Friday, February 1, 2013


Fixes explores solutions to major social problems. Each week, it examines creative initiatives that can tell us about the difference between success and failure. It is written by David Bornstein, author of “How to Change the World,” and founder of, and Tina Rosenberg, contributing writer for The New York Times magazine and author of “Join the Club: How Peer Pressure Can Transform the World.” Readers with ideas for future columns can write to the authors at
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Leading the Way Out of Debt

Adalberto Jaimes offers his clients personalized financial planning. Like private bankers and wealth managers, he helps people set their financial priorities and goals. He picks up the phone to negotiate deals and helps them take care of the paperwork.
Instead of working in a sleek Midtown bank, however, Jaimes’ office is a cubicle in the back of the Northern Manhattan Improvement Corporation in Washington Heights, where people can get services ranging from legal representation in eviction cases to asthma management. Jaimes, a native of Colombia, helps clients facing arrears in their rent, mountains of credit card debt, and credit scores that prevent them from renting apartments or getting jobs.
His services are free to clients. Jaimes is employed by Neighborhood Trust, a nonprofit that provides financial advice to low-income New Yorkers. Neighborhood Trust is the largest operator of New York City’s Financial Empowerment Centers, which were established in June, 2008. Jonathan Mintz, the commissioner of the Department of Consumer Affairs, said the centers were established to “take a look at the whole picture. How do you walk out of here not just literally with reduced debt, which is great, of course, but with your arms around your finances?”
Read more…


When Paying It Forward Pays Us Back

If you’ve listened to the debate on how the United States should avoid going over the “fiscal cliff” over the past months, you might believe that the government has only two options to address its budget woes — either slash social programs, as conservatives favor, or the liberal tack, raise taxes. That’s a myopic view, one that actually distorts the relationship between social programs and society at large. Many of the most effective ones are not a mere expense to be trimmed off a budget; they often can and do save considerable money for society. And they’d be even more economical in this regard if the government invested in their widespread adoption.
Often, to save money you need to change systems or add new functions, not eliminate them.
One such example is the Transitional Care Model (TCM), which provides planning and home follow-up by trained nurses for chronically ill Medicare patients during and after hospitalization. The TCM illustrates a key point. Often, to save money you need to change systems, or add new functions, not just cut things.
The TCM was developed over the past two decades by the University of Pennsylvania School of Nursing to fill an urgent gap in our health system, one that is likely to be familiar to many readers: millions of chronically ill older patients (or their spouses, partners or children) are poorly prepared to take proper care of themselves or their loved ones after a hospital stay. (According to a recent report, there are more than 42 million unpaid family caregivers in the United States.)
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A Hospital Network With a Vision

As the United States struggles to find new business models for health care, some innovators are looking to other industries, ones that provide high-quality services for low prices. In a recent article in The New Yorker, for example, Atul Gawande suggests that the Cheesecake Factory restaurant chain — with its size, central control and accountability for the customer experience — could be a model of sorts for health care. That’s not as outlandish as it seems. The world’s largest provider of eye care has found success by directly adapting the management practices of another big-box food brand, one that is not often associated with good health: McDonald’s.
Aravind can practice compassion successfully because it is run like a McDonald’s.
In 1976, Dr. Govindappa Venkataswamy — known as Dr. V — retired from performing eye surgery at the Government Medical College in Madurai, Tamil Nadu, a state in India’s south. He decided to devote his remaining years to eliminating needless blindness among India’s poor. Twelve million people are blind in India, the vast majority of them from cataracts, which tend to strike people in India before 60 — earlier than in the West. Blindness robs a poor person of his livelihood and with it, his sense of self-worth; it is often a fatal disease. A blind person, the Indian saying goes, is “a mouth with no hands.”
Dr. V started by establishing an 11-bed hospital with six beds reserved for patients who could not pay and five for those who would pay modest rates. He persuaded his siblings to join him in mortgaging their houses, Read more…

