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Alan Johnson August 17, 2014 Community Health PCV Revised February 1, 2015 Madagascar 2013-2015

A Data Collection and Community Mobilization Strategy for Madagascar PCVs I have some ideas for a strategy to help Peace Corps Volunteers (PCVs) in Community Health multiply the impact of their efforts and collect project data through mobilized community members. Because it can involve a level of financial investment and commitment, it would be a strategy that individual PCVs could elect to adopt. Certain elements of the strategy might be applicable and useful for all PCVs, but I think the limited investment and commitment I am talking about can be valuable tools to leverage much greater community contribution in pursuit of Health Project objectives and goals, and more broadly, community health. My thoughts come largely from the book No More Throw-Away People: The Co-Production Imperative by Edgar Cahn (2004). While Cahn primarily critiques dynamics in the United States, his thesis touches on the kind of work PCVs are trying to do developing people and communities while also identifying failures and negative externalities of common, often well-meaning approaches to community development. Below, I start with a little context regarding PCV data collection, describe a potential strategy to address current shortcomings in theory and practice, and finally expand upon the logic. Because I find his points interesting, but also because they inform the logic for the strategy I describe, I have included excerpts from Cahn’s book at the end along with comments. There are real opportunities to improve PCV effectiveness and to activate communities, but these ideas still need a lot of development to work out their potential applicability for PCVs. If anything, I think this discussion might help some PCVs come to a better understanding of the dynamics of community development, may give context to past experiences, and may lead to ideas for future approaches. Through honest, critical evaluation of how we interact with our communities and of the sustainability of our efforts, we will improve not only our ability to serve the Malagasy people but also the Peace Corps Madagascar program itself. PCV Data Collection & Reporting Many PCVs face difficulty with the practical necessity of data collection, and we are at a point in Peace Corps’ history when the agency is increasingly pursuing quality data from the field. We do so much at our sites, yet we struggle capturing the bulk of our impact. Data collection is necessary not only for reporting to congress and evaluating program performance, but also for PCVs themselves to examine the cumulative outcomes of their work. PCVs need regular, real-time feedback on their efforts to be able to identify hidden failures and to make improvements. All too often we realize errors in hindsight, at the end of projects or at the ends of our service, when it is too late. Currently, strategies for PCV data collection are underdeveloped and the quality of reported data can be questionable. Even with developed criteria for project indicators, the burden of data collection may still tempt PCVs to generate their data from “gut-feeling” estimates, if they report data at all. PCVs who estimate the outcomes of their work may, in effect, be evaluating (and in some cases constructing) their feelings about their efforts rather than honestly appraising their projects. Part of the reason for estimation might be that PCVs lack reasonable and effective data collection strategies and tools. The current guidance for PCVs in Madagascar is that it is okay to report small, realistic numbers to encourage them to take more care in data collection and to improve the quality of overall data. While good advice, this is a coping mechanism that does not address the underlying issues with data collection. It does not improve the process but makes it more manageable for PCVs given the current limitations with strategies and tools. If reliable data can only be collected and verified when the PCV is present, when the PCV pushes for measurement, and when the appropriate tools are used, then a lot of quantifiable and qualitative PCV community outcomes will go unrecorded.

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Project summary data for the revised Peace Corps Madagascar Health Program in its first fiscal year (ended September 30, 2014) shows that PCVs are not reporting on outcome indicators. As of the writi ng of this paper, the Health Program has 35 reporting indicators—12 are outputs and 23 are outcomes. 7 out of the top 10 most reported indicators among PCVs are outputs, while 9 out of the top 10 least reported indicators are outcomes. Five-year targets were set for each reporting indicator, but after one year, 13 of the 15 indicators not on track to meet targets are outcomes. Many of these outcome indicators are significantly below the targeted pace. It could be argued that in the first fiscal year of the revised Health Program, it would be expected for reporting outputs to be high while outcomes developed slowly. However, the first group of Health PCVs had already been at site 5 months when the fiscal year began, and the project summary data seems to show that even a year later, very few PCVs are reporting on outcomes. PCVs in the first health group could have attempted to evaluate a range of outcomes several times over by the end of the fiscal year. In a Health Program with roughly 30 PCVs, no more than 4 PCVs reported on the outcome indicators related to acute respiratory infections, diarrhea, and malaria care seeking. The number of PCVs reporting could be less than 4 if the same PCV reported on multiple indicators. Because pneumonia, diarrhea, and malaria are the leading causes of child mortality in Madagascar, most Health PCVs should be devoting a lot of effort to achieving those outcome indicators. Since outcome reporting has been significantly below the expected pace and since so few PCVs have actually reported on outcomes, it does not seem that PCVs are measuring low numbers of community members achieving outcomes, but rather that PCVs are not measuring outcomes at all. My first attempt to address data collection issues was a “PCV Outcome Tool” (May 2014). I was trying to come up with a way to measure behavior and care-seeking outcomes without a PCV having to track down each individual who attended a training or sensitization event. Such extensive follow up work places a heavy burden on PCVs. They must work slowly and methodically. It would be unfair to shift that burden, even partially, onto already stressed community health workers (CHWs). With the tool, I was thinking that in certain cases, rural health clinic (CSB) staff and CHWs could help PCVs verify if people seeking care had attended a PCV event. The data collection tool would not have required CSB staff or CHWs to track down people, but it still would have involved an additional burden of questioning and paperwork for them. I now realize that it is problematic when looking for a solution to try to squeeze more out of CHWs and CSB staff. If we try to squeeze more and more capacity out of CSBs, CHWs, and PCVs, is the product of our efforts necessarily improved community health? We may get burnout, frustration, and a decrease in the quality of care, but we cannot get healthy communities without the significant contribution of ordinary community members themselves. In my experience as a PCV, I have observed that many Malagasy are knowledgeable about health, but the failure often occurs in acting upon that knowledge in everyday life. An experienced Health PCV told me that during a training for CHWs on a certain health topic, she discovered that her CHWs had already received training and still remembered it. She had assumed that the problem was lack of CHW knowledge, when in fact the issue was that her CHWs were not actively using their training. A USAID staff member from the Antananarivo office made the same observation to me on a visit to my site in August 2014, reflecting on the deficiencies of past programs. To motivate and mobilize CHWs and even ordinary community members as producers of health rather than just consumers or observers, we need a strategy that incentivizes small, feasible, internal contributions to public health. A Strategy to Induce Community Member Contributions A PCV can create incentives for the groups with whom he or she works to conduct public health outreach and collective health monitoring and care seeking. The strategy centers on earning points, credits, or whatever you might label them. For example, a PCV conducts a baseline survey and discovers that proper hand washing is not practiced in a community. The PCV then trains CHWs, school teachers, community leaders/mobilizers, or even ordinary citizens on the topic, as needed. To earn points, a participant of the training must train a designated number of other people on what they learned from the PCV. They get names and signatures from the people they trained and then submit the documentation to the PCV. The PCV then travels with the trainer to visit the people who signed his or her list. If a certain percentage of those people meet the criteria through verbal assessment or demonstration, then the trainer earns points. Because the people they train must demonstrate knowledge and/or behaviors, the trainers themselves must utilize or develop information education and communication and behavior change communication (IEC/BCC) skills in the process.

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CHWs have told me that some community members are disinclined to invite them into their homes and speak with them because they believe CHWs are getting compensated for their time and efforts and there are feelings of jealousy. As a potential way to mitigate uncooperative or jealous feelings among community members, the outreach strategy described above could be implemented in combination with the collective health monitoring and care seeking strategy described below. Combining the two by focusing on particular villages could foster cooperation by offering everyone the opportunity to benefit. The strategy could be used to incentivize and measure care-seeking outcomes as a result of PCV trainings as well. For example, a group of mothers attends a training on malaria. Within a few weeks of the training, a child of one of the mothers gets a fever. The mother takes the child immediately to a CHW or CSB for a Rapid Diagnostic Test (RDT). The mother can have the CHW or a member of the CSB staff sign or stamp a slip of paper indicating they sought treatment (and completed treatment for RDT (+)) and deposit the paper into a PCV drop box at the CHW’s office or the CSB, to be reviewed later by the PCV. To earn points, the onus is on the participant to get documentation, not on CHWs or CSB staff. This method would help the PCV distinguish from the general public care-seekers who attended PCV sessions. For care seeking, because (hopefully) individuals will not get sick often enough to earn ample points to reach reward levels, maybe rather than having individual accounts, there could be group or village accounts so that everyone can earn rewards for collective health monitoring and effort. Incentivizing collective health monitoring within a village will increase awareness of public health issues and strengthen social ties as well. Rather than reinforcing selfish behavior at the expense of community, this strategy clearly links individual gain to collective gain. Rather than a PCV tracking down every participant of training events to see if they have achieved certain outcomes, this strategy encourages achieving participants to identify themselves. To illustrate what a crucial difference this is, consider yourself in the above scenarios but without the strategy in effect. In the first scenario, you trained a group of trainers. In order to measure their accomplishments, you would have to set a date to vi sit each trainer. Until you tracked down each of them, you would not know who attempted the task and who did not, or who completed the task and who still needed more time. Tracking down people can take time, and much time will be wasted tracking down those who did not ev en attempt. Some may have been busy with personal commitments and were still working to complete. You would have to set aside more time to follow up with them. Without a point system and incentives, participants have little reason to conduct outreach compared to how they might otherwise spend their time, and even if they did, there would be no urgency for them to report back to you. After a certain amount of time, they might just forget. Without a strategy in place, collecting data on outcomes can be an inefficient and wearying process. Now consider the second scenario about care seeking. You face a more daunting challenge in following up with participants and evaluating outcomes. You have to track them all down, you have to determine if anyone in their families has been sick, and you have to confirm if they actually sought care and completed treatment. Would you trust what they report? Unlike the outreach scenario above, you cannot schedule when someone may get sick. You have no choice but to survey, and re-survey, and re-survey everyone. Without a strategy, the burdens of data collection severely limit the reach of PCVs. Another crucial benefit of the strategy emerges from this discussion: achieving participants do not just identify themselves to the PCV, but they each identify themselves at the moment they are ready. Because points are on the line and because participants want recognition, they will promptly contact the PCV or submit their documentation. When the evaluation of project outcomes in a community is based on schedules or deadlines set by a PCV (or by any outsider), it imposes a problematic framework on community members. Output indicators are in many ways about the PCV: What did the PCV do? How many people were trained? How? Where? When? PCVs have a high degree of control over project inputs, activities, and outputs. But PCVs have significantly less control over project outcomes because they are not about PCVs, they are about community members: What did community members do? How? Where? When? Outcome evaluation strategies that do not recognize the central role of community members in the process, and that do not afford them the opportunities to achieve outcomes on their own terms and at their own pace, are set up to fail. This strategy seeks to correct certain fundamental failures in the ways that conventional strategies are often framed and pursued.

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A PCV can act as a point account keeper. Reaching certain point levels can earn a person, group, or village rewards. The PCV can regularly produce “community contribution statements” for participants, as well as statements that compare balances for individuals within certain groups (among CHWs, school teachers, ordinary citizens, villages, etc.). If people reach certain point thresholds and earn rewards, points will not be deducted from their accounts, but will accumulate always so that each participant’s overall contribution to public health can be quantified and proudly displayed on a “community leader board.” This may inspire competition among participants to be the biggest contributor to community health. Beyond earning points for oneself or for one’s own group, to encourage altruism, participants could have the opportunity to donate rewards to others or to a community pool to help those in need or to be used on community events or in support of larger community projects. Aside from tracking point levels, an account statement would provide a history of community contribution activity, in many ways like a résumé. It would not recognize participants for the passive fulfillment of generic community functions, but rather would root recognition and praise in specific, active community contributions. For example, CHWs would not earn status for sitting in their home or office, waiting for sick people to come to them, and then treating; rather, specific outreach and prevention efforts will earn them status. This method builds memory into the process of community contribution; what is accomplished today—however small—will not be forgotten. Each individual achievement holds value that carries into the future, accumulates, and continues to benefit the participant. I said before that CHWs are already stressed. This strategy would not force them or any other similarly burdened community member to participate, but would create an environment in which outreach and active contribution are more appealing. If their current situations really do not afford them any spare time or effort to participate in the strategy, then they would not be penalized. But the strategy may change the calculus for them, and all of a sudden they may find that they do have spare time and effort to contribute to their community. It gives them the freedom to choose when, where, and how they want to contribute; it does not restrict anyone to the PCV’s schedule. This strategy is designed not to “squeeze” people or increase their burdens but rather to activate latent capacity. On a limited scale, I think a PCV could manage this strategy. However, if the strategy had the sponsorship of an organization—whether an NGO, a business, or a government ministry—that organization could leverage widespread community action for a minimal investment. There are many organizations that could benefit from, or that explicitly strive to achieve, strong, developing communities. In this context, PCVs would be in prime position to facilitate the strategy locally in partnership with the sponsoring organization. Provided that Peace Corps and Health Project goals and objectives aligned with a potential sponsor’s, such a partnership could allow PCVs to keep doing what PCVs already do, just with new tools and in a much more conducive environment. Successful implementation of the strategy itself could be a significant draw for outside organizations or investors looking for promising communities and projects. The account statements and community leader boards mentioned above, as detailed records of active community contributions, could serve as powerful supporting documentation in grant applications, like a strong credit history, and could catch the attention of government officials and the media. In this way, implementation of the strategy could eventually earn a community access to needed resources and spark a wider range of community development efforts. While my discussion focuses on community health, this strategy could be adapted and applied to other sectors. In addition to sector focus, the strategy could be constructed with a certain orientation: s trengthening community, social service, systems change, helping underprivileged groups, etc. This strategy can help PCVs achieve Health Project indicators as well as Peace Corps initiative indicators and cross sector programming priorities. Incentives The most difficult part of the strategy is determining what rewards might be offered and setting appropriate point thresholds for point “redemption.” Ideally program rewards should promote community development, health, and relationship strengthening. Ideally, they would also come from or be sponsored from within the community. Some might argue that this strategy assigns a monetary value to the contributions of community members by equating their time and effort with certain rewards. While small investments of different sorts might be necessary to support the reward

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structure, it does not assign any clear monetary value to community contributions. Rather, the small investments (rewards) are ways to leverage community action much cheaper and more efficiently than if community members would be paid salaries for the contributions (work) we are trying to elicit from them. This strategy is designed to activate latent capacity in communities, taking advantage of who people are and what they already know how to do, rather than turning them into professionals. For a detailed analysis of the significant differences between certain non-monetary incentives and monetary compensation, see below pp.26-40. A system of “point banking” would have to be developed with community members, and could be tailored to reflect different participating groups within the community. The particular rewards to be earned through the program must be mutually agreed upon between the PCV and participants, not necessarily community wide but by subset. With the rewards determined and the process for earning them laid out clearly, the strategy would be transparent and there could be neither claims of favoritism toward certain participants nor expectations of entitlement to unearned rewards. Rewards must be realistic and they should promote a “shared vision of the world,” as Cahn says. In other words, ridiculous or expensive rewards would be off the table—unless a PCV could secure a donation of, for example, computers from an outside organization. A group of participants could select a particular set of rewards that reflect their dreams for their community, and through their program contributions, they can earn tools or resources to help them achieve those dreams. Once again, some might take issue with asking people “in need” to work or “pay” for tools or resources needed to help them help themselves. PCVs share knowledge and skills and serve as assets to those in their communities who partner with them. These are not one-way transactions of charity; communities get the most from PCVs when they work with them and create value together. PCVs require active partnerships—active contributions by members of their communities. This notion of community ‘buy-in” is also established in the Peace Corps small grants program through the requirement of a community contribution. Similar to the strategy I propose, with the small grants program, when promised community contribution reaches a certain level, they essentially earn the release of funds and resources for projects. Unfortunately, the community contribution required for the grants could be entirely passive and undermine sustainability; passive investment may generate community interest, but active investment generates community ownership. PCVs integrate into communities well and gradually establish partnerships; it i s Peace Corps Goal 2, and we achieve it simply by living in our communities for two years. On an individual level, the nature of that process and those relationships is active, but on a community level it remains largely passive. We are great at impacting individuals one-on-one, but we are not good at structuring our efforts to multiply our impact and achieve larger scale. Success with Goal 2 spills over in support of our Goal 1 efforts, but that is all it is—a spillover. It does not matter how well we integrate if the same systemic constraints that limit development remain. I am not saying that we can or will impact everyone in our communities, but I am saying that opportunities exist for us to make a larger and quantifiable difference. If there are no sponsoring organizations, the variety of incentives available depends on individual PCVs and their communities. Some PCVs may be comfortable with certain incentives and not others, or may be able to contribute particular knowledge, skills, or services that other PCVs cannot. There are many incentives that PCVs could reasonably finance or provide. Each of the potential incentives I list below I could have financed comfortably out of my Peace Corps living allowance and in combination with other incentives as well. However, what PCVs do with their money is their choice; the amount of money they could possibly invest in their communities through this strategy, and their interest in doing so, might be limited. Based on anecdotal evidence, some PCVs are already giving away incentives at their sites without leveraging them for community mobilization. Incentives from PCVs can be effective, but incentives from within communities are ideal; they can be sustainable and transformational. In that respect, a PCV should discuss with interested community groups what incentives from within the community might be appealing and appropriate, giving them the power to choose what they earn. The following is by no means a comprehensive list of potential incentives. Some may be more appropriate than others depending on the context.

