Berkley Center

Background: Originally from Australia, Mark Webster was country director for ADRA Nepal before assuming his current role at ADRA International as bureau chief for program management. The Adventist Development and Relief Agency (ADRA) was created by the Seventh-day Adventist Church to follow Christ's example by being a voice for, serving, and partnering with those in need. Mr. Webster and the program management team oversee all the United States government-funded grants and are responsible for reporting to donors who partner with ADRA. The agency initiates community development targeting food security, economic development, primary health, and basic education. Mark Webster recently interviewed with Katherine Marshall of the Berkley Center for Religion, Peace, and World Affairs, highlighting his development work with ADRA.

There are three themes that I hoped to pursue with you: the specific role of ADRA on malaria, ADRA's development work more generally, and your own path. Perhaps we can start with the third. How did you come to ADRA?

Most of my career has been with ADRA. I come from Australia, originally studied English literature, and decided to work with ADRA initially as a volunteer. I joined ADRA as a regular staff member, originally working in Asia from 1996 to 2006 (Laos and Nepal). I came to the U.S. in late 2006, and have been at ADRA headquarters here in Silver Spring since then. I count myself a development professional, with my graduate degree in the administration of non-profits. I was a Christian and Seventh-day Adventist member in Australia, an environment where the churches are clearly losing ground. I was attracted to ADRA's faith inspiration, and initially wanted to do my part in making the world a better place! And then it became a career and I have worked here ever since.

And can you give some background on ADRA?

Seventh-day Adventists have a long tradition of social, humanitarian work. This work stepped up significantly after World War II, with responses to the enormous humanitarian needs of that era. The entity that became ADRA was started then, in 1956, and about 25 years ago the church decided that there was a need to make this work more professional, so ADRA was created. Today, ADRA is a distinct non-governmental organization, with offices in many parts of the world, and its headquarters here, part of the Seventh-day Adventist world headquarters complex in Silver Spring, Maryland.

ADRA is now in a third phase (first relief, then moving into development, and today quite multifaceted). It is a pretty mature organization. A key turning point has been a conscious decision that not only do we do development work on behalf of our constituency, but also we engage through this work in educating that constituency about our responsibilities for the matters and issues we care about. ADRA seeks to create new ways to engage. This is a key challenge looking ahead, and is item number one in ADRA's strategic plan. It's an area where we can do much more.

While ADRA is an independent agency of the Seventh-day Adventist Church, it is still connected to local churches in the places where it works. It also works with the Adventist education and health organizations, which are themselves independent entities. ADRA's objective is to work in an integral fashion with these entities at the field level.

Over time ADRA's relationship with the church has not been without tensions, as there were questions as to how independent from the church it needed to be. ADRA in a sense tacked back and forth and addressed successive understandings and misunderstandings. Continuing to work closely with the global Seventh-day Adventist constituency, which is large and growing (the most recent estimate of church membership globally is about 15 million, in over 200 countries) is a key strategic challenge for ADRA.

The changing global nature of the church is also affecting ADRA in ways both direct and subtle. The church was clearly born in the United States, but membership is growing in the global south, with Brazil and the Philippines with particularly large membership, but generally fast growth particularly in Africa and south Asia. A result is that the church is evolving in terms of its power structures. Today, the majority of members are in the south and this is slowly changing the composition and character of the church's leadership.

All these forces are tending to involve the church more in social responsibility, beyond its core business, which of course is religion. And one idea, with many allies in the world church, is to see ADRA's work as an integral part of the core business of the church. For many in both ADRA and the church, ADRA's work is a way to express deeply-held beliefs as to what we should do in terms of our responsibilities.

How does ADRA approach the question of how far it engages in proselytizing? Some organizations like CRS deliberately do not engage, while others see proselytizing as an inseparable part of the work.

ADRA comes close to the CRS position: we don't do it. Proselytizing is left to other parts of the church hierarchy. ADRA staff is not composed only of Seventh-day Adventists. At headquarters, most are church members but not in field offices. Most staff do hold clear religious beliefs, but these vary widely and include many different religions; many are not Christians. Nonetheless, this separation can be a source of debate and even tension with some counterparts on the church side.

ADRA needs to reconcile what can be quite polarized views about what the church should be in society. We need to work out ourselves how we, as relief and development professionals, can learn to work better with the church structures and mechanisms. This exploration has not been a central focus over the past ten years, but is likely to be much so in the next decade.

How does ADRA work with the Adventist health and education organizations?