For Drug Users, a Swift Response Is the Best Medicine

Ben W. Joseph was a trial judge in the Chittenden County Criminal Court, in Vermont, and he had a problem — one shared by judges across the country that results in billions of dollars of wasteful spending by governments every year. It was 2008, and substance abuse was soaring, particularly among young people whose drugs of choice were pharmaceuticals like OxyContin, a highly addictive pain killer that has an effect similar to heroin but is much easier to obtain. Each month in his Burlington courtroom, Joseph saw defendants who’d been arrested for drug-related offenses — from driving while heavily intoxicated to stealing to feed an OxyContin habit (an 80-milligram pill can cost $100 on the street).
Joseph saw how their lives spiraled out of control and created havoc for others. “I was seeing people who had drug and alcohol related charges come back over and over again,” he recalled. As the drug use intensified, so did criminality. “When people have serious alcohol and drug problems, it won’t take long before they’re stealing from their grandparents.” And when the pill market got tight, drug dealers pushed out more heroin.
What the defendants needed more than punishment was treatment. But delays in the justice system and lack of coordination with social service agencies meant that opportunities to intervene were regularly missed. Between a defendant’s arrest and trial, a case can drag on for a year or more.
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At Year’s End, News of a Global Health Success

At this time of awful news of the needless death of children, there comes reason for optimism about the health of the world’s youngest.
Income and growth data don’t capture the tremendous gains in quality of life in poor countries.
Sierra Leone, Malawi, Laos, Bangladesh and Nicaragua are among the poorest nations in the world. The state of countries like these is often cited to illustrate the failures of development, the persistence of poverty. But here’s what has changed: Bangladesh dropped its death rate of children under 5 by two-thirds between 1990 and 2010. Child mortality is down by 56.5 percent in Malawi since 1990, 63.8 percent in Sierra Leone, 55.6 percent in Laos, and 61.9 percent in Nicaragua.
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Moving Forward in Tough Times

Welcome to the second annual Fixes holiday season retrospective! Almost every week, over the past two years, we’ve covered a response to a social problem that’s noteworthy, usually because it’s producing better than expected results. We highlight these “positive deviants” because 1) they’re under-reported; 2) they show society not just what’s going wrong but how it might improve; and 3) they’re inherently interesting, like a good puzzle or whodunit. Because we get more leads than we can cover, we typically focus on initiatives that have a track record, evidence of effectiveness and potential for broader impact.
So, last week, I reached out to three dozen organizations we’ve covered to find out how they had fared during the past year. Even during this difficult economic period, I was struck by how many had augmented their work. It seems that, while we’ve been occupied with the economy, the election and Gangnam Style, some interesting changes have occurred under the radar. Here’s a roundup for 2012:
On the education front, a number of groups have gained traction addressing this challenge: How can we nurture the social and emotional development of children? Roots of Empathy, which brings moms and babies into thousands of classrooms and builds empathetic capacity among children, expanded its work to Europe and the United States and saw its influence shape educational policies in Canadian provinces. Playworks, which shows schools how to improve recess, underwent a randomized controlled trial, and preliminary results indicate that its play-based program significantly reduces bullying, exclusionary behavior and class conflicts (teachers report that students take 27 percent less time transitioning from recess to learning activities). The Positive Coaching Alliance, which helps coaches teach character-building lessons through youth sports, now reports that it is reaching a million youths. (Check out P.C.A.’s free online e-Talking Points for coaches.) Read more…

Putting Charities to the Test

December is giving season. According to Charity Navigator, charities surveyed reported that 41 percent of their annual contributions from individuals arrives between Thanksgiving and New Year.
How do you decide where to give? People want to give where their money will be used effectively, of course. For many, that means researching on Charity Navigator or the Better Business Bureau’s Web site to see which charities are well run and take only a small percentage of donations for administration or fund-raising needs.
Calculating efficiency is important, but some charities do useful things the numbers can’t capture.
Overhead does matter. But it is dwarfed by a different question: Is this group’s work effective?
“When people think of giving, they look at the issue of whether a charity has a 10 or 20 percent administration cost, and that makes the difference for them,” said Toby Ord, a researcher in moral philosophy at Oxford University and founder of an organization based there called Giving What We Can. “But in reality some things they could be funding are hundreds or thousands of times more effective than other things. People never guess there could be such large discrepancies. Instead of a 20 percent difference, there can be a 1,000 percent difference.”
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The Power of Failure