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Incentives (things):

Certificates o Commendation for specific contributions to community health.

Printed pictures o Pictures of participants during training sessions, making active contributions in the field, etc. o Pictures of participants posted in public areas (CSB, commune office, fokontany office etc.) in

recognition of contributions, like a “contributors of the month” board

School, community center, or education support o Supplies: pens, pencils, erasers, notebooks, chalk, etc. o Materials: books, Malagasy-English dictionaries, world map posters, etc. o Equipment: blackboards, desks, etc. (limited number new or limited to repairs of existing) o Infrastructure:

Water, sanitation, and hygiene (WASH): kabone (pit latrine) or partial construction materials; tippy tap or other hand-washing station; repairs to structures

Electricity: full or partial funding for solar panels or other power generation system, batteries, lighting, etc.

o Assistance with construction or repairs

Public sanitation and hygiene stations o Kabone or partial construction materials

The kinds of materials needed for proper sanitation depend on the particular region of Madagascar and the particular site. For example, at my site in the eastern coastal lowlands, the most basic kabone can be built entirely with local, natural materials and with local skills and labor. No rocks, bricks, cement, wooden planks, nails, or tin and no technical specialists are needed, as they might be in other regions. However, to improve the quality and durability of kabone at my site, this strategy could make SanPlat, a specially designed and easy to clean pit-latrine floor slab, more affordable and accessible to community members through partial or full funding from a sponsor, whether a PCV or other.

o Tippy tap or other hand-washing station o Assistance with construction or repairs o Note: While there tend to be issues with ownership and maintenance of public facilities, 1) if people

choose these stations as potential rewards and 2) if people put in the necessary time and effort to earn those rewards, then those individuals will already have a significant, active investment in ownership over those stations.

CHW offices o Miscellaneous supplies: notebooks, pens, etc. o Assistance with office organization and supply management o Partial construction materials o Assistance with construction or repairs

Minor road repair (to improve access to needed resources: health clinics, schools, markets, etc.) o Partial construction materials o Assistance with construction or repairs

Breakfast, coffee, or snacks at next meeting (applicable to groups) Potluck meals, with some special contribution by the PCV (applicable to groups)

Printed posters

Printed childhood nutrition books Custom T-shirts (promoting group or mission pride)

Discounts from certain local vendors or service providers for program members who achieve a certain level of contribution or who earn a minimum number of points each month

o Discounts could be very small and still be effective, especially in rural communities. The discounts would not be available to everyone in the community but only to program members. Even more, only program members who achieved a certain level of documented contribution, preferably on a monthly basis, could earn the discount. So, for example, I have identified a vendor willing to participate in this strategy. At the end of the month, I give him or her a list of the program members who earne d the necessary

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amount of points for that month. Only those members on that list earn discounts for that month, and every month the list resets. This arrangement would limit the risk for vendors and service providers while potentially increasing business volume.

o It is likely that vendors would be unwilling to risk potential losses in revenue from offering any form of discount. As a solution, a PCV could offer to subsidize the discounted amount for the vendor, provided that detailed records and receipts are kept for all applicable transactions. Additionally, this arrangement with the vendor could be treated as a business experiment or study. The PCV and vendor could analyze the effect of the discount on business performance. If successful, the vendor may eventually become comfortable adopting the discount incentive without subsidization. In the course of the experiment, other opportunities for business improvement might be identified and implemented as well.

o Because discounts would only be available to program members, membership and community contribution would earn people status. Participating vendors and service providers could also earn status through their support of community mobilization and development.

Incentives (experiences and services):

Parties (applicable to groups) Learning special skills

o IT o Document drafting

For example, résumés, grant or project proposals, etc. o English sessions o Music or instrument lessons o Sports o Unique crafts

Writing (general) o For example, writing notes, letters, or documents for someone who does not know how to write or who

has difficulty writing.

Tutoring Odd jobs

Delivery o PCVs could help remote villages gain greater access to needed goods or resources. For example, I

conduct monthly healthy cooking sessions in a remote village 12km away from my community’s main town, which is an additional 18km away from the district capital. Peanuts cost 800 Ariary per cup in the village, 700 Ariary in the main town, and 600 Ariary in the district capital. With people in remote areas often the most vulnerable, higher goods prices can intensify their stress and force them to go without. Protein is limited in daily diets and child malnutrition is a consistent concern, so access to cheaper peanuts could make a difference in the lives of villagers and have long-term community effects. As a PCV, I have relatively easy access to the district capital compared to many others in my community. In exchange for participation in the strategy, I could potentially come to an agreement with vendors in the remote village to purchase peanuts on their behalf in the district capital and deliver to them when I conduct my cooking sessions. To be clear, the vendors would be purchasing the peanuts at 600 Ariary per cup, not getting them for free. Rather than providing an opportunity for vendors to take advantage of community members and earn more profit, they would have to agree with community members to set the price at 700 Ariary as in the main town. As an alternative, if I was feeling lazy and did not want to travel to the district capital, I could elect to acquire peanuts in the main town and subsidize the cost difference (100 Ariary per cup), which would be minimal. This model could apply to a variety of other needed goods. If I am already spending time and effort travelling back and forth betwe en the district capital and the village, the additional effort to transport goods for them would be insignificant for me, but the savings for villagers would accumulate.

Business consulting Incentives (psychological):

Personal recognition

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o By community leaders at public events (PCVs should always recognize people’s accomplishments) o Messages on the radio o Status earned from individuals and families served

Regular “account” statements (personal and public) document specific contributions

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Edgar S. Cahn, No Throw-Away People: The Co-Production Imperative, 2nd Ed. Essential Books, Washington, D.C., 2004.

Bellow I provide excerpts from Cahn’s book that I find interesting and relevant to community development. Even though Cahn primarily critiques dynamics in the United States, I comment on how the excerpts potentially relate to the experiences, work, and roles of PCVs in Madagascar and to the strategy I describe above. My perspective is, of course, limited, so the perspectives and comments of others would be needed to flesh out the issues raised and how closely or distantly they reflect dynamics and opportunities in Madagascar. Cahn’s premise is that systemic dynamics, and the resulting way we are trained to think, devalue the contributive forces we need in order to develop and maintain strong communities. Cahn says that the conceptual framework we are taught in the United States is predominantly a market framework: to improve quality of life and address our great problems, we need money, trained professionals, and specially developed programs. Cahn claims that our market-dominated framework blinds us to the fact that when it comes to addressing social and community development issues, the best people for the job are not professionals and the best tool is not money. Community members themselves are the most qualified and their time and skills are the best tools. Because our conceptual, economic, and policy framework lacks this recognition, well-meaning and well-planned efforts will invariably and unintentionally produce negative, inhibitive effects in the sphere of family and community. Cahn illustrates the ways in which the “non-market economy” or “core economy”—the sphere of family and community—is systemically subordinated to the market economy. The result, particularly in development, is that often as hard and as earnestly as people try to make a difference in the lives of others, fundamentally, little changes, and we find ourselves in the same place we started. Cahn’s solution is to elevate the non-market economy from a relation of subordination to one of parity with market. This leads to Co-Production, the recognition that unilateral market solutions do not work—the active contribution of the non-market is essential. Co-Production means that teachers need students to do their homework in order to learn and do well in school. Teachers do not unilaterally produce education; rather, it is a collaborative effort between teachers and students (and parents). Co-Production means that health workers need their patients or fellow community members to adopt healthy behaviors to prevent serious illness and the need for extraordinary treatment. Health workers alone do not produce health. Without significant contribution from the intended beneficiary, many professionals cannot achieve the ultimate aims of their jobs. Unfortunately, preference for market thinking and solutions perverts the results and prevents many from achieving those ultimate aims. For example, maybe teachers originally dreamed to challenge and inspire students and form the minds of the next generation of great leaders. That is what teachers are supposed to do, right? But now, in order to advance in their jobs, or even to keep their jobs, some teachers must be careful not to deviate from the approved curriculum and have been instructed by school administrators to “give” students positive grades so as not to anger the “customer,” the parents.1 Similarly, health workers should ultimately desire a world in which people are healthy, and through their efforts they might make the world a healthier place. Yet with focus often on treatment over prevention, to be needed and to earn a living (and sometimes to pay off large student loans), it could be argued that they need people to get sick. Some might be tempted to prescribe a range of overcautious or even unnecessary tests, medications, or treatments, at great expense to the patient and the patient’s health insurance provider.2 Doctors may also fear angering the customer, the patient, fearing malpractice claims, and so might tend toward patient appeasement.3 When Co-Production is absent or ignored, we tend to generate results contrary to those originally intended.

1 “I would love to teach but…,” The Washington Post, December 31, 2013, http://www.washingtonpost.com/blogs/answer-

sheet/wp/2013/12/31/i -would-love-to-teach-but/. 2 Aaron E. Carroll, “Doctors’ Magical Thinking About Conflicts of Interest,” The New York Times, September 8, 2014, http://www.nytimes.com/2014/09/09/upshot/doctors -magical-thinking-about-conflicts-of-interest.html?abt=0002&abg=1. 3 Jordan Rau, “Doctors Think The Other Guy Often Prescribes Unnecessary Care,” NPR, May 1, 2014,

http://www.npr.org/blogs/health/2014/05/01/308731318/doctors -think-the-other-guy-often-prescribes-unnecessary-care.

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How do we correct these market perversions and achieve parity with the non-market? How do we elevate the value of non-market contributions and achieve Co-Production? Money is the market solution, through programs and paid professionals, but money is an inefficient tool for this purpose and can easily create negative externalities for the non-market, as seen in the examples above. Another kind of compensation or incentive is needed to value contributions in the family and community—another tool with different characteristics. That led Cahn to Time Dollars and Time Banking, which has proven effective in local applications in the United States for nearly 20 years and has emerged in many other countries.4 To put it simply, within a limited network of individuals, one hour of your time and skills contributed to another earns you one hour of someone else’s time and skills contributed to you. For example, an elderly man on a fixed income may need help with household tasks (changing lightbulbs, fixing leaky pipes, doing yard work, picking up groceries, etc.). He does not want to be a burden on family or neighbors, and he cannot afford to pay someone out of his limited income, so being a member of the Time Bank network, he contacts the administrator. You are in the network as well, and you indicated you are capable of these tasks, so the administrator contacts you to help. You earn Time Dollars for your time spent assisting the elderly man, which he earned babysitting for another member. You, in turn, need help writing a business plan, so you spend your Time Dollars getting assistance from a member with business knowledge and experience. In this example, the elderly man did not have to beg for charity or be a burden to others, and he did not have to go without to pay for those services. Even though he lacked physical strength and money, he possessed skills he could contribute, which allowed him to earn the assistance he needed and preserve his dignity. Cahn’s strategy achieves a kind of parity between market and non-market by saying that the time and effort of professionals can often be as valuable as the time and effort they need from ordinary people in order to have any chance to succeed in the ultimate aims of their jobs. As in the example I gave above, why should dignity be easy to maintain for those with comfortable salaries and money to spend, when it is hard to maintain for those with limited income and little money to spend, but who are still capable of contributing so much? The elderly, the disabled, the vulnerable, the disadvantaged, and the poor are not helpless objects of charity or indolent drains on society as they are often characterized from a market perspective. This perspective denies them dignity and denies them opportunities to contribute their vast wealth of knowledge, skills, time, and energy. Sustainable community mobilization and data collection are some of the greatest challenges and priorities for Peace Corps. Ideally, PCVs trigger community development from within, helping communities identify and utilize assets they already have. We all know this is hard work. It is hard work to mobilize individuals, let alone communities. Results take time, and often take on intangible forms. If achieving the result is hard enough, capturing the result with data presents a new range of challenges. In many respects, it seems like the concept behind Time Banking—if not Time Banking itself in one form or another—could make a difference in the work of PCVs and the development of individual sites. Time Banking is simultaneously a community mobilization, empowerment, and data collection tool, which PCVs currently lack and need. Cahn discusses numerous examples, across different sectors and for different purposes, in which Time Dollar programs have successfully mobilized program members to meet previously unmet community needs, with the tool itself a built-in form of measurement. Co-Production as a concept is already embedded in the role of PCVs, even if it is not explicated to the extent that Cahn describes it. A tool such as Time Dollars could help PCVs not only apply Co-Production but also structure it and measure it in their communities. I am not arguing that Peace Corps should adopt Time Dollars or Time Banking, as developed by Cahn, or that such programs would necessarily work at PCV sites. However, I do think that they at least could provide some tools and best practices, or inspire new ones, which might be suitable for rural Madagascar and which PCVs might apply on a limited scale. I imagine that if there was support from an outside project or organization, a larger scale application might be possible.

4 Time Banks, http://timebanks.org/.

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The active contributions of those “being helped” are essential for success. “The consistent refrain that kept surfacing in all the expressions of concern, anxiety, and frustration [from many agencies] was how difficult it was to get and to sustain participation from the very people being helped. The refrain took varied forms:

--We can’t get them to turn out for meetings, even when they know it’s critical. --We can’t get them to call for an appointment—even the ones who need it most, especially the ones who need it most.

--We’re not charging anything. But no one comes in for help until it’s too late. --It’s virtually impossible to mobilize community support on any sustained basis. No turnout means no return.

… Could there be a constant, a missing factor that cut across the full spectrum of social problems? That question triggered an informal, highly unscientific inquiry to see whether the same constant would continue to pop up in different fields. Sure enough, it was there:

--Educators complain that they can’t succeed i f they can’t get students to do their homework. --Doctors and health professionals complain that they can’t get patients to change their l ifestyles: poor eating habits, lack of

exercise, smoking. --Police explain that there is no way they can make a neighborhood safe without getting people to organize some kind of patrol or look-out program. --Substance abuse counselors and drug treatment programs say, ‘We can detox a person—but if they won’t go to a support

group or a twelve step program, there is no way we can keep that person off drugs or alcohol.’ --Gerontologists say, ‘We can prescribe pil ls, design a diet, replace a hip, provide by -pass surgery or angioplasty—but it takes work by the patient to stay healthy, avoid depression, and reduce the risk of dis ability.’ --Politicians and officials tell me they want to improve government efficiency, effectiveness, and accountability but that—

regardless of laws passed, regulations promulgated, and money expended—without the backing and vigilance of alert civic groups, nothing changes. --Housing authorities describe how all their efforts to keep the buildings in good shape fail because they can’t get the

residents involved. --Community Development Corporation staff say, ‘We can build affordable housing but we can’t build community by ourselves.’

It didn’t matter what the problem was or what discipline the person belonged to; it became evident that they were all saying the same thing…: --We can’t succeed because we can’t get the participation we need from the very people we are trying to help.” (20-21) “Without labor from the intended beneficiaries, nothing that professionals do can really work.” (26) Comment: PCVs fit comfortably in the list above of those who cannot succeed in their jobs, missions, or service witho ut active participation from the community members they are tasked to serve. Peace Corps recognizes the necessity of mobilizing communities to achieve sustainable gains, but as I will discuss later in more detail, recognition often does not translate into suitable implementation. The job of PCVs is developing people, not things. As important as our work is, we cannot force people to do anything. People always have a choice. For our jobs as PCVs to be successful, we depend on people in our communities choosing not only to listen to us, but also to follow our example and to change their behaviors as a resu lt of our work. It is easy for PCVs to focus on outputs: big events, publicity, murals, trainings, speeches, etc. They are immediate, they generate easy (and sometimes big) numbers, and they make PCVs feel like they are doing things. However, despite the wide net cast, it is hard to catch many fish when it comes to outcomes. Many people may remember the information they were taught and the training they received, but how many actually act upon it in their daily lives? Community Health Workers (CHWs) are a prime example. I have conducted knowledge and skills surveys with my CHWs. I have seen NGOs conduct the same surveys with them. I have observed NGO trainings of CHWs when the trainers have acknowledged, and the CHWs have demonstrated, that they were already knowledgeable. And yet when I observe CHWs in their communities, I see still very few are mobilized and proactive. Even for CHWs who earnestly express a desire to be active, to do more, the impetus is not there, and they find themselves stuck in a framework that constrains them. Programs designed to support and improve the work of CHWs have been doing the same things over and over again, but the results continue to come up short of the goals. Development professionals are starting to recognize that a new strategy is needed to mobilize CHWs.