Relationships tend to be worked out on a case by case basis. Just as an example that I know well, in Nepal, ADRA has a strong relationship with the Adventist hospital there, and there are several joint projects. For example supporting mobile teams doing cleft palate surgery and other specific interventions. But the specifics can vary substantially from country to country.

There are particularly strong and long-standing partnerships with education institutions in the United States. For example, Andrews University in Michigan established a Master's program in development in cooperation with ADRA, and ADRA sent many staff there. The program is now independent, though there are still contacts and ADRA participants. The other main U.S. higher level institution is Loma Linda University in California, which is active in health education. Again, there are joint programs.

The Seventh-day Adventist Church is particularly active in the health field. Can you offer insights on why?

The focus, which indeed is strong, is partly tied to core Adventist beliefs, and their focus on health, nutrition, and lifestyles, and partly to history, and the keen interest of people like Dr. John Harvey Kellogg (a prominent figure in the early Seventh-day Adventist Church and cereal pioneer).

Early evangelicals also saw health and education as part of their proselytizing efforts; missionaries could be pastors and bring the word of God, but realized they might be more effective in their mission if they brought schools and hospitals. Many missionaries were trained as doctors and teachers.

How does this play out in the Mozambique Together against Malaria program?

We see the malaria program as an important opportunity to develop new models that could be replicable elsewhere, and thus as an important chance to learn lessons particularly about the links between the local church and ADRA as a relief and development organization.

How did the program start? Did ADRA take the initiative?

No, in this case the initiative came from Jean Duff and the Washington National Cathedral. ADRA did have long-standing programs in Mozambique, dating from the humanitarian relief activities in the early 1990s, and there is a strong Adventist Church there, but ADRA was not explicitly involved in malaria programs; the main focus had been (and remains) food security, including food aid and agriculture. There is also some health programming. ADRA had worked with the U.S. government in Mozambique and was known to have good administrative capacity. After contacts from Mozambican religious leaders, seeking help in launching an interfaith malaria program, the Cathedral Center approached the U.S. PMI Program (President's Malaria Initiative); PMI sought reassurance of professional development experience, and from those contacts ADRA was approached and agreed to engage. It made sense to all as a partnership.

ADRA is engaged in HIV/AIDS work in several countries, including Mozambique, also Kenya and Tanzania, and there are some similarities in the model of operation, that is, a collaboration among local churches and health systems and the health ministry, as well as outreach to different faith traditions. These programs (some of which are financed by PEPFAR, and also by the Swedish aid agency and church) have a particular focus on education, and work with both schools and congregations as well as the Adventist hospitals.

Nonetheless, in many ways the Mozambique malaria program is new and unique. There are malaria programs that are part of health interventions—for example distribution of mosquito nets is part of a health scheme in Laos, and many programs in high malaria incidence areas would include training of health workers, for example on malaria treatment. But to date malaria was not central. Further, the relationship under the program with different churches is quite distinct. And with the importance of malaria in many countries, there is significant potential for scaling up. Partly for that reason, the Mozambique malaria program is run out of the D.C. headquarters office.

How do you see this as a model? A model of what exactly?

The interfaith approach plus the direct and active engagement of local churches in health messages are the main features. The program benefits from the quite limited religious tension in Mozambique and the relative simplicity of the messages, about mosquito nets and early diagnosis. Use of churches as training sites is another important innovation.

The Mozambique program was launched formally in June 2007. How is the implementation progressing and what are some of the lessons to date?

The project is doing reasonably well, though implementation has proved to be rather more challenging that the different partners had anticipated at the outset. Some mistakes were made and there have been significant modifications of the program along the way. Thus the experience already offers important lessons. These turn especially around capacity issues of the church leaders and infrastructure and the significance of often differing understandings and expectations of different partners. The role of politics in programs like this is not insignificant.

Most encouraging to me is that a recent review mission that included independent observers and some who had been skeptical of our approach came away with a positive assessment and recommendation that the program should move forward.

Can you give me an idea of the course of events? Why the challenges and how did the program change along the way?

The program was put together under considerable time pressures. There was also a significant push from above, partly because of PMI leadership interest in engaging faith institutions in the Malaria effort, and partly because First Lady Laura Bush was to visit Mozambique in June 2007 and the malaria program was to be featured and formally launched as part of that visit. For that reason preparation and negotiations were accelerated. Then, barely two months after the agreement was signed, PMI sought a considerable revision of the program, expanding its scope very substantially but within a similar funding envelope. ADRA and its partners have cooperated and in turn PMI has agreed to provide much needed additional funding.

What was the essence of the change and the difference of views?

