A Discussion with Ed Scott

April 25, 2012

Background: This exchange is based on discussions between Ed Scott and Katherine Marshall on April 25, 2012, followed up in subsequent emails. The context was the Berkley Center reflection on its five-year research and policy work on development and religion, but the exchange also focuses on Scott’s philanthropic work and philosophy. He describes his long-standing conviction that religious institutions and ideas are central to development work, but almost always underappreciated. He reflects on why the critical effort to link development and religion has proved so difficult. Attitudes towards religion are complex and governments can, for a number of reasons, be reluctant to engage religious communities and faith-based institutions or see development dollars escape their direct control. Scott stands out both for his commitment to institutional development and capacity building in the development field and for his personal philanthropy. He highlights the important and promising work of CIFA (the Center for Interfaith Action on Global Poverty). He expresses his disappointment in the slow uptake of the idea of engaging faith institutions more actively in development, particularly in the realm of behavior change. The HIV/AIDS pandemic is a prominent and poignant example of how faith institutions can help encourage behavior and attitude change.

You have a remarkable record as a philanthropist and policy advisor, acting, as I have heard you say often, as a “serial NGO founder.” How did you come to focus on the roles of religion in development?

I have always been a great believer in making things work and keeping one’s eye on the goal. Accordingly, I have been less obsessed than many colleagues with methodology and idealized notions about which partners one should work with. I also started from a long-standing interest in global poverty and particularly global public health. That led me to focus both on strengthening the intellectual underpinnings of development work and building intelligent, directed advocacy.

Over the years, as I worked on poverty and development, two things in particular became evident to me. First, a high percentage of services that are aimed at fighting poverty and improving public health in developing countries are, in practice, delivered by faith-based organizations. That includes organizations like Catholic Relief Services, World Vision, Compassion International, Islamic Relief, and the Aga Khan Foundation, which are all large faith-based institutions. There are many other institutions, some far smaller, that run hospitals, clinics, and community services, often from the base of churches. Compassion International, for example, does tremendous work to develop the capacity of children, and they do it all through the churches. It is clear that they are delivering a significant percentage of the services that are reaching the poor, including vaccinations and care for people affected by HIV/AIDS.

Second, it became evident to me that some of the areas that are most central to development policy and effective public health programs depend heavily on people’s values, and on people’s feelings about their cultural identity. This is true for both the developed and underdeveloped world. A large part of people’s personal ethical and moral architecture is shaped by what they have learned in their churches, mosques, and other places of worship. Even if it does not come directly from there, it comes indirectly from parents or someone else they respect. This includes attitudes towards girls and women, polygamy, multiple sexual partners, young girls as sex partners, and so on. It covers matters that are clearly in the realm of moral values and many that are not, such as just avoiding going outside at night when mosquitoes are likely to bite. In short, it is about a wide range of human behaviors.

Thus, I am convinced that the most effective way to change behavior is to get faith-based actors to be partners in the efforts. An example of where faith-based actors can play a strong role is in attempting to promote a rejection of tolerance for violence against women. How do you convince men in their 30s and 40s that violence is not only morally wrong but also plays a major part in the spread of HIV/AIDS and other sexually-transmitted diseases and infections? We need to address not only the behaviors but also their moral basis and the way they are perceived within the community.

HIV/AIDS is still a huge problem. Some people seem to think the problem has gone away. There is not as much visible attention to these issues today as there was in the period when President George W. Bush spoke in his 2003 State of the Union Address about the problem and when we saw the creation of PEPFAR and the Global Fund (to Fight AIDS, Tuberculosis, and Malaria). These latter initiatives have saved millions of lives, but the harsh reality is that the rates of HIV infection are still at roughly the same levels in many high prevalence countries. HIV/AIDS places an extremely heavy burden on the world, and the prospect is for the developed countries to send money, indefinitely, to the developing countries for the purchase of life-saving drugs, since there is no vaccine and no cure immediately in sight. The HIV/AIDS virus still has considerable force and fury and is continually changing.

Faith-based institutions have to be a key element in addressing the problem. They are able to mobilize large amounts of money and they have large numbers of extremely selfless volunteers. Thousands of these volunteers from the developed countries travel overseas every year to help, and for every one of these volunteers there are thousands in the developing countries who can be mobilized.