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PCVs are working with their community members, but when it comes to mobilizing them—converting knowledge and skills into sustained action—we struggle and often come up short. Generation after generation of PCVs confronts the same problems; it does not get much easier for replacement PCVs. We are missing the full picture. Achieving partnership is easy for PCVs simply by virtue of living in our communities for two years. But we lack some of the skills and tools to turn partnerships into something more—into Co-Production. Co-Production is imbued with a set of core values, with a social justice perspective, that aims to address the systemic deficiencies that make it so difficult for CHWs, and community actors more broadly, to fully engage in the socially beneficial work they are capable of doing and that we need them to do. Ultimately, as PCVs we do not need our community members to attend trainings or big events, to see posters or murals, or to hear speeches. We need them to be active and use their knowledge in their villages and in their homes, on their own terms and in their own time. “The history of the past century or more is the history of the market economy taking over functions previously performed by the family, kinship groups, neighborhoods, and non-market institutions—because of seemingly superior efficiency. We have contracted out as many of the functions of the informal economy, the non-market economy as we can. McDonald’s now provides the meals; Kindercare the day care; public and private schools the education (such as it is); Nintendo the child care and entertainment; Holiday Spa and Gold’s Gym the exercise; insurance companies the protection; Medicare and Medicaid the nursing care—and on and on the list goes. The superior efficiency of the market turns out either to be illusory—or to have hidden costs. It assumes continued uncompensated contribution and support from the very non-market institutions the market is undermining. Employers assume that employees can manage their private lives and live in neighborhoods where they can raise their children and from which they can commute safely. Government assumes and counts on some minimal degree of participation from families, neighborhoods, communities, and constituencies. All rely on a hidden, largely unacknowledged labor subsidy from home, neighborhood, and community. Increasingly we are coming to realize that the household economy, the non-market economy cannot keep contracting out functions to the market economy without dangerous repercussions…. The market economy peddles products that purport to be real substitutes for what families, extended families, and communities produce; they are not. At best, they complement and enrich. At worst, they provide the illusion of adequacy—with the real cost for what is lacking emerging later, with a much higher price tag…. As we contracted out function after function, we left emotional ties, relationships, and values without function, without soil.” (114-116) Comment: What do we, as PCVs, assume about our communities? What do we assume about the people with whom we work? Similar to Cahn’s remark, we somewhat assume but mostly hope for the “continued uncompensated contribution and support” of individuals, families, and communities. We hope that people will listen to us and understand the value of our messages. We hope that people have ample time, energy, and motivation to do what we ask of them “for their own benefit.” Do these hopes resemble the reality we witness at site? They tend to be further apart than we would like. The decisions and actions of others are out of our control. However, the process does not have to be so tenuous. We can take greater control of the process and improve the environment in which our community members make decisions so that we might no longer hope for abstract outcomes but rather guide people to concrete ones. “Cheap labor, secured by subordination, exploitation and discrimination, is no longer the infinitely renewable resource it once was.” (133) “‘How did you treat your substitute teacher?’ When I ask that question, a smirk combined with a slightly demonic grin spreads across the faces of most people. Those days were like having a break. Even when the substitute teacher was really trying, no one listened. She could take down names and note behavior; she could threaten to contact the regular teacher. But none of that was real to us as children. Those were the days when we would try getting away with things we wouldn’t dream of doing with the regular teacher. That’s because it simply didn’t count. No action had consequences because that substitute would simply be gone. You would never see her or him aga in. Memory didn’t exist. I have yet to meet the person who can remember learning anything from a substitute teacher, or trying to do something special to make a good impression. Now try to imagine living your whole school career with substitute teachers—or living your entire life in a world where nothing you did had consequences because you would never see today’s people again. You could lie, and no one would find out. You could take something that belonged to someone else; no one would ever catch you or ask you to give it back. You could accidently break something, and no one would ever know you did it. At first,

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that might seem great. But if that were life, your whole life, if nothing you did mattered, why would you even try to do anything special? All that would matter would be what fun you could have, what goodies you could get, here and now. If life feels like a series of one-time encounters with substitute teachers, then why not treat every stranger as someone to take advantage of? Take the sucker for everything you can get. Why not? That is the world we live in, many of us. Particularly children, and especially children growing up in poverty. That’s 40 percent of the children in this country —and we are rich; maybe the richest country in the history of the world. Nearly half of our kids are growing up in a world where nothing they do matters. No one cares. No one will remember. For the most part, the chances of getting caught are pretty small—for taking advantage of someone, for lying or cheating or steal ing or hurting someone. That’s not exactly a safe world to live in. No trust, no honor, no restraint…. Trust and cooperation become possible only if there is a future. Then, the shadow that the future casts on the present makes trust and cooperation in the present possible…. That is why the Time Dollar Youth Court [in Washington, D.C.] seeks to establish a new causal relationship between present and future. Prior practice in the District of Columbia was almost uniformly to send a youth home at the first arrest. The prosecutor would ‘No Paper’ the case. It wasn’t worth taking it seriously. The message that sent was: You get three freebies before anyone takes you seriously. That meant three times getting caught—and who knows how many times not getting caught. By the time a youth came before a judge as a first offender, that youth was already well along a road that said: Acts don’t have consequences. Nothing matters. Just try harder not to get caught. Guess where youngsters can turn for that kind of savvy? The streets. These are the young people who have serious discussions about how they are to be dressed for their own funerals, what clothes they want on them, and what kind of coffin they want to be laid in. For them, there is no future. There is living now, going out in style and maybe, hopefully, leaving a baby or two behind. Creating a Youth Jury is not about processing cases. It means creating a peer culture where it is safe to say: Don’t take that risk. It means getting youth to believe that acts have consequences and that they, as jurors, can help shape the future for themselves and for their peers.” (170-173) Comment: It seems that there is little memory built into recognition of the work of CHWs. Each action they take must fit within generic reporting categories, which then get recorded as numbers and finally submitted to their supervisor at the CSB, and possibly, in separate reporting forms to an NGO. From what I have witnessed at site, both CSBs and NGOs place emphasis on CHWs filling out their reports correctly and submitting them on time. Most of the praise CHWs receive is for doing as such. Much less emphasis seems to be placed on public outreach and sensitization. In other words, the message conveyed to CHWs is that the quality of their efforts is not as important as the mechanical process of reporting. Even then, once submitted, reports often seem to be forgotten; the table resets and everyone starts over again in the same place. As an example to the contrary, Mikolo, a USAID-funded program run by Management Sciences for Health, has begun awarding CHWs various ranks depending on certain performance criteria. However, I have not yet received clarification on these criteria; they may still only evaluate CHWs on administrative tasks and not on community activities. Why make any special effort to promote community health when that extra effort will neither be recorded properly nor earn praise? The strategy I propose builds memory into the process and increases the focus on the quality of CHW (or community member) contributions to community health relative to the current focus on administration. Rather than others trying to make CHWs more like professionals, CHWs could be more effective by just being themselves.

PCVs are not professionals, and yet professional-client dynamics still characterize our site relationships. Professional Monopolization: “Often professionals incapacitate citizen groups. Citizen action is hard work. Handing things over to a professional feels safe, sure—and easier. The result is that people buy a diagnosis of both problem and solution that is sanctified by professional expertise.” (25) Professional Exploitation: “The citizen energy needed to hold government and professionals accountable and to effec t real systemic change can readily end up being siphoned off into activities that simply expand or enrich systems that are ineffective or unresponsive. Citizens and neighbors can cease to be community people drawing on their own native strengths, if they devote themselves entirely to activities that make professionals the ultimate source of approval and validity.” (25)

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Comment: As described above, I have observed this dynamic at site with my CHWs. If CSB or NGO workers are pleased by timely and accurate reports, then CHWs may focus on paperwork more than community work to attain their approval. CHWs who have been trained and retrained on health topics and proper interventions, on management skills, and on new report form after new report form will not necessarily learn how to serve their communities better. They will, however, learn how to serve the professionals better. The NGOs will report that CHWs have been trained and that knowledge and skills have been improved, but behind the data and between the sporadic NGO follow-up visits, little will have changed in the community. Conducting house-to-house sensitization with CHWs early in my service, I would ask residents questions to get a sense of baseline knowledge and behaviors. Even though I was surveying the residents, on some occasions I would have to stop CHWs from interjecting and supplying the answers. They wanted to show off their knowledge to me, or to make it seem that they had trained others well. Many CHWs have been conditioned in this way. Validation should not come from professionals but should be generated by the work they do in their communities every day . Constant retraining on health issues and on reporting methods keeps CHWs trapped in the same, old, “ineffective” and “unresponsive” framework. A new approach is needed to build their confidence as well as to adjust their sense of to whom they are accountable. When a USAID team visited my site in August 2014, I witnessed the lengths to which local NGO workers and community members will go to mask actual field conditions and practices. All of my CHWs work out of their houses, with no buildings available to serve as offices, and yet during the visit, they hosted the USAID team in what they presented as well-organized offices. I had thought that, in pursuit of community health goals developed with Mikolo, my communities had come together and established new offices for the CHWs. However, when the team left, things returned to the way they had been before. In one village, all equipment, materials, and medicine were moved back into the CHW’s house. In another village, the “new office” became a shop, selling rice as well as alcohol and cigarettes , among other things, even though the sign remains identifying it as a CHW’s office. My CHWs told me that they had been instructed to move their offices for the visit. Rather than presenting the conditions under which they work, they presented what they thought the visitors wanted to see. Professional Domination: “Citizen participation, when sponsored and structured by professionals and organizations, is not necessarily a form of participatory empowerment. It can degenerate into busy-work that keeps citizens from taking direct political action to curb or correct systemic malfunction. All of us can be seduced by the illusion of power we get from being invited to meetings and even sitting at the table. We need to be wary of being relegated to an advisory role. All too often, we discover that we have genuine decision-making authority only with respect to trivia.” (26) Comment: PCVs have to be careful not to trigger “professional domination” traps. We have been trained on the terminology—we know how to say the right things about participation, empowerment, community assets, etc. But how many PCVs really understand what the terminology means or how to put those principles into practice? PCVs are not professionals, and it cannot be expected that they are experienced in community empowerment. For the most part, we learn by doing, and it takes time. I am not saying that PCVs have to be or can be perfect in this regard, but I worry that many PCVs are striving to achieve symbolic “community engagement” when they conduct Participatory Analysis for Community Action (PACA) and in project development and management. “Community participation” becomes a hoop to jump through, a task to complete, a box to check off, rather than a critical process. We may be talking about subtle variations in the ways PCVs understand and approach community engagement, but it can mean the difference between project success and failure, between short-term effects and long-term sustainability. Criticism of Peace Corps often focuses on Goal 1 effectiveness, while conveniently ignoring achievements in Goals 2 and 3. While we must always keep the larger mission in mind, successes in Goals 2 and 3 should not become excuses for our real Goal 1 limitations and failures. It is hard for some PCVs to acknowledge the failures we sometimes experience in our efforts and with our methods, but failure is a fact of life for all PCVs. We should evaluate ourselves on each goal individually and earnestly strive to improve our performance. We should honestly evaluate ourselves on how well we really include and empower our communities.

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There seem to be two competing currents within Peace Corps regarding the pursuit of Goal 1 by PCVs, and it is unclear to me if they can be reconciled or if Peace Corps is currently pushing in one direction more than the other. As I said before, PCVs are not professionals. Peace Corps cannot train PCVs to be technical experts or give them all the answers. The beauty of the Peace Corps model is that communities provide the training ground as well as the trainers. It is a slow, bumpy, and complex developmental process. The traditional Peace Corps approach primarily emphasizes the personal and professional development of PCVs. Once PCVs and their communities are finally ready, then the really important work can potentially begin. The drawback is that PCVs often reach this stage of confidence and competence with their close of service already on the horizon. In the July 2014 Peace Corps Madagascar post newsletter, one of the featured “Lessons Learned” from a Health PCV stated: “I've noticed that my confidence, my language skills, and my organization seem to have come a little too late as well. I guess that's the interesting thing about Peace Corps, once you have the smarts and feel comfortable it's about time to leave” (15). Time is short to apply the lessons learned. PCVs certainly benefit greatly from their service, but do their communities—rather than select community members—benefit to the same extent? There is currently a competing push to “professionalize” the Peace Corps, as many have commented particularly in the wake of the agency’s implementation of a reformed applicant strategy. PCVs already have been experiencing this push in the form of enhanced data collection and data quality efforts, better defined project objective indicators and criteria, and an improved Volunteer Reporting Form (VRF) platform. More and more emphasis is being placed on Goal 1. Pushing for improvements in data collection will not improve performance on Goal 1. It may capture more outputs (more stuff done), and make PCVs appear busier, but sustainability, outcomes, and impact will remain uncaptured and subject to the same limitations as in the past. I would ask: What, specifically, are we striving to accomplish through Goal 1? Are we taking the right approach and using the necessary tools to get there? Is Peace Corps mainly a developmental experience for future development professionals, with “actual” development coming about late in service, incidentally, or years later with another agency? Though it might sound like I am being harsh, I am a firm believer in Peace Corps. I just think it is necessary to take a critical look at our understanding of what we should be doing and compare it to what we are actually doing. “In our efforts to deal with social problems, programs keep crashing. We keep trying to fix them, upgrade them, reinstall them. But it becomes clearer and clearer that the problem is not with the programs; it is the operating system that is malfunctioning. More and more of the things that families and neighborhoods used to do are not being done —or are getting done by much more expensive, cumbersome, specialized agencies that are not designed or staffed to handle all the things that families and neighborhoods used to do for themselves. There were a lot of things wrong with the old operating system—but for much of the past millennium, it worked reasonably well. If we are going to be honest about it, we will have to admit that the old operating system worked as well as it did because it was heavily subsidized by the subordination of women and the exploitation of minorities, immigrants and children. It took a lot of free labor and cheap labor to keep that operating system going. As ideals of equality and opportunity emerged, as jobs opened up for women, as certain forms of discrimination and exploitation became unacceptable, that labor ceased to be available on the same quantitative and qualitative terms. The lure of the market and the apparent rewards of employment empty the kitchen table, the home, the neighborhood, whole communities, whole regions. The arbitrary limitations built into that old operating system are no longer acceptable. We need a new operating system for our society, one built on equality and reciprocity, on mutuality and caring…. We are currently trying to fix the old operating system with specialized programs operated by professionals supported by money and operating within the constraints of the market economy. So we ask schools to take over the role of families, police to take over the role of neighbors, the health care system to function as a support system, and specialized, public interest advocacy groups to function as the equivalent of an alert, engaged citizenry.” (54-55) Comment: We have new idea after new idea to address social problems and community development, but we rarely alter our fundamental approach. As a result, we have seen many issues fail to improve or in fact get worse . Entrepreneur and activist Dan Pallotta says that our model for addressing social issues

doesn’t seem to be working. Why have our breast cancer charities not come close to finding a cure for breast cancer, or our homeless charities not come close to ending homelessness in any major city? Why has poverty remained stuck at 12 percent of the U.S. population for 40 years? And the answer is, these social problems are massive in scale, our organizations are tiny up

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against them, and we have a belief system that keeps them tiny. We have two rulebooks. We have one for the nonprofit sector and one for the rest of the economic world.5

See comment on the limitations we place on ourselves in addressing social and development issues p.28. See also Cahn’s claim about hunger and homelessness rates p.37. “Professionals driving nice cars, carrying cell phones, and going home to the suburbs at 5 p.m. will have a hard time asking for sacrifices from people they are seeking to help. Who are they to preach sacrifice for the good of others? Professionals get upset when those they are trying to help don’t show up for meetings or appointments. But we know who gets paid to attend those meetings and who does not. And we know whose lives have at least the structure of an eight-hour day and a regular pay check and whose do not.” (57) Comment: PCVs are not professionals, though many Malagasy do not believe us. We do not drive nice cars… but rather really nice Peace Corps-issued bikes, which our communities know were not cheap. We carry cellphones, though increasingly they are smartphones, often along with tablets and laptops. We do commute to most of the villages where we work, and we do try to get home before dark. We do ask for sacrifices from people, to the extent that behavior change can entail sacrifice. PCVs are not surprised by low attendance at meetings and events. It is true, we get “paid” to do all of the things we are doing, but no one is compensating our community members for the contributions we ask of them. Many in our communities have to work whenever they can and as long as they can, day after day, to earn a living. PCVs have the luxury of a monthly deposit in their accounts, which includes money for leisure activities. We may not broadcast these differences to our communities, but many people notice. Integration in our communities tempers the negative effects of these differences, but we will always be well-off compared to those around us. It does not matter if we set a great example for our communities if they have little opportunity or incentive to follow it and to contribute in the ways we need them to contribute. Regardless what we believe and say about the role of PCVs at their sites and in development, we can never fully get rid of the professional-client dynamic underlying PCV-community relations. The mere fact that we are PCVs means that we come to our sites with specific goals and objectives that we are trying to obtain with and from our communities. We have a certain degree of control over output reporting indicators, but we have little control over outcomes. We have to address the dynamics of our relationship with our communities in order to get people to contribute willingly and achieve outcomes. Newly installed PCVs are often welcomed by their communities as if they are professionals who have come to provide (free) services. When that bubble is burst (“No, I’m not a doctor. No, I don’t have lots of money to spend or medicine to hand out. No, I can’t snap my fingers and build new clinics and schools or repair roads.”), we find that the percentage of people who are willing to mobilize and work with us drops. The incentives for collaboration seem weak and do not outweigh the pressures and requirements of everyday life. There is something missing, and the result is that instead of communities developing and becoming self-sufficient, they stay the way they are and remain in states of dependence. The problem? When it comes to priorities, paying work can often outcompete family and community work for people’s time and effort because of how some of us tend to assign value. CHWs get paid a little, occasionally, to work events, attend trainings, and sell certain medicines. There is a certain level of value accorded to the position of CHW, but that value does not extend to regular outreach work. They get compensated to treat people and sometimes to survey households, but not to expend the effort to track people down and seriously promote illness prevention. In other words, they get compensated enough to sit, but not to go. In this way, some CHWs do not promote improvement of public health but merely expand diagnosis and treatment capacity. When the work required for communities to improve themselves is defined as a burden of civic duty and earns no reward compared to what people are already doing, the tendency is for things to stay the same. A group of foundation executives all noted something troubling: “Every time foundations picked a p roblem to target, the problem seemed to get worse! Over time, the group developed its own analysis of what they saw happening. They

5 Dan Pallotta, “The Way We Think About Charity Is Dead Wrong,” March 2013,

http://www.ted.com/talks/dan_pallotta_the_way_we_think_about _charity_is_dead_wrong/transcript?language=en, 2:25-3:10.