PMI has a particular interest in ensuring large scale coverage through the program, reaching large numbers of people quickly and cheaply. ADRA, of course, shares that concern, but is equally interested in the model of interfaith cooperation and learning about how to engage churches in health messages. There may also be some skepticism within PMI professionals about the merits of the faith perspective—they remain to be convinced that working through churches is an effective way to fight malaria, and they tend to focus on the technical solutions more than the delivery mechanisms. The argument that is joined is essentially whether the “soft” approach, through messages, training on a large scale of church leaders and workers, and focusing on church networks, is really effective. Their focus tends to be on net distribution, spraying efficiency, and health interventions, more than on education.

My view is that both the “soft” and “hard” approaches are equally necessary.

In specific terms, the changes that PMI sought after program approval involved a substantial expansion of program coverage, from a single province (Zambezia) to three additional provinces with some nation-wide aspects, all within the relatively short three-year project period.

Thus we have redesigned the project, so that, first, it is expanded from one to three to four provinces, and second so that it includes a more robust and ambitious effort to engage with religious leaders at a national level. This involves, notably, supporting faith leaders in working through the national media. This is positive because they are good at it and the start of implementation here is promising. We are working with individual faith leaders in their efforts to get the message out, in the most effective manner.

Any particular “lessons” that you can highlight, even recognizing that these are very early days?

The main lessons for us, that perhaps we did not learn quickly enough, were about the strengths of faith leaders and how we could work with them through the program, as well as the weaknesses that we needed to address.

The program on the ground is coordinated largely by ADRA staff and there was a natural tendency for them to proceed on a “business as usual” approach. When they met an obstacle, the tendency was to find a way to move the program forward, even if it involved going around the faith partners who were central to this program and approach. ADRA staff were often too impatient to get results and understood and appreciated the deeper program objectives too little. For example, if they met indifference or resistance among faith leaders at the Province level, they went straight to the district, thus alienating the provincial leaders. That was costly in the next stage and was a reason for some setbacks.

We also underestimated the importance of giving enough time and support for national religious leaders to engage their counterparts at the provincial level. That explained in part their early reluctance. It did take time, and with our time pressures, we were impatient to move ahead. But that stage proved essential and could not be bypassed.

There were also some issues around ownership: whose program was it? Mozambican religious leaders? ADRA? PMI? The idea clearly originated with the Mozambican national religious leaders, but they were not always centrally involved in the design stage, and with the accelerated preparation and approval, not to speak of the redesign just after approval, felt sometimes pushed aside. They saw the program as taken on by the development industry. There were also some tensions around how funds flowed and controls on use of funds.

The religious leaders were also somewhat less engaged in the program objectives than we had hoped and expected. Malaria was and is important, but it is not their central objective.

And there are a host of classic capacity issues. The religious leaders are excellent communicators but have limited operational capacity to back up their rhetoric, at even the most basic levels (arranging meetings, planning calendars).

How has the interfaith dimension worked?

In general very well. It has, however, not been without some tensions. For example, there were some disagreements between Christians and Muslims around Ramadan—the program had to proceed notwithstanding, and it took time to communicate those imperatives.

We also have been caught short in recognizing that there is virtually no interfaith structure to build on, or that could be replicated from national to provincial and district levels. It has to be built from scratch. We had understood that a group had in fact formed under the aegis of Roll Back Malaria, but we found that they were not really functional. We are still working out how to support the good will on interfaith, and to help build the structures that are needed to move forward.

Where do things stand as of today?

The program has been underway for just over a year. It was formally launched in June 2007 but really got started several months later, in November/December 2007. We have thus just completed a year and, since the program works with annual budget tranches, have approval for the second year. And the good news is that PMI has agreed to an increase in the overall program envelope for the three-year program from $2.1 million to $2.6 million. The budget is still very tight, especially given the substantial program expansion, but the increased funding is welcome. In addition to this PMI funding, the United Nations Foundation is providing funding for nets, and ADRA itself is contributing some support. A major shipment of nets is scheduled to arrive this month.

What is the status of and plans for evaluation?

There are two separate efforts. The first, engaging the University of Toronto, is near completion. It is an evaluation cum case study. It forms part of a series of case studies of community development. We are looking forward to seeing a report soon.

The second is the broader monitoring and evaluation of the program per se. Here, PMI has taken over the work and it will be part of a broader national monitoring and evaluation.

The effort is complicated by the program's fast start, because in practice the baseline studies, on which any evaluation must be grounded, in practice are only just now getting off the ground. PMI is trying to draw the ADRA program into the larger malaria national program, which presents some obvious difficulties. We expect to see the first results of this work early next year.

