Sunday, February 16, 2014


I co-direct the "Public Health and Surgery" course here at the University of Utah. This week in class we were discussing 'failure'. We heard from colleagues who had experienced program collapse, we watched David Damberger's talk on "Learning From Failure", and we had a nice chat about how and why projects 'fail'.
As I was listening to my venerable colleagues talk of adaptations made to ongoing programs in light of failed predictions, it struck me that the word 'failure' is often an inaccurate one in the global health / development paradigm - I even tweeted about it.
No successful global heath project has functioned perfectly out of the gate. Whether you look at smallpox eradication, vitamin-A administration in Nepal, or trachoma therapy in Northern Africa, all required modification and adaptation as initial expectations proved inaccurate, the program developed, and circumstances changed. Alanna Sheikh wrote a very nice post on this very subject - "When a program doesn't work".
There is, of course, much that could be discussed regarding when one should admit defeat with a particular endeavor. Erroneous premises, intransigent administrations or uncooperative donors can all doom a project. If and when to throw in the towel is, to misquote Dr. King, the "most persistent and urgent question".
I completely support the increasing culture of transparency around 'failure' for all the usual reasons (e.g. don't reinvent the wheel that doesn't roll, clarify to donors that this work is hard and complex, solicit help from initially uninvolved experts). However, I think we need a different word for the times when things don't go as we desire.

Until we walk away, it's not failure.

September 3 1967 - the day Sweden switched from driving on the left to driving on the right.