How to balance numbers with people: losing sight of the cause

Living in Mwanza, Tanzania as an expat is like being in freshman year of college again except with slightly different questions. Instead of “what dorm do you live in?” and “what is your hometown?”, people continuously ask “how long have you been here?”, “which country are you from?” (although my very obvious American accent answers that question by itself), and “what are you doing here?”. The first two questions are pretty straightforward but the third question normally confuses people because of my vague job title: program analyst for Touch Foundation. That title translates to my sitting at a desk working on excel to organize data and create models, work central to our monitoring and evaluation (M&E) effort of various health system strengthening programs. The science major in me loves this. I lose track of time when I’m immersed in a project. I get excited when there is a challenging concept to grasp or formula to learn, and find instant gratification from figuring out how the numbers fit together. However, there is a large part missing from my daily routine and work: the population I am working with/for to improve healthcare in Tanzania. I go most of my days not thinking about the reality of the dire situation of healthcare in Tanzania. This is problematic considering our office is surrounded by coffin shops that are constantly producing coffins for the avoidable deaths that happen on a daily basis at the regional referral hospital five minutes up the road.

This lack of context and desensitization became even more apparent when I started working on M&E for our Mobilizing Maternal Health program. We are measuring how many women’s lives were saved with the implementation of an emergency transport and referral system in a neighboring district. To gather raw data on maternal deaths at the hospital I traveled to the hospital, a fun hour long ferry ride followed by a bumpy 30 km dirt road. Being at the hospital definitely put the deaths into context. The bustling health care workers going from ward to ward, mothers carrying two babies at a time, and pregnant women roaming the hospital waiting to give birth. However, as soon as I arrived back at the office these women became just numbers.  To start the analysis I stripped down the complex life of deceased women into a raw number for an excel model. This raw data was used to inform conversations about our impact and the status of the maternal mortality ratio in the district.

In the midst of calculating a maternal mortality ratio and drafting a graphic for a power point slide the actual women we are impacting were lost. However, we were able to reach a conclusion about the cost-effectiveness of our program and justify the continuation of our program. This information will also be used in the future to inform our program design but also programs in similar settings throughout lower-income countries to improve maternal health. Therefore, there is value in M&E to continue to foster evidence-driven programs that are effective. However, I am torn between balancing objective analysis with the subjective nature of human life.

Objective analyses are crucial to be able to make forward movements in improving healthcare in Tanzania (something Touch Foundation values and prioritizes), but what is the tradeoff? Is it possible to remain connected and empathize with the mamas while conducting objective outcome driven analyses?

I do not have the answer, but working at Touch Foundation has started me on the journey of discovering this balance by showing me how difficult it is. I hope that as my career continues I will learn to strike a balance between these two contradictory but crucial aspects of global health and international development. I believe that with this balance the value of the dollars that are donated by the millions to international development will come closer to reaching their full impact in a helpful, effective way.

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