How did you come to this appreciation that religion is a key element for development?

As a start, please note that I have not said anything about promoting any particular set of religious beliefs. I have no interest in that whatsoever. However, it is important to acknowledge that some organizations are indeed in that business and have that as part of their core mission. An example of this would be Compassion International.

But my awareness did not come at a single moment. As I learned about development work and about the key issues of global health and poverty, both at the community and the policy level, it became obvious that religious institutions were not adequately utilized in promoting development as well as behavior and attitude change.

Your description of how you came to focus on faith in development is quite similar to the way that James D. Wolfensohn (who launched the Faith Development Dialogue when he was at the World Bank) describes his own journey. Have you discussed the topic with him?

No, I have not. However, I have spoken at considerable length with Tony Blair, who created the Tony Blair Faith Foundation. TBFF, however, has a slightly different origin from CIFA in that Blair’s support and interest in religious communities grew from his strong faith convictions. My motivation came from looking for leverage and efficacy in addressing the key poverty and health issues in the developing world.

How do you explain the unexpected obstacles that we have met in seeking active engagement of faith institutions in development work?

I believe that the issue of proselytism is one reason. Understandably, this makes many policymakers uneasy and they often see religion primarily through that lens. Another reason is that, just as in any business, there is competition. Faith-based development organizations often see each other as competitors. This factor may not be overwhelming, but it does seem to be present, even if the organizations in question would deny it.

But, I believe the most significant reason is that many development professionals have nothing but contempt for the faith-based individuals or organizations involved in development. They see them as basically deluded and ineffective, with narrow religious goals in mind. They sometimes dismiss them as uneducated simpletons who do not really understand policy or community development. Because policy professionals often feel that way, it can be very hard for faith-based institutions to get money. Usually, the only reliable source of funding is what they can raise from their own flock. While some more poorly-run secular NGOs or contractors can get government money relatively easily, some long-established, well-run faith-based institutions cannot. To me, the exclusion of faith-based institutions from many development programs and the frequent lack of coordination between faith-based institutions are unfortunate.

What do you see as the solution?

Someone has to shine a spotlight on these problems and get people to collaborate. That involves educating both the key political actors and educating the public. CIFA (the Center for Interfaith Action on Global Poverty) was founded precisely to address this issue. However, CIFA’s progress on encouraging faith-based institutions to collaborate has been slow and measured. People close to the process, some at very senior levels, think the idea is great, and it has been well-received intellectually. The challenge to rally wide support and major financing is something that CIFA continues to address—and quite creatively, in my opinion.

What do you see as your own next steps in this effort?

My own style has generally been to provide the impetus and initial financing for a start-up organization, help it find its footing, and then move out of the way. I am the founder of four different NGOs in Washington, D.C. Three have been wildly successful, and the fourth, CIFA, is doing very important work, but its growth is coming more slowly than the others. I give support and advice, but let the staff implement it. They build the institution, and I let the process take its course. It has been a heavier lift for CIFA than I had anticipated. I had expected that the Gates Foundation, the U.S. government, and other major players, including multilateral organizations, would rally behind this effort faster than they have to date. The policy and donor community has a long way to go in terms of supporting impactful interfaith action.

In short, the next steps are not very clear. If I were to find myself close to the president, or any future president, I would try to get far more attention focused on the topic because it is so important.

What has been the response of the governments of the developing countries?

That is indeed an even bigger problem. Governments tend to be very jealous of development dollars and there is fierce competition for funds. Take the case of the Global Fund as an example. We hear the assertion that some huge percentage of health care in Africa is provided by faith institutions, perhaps around 40 percent or more, and that this figure is perhaps an underestimate when it comes to action at the community level. Yet when the Global Fund started its work, only 3 to 4 percent of its grant funding went to institutions that had anything to do with faith. After five years they increased the figure to about a paltry 6 percent and there are efforts to further increase it. But, in relation to the 40 percent service-delivery figure by faith-based organizations, there is a clear shortfall. And it is clear why: the national Country Coordinating Mechanisms (CCMs) make the funding recommendations to the Global Fund. The CCMs are organized by the governments of the respective recipient countries. While the CCMs may have some faith group participation, it is frequently at a low level, and is generally kept very much under control. The governments basically take the view that faith-based institutions do good work, but they already have funding sources, i.e. the faith adherents in the developed world. The governments want to get their hands on every development dollar they can, to enhance their ministries of health and advance their own priorities. Likewise, there can be concern by governments about proselytism and separation between church and state, or about not being seen to heavily favor one religion or another. Thus, the faith-based development institutions and charities more often than not find themselves frozen out.

