this collective has seeded several major global data transparency initiatives, such as the Extractive Industries Transparency Initiative (EITI), Open Government Partnership, and the International Budget Partnership.
Despite all the funding muscle behind this work, it’s been rough going. In 2015, Hewlett conceded in a strategy shift that “the promise of work on transparency has not yet been realized in significant improvements in service delivery.” This failure reflects weaknesses in the movement’s initial theory of change. In its early days, the movement’s main focus was transparency—often with respect to very technical data, such as financial reports issued under EITI—with no clear theory of change about how civil society or citizens would even understand this information, let alone use it to hold governments accountable and improve access to basic services.
Hewlett’s updated main strategy—along with three accompanying sub-strategies released in 2018 on fiscal transparency, governance and service delivery—acknowledged these limitations and called for greater focus on helping citizen groups use this information to organize and “engage meaningfully” with government—a shift reflected in the program’s new name: “transparency, participation, and accountability.” The regional focus is Mexico and West Africa.
Drilling down into these sub-strategies, the program now distinguishes between the “short route” to accountability, or social accountability, and the “long route,” which is political accountability. This distinction comes from the intellectual inspiration for the movement—the World Bank’s 2004 World Development Report (WDR), subtitled “Making Services Work For Poor People.” That report articulated a general theory for improving service delivery to the poor by “strengthening accountability,” through both the “short route,” namely increasing citizens’ monitoring and influence over frontline service providers (health clinics and schools) or the “long route,” which involves increasing citizens’ power over politicians and policymakers, presumably through elections, who then change the behavior of the frontline providers.
The governance and service delivery sub-strategies say the foundation is focusing on both types. Toward social accountability, it is funding advocacy, civil society monitoring, and participatory budgeting; toward political accountability, it is supporting approaches such as journalism and the use of freedom of information laws.
From 2011 to 2019, top grantees for Hewlett’s Citizen Voices work have included the Canadian government’s International Development Research Center ($36.5 million), the Center for Global Development ($17.6 million), the Natural Resources Governance Institute ($14.6 million), and the International Initiative for Impact Evaluation ($17.8 million). An Accra-based organization—the African Center for Economic Transformation—also made the top 10, with grants totaling $9.4 million.
A Questionable Theory of Change
Given the huge sums of money that stakeholders have sunk into this agenda, Hewlett’s Citizen Voices program—as well as the larger movement it’s part of—warrant some serious scrutiny at this point. When I asked Levine about evidence of success since the 2015 revamp, she said that the trends were “not very encouraging in some places,” and suggested this was due to closing space for civil society in many of the countries they worked in. Although this may be true in certain cases, the real problem is the strategy itself, and gaps in theory and evidence that the 2015 revisions failed to address.
First, this agenda was never—and is still not—based on a historically informed analysis of the actual causes of service delivery gaps in specific low- and middle-income countries. The movement implies that the main cause of inadequate service delivery to the poor is government corruption, although often it does not explicitly say it, and it rarely provides concrete evidence about the link to service delivery.
For example, the 2004 WDR asserted that the main cause of inadequate service delivery to the poor was government corruption, without actually providing persuasive empirical evidence. Although it noted that a survey of a primary healthcare facility in Bangladesh found a doctor absentee rate of 74 percent, it provided neither context nor analysis to explain the reasons that workers were not showing up. It simply assumed some form of corruption. For all the discussion of teacher or healthcare worker absenteeism in various studies cited by researchers associated with the movement, I have yet to see a reference to a survey or case study in which they actually asked people why they didn’t show up to work.
Practitioners and activists have an “action bias,” and often race ahead of both theory and evidence—in this case building a global movement on an untested theory that government corruption is the main cause of service delivery failures in all low- and middle-income countries. While this may be the reason in specific places and times, as this 2018 investigative New York Times article on corruption at a primary school in Mpumalanga, South Africa makes clear, the precise nature of the phenomenon needs to be described and proven, rather than merely asserted. Without a nuanced causal analysis, as former Carnegie Endowment fellow Sarah Chayes noted, “many attempted remedies prove ill-adapted to local realities and achieve little.”