Seven years ago, the consulting group Bridgespan presented details on the performance of several prestigious nonprofits. Nearly all of them had one thing in common — failure.  These organizations had a point at which they struggled financially, stalled on a project or experienced high rates of attrition.  “Everyone in the room had the same response, which was relief,” said Paul Schmitz, the chief executive of the nonprofit Public Allies.  “It was good to see that I wasn’t the only one struggling with these things.”
Transparency about what works and what doesn’t is crucial to eventual success.
As in any field, people who work in nonprofits, social enterprises, development agencies, and foundations experience failure on a regular basis.  People make hiring and budgeting mistakes.  Shipments arrive late, or not at all.  Organizations allow their missions to drift.  Technologies prove inappropriate for the communities meant to benefit from them.
“We are working in some of the most difficult places in the world,” said Wayan Vota, a technology and information expert who organized the third annual FAILFaire conference two weeks ago in Washington. “But failure is literally the ‘f-word’ in development.” The idea behind this FAILFaire, which was hosted by the World Bank, was to highlight, even celebrate, instances of failure in the field of social change as an integral part of the process of innovation and, ultimately, progress.
Some nonprofits are tempted to hide their failures, partially for fear of donor reaction. But most acknowledge that transparency about what works and what doesn’t is crucial to their eventual success.
“Not talking about [failure] is the worst thing you can do, as it means you’re not helping the rest of the organization learn from it,” said Jill Vialet, who runs the nonprofit Playworks.  “It gives [the failure] a power and a weight that’s not only unnecessary, but damaging.”  Vialet instead supports failing “out loud” and “forward,” meaning that the people involved in the failure should speak about it openly and work to prevent history from repeating itself.
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What a Little Land Can Do

The poorest people in the world are those who don’t have land. In India, landlessness is a better predictor of poverty than illiteracy or belonging to castes at the bottom of society.  At least 17 million rural households in India are completely landless, living on others’ land and working as sharecroppers or day laborers tending other peoples’ crops.
Landlessness is a huge problem all over the world.  More equal distribution of land is a valuable goal — it is efficient in both fighting poverty and producing food.
But redistributing land is one of the most difficult and controversial of all political tasks.  A history of land reform is a history of revolution. The concentration of land in the hands of the rich is a prime source of conflict.  When a leftist movement has won, its first action has often been land reform — the further to the left the new government, the less likely it is to compensate landowners (and the more likely to shoot them, which was the norm in China and the Soviet Union).
But confiscatory land reform is not the only kind. Many programs have paid landowners market value for their land.  Perhaps the world’s most influential architect of a more democratic land reform is the University of Washington law professor Roy Prosterman, who founded the Rural Development Institute, now known as Landesa.  Prosterman and his group have worked with dozens of countries to design market-based land reform.  But his ideas, too, have been used for political ends; if you know Prosterman’s name, it’s because you’ve heard of Land to the Tiller, the United States-backed land reform in Vietnam during the war.  The United States adopted Prosterman’s ideas in Vietnam, the Philippines and El Salvador to turn peasants away from leftist guerrillas.

Top, Land in West Bengal, India, before the Landesa microplot program was implemented in 2010; bottom, nearly two years later. 
Landesa.orgTop, Land in West Bengal, India, before the Landesa micro-plot program was implemented in 2010; bottom, nearly two years later.
Today, political forces are arrayed against land reform. India, for example, had a land reform program since the 1960s that set ceilings on land ownership.  Read more…

The Rise of the Social Entrepreneur

Recently, I wrote a column suggesting that, in the field of social change, we’re getting smarter. I went so far as to say that we may even be going through a new Enlightenment. I mentioned three ways we’re improving — employing new understandings about human behavior to get better results, using evidence more regularly to assess and guide problem-solving, and constructing integrated solutions to social problems. I also promised to highlight some other advances.
Individuals with great ideas can often accomplish what government or large organizations can’t.
Today, I’m focusing on a key innovation that underlies much of these gains: the recognition of the role played by entrepreneurs in advancing positive social changes. I don’t mean businesspeople solving social ills, but people spreading new approaches — through nonprofits and businesses, or within government — to address problems more successfully than in the past.
At times, it can be hard to believe that progress is happening. Most of our news focuses on problems, not creative responses to them. Moreover, in the wake of the presidential campaign, we are acutely aware of the bitter divisions that hamstring efforts to work together.
But the rhetoric of a political campaign is misleading. It makes us think we have to choose between government and business — as if those are the only tools in the box. We don’t. One of the most interesting stories in social change today is how much creative problem-solving is emerging from citizens scattered far and wide who are taking it upon themselves to fix things and who, in many cases, are outperforming traditional organizations or making systems work better. At Fixes, we’ve reported on dozens of creative efforts in education, health care, vocational training, prison reform, foster care — many of which have been initiated by citizens.
Read more…

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