In short, governments are typically lukewarm to engage faith institutions and they will likely be that way for the foreseeable future. Then you bring corruption into the picture. If there is no flow of funds to governments, there is much less opportunity for corruption. There is both soft and hard corruption, venal and just political. Funds can just go for other government purposes. If funds go to faith-based institutions and charities, the opportunities for graft all around are considerably diminished.

You have focused for many years on HIV/AIDS. How do you see the faith roles there?

As in business, you need to keep coming back to the baseline. For HIV/AIDS, as for many other issues, the baseline point is that if behaviors and norms do not change, they will inhibit development across the board. In large measure, those behaviors and norms are shaped, formed, and perpetuated in faith-based environments. So we have to find out how to align the changes in norms and behaviors with what faith-based communities are teaching and modeling. It is a complex problem. We need to recognize that religious leaders can be as much of a problem as others in the community. Young girls in some places in the developed world are treated as chattel and abused. As a result, there is a much higher HIV/AIDS infection rate for girls than boys of the same age in many high prevalence countries. This is the most striking, horrible example of the outcome of predatory behavior aimed at young girls. So not engaging with faith institutions that possibly can change the moral and behavioral dynamic seems foolhardy and counterproductive.

There are real challenges with respect to the war on HIV/AIDS. I see donor fatigue as a huge risk. Even though the cost of treatment has dropped sharply, the cost is still not insignificant, and there are more and more people alive who will need these drugs for the rest of their lives.

The first significant problem the Global Fund faces is how it is financed. Ninety-nine percent of its funding comes from “passing the hat” to the governments of the developed countries. That means money flows only at the donor’s discretion. Hence, there is real long term unpredictability. The Global Fund could easily discover one day that it has no money. Then lots of people would die and you can be certain that there would be endless finger pointing. There has not been enough attention and consideration about how to creatively address the problem of financing the Global Fund on a systemic, sustainable basis. The idea of UNITAID was brilliant. It ties funding automatically to charges for first class and business class international airplane tickets and seeks other innovative development financing mechanisms. In my view, the U.S. and other developed countries that have not signed on to this idea are shortsighted. If we are honestly committed to addressing these global health and development challenges, we need to find innovative and creative mechanisms to escape the strong potential for a major funding shortfall.

The second issue is that the Global Fund has not been nearly as active or aggressive as it should have been in the standard-setting evaluation realm. Instead, in my view, the Global Fund has in the past given countries way too much freedom to do what they propose without a proper measurement and evaluation justification. Recently, it seems to be changing for the better.

A broader problem is that so far no one has cracked the prevention challenge. There is a lot of money being spent to prevent the spread of HIV/AIDS, but a lot of it is inefficiently spent. In short, the Global Fund needs a stronger and more effective operating executive and board leadership. Corruption at the country level of Global Fund programs is an issue, but it is a minor, and often overblown, problem. I remain extremely concerned that the consensus that presently exists on how to address HIV/AIDS and development more broadly could come undone.

Do you think that the appointment of Jim Yong Kim as president of the World Bank can help?

That could help. It might mean more World Bank money for HIV/AIDS programs, and it will bring to development the point of view of a true moral spokesman. He is a good person with a strong record of personal commitment.

But aid fatigue is a real challenge and I can see why people are a little bit jaded. Let’s take some fellow who has lost his job at a Detroit auto plant. He goes to church on Sunday, and hears the pastor talking about AIDS in Africa. Then he hears that despite huge spending there, the new infection rate has not dropped significantly. The Global Fund wants and needs more money every year. Yet many people in the recipient countries have not changed their behavior in any significant respect and people continue to get infected. So, this fellow might reasonably ask his one of his senators or his U.S. representative: “What’s this about? Why should I be helping people who do not want to change or take responsibility for their behavior when I am out of work and we have huge national and personal debts?”