The complicated reality is that, as Levine herself said in an interview, there are many possible reasons for the failure of governments to deliver quality services to citizens, and corruption is just one of them. In many countries in sub-Saharan Africa, where liberalizing governments adopted decentralization reforms in the 1990s, local governments are primarily responsible for the delivery of basic services such as health, education, and water and sanitation.
But these local governments had to be created from scratch, and in the rural areas, where the data clearly shows that access to services is the worst, this challenge was made even more daunting by the phenomenon the Africanist Mahmood Mamdani describes in his path-breaking book, “Citizen and Subject.” He documents the remnants of a form of late colonial governance in rural areas, which he called “decentralized despotism.” It relied on tribal and customary power and the reproduction of ethnic identities.
This recent study of the post-Apartheid state’s delivery of “built” public services to the black majority argues that the failures in the former rural “homelands” are mainly a result of the fact that local governments in these areas had to be created from scratch, and overcoming this deficit of technical and administrative capacity is a gargantuan task. Building capable local governments in rural areas while at the same time confronting the institutional legacy of customary despotism remains the paradigmatic challenge to achieving meaningful democratic and development outcomes in sub-Saharan Africa.
Moreover, building government capacity, especially at the local level, requires a completely different set of solutions than the transparency and accountability movement is prescribing. The movement’s preferred agent of change—civil society, which, after all, is concentrated in urban areas—may actually be marginal, if not irrelevant, to solving this problem. Perhaps the focus needs to shift from civil society to investing in civil servants, especially at the rural local government level.
The flawed approach of the transparency and accountability movement is hardly news at this point. By 2015, the bulk of the impact evaluation evidence suggested that social accountability interventions—in which civil society and citizens directly monitor service providers—have not improved service delivery outcomes. The studies cited in the main text of Hewlett’s own strategy documents are pretty consistent about the limited evidence base, such as these contributions by Johanna Speer in 2012 and Boydell and Keesbury in 2014.
The most promising evidence to date was from a landmark randomized control trial in Uganda by researchers Martina Bjorkman and Jacob Svensson, published in 2009 as “Power to the People,” which found that providing community members with information about the quality of services provided at public health clinics reduced absenteeism, increased utilization, and significantly reduced under-five mortality rates within one year. However, a still unpublished 2018 paper commissioned by Innovations for Poverty Action, which evaluated a similar intervention in Uganda implemented on a much larger scale, found no effect on utilization rates or health outcomes, including child mortality.
Even researchers at the World Bank, in this 2016 report, have now revised their assessment of the 2004 WDR, and argue that the focus on social accountability was misguided because it popularized the idea that politics could be bypassed. The 2016 revision argues that the movement’s focus should shift to the “long route” of political accountability and altering the incentives of political leaders, not only through voting and elections, but also through internal government accountability mechanisms, such as checks and balances and robust audit institutions.
Although the governance sub-strategy suggests Hewlett will address political accountability, it limits its focus to tools such as journalism, digital media and community radio that can “influence governance beyond the ballot box.” But here lies the conundrum: Real political accountability obviously requires a focus on voting and elections, and the types of mass-based organizations that are not professionalized civil society groups—such as political parties, especially opposition parties, and mass movements such as trade unions and other types of social movements.
Hewlett staff may already be rethinking the strategy. In a recent blog post, Levine wrote that her work with WIEGO has taught her the necessity of collaborating with social movements to achieve lasting change. Although the current governance sub-strategy explicitly says it will not fund social movements, perhaps this could change in the future. Hewlett has supported WIEGO, an organization that represents the interests of informal workers, with more than $10 million in grants in recent years, and Levine told me she could imagine Hewlett supporting formal workers’ organizations in the future.