PMI's interest is primarily in the technical indicators of results. They are less interested in the community development objectives, which are thus far less part of the evaluation approach and specific indicators.

My view is that the effective communication of health and development messages through faith leaders deserves more attention. It offers great potential but is more difficult than we thought it would be.

For example, we have learned much about the kinds of messages that can practically be communicated. Messages initially were too complex; simplicity is an important lesson. The program has refined messages so that there are five simple messages: use nets (and how), how to cooperate with spraying, what to do if you have a fever. It is important to take into account how the messages will be translated into local language. And the materials must be easy to reproduce and distribute: large reports are of little to no use.

Any lessons on interfaith collaboration? What about collaboration with traditional religious leaders (who are particularly important in Mozambique)?

The most important overall lessons are about the importance of simple structures and capacity if the interfaith potential is to be realized. The structures need to be sustainable and effective. That means tacking on the necessary capacity to the existing, very simple, interfaith systems. We have learned that what is needed varies a great deal from place to place. The fact that some religious bodies are active only in a single location means that local adaptation is critical. The Adventist churches have tended to be among the best organized with greatest capacity. This is proving helpful but also contributed to expectations for higher capacity than in fact is the rule.

The program does work with traditional religions, and there are some positive dimensions. There are also some problems. It has proved very difficult to engage these groups at the national level. Further, in some cases the messages have clashed. There has been a tendency for traditional religions to press traditional, herbal medicines, which PMI (among others) do not believe are effective. And there have been instances where in fact traditional religious leaders have told villages to prevent spraying work, saying that the sprays are poisoned.

There are also some tensions around money, with high expectations on direct flows to and through faith institutions. This has to be worked out case by case on the ground.

How is coordination among the different Malaria programs in Mozambique going? What are the challenges?

Reasonably well, though there are large challenges. We are seeing some collaboration on the ground. For example, the World Bank is supporting Ministry of Health programs which do benefit ADRA's work. In general, collaboration with the Ministry of Health is going well. Spraying and nets distribution programs, which are implemented by RTI and PSI respectively, are going well. UNICEF is doing considerable analysis of malaria work and issues which is a good complement. In general, PMI is currently the heavy lifter on Malaria in Mozambique.

Some concrete examples of good collaboration at the field level are cases where education messages by religious leaders went out before spraying teams arrived in villages, making the communities more receptive. They also helped in mobilizing volunteers and staff.

What are other important faith malaria initiatives in Mozambique? Which groups are most active?

World Vision is active in health work in Mozambique and has some long standing malaria programs. We have been able to collaborate with them through community health committees. These are not explicitly or primarily faith linked but in practice faith institutions are pivotal in most of them.

How has the objective you mentioned early in our discussion, of reaching out to the Adventist community through this pilot project, worked?

Quite well. We have benefited from the strength of the Adventist Church in Mozambique, and especially in Zambezia province. So there have been some visits and church leaders have spoken about the program in the United States and elsewhere.

There have been some obstacles, notably some initial reluctance from the local Mozambican Adventist leaders to press the interfaith dimension, but this is advancing. Interest in the program and its novel features is high in the U.S.

The Seventh-day Adventist Church is increasingly involved, overall, in interfaith activities. There are dialogue efforts with Buddhists and other faiths for example. Historically Adventists were somewhat wary of global interfaith movements, with a tendency to separate themselves based on the church's unique doctrines.

Overall we see a positive model emerging and keen interest from church leaders. It offers the positive platform we had hoped for.

There are differences in approach by region. In Mozambique, the engagement of church members clearly is not primarily financial as they have few resources. But ADRA also does not wish to see members purely defined as beneficiaries. Thus the project offers good avenues for real engagement in a social program.

In the U.S. and other rich countries, the outreach involves both direct engagement and the opportunity for financial support.

What are some overall lessons and impressions at this stage?

The faith picture is far more chaotic and organic than the development industry expects and would like it to be. This is true for all communities and community structures, but perhaps even more so for the faith world. Bureaucracies want order and structure. They also want fast results. Moving faster is likely to be less effective in the long term, seen from the community perspective. It is essential to take into account how communities see realities and their priorities.

For communities, malaria is not a separate or separable problem. It is part of the fabric of life. It is related to faith, family, employment, and so on. Reaching communities must take this interrelated vision into account. To engage, it is important to embrace the organic and chaotic nature of communities at least to a certain extent.

The objective is not to change the communities but to find ways to interface with them. The approach needs to be different province by province and even district by district. But it should be possible at least to define some principles to guide the approach.