There are parallels here to the early days when HIV/AIDS was first recognized in San Francisco. Many people at the time believed the disease was purely a “homosexual phenomenon.” As a result, there was a widely-held view that if people would not behave “responsibly,” then they should bear the consequences. Today, there is fortunately a much better understanding of HIV/AIDS: that the virus can be transmitted in different ways including through sexual intercourse, through mother-to-child transmission (during labor, delivery, or breastfeeding), or through blood exchange. With the awareness about the science underlying the spread of HIV/AIDS, attitudes changed. But the core point is hard to argue: that when people do things irresponsibly and knowingly, it can be harder to maintain a commitment from the public on that issue. It is human nature to say, “wait a minute…” So I think all national and global development and health institutions, whether the World Health Organization, Global Fund, PEPFAR, or World Bank, face a real challenge.

What about religion and gender? What do you think can help in addressing the patriarchal attitudes that come up in almost any discussion of religion and development?

I do think we are seeing progress. After all, we in the U.S. in recent years have had three female secretaries of state, and two female vice presidential candidates. We likely will have a woman president soon. We are seeing affirmations of social progress, even if they come in small steps.

As far as women and religion are concerned, we can’t give up. Attitudes on gender have to be part of the program. Unfortunately, many people hide behind religion to justify or perpetuate backward gender attitudes, allowing certain practices to continue such as female genital mutilation, honor killings, virginity tests, and child marriage, which is a major threat to the health of young women. Religion and culture are often used as a shield to justify and tolerate practices that are plainly wrong and fundamentally evil.

As we consider behavior change, think about our efforts in the U.S. to prevent forest fires with the Smokey Bear TV ads to raise public awareness, or the campaign to reduce littering and convince people to cease the practice of throwing trash from cars onto the side of freeways, or encouraging individuals to turn off the lights to save energy when leaving a room. Changing these attitudes took sustained work, over long periods of time. The same is clearly true for race relations. We have come a long way in the U.S. and made progress in changing attitudes about blacks and whites, however many problems remain. And yet in all these cases, religious leaders and institutions helped to bring about the changes and at the same time they had to change themselves.

Changing attitudes about religion and gender will take a similar campaign. I am not sure whose job it is to make people more tolerant. One way is to have role models of goodness: people such as Nelson Mandela, Desmond Tutu, Martin Luther King, Jr., and Billy Graham. But they are either old or no longer with us, and sadly there do not seem to be many new leaders of their stature coming along to take their places. Rick Warren seems to be one promising and effective moral leader on the scene. We need models of people who are fundamentally good, who represent what is best in humanity, and who promote behaving in good ways. I do not see many candidates standing up and taking on those roles, especially in the developing world. So, who is going to stand up and say that attitudes towards women and girls simply have to change? The example that CIFA has promoted in its work in Nigeria, where Christian and Muslim leaders together have taken the high ground, is positive, but there are not many visible examples like it.

You often cite Compassion International as an institution you admire and support. How did you first come to know of their work?

My encounter with Compassion International was really the start of my more serious work in philanthropy and it tells a lot about my core convictions. But my first philanthropic act began with buying a minivan for a waitress.

In our church one day, the pastor spoke about a single mom with two children, one of them disabled. He described the extraordinary daily challenges she faced, getting the children up, spending hours by bus to get them to the different places where they were cared for, working an eight hour shift as a waitress, then going through the process again to get them home and feed them. She was at her wits’ end. The solution seemed obvious to my wife Cheryl and me: she needed a car. So we told the preacher we would buy her a car, anonymously. But then it turned out she did not know how to drive. So, the preacher taught her to drive, arranged for the insurance, and so on. Six months later, in church, our pastor described how her life had been completely transformed for the better. That made a big impression on Cheryl and me. Up to that time, most of my life had been focused on making money and being a success in my career. I saw things differently from that point forward. It was also a turning point for me, since I was about to “retire” from my business life.

Then I began an involvement with Compassion International, a child development organization which supports over 1.2 million children in 26 countries. It provides a wide range of services from education to health care to recreation to career development. Using the child sponsorship model, it delivers its services through churches of many different denominations in the developing world and is a highly-respected organization.