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labeled the institutions and organizations that they funded Squares. Hospitals, universities, community service organizations, volunteer organizations were all ‘Squares.’ They labeled the people in community who clustered informally into affinity groups and grass roots associations Blobs. The Blobs seemed to have the energy, the vitality, the contacts, the gossip, the networks that were needed to deal with the problems. But the money invariably went to the Squares because the Squares knew how to manage it, account for it, spend it. They had the accountants, the bookkeeping, the tax-exemptions, the equipment, the institutional capacity, the expertise and the presumptive competence. The problem was that no matter how much the Squares promised to reach out in the community and get at the root causes of the problems, the Squares never got there. They really weren’t able to get to whe re the problems were or mobilize the energy of the community. A gulf separated the Squares from the Blobs.” They tried partnerships with the Blobs, but still “the Squares kept the money and dominated the scene—throwing a few crumbs to the Blobs, putting a few representatives on the Board, hiring some ‘natives’ as outreach workers. But the partnership approach didn’t seem to pay off as a way to capture the energy of the Blobs. The next step was an obvious one: Give at least some of the money directly to the Blobs to solve the problem. But when that was attempted in the form of grants and sub-contracts, something strange occurred: The Blobs were required to turn into little Squares in order to get the money and account for it…. By the time [the Blobs] jumped through all [the] hoops, they had ceased to be Blobs. Handling all the reporting requirements and other accountability demands meant there was no time or energy to be what they had been…. The Blobs have something the Squares need if the Squares are to make effective use of their specialized expertise and their institutional resources…. If funders really value what Blobs can do, they don’t have to give them a grant and turn them into accountants. If they earn the Time Dollars by being Blobs, it’s like a walkathon. Walkers do not receive minimum wage. The purpose is to create a way in which people can raise money for a cause or an organization. You start with what people can do, not what they can’t do. Walkathons do not require walkers to be jumpers or sprinters. It’s enough that they can do what they do…. Time Dollars enable Blobs to function as earners in their own right. The Blob Association can then have the choice of buying what it needs from the Squares.” (83-85) “Given the talents involved in genuine community leadership, how much sense does it make to invest large amounts of resources trying to turn grassroots people into parliamentarians or accountants? Even if we assume that capacity to run a meeting, develop an agenda, and handle disputes is important, in their absence these ‘deficiencies’ are often used as the basis for deferring implementation of a program. ‘Training’ can be used to postpone any shift in governance power until the money is virtually all gone. Technical assistance can involve a fixation on what people can’t do and don’t know how to do—rather than building on what they can do immediately. Much of technical assistance and training is justified as ‘teaching a person to fish.’ It represents an investment in capacity building. An asset perspective does not dispute that training and knowledge are valuable. It does, however, question whether there is an implicit devaluing of what people can already do, and an unnecessary delay in getting on with critical objectives.” (93) “People go into the helping professions because they want to help others. But that means they are looking at people through one very narrow lens: ‘Do you have a need that I can help to fill?’ That’s not evil. But it is the equivalent of always looking at the empty part of the glass…. If we want to fulfill our own commitment to make a difference in the lives of others, we need to find a way to use our expertise to unleash the capacity of the person we are helping.” (94) Comment: This is the reason why outcome indicators are so important for Peace Corps. If PCVs mostly work on outputs, then they are not using their expertise and not unleashing the capacity of people in their communities. Health PCVs would simply be substitutes for CHWs or other health workers, not improving the way things are done and the way things are but doing the things the same way and leaving things the way they are. “Clients and communities have decades of experience in being labeled ‘at risk,’ disadvantaged, target populations, urban renewal sites. Sometimes the language gets more positive: model cities, empowerment zones…. But the bottom line is always the same: you get resources by presenting your needs. You learn how to package them creatively for different audiences. The typical Needs Assessment or Problem Statement (the type required by foundations) finds what one might expect: unemployment, truancy, broken families, gangs, slum housing, illiteracy, crime, child abuse, graffiti, mental disability, lead poisoning, drop-outs, and an impossibly heavy caseload for some beleaguered helping professionals. Focusing on needs or problems means focusing on deficiencies rather than strengths, resources, and capacities. The deficit perspective prevails as the default mode of defining reality. It is fashionable to pay lip service to assets—but without internalizing how wrong-headed a deficit perspective can be or doing the hard work of figuring out

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how a true asset perspective would be operationalized…. Funding invariably seems to go to professionals and agencies who ‘own’ the problem, define the ‘proper’ intervention, and therefore own the resources needed for the solution. In order to secure resources, leaders demonstrate leadership by defining their communities in terms of problems and needs and by characterizing constituents in terms of deficiency and incapacity. A needs assessment [and a needs perspective] shifts power to the professionals and away from neighbor-to-neighbor relationships. Key survival relationships become those controlled by experts—the social worker, health provider, funder. Improvement is dangerous; it can bring about a loss of funding. Continued funding depends on a problem getting worse, becoming more intractable. Other destructive consequences follow. A needs assessment tends to focus all funding on survival rather than capacity building. Once on that treadmill, it is almost impossible to get off; all energy is invested in simply staying where one is.” (94-95) Comment: Many of our communities lack financial wealth. Without money to obtain things, need itself takes on the character of currency. Need is what wins the audience of outside organizations. Need is how communities obtain resources. Need is how impoverished communities begin to define themselves. PCVs and development professionals increasingly try to focus on assets, but no matter how hard we try, the conversation invariably starts with needs. This is, admittedly, a dramatic depiction of dynamics in some of our communities. However, the cumulative effects of these dynamics are significant and long term. I imagine that a needs perspective in a community is like a community afflicted by childhood malnutrition. Children may not be starving, but if the nutritional quality of their diets is lacking and remains unaddressed, there will be inhibitive effects on the community for generations. In this way, money is like an unbalanced diet for a community—it is vary (rice, the Malagasy staple); we may feel full on a diet of money, so to speak, but we cannot grow and be healthy on money alone. We need to increase the relative value of human assets and activate them to break the hold of a needs perspective. We need to reclaim the value due to people. Community is a living thing; money cannot buy it—people have to create it and maintain it. Communities need a balanced diet; they need vary and laoka (food eaten along with rice). As PCVs witness, many in our communities, both literally and figuratively, occupy their plates with vary but very little laoka. A change in perspective is needed. Right now, more people than not in our communities might say a glass is half empty. Promoting an asset perspective does not mean that people should see the glass as half full. It means that we should recognize that it’s both half empty and half full; there’s a balance. We cannot make needs disappear by focusing on assets in the same way that assets seem to disappear when we focus on needs. As Cahn says, we need to achieve a kind of parity. We need a strategy and tools to help an asset perspective compete with a needs perspective and to mobilize communities in pursuit of sustainable development. When needs assessments “focus on individuals or families, success in meeting a need translates into Exodus —moving to a better place—rather than building that community and transforming it into a place to live and contribute.” (95) Comment: One way in which PCVs like to promote youth development is through youth camps, often Girls Leading Our World (GLOW) camps. While these camps can really empower and teach girls valuable skills, PCVs often do not consider the difference between empowerment on an individual scale and empowerment on a community scale. It is great to empower girls to be healthy and to pursue ambitious dreams. We want them to study hard, go to college, and pursue good careers. A consequence of individually focused empowerment is that the home community often gets left out of the picture and remains disempowered. Individuals from rural communities who succeeded tend to be those who left to pursue opportunity and did not come back. It is brain drain. The brightest, the most skilled, and those with potential tend to get extracted. Everyone should have the opportunity to grow and to succeed. A girl has every right to be empowered and to pursue her dreams. However, I think we should encourage the individuals we seek to empower to keep their communities in mind. In their pursuit of empowerment—with the skills they develop and the resources they may find they have access to—they really could be catalysts for community development. The strategy I propose seeks to empower community members to be assets for their communities rather than draining a community of assets once they are developed.

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“Every time it comes down to the redefinition of work, I hit a wall. I win the argument—but that’s all. Time and again, I have asked: ‘How essential is this participation you are seeking to get from the client? How critical is his or her involvement to the outcome you are funded to get?’ The answer is always the same: ‘It’s absolutely essential. Without their participation, we can’t succeed.’ The follow-up question is where I lose them: ‘If you say it’s so important. If it’s absolutely essential to achieve what you’re being paid to do, why do you call it participation? Why don’t you call it work?’ At that point, their eyes glaze over. The brain shuts down. Immediately we are back in the zero -sum game of market, money, and scarcity. Work means ‘they’ get money. There simply is no way one can get enough money to pay everyone for the labor that is needed—and even trying it a teeny-tiny bit would create a dangerous, life-threatening precedent. In that mindset, it is hard to get recognition or acknowledgement of the fact that if success is dependent on that labor, then an unwillingness to call it work necessarily means one is counting on getting it free. One can bargain about hiring one or two outreach workers from the community, putting a few ‘client-consumers’ on an advisory committee—but calling it work, never.” (124-125) Comment: As PCVs we try to get people to contribute voluntarily to our projects and our communities, but we implicitly treat those contributions as “not work” when we know and they know that it certainly is. It is strange that in accounting for inputs for grant-funded projects, we are required to assign value to all forms of labor, whether paid or as community contribution. Yet, in our daily activities and projects, when money is not involved, we do not recognize inputted labor in the same way. In other words, when money is available, we seem willing to recognize all contributions of time and effort as “work,” but when it is not available, we resist that label possibly for fear that it might undermine our efforts as PCVs. We should also consider how we as PCVs are influenced by this paid-voluntary, work-not work dynamic. Before Peace Corps, I served as an AmeriCorps VISTA, and before AmeriCorps, I had been volunteering full-time with several local organizations in the Washington, D.C. area while searching for job opportunities. My local volunteering experience was fulfilling, but my priority was supposed to be finding a job (earning an income), and full -time volunteering without any form of tangible compensation was not sustainable. I then discovered AmeriCorps and Peace Corps, opportunities to continue full-time volunteering in service to my country while also receiving tangible, though minimal, compensation. “True” volunteering was not sustainable for me, but programs like AmeriCorps and Peace Corps that recognize the value of volunteer work and make full-time commitment possible were not only sustainable but more appealing. This may be a significant motivating factor for many considering national service. Why would the same motivational dynamic not apply at PCV sites? PCVs try to generate sustainable systems and outcomes. The participation, labor, or contributions we need from our community members might not be sustainable for them if we ask them to be “true” volunteers. However, if we pursue a strategy that makes those contributions both appealing and sustainable, we may significantly impact our communities. Unwillingness to recognize all forms of contribution as work, and counting on getting that labor for free, means that we make it difficult for people to do things on their own terms and in their own time. As outsiders, we often define the terms, set the framework, and try to persuade others to act within those constraints. Those constraints have real consequences. It may be time we loosened them. “Believing in clients, recipients, at-risk groups does not mean we must require them to start from ignorance, devoid of all accumulated knowledge, and reinvent the wheel. We need professionals and we should value what they have to offer. At the same time, we should be clear that professionals will not raise children—families will. And despite their flaws, we should affirm the capacity of ‘uncertified’ and ‘unlicensed’ parents, mentors, caregivers, tutors, peer support groups, and neighborhood block associations to do what they do supremely—and indeed, uniquely—well. Co-Production translates into a mandate to create new hybrids that make use of both and that do not give all the resources to the professionals while dumping the face-to-face work on families, neighbors, friends. They need resources too—and they need compensation in some form. We have to stop pretending that work in either economy, market or non -market, can be done without resources.” (134) Jill Kinney, director of a family crisis program with Catholic Children’s Services, created a program called Homebuilders—keeping a team of social workers always on call—to help families through crises and to strengthen them. The program was gaining widespread acclaim. However, she started to realize that there were flaws with her program, stemming from a reliance on professional intervention rather than building informal support systems within communities. When

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she went public with her observations, she was removed from the organization. “Jill dared to observe that many of the tasks performed by Homebuilders do not require a Master’s in Social Work. And she could prove it because she wrote the book on what Homebuilders do…. In her classic text, Keeping Families Together, she had shared an observation: ‘Clients are often the most willing to share information when the two of us are involved in concrete tasks, such as washing dishes or waiting in line at the welfare office. Teenagers are famous for opening up while being driven in a car.’ Why were social workers the only ones licensed to use that insight? Why not train people without graduate or even college degrees to use that knowledge? From a profit-and-loss perspective, that was a threatening idea. How could anyone without a Master’s in Social Work bill an hour of washing dishes as a professional consult? Old friends and professional acquaintances became concerned. Jill had obviously lost sight of what others thought should be her true purpose in life: to find a new way to bring revenue to her agency and to generate employment for more and more licensed social workers. ” (134-137) Comment: PCVs ideally are like the informal social workers Cahn describes, but how well do we build “informal support systems within communities”? How do we know? Currently, we mostly only have anecdotal evidence. Outcome reporting indicators attempt to measure the effectiveness of PCVs in this regard, and yet the tools for data collection and limited. Through the strategy I propose, we would generate quantifiable data and actually be able to measure supportive community interactions. “In Miami, the Annie Cassey Foundation had made a multi -year, multi-million dollar investment to transform urban mental health services for Latino children. The proposal had met Foundation specifications—but then proposals always do. It promised to shift mental health from a medical treatment model to a holistic model that addressed prevention and education as well as crises—and it promised to enlist the community in an effort to create a neighborhood environment designed to support the development of mental health. All the trappings needed were there: evidence of grassroots support, plans for a parents council, commitments to community empowerment. By the time the grant had passed the midway mark…professional services and staffing were absorbing most of the funding. The system change that had been promised to the community and envisioned by funders simply wasn’t happening…. There were lots of meetings. Community people were told they were being trained to assume governing authority—but first they had to learn how to do budgeting and interpret by-laws. It seemed likely that by the time they were ready, they would inherit an organization with no grant money left. Hostility escalated. There were lots of meetings. Interaction became a battle of attrition. Professionals win those battles. They earn their salaries coming to meetings. That’s their job. Community folks have to sacrifice, find baby sitters, change appointments—and somehow free up time in lives where the only certainty is an unexpected crisis…. Professionals, trying desperately to meet vast unmet needs in an unfriendly world are trapped. Ever since the participatory revolution of the 1960’s, professionals, caught in dysfunctional organizations, have learned how to function as flack-catchers. They say the right things or at least, they avoid saying the wrong things. They exude concern and respect; they express regret; sometimes they even acknowledge error (but only past error). They create a few seats on some Board for unlettered community representatives. They commit some funding to leadership training and social events. In return, they secure anywhere from six months to two years of passivity—while the leadership training goes on, and the leadership is co-opted by serving on boards, appearing at foundation luncheons, and traveling to distant places for conferences.” But before it was too late, the Foundation passed on information about Time Dollar programs to the organization, which ultimately changed the nature of the organization and saved it. One “Co-Production innovation is critical [to the program]: the professional therapists are being trained to include Time Dollar assignments in their treatment plans. Therapists are beginning to understand that they can be more effective if the family engages its friends as part of a formal Time Dollar support system. That rewards the friends for helping; it gives the family and the therapist a ready-made team to help guide, support, and if need be, intervene—at hours when the office is closed, in places professionals don’t go, on days when professionals don’t work. (138-140) Comment: PCVs, CHWs, and CSB staff cannot be everywhere at all times. We need to develop “ready-made teams [of ordinary community members] to help guide, support, and if need be, intervene—at hours when the office is closed, in places professionals don’t go, on days when professionals don’t work.” We need a more holistic, consistent approach to public health rather than sporadic surgical interventions. Ordinary community members are the primary guardians of public health, not professionals.

