Founder's Syndrome in Global Health

A quick search of “founder’s syndrome” leads to quite diverse results. Some include leadership that have founded an organization, but end up disagreeing on its direction or their own roles, or a founder that is unwilling to let go of an organization that would require a different leader to take it further.

In global health, we seem to be experiencing a different type of founder’s syndrome: the drive to constantly keep founding new organizations, mechanisms, initiatives, and platforms. This is not necessarily driven by ill-will, but can have various causes: being unaware of similar organizations that are already out there; initially seeing a need and niche, but soon realizing you need to address this in a broader way; or from a wish to accelerate progress or drive it in a more efficient way.

In their 2017 book Governing Global Health – Who runs the world and why? Chelsea Clinton and Devi Sridhar dive deeper into these trends, looking at some of the larger multilateral global health organizations (WHO, World Bank, Global Fund, Gavi). One of the most interesting insights is that principals (most often donors) get increasingly frustrated by agents (the organizations) that gain more independence, have information asymmetries (i.e. have more information about what they are really doing, and whether it is really working). In short, when there is a feeling that an agent/organization is not doing what it should, how it could, there is an urge to found a new organization.

In the corporate and tech sector in particular, existing organizations see many newly founded organizations as potential competitors down the line. There are many examples where start-ups, organizations, or even business plans have been bought in order to benefit from these in-house (and de facto remove competition). This also happens in health, where large companies buy or invest large stakes into start-ups or smaller companies.

What is worrying in the global health sector is an increasing co-opting of missions and messaging. Instead of working together, or simply trying to strengthen an existing organization or initiative, we are seeing mission statements or value-add messaging being literally copy-pasted into new organizations or initiatives (admittedly, some older organizations are trying the same tactics in reverse, co-opting anything that may look threatening as what they do already). The real(-life) problem is when there is a huge disconnect between what is being said (or “envisaged”) and what can actually be done.

There is also a huge risk in losing valuable experiences, lessons-learned and institutional memory. By founding something “new” that in some form already exists elsewhere, many lessons of why things worked – or didn’t – are lost. In global health we see the reinvention of the wheel happen every few years, sometimes every few decades, because of this. A response of “but now we have the right people / skills / knowledge / supporters / political will / etc” to do this right rings very hollow.

Incremental or even radical changes are often needed in our sector. Take the impact of climate change or the role of gender or education for health outcomes – it’s clear that mandates need to adapt, or new collaborations are needed.

But in the worst case, what is happening is that a new organization or initiative is founded – or an old one fully re-invented/re-branded, without any recognition to what is already out there. Communication materials read as if entire organizational histories have been erased. Or they are discarded as “old”, implying that they do not function or add any value.

Global health is already extremely siloed, and fragmented. We all preach collaboration, and partnership. But if we are not willing to give credit, to learn – or even to acknowledge – our words mean nothing.

The decolonization agenda that some thought leaders in global health have started is a great place to unpack some of these hot air claims. We, the new global vs. the long-standing, existing local. What will most likely be unpacked is a lot of power dynamics that we feel uncomfortable speaking about or addressing: money, gender, race.

There is nothing wrong in founding something new if it really is needed. But if you do, at least acknowledge that in global health, you are founding on the shoulders of many, many people and organizations that have come before you. Giving due credit does not cost anything, and means everything.

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