Levine’s articulates one of the arguments for collaborating more closely with social movements: “The identification of what’s wrong must come from those who are experiencing those wrongs,” she said. This is an important statement, especially considering that the transparency and accountability movement never really gave local movements or actors the opportunity to frame and define the core problems in service delivery. Instead, the agenda was pre-defined by external actors in New York, D.C., and London, who—however well-intentioned—had little experience in and knowledge of local contexts, especially in sub-Saharan Africa. This agenda reflected a liberal, Global North bias in favor of the power of data and technology to solve problems, without grasping the complexity of the problems themselves from the perspective of the primary stakeholders.
Perhaps these concerns were at least partly behind the 2013 creation of the other component of Citizen Voices on Evidence-Informed Policymaking, which, according to the 2018 strategy, aims to help “governments systematically use evidence to improve social and economic policies.” The strategy notes that evidence—especially locally sourced evidence—should play a greater role in agenda setting and policy formulation, given increasing skepticism about “cookie-cutter” programs imported from outside experts.
Localizing Global Development Philanthropy
Although Hewlett’s Global Development program has yet to fund local social and mass movements, Levine has attempted to shift more resources directly to local or regionally based civil society organizations. Her 2014 memorandum describes the program’s shift from general support for U.S.-based organizations to grants for in-country chapters (of international NGOs) and/or local NGOs.
“When I worked in D.C., I thought the epicenter of global development was in D.C.,” Levine told me. “But once I came out here and had more distance—physical and psychological—I was able to widen the aperture and have conversations about where global development really needed to go in the future. I started to see that future actions really should be in the hands of in-country decision-makers, both local civil society and government. The ultimate goal is building the capacity of in-country governments and organizations to respond to the needs of citizens,” Levine said.
In 2011, Hewlett gave only a small percentage of global development grants directly to foreign NGOs; now, it gives about 24 percent of grants and 15 percent of total funding to in-country organizations, according to Levine.
What’s Next for Hewlett’s Global Work?
As Levine hands over the reins, what could be next for the foundation’s Global Development Program? “For Hewlett, there is always a balance between continuity and evolution,” Levine says. But one thing is pretty certain—Hewlett will remain committed to family planning issues. “This has been a part of the agenda since the beginning, and there is virtually no chance that this will be abandoned.”
One interesting development is that in 2018, Hewlett allocated $10 million to an exploratory program called Beyond Neoliberalism, which will explore “new ways to think about political economy and the terms for a new 21st century social contract.” While this work remains in a nascent stage, the newfound willingness of major philanthropies such as Hewlett (as well as the Omidyar Network) to take on fundamental issues of global political economy and the future of capitalism represents a watershed moment.
Among other things, serious rethinking of market fundamentalism would reshape development theory and practice. As the brilliant political economist Colin Leys understood, whatever theory of global capitalism is embraced by powerful Northern governments ultimately determines the goals and scope of what we call “development.”
At this point, Hewlett’s transparency and accountability program may have an interest in reflecting on its own unacknowledged ideological commitments. With its focus on government corruption, this agenda was based on a highly ideological, anti-state, research agenda instigated by the World Bank. Although this movement hasn’t succeeded in improving service delivery to the poor, it has created a global network of progressive activists articulating an idea that fits into what the French theorist Michel Foucault called, in his lectures on The Birth of Biopolitics in 1979, “the general theme of state phobia.” In addition to the other concerns I raised about the strategy, if Hewlett and other donors wish to avoid inadvertently championing an aggressively neoliberal agenda globally while at the same time questioning neoliberalism domestically, it may want to reconsider the anti-state bias implicit in that program.
Levine hopes that as the Beyond Neoliberalism initiative develops, it takes into account the deep thinking that scholars and grantees in developing countries have already done on capitalism and inequality. She points to recent work on cash transfers, the future of work, and issues of equity and inclusion of disadvantaged groups. “The transmission of ideas should not just be one-way, from the United States to the rest of the world,” she emphasizes. “There are many innovative ideas about equity and inclusion from other countries that we can learn from.”