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“‘The Story of the Drowning Babies. The first woman who sees the babies floating down the river tries to pull out as many babies as possible, but she misses more than she helps. The second woman decides that if she can teach the babies to swim, some will learn and save themselves. The third woman decides the only way to save all the b abies is to find the bum who’s throwing them in and stop it at the source.’ (As told by Jennifer Gordon)…. Clients can get the bum who’s throwing the babies into the water. That takes no credentials—and probably a lot less training than rescuing babies thrown into the water or teaching those babies to stay afloat.” (155-156) Comment: Which role do we occupy as PCVs? In the area of public health, CSBs and CHWs often seem to fill the role of the first woman, primarily treating people as illnesses arise while to a much lesser extent teaching illness prevention. The second role of teaching babies to swim most closely describes the roles that PCVs play in their communities. We sensitize our communities on health issues and hope that “some will learn and save the mselves.” As Cahn says, our community members are in the best position and best capable of addressing health issues at their source. For this reason, outcome reporting indicators are paramount in measuring PCV success. As I observed above, outcome indicators are about what community members do, not PCVs. We need not only a way to mobilize community members to achieve outcomes but also a strategy to measure them. The strategy I propose accomplishes both objectives. “We all—policy makers, helping professionals, taxpayers, caring human beings—need to confront the limits of the ways in which we do things when we proceed, under full steam, to do our best and somehow, get nowhere.” (158) “Neighborhoods became ‘targets’ for various human service programs. Sometimes these were ‘outreach’ programs where downtown agencies sent in professionals. Sometimes they were one -stop social service centers that brought multiple agencies right into the neighborhood. Sometimes, they were like Homebuilders, which brought social workers right into your kitchen. But the bottom line was that regardless of where the services were brought, the money exited on payday from the neighborhoods being served to the neighborhoods where the professionals lived. Multiple studies have confirmed that only about one-third of the money spent to benefit the poor ever get into their hands. Now comes the welfare program. We have exported the jobs. We have exported the money. Now we are going to export the people and require them, as the price of survival, to go hunt down the jobs. The only folks left during the day will be the children, the elderly, the homeless, the addicts, the gangs—and from 9 to 5 from Monday to Friday, the professionals engaged in outreach and ‘community development.’ …. A parallel ‘depopulation’ has long been underway in rural areas. Small towns and villages are losing the young but retaining the old timers…. We have been disinvesting in families for at least half a century. Much of it has been in the name of progress. As soon as grandparents got social security, the three -generation family started to evaporate. Grandparents were delighted to get some privacy, at long last. The women’s movement has made major headway in freeing women from a status of subordination by opening up job opportunities. But progress has its costs. Increasingly the two-parent family became the one-parent family. Now, increasingly it is the no-parent-at-home family and the foster parent family. Or the no-family-at-all home: the shelter of half-way house.” (181-182)

What is Co-Production? “Co- is a prefix. It connotes a relationship—a partnership. ‘Co’ does not necessarily mean equal. The co-pilot is not the pilot. But both do share the cockpit—and except in an emergency, a plane can’t get clearance for take -off without both on board. Combining Co and Production signaled a shift in status from subordination to some kind of parity. There was deliberate ambiguity on just how ‘equal’ that parity was…. Production represented a finding that the consumer could no longer be regarded as passive, an invisible factor to be taken for granted. We were groping to define an altered role, function, and status for the consumer. The consumer was to be involved in production—and production meant the actual creation of value.” (22-23) Comment: The outcome reporting indicators are where PCVs can really demonstrate they have made a difference, but community members must be featured actors in the reporting process. Co-Production means that in order to achieve “actual creation of value,” community members must have the opportunity to be themselves, speak for themselves, and set the terms for why, how, when, and where they will go about changing their behaviors. If we constrain our

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community members with our own imposed terms, processes, and timelines, whether explicitly or implicitly, they will stop listening to us, stop following us, and abandon us to our own frustrations. “Co-Production offers the vision of a world that rewards decency and caring, cooperation, altruism, and collaboration as automatically as the market economy rewards self-interest, competition, aggression, and acquisitiveness…. We can create a society where every human being willing to help another can earn sufficient purchasing power to live decently, to develop and grow, and to pass on to the next generation a world that is better for our having been here.” (46) Co-Production “is a framework, a process, and a set of core values that define outcomes.” (85) “Co-Production combines self-interest and altruism on an institutional and professional level, just as Time Dollars combine them for individuals, transaction by transaction.” (151) “Most of us suspect that regardless of whether we pay more taxes, potholes won’t get fixed faster and schools won’t become instantaneously better. But we also know that if we had to serve on those pothole crews or if we had to take a turn tutoring or helping oversee an after-school program, we just might see some changes we really liked. If we ask ourselves, “What will it take to build the kind of village we need? Just maybe, it will take our own sweat. Maybe it’s not something we can buy. Maybe it’s a form of investment we can make with the social capital generated by collective effort.” (191) Comment: Co-Production is embedded in Peace Corps’ mission in the sense that PCVs work in partnership with their communities to collectively produce development outcomes. But Co-Production, from Cahn’s perspective, is far more than just partnership; it is not simply working together. Co-Production is explicitly active and defined by a social justice perspective, an aim to correct for injustices created by conventional theories of community development. It means that the contributions of both market and non-market, professionals and clients, PCVs and their communities are essential to achieve the world we all want to live in. PCVs are not technical experts, but they are assets to their communiti es. It sometimes takes PCVs a while, but eventually we discover the different ways in which we are assets. Those ways are not apparent from the start but are discovered in context. Through our experiences and the relationships we establish with our communities, we realize ourselves as assets. Our communities requested us to help them, but as eager as we may be, we cannot begin to understand how we might help them until we have lived with them and they have shown us. Co -Production forces us to recognize that development is a two-way street—we need our communities as much as they need us. We are assets who can benefit our communities, but we cannot realize ourselves as assets without the contributions of our communities.

Four Core Values of Co-Production: 1. Assets. The real wealth of this society is its people. Every human being can be a builder and a contributor. 2. Redefining Work. Work must be redefined to include whatever it takes to rear healthy children, preserve

families, make neighborhoods safe and vibrant, care for the frail and vulnerable, redress injustice, and make democracy work.

3. Reciprocity. The impulse to give back is universal. Whenever possible, we must replace one -way acts of largesse in whatever form with two-way transactions. ‘You need me,’ becomes ‘We need each other.’

4. Social Capital. Humans require a social infrastructure as essential as roads, bridges, and utility lines. Social networks require ongoing investments of social capital generated by trust, reciprocity, and civic engagement. (24)

Comment: Cahn’s four core values strike similar chords to Peace Corps’ mission. “Redefining work” might not seem directly relevant to Peace Corps initially. It recognizes that all contributions to society are important, and that we implicitly send the wrong message to people when we readily reward self-interested work in the market but not work in the family and the community. As a Health PCV, I face this dynamic every day in my work. I work to promote behavior change, with a primary goal to help families “rear healthy children.” While no one would say that health is not important or that raising healthy, smart children is not important, earning a living often outcompetes family and community for people’s time and effort. Working for pay, obviously, earns people money. Everyone recognizes the value of money. I

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see people work hard to earn enough of it every day, and it will dominate their focus if money is scarce and income irregular. Family work or community work might earn a little respect or a pat on the back from a PCV or a development professional, but for the most part it is treated as duty. People cannot earn a living off of pats on the back, so they might not strive for their families or communities as hard as they will for money. When we collectively incentivize work in the market but not in the family or the community, there should be no surprise when a disparity emerges and when it becomes much harder to achieve meaningful community-led development and behavior change.

Assets: Do we really know what we are talking about? Are PCVs effective at drawing out community assets? “We cannot stop at merely inventorying those assets. We must deploy them in actual transactions, in exchanges based on mutuality. “Why does it matter whether we call the glass half empty or half full? What is wrong with pre-occupation with the empty half? Fixation on what we don’t have, on how we would like others to be, on variables beyond our control doesn’t solve anything. All too often, it is a way to avoid accountability for doing what one can with what one has. There is a sign posted at gasoline pumps: Do not top off. Do not keep trying to fill the tank to the brim. It wastes a precious resource. Worse, it can create hazardous, inflammable conditions. A deficit perspective can prove incendiary. An asset perspective says: Maybe we already have enough to get where we are going.” (87) Comment: See comment on cooking sessions below p.31-32. “There is always a way to use an asset. Using what we have takes being proactive…. It isn’t always obvious. We have to find new ways, or very old ways, of putting people to use doing things for each other. It takes ingenuity and creativity, but it’s something we can do if we are determined…. The world doesn’t always say, ‘You’re exactly what I need’—any more than pieces in a hardware store jump up and say, ‘Take me and put me together with something over there.’ Making use of human assets is not a neutral, objective process. It is contextual, and it is driven by purpose, by a determination to count assets. Mechanical methods of making an asset inventory often omit real strengths . In England, for instance, the Fairshares Program listed assets that are often overlooked: on call at unsocial hours, spreading news, providing local knowledge, organizing social events, surfing the net, and plant watering. An asset perspective means finding ways for people who don’t think they have skills to discover their own strengths. As one woman in Tacoma, Washington, told me: ‘I didn’t know how much I knew until I was helping someone who didn’t know what I know.’ Assets don’t fit normal categories. They come out the way they come out. We learn about them by putting them to use.” (88-90) Comment: People have to be motivated and challenged to discover their potential as assets. As things currently are at many PCV sites, there is no motivation for people to challenge themselves and seek creative solutions for community health issues. The strategy I propose, however, provides both motivation and challenge, both context and purpose. It creates an environment in which people may think creatively to address community health issues. “In September 1999, The New York Times reported a new survey that found that older adults have a difficult time finding meaningful volunteer opportunities and that they feel that their skills are not valued by organizations…. Take a minute to consider what we don’t use. According to best estimates, when one counts the number of people who have lived to be over age sixty since the beginning of recorded history, slightly over half of them are alive right now. This is the greatest reserve of knowledge, experience, caring time, and untapped energy in the history of the world. Those over sixty have lived through more than a half-century of change—change that has accelerated at an unprecedented rate throughout their lives…. It takes a deficit mentality to turn such an asset into a problem of catastrophic proportions with dire fiscal implications. The message that we implicitly send to the elderly is that their primary responsibility is to die cheaply without bankrupting the country by running up Medicare and Medicaid costs. That mentality perceives seniors as a liability—except to the extent that they have accessible cash and represent a potentially ex panding market niche…. In our post-industrial society, we proclaim that brain power is more important than muscle power. Our elders may lack muscle power, physical agility, and dexterity. But when it comes to cumulative wisdom and insight based upon having

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seen repetitious patterns of human folly and human courage, they represent a national treasure and a triumph of the species over brute force and the vicissitudes of nature.” (90-92) Comment: When it comes to community development, public health outreach, and care seeking, the most creative and capable community members for the job may as yet be unknown to us and unaware of their own potential. The strategy I propose might identify such individuals and give them the chance they need to discover themselves and make a significant difference in their communities. “An asset perspective means enabling human beings for whom the market economy has no use to redefine themselves as contributors. That requires more than a static inventory. It requires a dynamic information system constantly updated by live transactions. An asset defines itself and realizes itself in the context of a transaction, in the act of helping another, meeting a need, filling a void…. Time Dollars provide a first prototype of one such information system about what neighbors can do and what neighbors need. An asset perspective means finding a way to convert latent capacity into kinetic energy.” (97) Comment: PCVs know that their communities often have many underutilized or as yet undiscovered assets—most significantly the time and energy of ordinary people. It is not enough to have assets; assets in and of themselves do not accomplish anything. You have to value assets, draw them out, put them to use, and give them a chance to live. CHWs, for example, may have the knowledge and skills to conduct community outreach, but many do not. CHWs rarely earn anything for their abilities to conduct outreach, but often for their abilities to treat sick mothers and children. If their skills, time, and efforts to conduct outreach were valued, CHWs or any community animators might be more inclined to put their assets to use. It is not enough to identify assets. They have to be activated. We do not have to spend time and energy turning community members into people they are not; they do not have to be professionals to do what we would like them to do. We can take advantage of what people already know how to do and what they can do immediately. Peace Corps is a perfect example of a program that draws out many of the ways in which participants are assets. Peace Corps does not tell PCVs, “You are assets in these ways….” Peace Corps does not train PCVs to be technical experts. Peace Corps does, however, place PCVs in communities and environments conducive to personal and professional development and self-discovery. It is through the Peace Corps experience and our active efforts to contribute and collaborate with our communities that we discover ourselves as assets. The communities where PCVs live and work need the same kind of conducive environment. Our communities may need a change in conceptual framework—just like we experience as PCVs—to achieve that environment. “After serving nine years as the Chairperson of the New Zealand Parliament’s Public Expenditure Committee, Marilyn Waring provides this description of the way in which government economists dismiss what women do:

‘Cathy, a young, middle-class North American housewife, spends her days preparing food, setting the table, serving meals, clearing food and dishes from the table, washing dishes, dressing and diapering her children, disciplining her children, taking the children to day-care or to school, disposing of garbage, dusting, gathering clothes for washing, doing the laundry, going to the gas station and the supermarket, repairing household items, ironing, keeping an eye on or playing with the

children, making beds, paying bil ls, caring for pets and plants, putting away toys, books and clothes, sewing or mending or knitting, talking with door-to-door salespeople, answering the telephone, vacuuming, sweeping and washing floors, cutting the grass, weeding, and shoveling snow, cleaning the bathroom and the kitchen, and putting her children to bed. Cathy has to face the fact that she fi l ls her time in a totally unproductive manner. She, too, is economically inactive, and economists

record her as unoccupied.’” (117-118) “The chief researcher [in a 1997 study on crime and delinquency in Chicago], Dr. Felton Earls, understood that this new finding had identified a long-overlooked asset, a form of social capital: ‘By far the greatest predictor of the violent crime was collective efficacy… a shared vision, a fusion of shared willingness of residents to intervene and social trust, a sense of engagement and ownership of public space. In particular we believe that collective expectations for intervening on behalf of neighborhood children is a crucial dimension of the public life of neighborhoods.’ The critical factor was not ‘external actions’ such as police crackdowns. What emerged was a finding of the ‘effectiveness of informal mechanisms by which residents themselves achieve public order.’…. Collective efficacy is real. Hard-headed, bottom-line policy makers want data, hard data—such as crime statistics or property values reflecting the prevalence of criminal activity.

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Now suddenly, soft stuff takes on hard, statistical significance. Neighborhood interaction, networking, local custom, and just being nice can no longer be dismissed as fuzzy, irrelevant, concepts. In this context, Time Dollars earned in neighborhood roles can be used as a measure of collective efficacy and as a reward to stimulate such conduct. Because numbers seem to count in public dialog, Time Dollars can function as a source of leverage. They suppl y evidence of the production of collective efficacy.” (176-177) Comment: Adapted from the idea of Time Banking, the strategy I propose would “supply evidence of the production of collective efficacy” regarding community health outreach and collective health monitoring and care seeking. As I hypothesize above, such “evidence” (data) could be highly attractive for outside organizations or investors, whether they might be interested in the strategy itself or in the community in general . As Cahn observes, data generated by this strategy “can serve as a source of leverage” for the community and open doors to further development opportunities. Reciprocity: How balanced are the relationships between PCVs and their communities? “Colleagues and friends have challenged me: How dare I charge indigent clients [in Time Dollars] for legal services? I tell them: I can keep a person from being evicted, but I can’t make where they are living a place I would want to live and raise my children. That means I have a choice. My life can be a series of well-intentioned but inconsequential victories that make no real difference in the lives of others. Or I can acknowledge that I need what my clients can do in their community as badly as they need what I can do in the court room. If my work is to have meaning, I need to acknowledge that I need them as badly as they need me.” (144) Comment: There are people in PCV communities, and people who PCVs encounter across Madagascar, who think that the “rich vazaha” (foreigner) can and should give them things and do things for them for free. I have lost track of the number of people who have asked me for money, food, candy, gifts, and medicine; who have asked me to have smartphones, digital cameras, laptops, and even cars shipped to them (at my own expense); who assume that I am a doctor or another sort of professional and that I am here to tell them what to do and how to do it. PCVs recognize that people who ask for things are not representative of the larger population, but at the same time, there does seem to be a widespread perception in Madagascar that the principle of reciprocity does not apply with foreigners. PCVs break that mold and challenge those very perceptions, but we cannot flatter ourselves and assume that we will fundamentally change reciprocity dynamics through our examples alone. Reciprocity needs to be built in, formally if possible, to the work we do with our communities and to the systems we try to establish. PCVs, contractually, cannot charge for the assistance they provide or receive any form of compensation outside of the allowances provided by Peace Corps. I think this contractual and philosophical limitation on PCVs leads many to the narrow conclusion that they are committing to serve their communities out of a sense of charity, and that charity must always inform the work they do. If that were the whole picture, then PCVs could never achieve reciprocity with their communities. PCVs make sacrifices; they give of themselves to help others. We conduct trainings and sensitizations out of a genuine desire to do good, but we can mislead ourselves into thinking that our presence, goodwill, and efforts alone will magically change people’s behaviors and impact lives. Over an extended period of time, it is possible but by no means guaranteed that our words and the examples we set will have such an effect For our sacrifices and goodwill to have any meaning, we must require the engagement of people in our communities; in one form or another, we need them to buy in. This “buy-in” or community investment does not take the form of compensation for the PCV, but rather time and effort contributed back into the community in pursuit of shared goals and objectives. It may seem counter to our underlying sense of charity to ask community members to earn tools and resources, but that is the best way for people to truly own the process. Passive support, participation, and investment do not achieve ownership; people will feel ownership over what they have worked for. “Reciprocity obliges a recipient of service to contribute in order to be a paying customer. It imputes a value to that contribution equal in worth to anything received by the consumer (receiver). In doing so, it makes an important statement to that person about his or her own self-worth. Free services can send an unintended message: if you have no money, you have nothing I need, want, or value. That can’t be the right message.” (146)