Compassion International creates awareness for its mission by visiting churches throughout the United States. They came to our church in Milpitas, California one Sunday, and my wife and I were taken with their presentation. So, we decided to sponsor a few children.

Later, I visited Compassion International’s headquarters in Colorado to learn more and ultimately agreed to financially assist them in opening some new programs. Several years after, I went, at their invitation, to visit one of the programs that I helped to start. They were celebrating the fifth anniversary of their work in that country. I asked where the event would be held and it turned out they were holding the celebration in a baseball stadium. To my amazement, the event involved over 25,000 kids to whom they had brought their program in only five years working through 1,200 churches. For me, this was a real epiphany and a stunning example of how effective a well-run faith-based program can be.

Later, I became aware that Compassion in Africa was facing issues with children infected with HIV/AIDS. Most had contracted the disease from their mother at birth, but often it was not apparent until the children were 6 or 7 years old. We had a conversation where I asked them what they planned to do. Just providing infected children with palliative services was, I argued, not enough. For example, treating the children with HIV/AIDS for upper respiratory disease or other illnesses with antibiotics did not help much with the underlying problem of HIV/AIDS. I offered them a seed grant of $750,000 if they would start an HIV/AIDS testing and treatment program, and hire an expert in this area who knew what they were doing and who could guide them in implementing the program.

They were initially reluctant to get into the treatment of those with HIV/AIDS. At first they said, “it’s not really our thing.” They were nervous about their church supporters in the United States. They feared a donor revolt because their congregations were quite conservative, mostly evangelical and on the right wing, and AIDS was a bad word to many of their donors. I countered that these were their children and that if Compassion International did nothing, then these children would surely die. I asked, “Is that something that is okay with you? Especially if you can do something to stop it?” After some prolonged hesitation, they agreed and hired a highly qualified, Stanford and Berkeley-trained immunologist. Then, in the higher prevalence African countries, Compassion International began to provide HIV infection tests to all their children and to their caregivers. Since they were caring for the poorest and most vulnerable children, most were AIDS orphans, cared for by relatives. Many of the caregivers also were HIV-positive and if they died, the children would be left in dire and hopeless circumstances. So, they went to the Compassion International sponsors, both congregations and individuals, to seek help. Many sponsors were providing a standard $29 a month to support a child. Compassion asked if they were willing to add $8 a month for the HIV/AIDS treatment effort. Compassion estimated that if 15 percent agreed, they could fund the program. They were pleasantly surprised and overwhelmed that 85 percent said “yes.” Now they raise nearly six million a year for these programs.

What conclusion did you draw from this?

There’s a lot more compassion out there than we may realize. And most people fundamentally are decent people.

Where did you go from there on your philanthropic journey?

I ran into more and more groups and people who were working on issues of poverty, and I took several trips to Africa in different contexts. On one trip, I was with the then-Secretary of Health and Human Services Tommy Thompson, and we visited a Catholic hospital in Rwanda. On another trip, I was in Liberia seeing the work of President Ellen Johnson Sirleaf to rebuild that war-torn country. A highlight was meeting Sister Barbara Brilliant, a nun devoted to educating and caring for a population devastated by civil war. I was very impressed. So, I became more and more deeply involved.

You are a rare philanthropist who combines a keen interest in policy with work that, like your support for Compassion, has a direct impact on specific people in specific communities. How do you see the tensions and synergies between these two different approaches?

I find that working in both dimensions—policy and direct action—gives me both insights and great personal satisfaction. Direct experience with people and institutions is very important. But I never forget the story of the starfish: a father and son were walking along the beach and the child picked up the stranded starfish, throwing them into the ocean. The father asked why he bothered, since there were so many starfish, and he could help only a tiny fraction who might even be stranded again the next day. “But,” the son replied as he tossed another starfish back into the sea, “I helped this one.” We have an obligation to help and we can do so much good, one person at a time.

Yet, leverage, ideas, and a global vision are equally important and that’s where think tanks and institutions come into the picture. A single well-executed policy or idea can make a huge difference globally.

However, think tanks and great thinkers can do nothing unless they learn from what happens at the community and individual level. That is where we need to make the connections and that is where faith-based institutions play such a vital role.

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