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“Lawyers who under other circumstances might have been reluctant to commit themselves to pro bono work were willing and even enthusiastic about doing so, knowing that every hour of legal work would generate an hour of self -help in the community…. Injecting reciprocity can expand the supply of scarce, expensive specialized services.” (147) “The relationship established through a client retainer differs from most pro bono transactions. When a legal matter is concluded for a client with no money, the book is closed. The relationship ends, and the files are sen t to archival purgatory. That is not the case in corporate practice. Lawyers do not consider a relationship closed once and for all when they finish a particular legal transaction for a major corporate client. To the contrary, maintaining and preserving th at relationship is the key to a lucrative practice. The Holland & Knight retainer with MANNA set up a continuing relationship, one in which the law firm felt itself committed to providing ongoing legal assistance on a variety of other community issues that affected the [Shaw] neighborhood. Lawyer behavior changed: lawyers started volunteering to go to the neighborhood school they had kept open, and to tutor there. The seemingly simple, mechanical restructuring of a service transaction into a fee-for-service relationship altered the dynamic, giving the lawyers a new sense of rootedness in community. Washington, D.C., has more lawyers per square inch than any other place in the world. These lawyers are recognized and retained by corporations and nations around the world to engage in power lawyering, to shape the policies and practices of government. Yet the local community of Washington, D.C., its residents, remain powerless, lacking a vote and representation in Congress, possessing the most limited home rule. The Council of the District of Columbia, the elected legislature, lacks final authority to determine how the taxes paid by D.C. residents are to be spent. Congress has the last word. The District is one of the world’s last remaining colonies, wrestling with major problems of education, health, housing, AIDS, drugs, crime, economic development and poverty. In the midst of that community, sits the vast concentration of power brokers for the world, many of whom genuinely desire to make a contribution to enhancing their community. But there is no connection, no bridge, no rootedness. A chasm separates the residents from this vast resource.” (148-149) How do non-monetary incentives to mobilize communities differ from monetary compensation? “Money is the all-purpose tool that market (including government) uses to fix anything that is broken. Yet, built into money are certain characteristics that give rise to some of the very problems we are trying to cure…. Money defines price and price defines value. But the pricing system built into money assigns a high value to things that are scarce and a low value to things that are commonly available. It assigns a high value to activities that make money and a low value to activities that don’t make money. That means that the ‘tool’ we are using to fix the problem can never adequately value certain activities until they become truly scarce: caring, learning, imparting values, sharing, neighboring, socializing, helping others. Likewise, child rearing, family building, neighborliness, altruism, and civic participation do not rank high on the money-making scale. Money devalues the very thing we need most in order to fix some of our most critical problems: strengthening families, revitalizing neighborhoods, developing community, restoring civic society, making democracy work.” (41) Comment: PCVs witness the effects of scarcity at their sites and experience it themselves. Throughout the application process to become a PCV, people are repeatedly warned that service conditions will likely be rough and luxuries lacking. Candidates assure recruiters, friends, and family that they are ready for the challenges and will be able to adapt to conditions in the developing world. Nevertheless, as we repeatedly observe with groups of Trainees, it is hard to understand the effect scarcity has on us until we are forced to experience it. In the United States, we have an abundance of infrastructure, utilities, and luxuries that we value but that are easy to take for granted. When Trainees are all of a sudden faced with limited or no electricity, with no hot or running or clean water, or with limited or no internet, the calculus and behavior changes. I remember at my pre-departure Peace Corps staging event, one of the most outspoken members of my group against our need for internet in Peace Corps was the first person to learn the Telma cell network internet deals in country and was often checking Facebook on his smartphone during pre-service training sessions. When I served as a PCV trainer, some Trainees were spending all of their walk-around allowance on phone credit to call family and for internet, and some were asking to exchange USD for Ariary because the walk-around allowance was not enough for this purpose. PCVs recognize how their behavior changes

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when they get access to electricity and internet after extended periods at site; many cannot pull themselves away from their computer screens, even if they have run out of things to do. No matter what we say we value and how much we value it, scarcity and abundance fundamentally change the way we calculate value and behave. The dynamics of scarcity are apparent at our sites as well and affect the work we do. When we conduct PACA, many of the responses we get for community needs and priorities are things that are or seem scarce. The following are common responses I gathered when surveying 27 demographic groups across 16 villages in my first three month at site: money, medicine, health clinics, doctors, health, schools, libraries, teachers, education, electricity, good roads, clean water, etc. What captures people’s attention is what they perceive as scarce. We fixate on scarcity, we convince ourselves that we really need what is scarce, and we assign those things high values. Consider how people perceive illness and health. For PCVs, it is hard to get people to care about common illnesses in the way we would like them to. Malaria, diarrhea, pneumonia—they are the primary causes of mortality in children under five years old in Madagascar, but for many people they are a normal part of life. Sonia Shah, a science journalist, compares how people perceive malaria in endemic countries to how we perceive cold and flu in the temperate world: “Cold and flu have a huge burden on our societies and on our own lives, but we don't really even take the most rudimentary precautions against it because we consider it normal to get cold and flu during cold and flu season.”6 Psychologist Dan Gilbert similarly describes how people’s reactions to certain occurrences stem from their perceptions of how common or unique they are, rather than absolute values. He says, “If I told you that there was a plague that was going to kill 15,000 Americans next year, you might be alarmed if you didn't find out it was the flu.”7 If it is some new, unknown, foreign disease or the tragic result of a disaster, people pay attention. If it is something they are used to and have lived with all of their lives, they will not attach as much value to it. Whether in Africa or in the United States, it does not matter how dangerous a disease is for young children, pregnant women, and the elderly if it is perceived as normal. We have a hard time assigning high value to what we perceive as normal. The proven illness prevention methods we promote in our communities are accessible for everyone—there is nothing scarce about them. I observed that people at my site suddenly got excited about mosquito nets when we had a net distribution; the limited number (the scarcity) of nets caught people’s attention. Health promotion and illness prevention options are ample, but people tend to fixate on and assign a high value to scarce health treatment resources. In other words, it is hard to get people to value what they can do themselves in the same way they value what professionals can do or provide for them. Given these psychological constraints on all of us, it is hard for PCVs to sustainably impact their communities without addressing the conceptual framework in which we assign value. “The market is only one of two separate economic systems. It is driven by money and monetary transactions. But real productivity takes place in two economic systems running side by side…. The basic unit of this second economy is the household—but it also includes a vast array of exchange networks including kinship, neighborhood, and community…. That non-market economy is, in fact, far more efficient than the market economy in doing certain things, among them raising children, taking care of the elderly, creating community, nurturing and maintaining civil society. That economy functions in ways that fundamentally differ from the market economy. It differs in mode of production: in lieu of specialization, it relies upon maximizing self-sufficiency. It differs in mode of distribution: in lieu of price as a mechanism to determine who gets what, it uses normative considerations like need, contribution and moral obligation. It differs in the form of compensation: in lieu of money, it relies on various forms of psychological rewards —pleasure and pain generated by love, praise, altruism, guilt, self-esteem, kinship relations, obligation, duty, loyalty, reputation, trust, mutuality, and commitment…. [Both markets] are in competition for the time and talents of every individual. What the market economy gains, the non-market economy loses. Co-Production supplies [a] larger framework and prescribes a way to structure that relationship so that it becomes a win-win relationship.” (41-42) “Efficiency is another economic concept altered fundamentally when Co-Production is taken into account. Measures of growth and productivity in the market economy need to do more than incorporate previously hidden externalized social

6 Sonia Shah, “3 Reasons We Stil l Haven’t Gotten Rid of Malaria,” https://www.ted.com/talks/sonia_shah_3_reasons_we_stil l_haven_t_gotten_rid_of_malaria/transcript, 6:42-8:41. 7 Dan Gilbert, “Why we make bad decisions ,”http://www.ted.com/talks/dan_gilbert_researches_happiness/transcript, 24:15-25:24.

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costs; they also need to incorporate the productive contribution of the non-market to the market. Thus, any assessment of efficiency is incomplete unless it also takes into account the economic health and productivity of the non-market economy. Let us be clear. The market seeks to tap the assets of the non-market economy. But it does so selectively, opportunistically and in ways that frequently degrade the non-market. Market forces are driven by money—and money has no enduring loyalty other than to make more money…. Implementing Co-Production enlarges the pie in a way that enables contributors in both economies to claim their due.” (45) “We need a new map of the real world. The map provided by the government and provided by economists is fatally incomplete. It defines reality exclusively in terms of money transactions. That’s all the GDP measures. It is a flat earth view. According to that map, it is growth when we build more prisons and nursing homes, when we have to clean up toxic waste, and when a couple gets a divorce and has to hire two lawyers. There is no growth if we keep people out of trouble, seniors out of nursing homes, when we preserve the environment and save marriages. Similarl y, when we measure the productive capacity in terms of our work force, we exclude about 50 percent of the population: children, teenagers, the disabled, persons on public assistance, volunteers, and seniors. Likewise, only paid work is ‘real’ work. That excludes child rearing (that isn’t paid child care), elder care (provided by family and relatives), volunteer work, community work, faith-based work, and all the civic work that is essential to making democracy work.” (48-49) Comment: In Peace Corps, how do we measure growth and productive capacity? Is growth measured simply in terms of the number of applicants and the number of currently serving PCVs? Is productivity limited to what PCVs do in terms of output reporting indicators? Is growth what PCV communities do themselves, on their own terms and in their own time, as a result of PCV influence—in other words outcomes? Is the growth we desire something we currently do not know how to measure? The strategy I propose could be a step in the right direction. “We cannot begin to address fundamental problems so long as we remain trapped inside a defective framework that creates the problems. If social progress is limited to what we have money to buy, we are going to have to tolerate a great deal of needless suffering and deprivation. The only money available is whatever can be extracted by taxes and by charitable contributions from individuals, corporations, and foundations. There is a limit to what can be skimmed off the top. Global competition will squeeze what there is, relentlessly.” (49) Comment: When we look at the history of our attempts to address difficult social i ssues, decades of programs and millions of dollars have achieved little change. While Cahn explores the consequences of the non-market economy’s subordination to the market economy, Pallotta explores the consequences of the nonprofit se ctor’s subordination to the for-profit sector. He observes, “We are asking nonprofit groups to deal with social problems whose scale is beyond easy comprehension, while denying those groups the tools they need to build any meaningful scale themselves. Something is wrong when Coca-Cola and Burger King have a potential for growth that we deny, on principle, to the Boys & Girls Clubs and the National Breast Cancer Coalition.”8 We have limited ourselves to a conceptual framework and tools that can only ever get us partway to a solution. Because we constrain funding for social issues to “what can be skimmed off the top,” we handcuff ourselves. We ourselves set up the obstacles that prevent us from solving our greatest social and development is sues. Concerning the historical impact of this dynamic, Pallotta adds, “Since 1970, the number of nonprofits that have crossed the $50 million line in annual revenue is 144, according to George Overholser and Sean Stannard Stockton, writing on the blog Tactical Philanthropy. The number of for-profits that have crossed that line during the same period is 46,132.” Our long-held approaches to development and social issues have often created stagnation. This is failure. This is futility. And yet we push on, hoping for different results. We have the power to release our full potential in pursuit of the dream of a better world. We need a better strategy and more appropriate tools to achieve that dream. “The non-market world, within its realm, functions more efficiently than the market world. If we had to buy—at market prices—the goods and services needed to address social problems, we would all be in deep trouble…. What would it take to provide the full range of services that a family provides to raise a child? We know that feminist groups costed out

8 Dan Pallotta, “Why Can't We Sell Charity Like We Sell Perfume?,” The Wall Street Journal, September 14, 2012,

http://online.wsj.com/news/articles/SB10000872396390444017504577647502309260064 .

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the market value of a mother/housewife to be, in 1980 dollars, $66,000. Neither families nor the government can afford to buy those services at that price. The average stipend paid a licensed foster care family is three times what is paid to a mother receiving public assistance.” (50) Comment: By investing heavily in professionals and programs, we may be undermining community members. Cahn emphasizes that professionals will always be needed, but that professionals are needed for what they can do just as much as community members are needed for what they can do. There must be a relationship of parity for any efforts to be sustainable. The example of Jill Kinney’s Homebuilders program demonstrates this point pp.19-20. “No society, no matter how rich, can afford to buy at market prices those things that home and family and neighborhood supply: love, caring, wisdom, culture, knowledge, and 24-hour, 7-day-a-week support. Small investments here can leverage profound changes.” (50) Comment: This is the core of the strategy. “Unless one can find a way to increase the value associated with contributing, creating, or maintaining a public good, these goods will continue to be undervalued. Anything free, regardless of quality, tends to be devalued. Public goods and social goods are regarded as free. They are not—but no one actively desires to pay for them. The reward system used to remedy that undervaluing cannot be the same as what the market uses. Money in your hands is yours. It says: ‘Spend me to get the best deal you can for yourself.’ When we function as consumers spending our own money, we want to get what we think is the best buy for the money. Few people consider more public goods and social goods a ‘best buy’ for themselves. Money will not remedy this tendency to undervalue public goods. It will reinforce a market preference for private goods, for consumption, for acquisition…. It will take other forms of compensation that combine the rewards of volunteering with the rewards of market in order to offset the tendency to undervalue services and participation in activities that benefit the community at large.” (57) Comment: It is not only that we undervalue public goods, but also that we suppress incentives for creative, talented individuals to enter careers in service to humanity. Pallotta frankly presents the bizarre logic to which we adhere:

So in the for-profit sector, the more value you produce, the more money you can make. But we don't l ike nonprofits to use money to incentivize people to produce more in social service. We have a visceral reaction to the idea that anyone would make very much money helping other people. Interesting that we don't have a visceral reaction to the notion that people would make a lo t of money not helping other people. You know, you want to make 50 million dollars selling violent video games to kids, go for it. We'll put you on the cover of Wired magazine. But you want to make half a million dollars trying to cure kids of malaria, and you're considered a parasite yourself. And we think of this as our system of ethics, but what we don't realize is that this system has a powerful side effect, which is, it gives a really stark, mutually exclusive choice between doing very well for yourself and your family or doing good for the wo rld to the brightest minds coming out of our best universities, and sends tens of thousands of people who could make a huge difference in the nonprofit sector marching every year directly into the for-profit sector because they're not willing to make that kind of l ifelong economic sacrifice.9

Is this dynamic similar in Madagascar? For those Malagasy who even have the opportunity to choose, would they tend toward a self-interested career or one of public service? Would compensation often be the deciding factor? Do PCVs witness that many of their community members must devote most of their time to doing well for themselves and their families, and that “doing good for the world” seems like a distant concern? See comment below on return on investment regarding college education p.33. “Trying to fix the non-market economy from the outside won’t work. It means relying on money and paid specialized staff to deliver results. Instead, money will do what money does: reinforce the tendency of people to think in terms of scarcity when what is needed is love, caring, neighboring, and involvement. When money is involved, people tend to think selfishly, to ask ‘What’s in it for me?’ followed closely by the question, ‘What have you done for me lately?’ If

9 Pallotta, March 2013, 3:10-4:58.

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public goods or programs paid for by government or foundations are involved, people prefer to be free-riders, counting on others to pay the tab. Co-Production supplies a remedy. It says: Pay for what you get by contributing what you can. It says, No more free rides. But it also says, We value what you can contribute; and we do not equate what you have to offer with how much money you can afford to pay.” (57) Comment: We have to overcome the expectation that people will get things by being passive observers rather than active contributors and creators of value. Money does not work, but even with other incentives we have to be careful not to foster the hope that everyone will be rewarded regardless of contribution level or activity. When everyone is rewarded in this way, it encourages people to be mediocre and limit their effort. Youth who attend a PCV camp and who are told that they will all get t-shirts at the end have been promised their reward before even participating. What will motivate the youth to participate actively in the camp or to conduct follow-up activities in their communities afterward? A CHW who puts in a lot of effort on a project and yet earns the same reward as one who contributed much less learns that there is no incentive to be great and to do something special. With the strategy I propose, people cannot sit and wait to collect their rewards. The participants themselves have to make the decision to earn them. Those who contribute more will be recognized and rewarded as such. “What if we understood that money itself might be addictive? Would that be an external cost worth noting? Is it just possible that sometimes, reliance on money leaves no time for giving love to children or to the elderly, no time or resources for feeding hungry people, no time to invest in community or civic activity, no time to do anything but make more money and more money and more money—and then wonder if that was enough? Does that begin to sound like an addiction? No one that I know thinks that family is unimportant, that democracy is not precious, that safe and vibrant neighborhoods are not important, that a healthy life style does not pay off in the long run. But we just can’t be bothered doing it ourselves—and we hope that we can earn enough money to find a way to enjoy all of those things.” (61) Comment: Is it possible that people in our communities are “addicted” to money? Have we heard people say that they cannot attend meetings, trainings, or events or participate in projects because they have to earn money? Have we heard people say that they do not have enough time to feed their infants properly (or even feed themselves) because they work out in the fields all day? Have we heard people say they do not have enough time to take their children for vaccinations or that they will not buy needed medicine because it is too e xpensive? I have heard all of these excuses repeatedly over the course of my Peace Corps service. Earning an income is a justified priority, but it can turn into a fixation and lead to zero-sum decisions to pursue money over other important things. This strategy, as Cahn says, does not replace money as a development tool but rather complements it. If people in our communities could be described as “addicted” to money, this strategy would help wean them off of their reliance a little. As I said above, it might change the way some people assign value, and all of a sudden they might find time and strength to pursue other things. The Dark Side of Money “1. All-purpose purchasing power

Money’s all-purpose purchasing power may be its most useful characteristic. But if money can buy anything, it can buy our

young, our elected officials, our judges, the Savings & Loan executives to whom we entrust our l ife savings, our most highly classified weapons systems. The all -purpose buying power of money fosters the il lusion that we can buy anything: love, family, caring, friendship. There may be some things that money just can’t buy—and shouldn’t buy. Those things tend to be

based in the non-market economy—for a reason. 2. Money’s superior mobility

Money is accepted anywhere. Money knows no geographic loyalty. It goes where it will secure the highest return. But that mobility comes with a cost. Building a community means sinking roots, making a commitment, sticking it out through hard times…. Money flows with centrifugal force—away from community and toward optimal return. Mobility can produce

hidden costs. The young abandon the old to go ‘where the action is’ in pursuit of opportunity and bright l ights…. 3. Motivation

Monetary motivation has its dark side. George Soros chara cterized the dark side of this motivation in these words: ‘People rely increasingly on money as the criterion of value. What is more expensive is considered better. The value of a work of art can be judged by the price it fetches. People deserve respect and admiration because they are rich. What used to be a

medium of exchange has usurped the place of fundamental values…. Society has lost its anchor.’…. there is another dimension to money as a motivator. It rewards specialization as scarce and therefore mor e valuable. The runaway costs of our health care system are in part the direct result of the disparity of earnings received by general practitioners and

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specialists. When all care has to be purchased piece-by-piece from specialists, the cumulative cost of general coverage becomes prohibitively expensive. Specialists guard their specialty; they tend to be the last to embrace Co -Production.

4. Money as egalitarian …. In theory, money excludes no will ing worker with time and talent. In theory, money confers equal purchasing power on

all, regardless of race, class, gender, age or national origin. But the theory isn’t working…. For the non -market economy, money’s egalitarianism means that that the market can compete with the non-market for time and energy. Children don’t have money so they can’t bid for their parents ’ time and priorities with that medium of exchange. Family, neighborhood,

and community all lose out…. For workers, money’s egalitarianism puts them in a worldwide race to the bottom. There is neither time nor energy to invest in family, neighborhood and civil society when one job or two stil l leave one hovering near the poverty l ine.

5. The invisible hand of price …. Price will always devalue what is not scarce—l ike air and water (until polluted) and basic tasks l ike caring, neighboring,

citizen involvement, rearing, and learning (until we make them scarce and unavailable commodities). That means it will always devalue the universal assets that define our humanity. The hierarchy established by price d oes not typically support collaboration, cooperation, sacrifice and altruism. Price has other drawbacks. Market wages convert price into status hierarchies that subordinate women and those tasks that women have historically done. Accepting money means accepting

the status defined by the wage. That is the cost of price. 6. Money as efficient

Economists love efficiency—and for them, money provides the ultimate measure of efficiency. The issue they rarely examine is: Efficient for what purpose. Consider l ight bulbs; are they efficient compared to fluorescent? The answer depends on what the question really means: Efficient for what? Heat or l ight or a sustainable environment? How efficient is

money? It measures profit but how efficient is it as a measure of equi ty, of value, of beauty, of justice, of the environment, of what builds and sustains family, neighborhood and community? Co-Production insists that the market pay for the external costs imposed on non-market. When rapidly accelerating disparities of income decrease opportunity, induce

alienation, heighten divisiveness, and decrease trust, who pays for those ‘externalities.’ The cumulative cost of this ‘efficient system’ mounts….

7. Money makes money In his book, The Death of Money, Joel Kurtzman, executive editor of the Harvard Business Review and former editor of the Sunday Business section of the New York Times, lets out a dirty l ittle secret. Two tril l ion dollars change hands in world

markets each day [and that number is certainly greater today]—but at most, only 20 percent of those exchanges have anything to do with goods and services. That means that 80 percent of the wealth that people are ‘earning’ has nothing to do with goods and services. Arbitrage and hedge funds account for most of that 80 percent. Earning money now means around-the-clock gambling in a global casino that takes bets on exchange rates, mortgage rates, commodities futures, and

anything else the ‘financial industry’ can package as a ‘product.’ Money has taken on a l ife of its own: its function is to reproduce for the sake of reproducing—regardless of the impact of its health on the human community. If doctors saw cells multiplying without function in the way we see money multiplying, they would have no difficul ty with the diagnosis. They would call it cancer. Whether a tumor or growth is malignant or not depends upon whether it destroys other vital organs or

impairs critical functions…. The non-market economy has its own work ethic. Family and civic responsibility are real work—even if the market economy does not count them as work. When collecting dividends counts as work but changing diapers does not, the external cost to the non-market economy is clear.

8. Money’s superior enforceability Money gives you a contractual right. But the remedy is normally l imited to money damages. Our legal system places no

special value on keeping one’s word; it is expressly designed to permit one to break one’s word if one can find a more profitable deal…. The non-market economy operates on a different sense of obligation. It says: your word is your bond. What goes around comes around. Your reputation for honoring your word is the most important asset you have. Money

tends to erode the real meaning of obligation. 9. Money as the measure of value

…. Ultimately, value is based on what human beings need. Money would have no meaning in a world denuded of people. When we equate money with value, everything is reversed. People become surplus, disposable, value-less….” (64-69)

“The real cost of money—the real price we pay—is not just interest. It is the hold that money has on our sense of what is possible, the prison it builds for our imagination. Ask yourself: Did Einstein wait on a research grant to think about relativity? Did Moses wait on a travel grant to get out of Egypt? Did Mandela wait on campaign financing to create a break with the past that produced a 90 percent election turnout? I don’t think so. We invest money with magical powers that in truth belong to us, have always belonged to us—powers that are ours by virtue of what human beings are. We think we need money to give us permission to do what we already have the power and capacity to do.” (69)

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Comment: People will often tell PCVs that certain things are not possible because people have no money to pay for them. PACA, health clinic data, and the observations of CSB staff and CHWs had all indicated that childhood malnutrition was a problem and a priority in my commune. CHWs in one community wanted to do healthy cooking sessions, but they said the sessions would never work. The reason they gave: no money and no equipment. In other words, it was not possible. After weeks of visits and conversations, the CHWs finally said, “Let’s give it a try.” We divided up responsibilities, and everyone contributed to cooking sessions that stretched over 10 months. When we were finally ready to give it a try, we found that the resources we had thought we were lacking, in one form or another, had been available all along. Money was not the obstacle; the obstacle was in our heads. “Money supplies the lens through which we compute the gaps between supply and demand, between resources and needs, between what is ‘feasible’ and what is ‘not feasible’ because not affordable. When we see our communities failing, families falling apart, neighborhoods deteriorating, clean air and water becoming scarcer, open space disappearing, we feel helpless to address the problem because all we know is how to use money to solve it.” (71)

Chart 2: Remedying Money’s External Costs (72-73)

$ Characteristics Problem or External Cost of Money Time Dollar Characteristics All-purpose Can buy guns, drugs, bribe officials. Limited purpose

Highly mobile Money can leave neighborhoods, communities, nations too quickly.

Locally anchored

Pricing: value of hour based on scarcity, skill

Caring, love, civic engagement are devalued; market pricing embodies market values. If everything has a price, everything is for sale.

All hours valued equally; compensation includes psychic rewards

Paper money Paper money leaves no trail; the parties come and go as strangers. Trust requires memory. When money substitutes for trust, trust atrophies.

[Social] currency. Building trust requires memory so that present is shaped by the future

Compensation defines work force Persons not in workforce treated as if they have nothing of value to contribute. Excludes children, elderly, disabled.

Children, elderly, disabled are contributors; earn Time Dollars

Money bears interest Interest and exchange rates make money a valuable commodity. Commodity value of money drives up transaction costs, rewards arbitrage and speculation on derivatives.

No interest and no commodity value make other transactions possible

Money debt = legally enforceable Breaking one’s word is fine, so long as damages are paid. Obligation is based on enforceability and damages, not honor and trust. Legal remedy is often prohibitively expensive.

Moral obligation may be safer than legal obligation. One’s word is one’s bond.

Taxable to support government Tax dollars set limits on public expenditures to address social problems. Indices civic paralysis waiting for government funds.

Time Dollars reward caring and civic participation, are not taxable, virtually unlimited.

Comment: The limit of Time Dollars is theoretically the limit of human capability, whereas the limit of money is the money supply—to put it simply. Even though the supply of human capability is great, we continue to draw from the limited money supply to address social and community development issues. We take advantage of only a small portion of the resources available to us. For PCV communities, money is often scarce, yet there is an abundance of human capability. Through the strategy I propose, community members might not have to struggle in the way they are accustomed to obtain limited resources from others. Rather, they could create resources for themselves with their own

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hands, their own minds, and their own efforts. They would be in control of their earning potential, not someone else and not limited by supply. Among other characteristics, this is a strategy of empowerment. Time Dollars Have a Different Genetic Code “1. All-purpose purchasing power

…. Time Dollars as a currency with restricted purchasing power may be inferior for certain purposes, but it sends out a message: Maybe we don’t really want all the things we value most—our future, our fate our l ives—determined by market value and up for grabs to the highest bidder. And perhaps we need a currency that, regardless of the market, enables us to use our time to secure a kind of self-sufficiency….

2. Mobility Time Dollars are a local currency—issued locally and honored locally…. We need a local currency that will stay put as a kind of safety net, given the rate at which vast tidal waves of speculative money can wash over an entire nation, create an instant boom, and then depart overnight. Time Dollars reverse that flow. They induce a centripetal force, functioning as a reward for sinking roots, staying in place, accepting responsibility, building community, keeping family together….

3. Motivation There is no doubt that money rewards self-interest, greed, ruthlessness and material acquisition. We need an economy that rewards decency, caring, civic participation, and learning as automatically as the market now rewards unbridled self -interest, winner-take-all competition, and runaway specialization. Time Dollars devalue specialization; they assert that the most special and important thing a human being can do is to be a Human Being. That is about as unspecified a job

description as one can get. But it puts you in pretty good company—l ike Mother Teresa and Gandhi and Martin Luther King. Time Dollars provide a reward for caring and decency. They reinforce psychic rewards associated with volunteering. They provide external validation for doing the right thing….

4. Egalitarian materialism When a bil l ion dollars entitles one to capture the media, run for president, or be regarded as a sage, maybe we need less

egalitarianism. Maybe we need some elitism based on contribution, morality, and integrity. Time Dollars offer a highly selective opportunity to become a member of a highly elite, exclusionary club. Acts of caring and decency purchase privilege.

Comment: PCVs witness, both at site and in the United States, that money affords people status and privileges . At my site, the people with the most money have larger houses and more luxuries, can afford to send their children to schools in larger cities including the capital, and constitute an “inner circle” so to speak of political elite. As PCVs, would we be glad to see privilege awarded to those with the most money or those who contributed the most to their communities?

5. Price Time Dollars reject market price as a distributive and rationing mechanism. If tough decisions had to be made about who gets and who does not, two simple principles would suffice: those with greatest need would get a priority and those who had contributed by helping others would get a priority. If that sounds utopian, ask yourself if your parents or grandparents ever went without so that you could go to bed with a full stomach—or get a college education. There is no single

characteristic of Time Dollars that distresses economists more than the absence of price as a rationing mechanism, as a way to determine who gets what. One teenager from Anacostia in Washington, D.C., was earning Time Dollars doing yard work for elderly homeowners. The Time Dollars meant a lot, he said, because otherwise his buddies would think he was a chump. He could give them as a present to his grandmother. Challenging him for helping his grandmother was a no -no. Earning

something he could give away gave him status. Market wages would have subjected him to peer ridicule from those who are making far more dealing drugs. Price may not be all it is cracked up to be.

Comment: Many now talk about return on investment (ROI) for parents regarding their children’s education, or for students themselves. The focus of every conversation is not on contribution to society but on career earnings (money).10 This sort of analysis is inherently flawed, in the same way that Cahn critiques gross domestic product (GDP) as the primary measure of a country’s productivity and growth p.28.

10 “Is college worth it?,” The Economist, April 5, 2014, http://www.economist.com/news/united-states/21600131-too-many-

degrees-are-waste-money-return-higher-education-would-be-much-better. Kate Ashford, “5 Steps To Calculating Your College R.O.I.,” Forbes, August 29, 2014, http://www.forbes.com/sites/learnvest/2014/08/29/5-steps-to-calculating-your-college-r-o-i/. Melissa Korn and Douglas Belkin, “College Applicants Get Glimpse at Their Future Job Prospects ,” The Wall Street Journal, October

31, 2014, http://www.wsj.com/articles/college-applicants-get-glimpse-at-their-future-job-prospects-1414783194.

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See also previous comment on the difference between compensated and uncompensated volunteering p.19. 6. Efficiency

Money may be very efficient from distinguishing the haves from the have-nots. It seems to be singularly inefficient in bridging that divide or in enabling society to place value on what it says it values: caring, neighboring, rearing children, civic

participation, learning, and building community…. There is one thing that Time Dollars do far more efficiently than money. No monetary system provides a gauge for the extraordinary wealth of human talent for which the market finds no use or the vast unmet need that our system finds it convenient to ignore. The omission of all non-monetarized economic activity of family, neighborhood and community represents one of the largest failures in the money-based national accounting

system. The item is not small. One recent estimate projected the market value of help given within family by and for seniors at more than $196 bill ion. Is that kind of omission what we mean by efficiency?

7. Money makes money Time Dollars generate no interest. But they are inflation proof. An hour will sti l l equal an hour, regardless of what the Federal Reserve does. If you ask what is the global economy’s most important economic product, then forget cars or food

or computers. If money is the exclusive measure of value, then then the most important product that the global economy produces is money…. There used to be an ad that ran, ‘We make money the old fashioned way. We earn it.’ The money that money makes has a cost: in social cohesion, in growing inequality, in the demise of a l iving wage, in opportunity denied, in

breakdown of community, in moral values, in the viability of democracy, and even in the sustainability of l ife on this planet. Maybe we need to find another way to make money. The old fashioned way. Co-Production does that. It honors contribution as work.

8. Superior enforceability Time Dollars do not create an enforceable legal obligation…. Time Dollars are only backed by a promise, by trust, and by a

moral principle of reciprocity. The IRS has no interest in mere moral commitments. But ask yourself one question: Which would you rather rely on, a lawsuit or a moral commitment, if what you really needed and wa nted was companionship and caring? ....

9. All-purpose measure of value Money emphasizes and exaggerates relative worth. A currency that treats all human time as equal makes a very different

statement about value. The value of helping another is not measured by market wage; and one’s own value, as a human being, is not measured by marketable skil ls. We have always known that but, in a world dominated by money, such assertions sound fuzzy, moralistic and rhetorical when confronted with the demand, Show me the money.” (73-76)

“Time Dollars enable us to develop an awareness of the extent to which money distorts our calculations as to what is possible. It distorts our view of what people can do, what people are willing to do, whom you can trust, what moti vates people, what human nature is—and what it is possible for us to achieve. The extent to which artificial boundaries are built into money—into its genetic structure—becomes clear when we alter the currency we use. We find that a different world and a different set of possibilities emerge. Time Dollars are practical—like Frequent Flyer miles or discounts for being a member of Triple-A or AARP. They generate numbers. The exchanges that take place are just as real as an exchange driven by money or barter. That supplies critical, empirical ‘proof’ to the assertion made by Co-Production that the non-market economy is a real economy, and that work done in the non-market economy can confer power in either economy, market or non-market. At a minimum, Time Dollars actually function as a tax-exempt barter currency to generate exchanges in the non-market economy. They make it possible to go beyond charity and beyond volunteering. They confer a reward: access to surplus goods secured as a charitable donation from the market economy without undermining market price. As the examples in this book confirm, Time Dollars are already being used to access food, clothing, computers, legal services, health care services, housing, rides to the store, and even enrollment in colleg e courses. If nothing else, Time Dollars take Co-Production out of the realm of speculation and theory. They demonstrate that we can create a medium of exchange that makes Co-Production practical as a win-win strategy that taps assets and generates productivity beyond that which money and market have been able to do. From that point of view, they are simply a new tool, available as a kind of ‘appropriate technology’ to enable the non -market economy to compete for a larger share of energy, time and talent and to enlist the capacity of those whom the market devalues or excludes.” (77) “Counting counts. We live in a world where nothing exists without numbers. If you can’t count it, if you don’t record it, then it never happened. The Scottish have a saying: ‘You don’t make sheep any fatter by weighing them.’ But that doesn’t seem to be the case with Time Dollars. Basically, Time Dollars just count the hours people put in. But even when people don’t spend the Time Dollars they earn, something else happens. Observers note that turnover in Time Dollar programs is far lower than in volunteer programs. It was less than 10 percent in all of the original programs, and less

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than 3 percent in the largest Miami-based program. The only thing we did differently was to count. And people earned the Time Dollars without stopping whatever volunteering they were already doing. These sheep got fatter when they were weighed. The act of measurement, of inquiry, had somehow altered what we were studying. How could that be? Many people have had the experience of talking to someone who suddenly grabs a pad and starts writing. This gives one the feeling that what one is saying is really valued—this person is taking it down because they are going to use it. Recording something makes a difference. It confers value. It invests an act or a statement with a degree of permanence. It means that what is learned or done will not be forgotten. It just might shape the future. The philosopher-scientist Werner Heisenberg articulated an insight known as the Complementary Principle. It asserts that measurement is not neutral and external. The scientist, in making measurements, interacts with the observed object and thus causes it to be revealed not as it is in itself but as a function of measurement. Applied to assets, Heisenberg’s principle means that the act of measuring alters the nature of what is measured. We had actually been making the sheep fatter by measuring them. Measurement and recording are not neutral actions. Counting what people do is a way of valuing what they do. The act of measuring can alter reality.” (96) Comment: Simply counting and recording the positive contributions of people in our communities can be an empowerment tool and mobilize community members. Comment: Time Dollar programs have high participant retention rates compared to conventional volunteering programs. Even more interesting, participants tend to continue outside volunteering they were already doing, and in many of the examples Cahn gives, many actually start volunteering as a result of program participation. If volunteerism is still a new concept to many Malagasy, and if it is hard to convince Malagasy to volunteer “for free,” even in their own communities, this strategy might provide an appealing opportunity and introduction to volunteering. “Merely the issuing of Time Dollar bank statements operates as a kind of reward. Those of us who enrolled in frequent flier miles programs know how pleased we are to see the mileage grow, even if we know we may not be able to use those miles for months or even years. And if we can, we like using the same airline because we like to see the miles accumulate.” (97) “These are not one-way transactions; each act embeds the participant in an ongoing relationship. A time dollar earned means a new Time Dollar is available to spend. Helping another means you can count on someone to return the help…. Acts of giving cease to be simply isolated, unilateral transactions.” (98) Comment: Building social ties directly through transactions among program participants is the primary way in which the strategy I propose differs from Time Dollars. This characteristic of Time Dollars is an important factor in the success of Time Dollar programs. Keeping the strategy potentially manageable for PCVs and focusing on project-related objectives, I could not think of a way to incorporate this characteristic as effectively as in Time Banking. This is not to say that promotion of relationship-building and strengthening is absent from the strategy; it would tend to come about in the course of conducting outreach or collective health monitoring. A proper Time Dollar program would require a lot from community members and from a facilitator. I am not sure if rural Malagasy communities would be amenable to the concept of such exchanges among members. More likely, it may be possible among small, already established groups within communities and with an adapted model. “The bank statements report who helped whom, how, when, and for how long—the moral equivalent of frequent flier miles for a life’s journey.” (99) “Where—in which economy—would an investment give greater return? The return from the market economy will be determined by the amount of money available for payment at market prices to social workers, hospitals, schools, child care centers, police officers, lawyers, doctors, and administrators. The return from the non-market economy will depend upon a combination of factors. Money will only be one determinant. But there will be others that determine how much caring, health, safety, learning, and development is generated. Trust, cohesion, moral obligations, kinship relations, neighborliness, community bonds, tradition, culture, and community standing will all shape the return on investments designed to address social and economic needs. In the market, you get what you pay for—if all goes well. But that’s all

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you get…. [Co-Production] looks to use limited dollar resources to expand non-market involvement, either alone or in new forms of collaboration with the market.” (116-117) “Money equates value with market price . Functions performed in the home—rearing, nurturing, learning, valuing and caring—are simply ‘unskilled labor.’” (117) “A market definition of work disallows, deletes, and denies the public value of work done for one’s own family. It characterizes work done at home and in the neighborhood as private goods, devoid of public value and social benefit. Conventional market thinking asserts that raising your child only benefits you. Arguably, there may have been some validity to that in bygone ages when children helped harvest the crops, or at the beginning of the Industrial Revolution when children could bring home wages if sent off to factories and put to work in coal mines. That logic, if it ever held, does so no longer. But it is convenient to pretend that i t still does. Children are not private goods. The economist Nancy Folbre points out that the public at large has a major stake in the future productivity of children…. Her premise i s straightforward: Every citizen of the United States enjoys ‘significant claims upon the earnings of future working-age adults through Social Security and public debt.’ It follows, she argues, that i f the public at large has a stake in every child’s future earnings, then rearing children amounts to the production of ‘public goods’ and that ‘individuals who devote relatively little time or energy to child-rearing are free-riding on parental labor.’ That supplies the basis for a more sweeping challenge to her own profession: Economists need to analyze the contribution of non -market labor to the development of human capital: as children become increasingly public goods, parenting becomes an increasingly public service. In short, if we need a future work force that is able to pay for Social Security and Medicare and to pay off the vast public debt that our generation tripled in the 1980s, we had better invest in the parenting needed to produce that earning capacity…. [From a market perspective] we are saying, ‘It is none of my business how you raise your children.’ We are saying that the development of the entire next generation—its education, its values, its life style—is purely a matter of private concern. We are making a choice about investment in prevention and development without knowing it. And we will find ourselves declaring indignantly and self-righteously that we should not have to help bear the cost or compensate families for doing something that is for their own benefit, and that it is exclusively their responsibility…. If we deny and disregard the public benefit element, we will not be willing to share the cost of basics like child care. If we refuse to acknowledge that the public has a stake in how adequately families discharge their essential functions, we will not be willing to help foot the bill or supply the resources needed to supplement what families can do by themselves. We will not be willing to find any way to compensate non-market workers. If we deny that we benefit, we have no obligation to pay based on benefit received.” (119-120) Comment: As Cahn describes, many in the United States are strongly opposed to investing in supporting families raising their own children, but end up paying much more for strangers to raise them. The same predisposition might be said to be dominant in development: we invest more for professionals to develop communities than we do for communities to develop themselves. Resources tend to support existing or reinvented professional programs and efforts rather than communities themselves. As Cahn illustrates, we are often hesitant to invest in public goods, but this hesitancy comes at our own expense. “The exclusions from [the market definition of] ‘work’ yield strange, unanticipated, and unwanted consequences. Consider the following scene: imagine 15 women sitting in rocking chairs in a circle, each with her own baby on her lap. That is not work. Now imagine that an instruction is given: ‘Hand your baby to the person on your le ft.’ Now that is work. Something is wrong with that logic. This definition of work yields a strange and unwanted consequence. It leaves us with only one way in which child rearing can be considered to be productive work. Strangers must raise our children. Then it is work. That makes no sense. It describes accurately the path the government has embraced. It is the definition that is embodied in law, in public policy. We take the child away from the parent or we send the parent away from the child. That’s the only way the market knows how to make child rearing work. It is a one-two punch. Children’s Protective Service agencies are in charge of removing the child from the parents; the welfare authorities are in charge of sending the mother away from the child. Neglect and abuse cases soar. The automatic solution is out-of-home placement. Foster care has more than doubled. Like prisons and nursing homes, Children Protective Service agencies are a major growth industry.” (120-121)

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“Allowing the market to define work leads to prohibitive costs. In 1995, federal and state spending on investigations, casework services, foster care, and adoption assistance exceeded $11.2 billion. That figure does not include local funds or funds spent on individual cases by the courts, law enforcement, schools, or the health and mental health care systems. We pay considerably more to foster families to raise other people’s children than we provide in public assistance for single mothers to raise their own. The federal government spent about $11,698 per child on foster care maintenance and administrative costs—but only $1,012 for each person receiving [welfare]. That means it costs 11 times more for the federal government to provide foster care than to provide basic income maintenance. When one adds in state costs, the average government cost of supporting an individual on welfare was $2,499—while the cost of operating the foster care system was $21,902 per child. There are other costs. The caseload of Children Protective Services has more than doubled. A half million children are now in foster care—an increase of nearly 50 percent in one decade. The agencies charged with investigation were falling dramatically farther behind. Child Protective Service agencies investigated only 28 percent of the recognized children who met the government’s Harm Standard—a significant decrease from the 44 percent investigated in 1986. Schools identified the largest number of maltreated children but only 16 percent of these children were investigated…. The current definition of work is seductively fraudulent—with catastrophic long-term consequences. Our faith in money and what money can buy has programmed us with a filter that masks defective performance and misrepresentation by the market. The terrible truth is that youngsters removed to foster care are ‘ten times more likely to be maltreated while in the custody of the state than in their own homes.’…. the most recent study of ‘foster care’ alumni tells us what we are really buying. Within 12 to 18 months after leaving the foster care system, 33 percent were receiving public assistance, one -fifth of the females had given birth, and more than one-quarter of the boys had been incarcerated. 26 percent of the males and 15 percent of the females had been beaten or injured. 10 percent of the females had been raped. 37 percent had not finished high school. 40 percent of the nation’s homeless are former foster children . If that’s what the market definition of work gives us, it’s a pretty defective product. The hidden costs keep coming due. The definition has to be replaced. The new definition must, at least, meet the standard imposed on commercial goods, which defines ‘marketable’ as ‘useable for the purpose for which it is sold.’ This definition fails even that test.” (121-122) Despite market interventions and “even with unprecedented prosperity over an unprecedented stretch of years, something disturbing is happening: Hunger and homelessness have increased in cities for 15 consecutive years.” (123) Comment: See comments on the failures of traditional approaches in addressing social issues pp.15-16, 28. A critical consequence of welfare policy is that “the faster we succeed in moving the most work -ready, upwardly mobile welfare mothers into jobs, the faster we disinvest in families and communities. A daily commute to low-wage, entry-level jobs will deplete disadvantaged neighborhoods of their most precious resource: indigenous leaders, community spokespersons, role models, caring parents, entrepreneurs, and norm-setters.” (124) Comment: See pervious comment on community versus individual empowerment p.18. “Activity that creates value for others and for society is work. We tend to think there are only two alternatives : volunteering and market wages. We are wrong. And we tend to equate volunteering with working for nothing. Again we are wrong. Co-Production supplies a context requiring proof that some alternative is possible. Time Dollars supply that proof. They are one such alternative. They are a hybrid that combines volunteering and wages. At the London School of Economics, Nicholas Barr, a protégé of Richard Titmuss, the great pioneer thinker on altruism, had made a theoretical prediction: When you combine two rewards, psychological and monetary, the more you can intensify the psychological reward, the less important the monetary one will be. One phenomenon that disturbed the first coordinators of Time Dollar programs was that many Time Dollars were not getting spent. Yet, even though people did not spend down their Time Dollar bank account, they continued to earn Time Dollars. The turnover or burn out or attrition rate was far lower than volunteer programs in the same communities. We were watching Barr’s prediction at work: The conferring of Time Dollars intensified the psychological rewards associated with volunteering. The greater that reinforcement, the less important the actual purchasing power associated with Time Dollars. In fact, people were getting what they wanted without actually spending the Time Dollars. Some were buying a kind of insurance they hoped they would not have to use. They were getting the assurance that insurance provides. Some were buying access to a social setting, a new group of friends, strangers whom they could trust. Just being part of Time Dollars engaged them in a social network of

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exchanges that provided that access. For some, it was a way of filling their lives with special social events—because most programs had regular meetings or pot luck luncheons or birthday celebrations. Gar Alperovitz, an iconoclastic thinker about what he calls The Third Way, says that the volume of unspent Time Dollars is really a measure of the unmet need for community that Time Dollars are filling.” (126) Comment: Compared to baseline site health data, the strategy I propose might provide a means to measure previously unmet need in PCV communities, which would also quantitatively reflect the effects of PCV efforts. Comment: As further consideration of the relationship between psychological and monetary rewards, Carey K. Morewedge et al describe that “when people are given a choice between an outcome that is comparatively superior but absolutely inferior (e.g., a job that pays them $45,000 and pays everyone else $40,000) and an outcome that is absolutely superior but comparatively inferior (e.g., a job that pays them $50,000 and pays everyone else $55,000), a sizeable number choose the former.”11 Status is an unstated form of psychological compensation in this example, and it seems to hold more sway in people’s decision making than the actual associated dollar amount. “If we refuse to accept the market definition of work, we do not have to accept the market definition of compensation. Different rewards are appropriate for different tasks by different groups in different settings…. First, there are meaningful forms of reward that reinforce altruism directly. Elderplan, a Social Health Maintenance Organization, offers its members an opportunity to buy gifts of 15 home-delivered meals to be given by the donor to a home-bound senior. Blue Cross-Blue Shield of Pittsburgh enabled its members to buy $10 gift certificates from local grocery stores for needy families. At other Health Maintenance Organization sites, there is discussion about enabling members who earned Tim e Dollars to buy health care coverage for women in shelters or others who are presently uninsured. Second, there are goodies of significant market value that can be secured as donations or by outright purchase: tickets to movies, to lectures and museums, discounted rates for shopping trips or tours and even cruise ships. One housing developer enabled families to cash in their Time Dollars for a lecture at the Smithsonian by novelist Terry McMillan, and for a two -week summer camp for the children. In different cities, cruise lines and tour buses have given special rates for Time Dollar groups. Finally, there are social events and pot-lucks made available for Time Dollars, embedding the tangible incentive in a social setting. In Maine, Time Dollars can be used for everything from massages, to dance lessons and oil changes. Those are either secured as member-to-member exchanges—or ‘awards’ donated by members. Time Dollars can be used to purchase tickets to the Portland Symphony; the Symphony is awarding Time Dol lars for helping in the music filing library. Portland’s Adult Education program accepts Time Dollars as tuition payment for all its classes and allows Maine Time Dollar members to use their auto mechanics and carpentry workshop to provide oil changes. In return, Maine Time Dollar members act as tutors and teachers assistants or provide child care during some of the classes. In St. Louis, Grace Hill Neighborhood Services has long operated Time Dollar stores, stocked with contributed merchandise ranging from food to soap to toys and educational materials.... The Chicago Peer Tutoring program spends between $20,000 and $30,000 annually enabling participants to cash in their Time Dollars. At the end of the year, every Time Dollar earned has been spent—to redeem a recycled computer for every participant. This brings us to the second question. Who pays for the actual dollar costs? .... The Time Dollar Institute says to the Chicago Public School system, that’s part of the cost to the school system of buying Co-Production. It’s a bargain…. Elderplan, an unusual Social Health Maintenance Organization in Brooklyn, has taken the Co-Production principle even further, embedding it first in its premium structure, and later, in an extensive Credit Shop Catalog full of health-related items that can be bought with Time Dollars. Ever since 1987, Elderplan has been putting Co-Production into practice. It says, We need our consumers, the elderly, to be co-producers of health—and we are committed to finding ways that can effectively compensate them for the contribution they make. From 1987 till 1998, seniors who earned Time Dollars helping other elders in their Member-to-Member program could cash them in for a 25 percent discount on their health insurance premiums…. Elderplan also convinced some lawyers to write wills, advanced directives, and living wills in return for Time Dollars. All of this costs money. The big-ticket items [in the Credit Shop] cost Elderplan anywhere between $50 and $100. Do the arithmetic on that for 500 members. That means that Elderplan is spending somewhere between $25,000 and $50,000 a year on Time Dollar redemption items alone. That is on top of staff costs. Co-Production is worth real money to Elderplan.” (127-129)

11 Carey K. Morewedge et al, “Consuming experience: Why affective forecasters overestimate comparative value,” Journal of

Experimental Social Psychology 46 (2010): 986).

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Comment: The principal behind the strategy I propose, as Cahn illustrates through numerous examples, is that by spending X hours of effort or X dollars on rewards (far less than the cost of salaries), you can generate X hours of active contributions to community by community members themselves (contributions that were not being made or were not possible before). Co-Production is worth enormous community gains and real monetary savings by all. Consider the examples Cahn gives above. The equation for donors and sponsors is not monetary alone. If a program participant buys a $10 gift certificate with Time Dollars and then goes on to purchase $25 worth of goods or services using the gift certificate, the transaction does not result in a net loss of $10. Rather, the equation is: $25 of goods or services = $15 revenue + X hours of local community contribution generated. This might sound similar to some business promotions that offer to donate a certain percentage of proceeds to select charitable causes. However, the connection to local community is often distant. Maybe the recipient is a big charity located in another town, county, or state. Maybe it will take months for that cash contribution to get where it needs to go. For all intents and purposes, when the consumer makes a purchase and generates such a contribution, the money disappears. In contrast, the strategy I propose is explicitly local and immediate. The connection is clear for community members. As I describe above in my exploration of potential forms of incentives, a monetary investment in incentives may not even be necessary. Certain incentives may only require an input of time and effort by PCVs or other supporting community members. For example, in exchange for X points, a PCV might help an individual learn a new skill (resume or grant writing, IT, English or other subject tutoring, small business or project management, musical instruments, sports, etc.). Incentives could come in the form of other services, such as the “delivery” example I described above as well. “Simply charging a fee in Time Dollars can empower the client in two ways. It acknowledges that the client’s time and efforts have a value equal to that of the professional. And, if the Time Dollars are to be earned in a manner that is mutually determined, the fee establishes a framework that enlists client and professional in partnering around a shared objective. When a fee is paid in money, that connection and that partnership won’t happen. There is no necessary connection between what you buy and how you earned the money to pay for it. That’s true of most professional services: law, medicine, education, therapy. That changes when professionals charge a fee in Time Dollars, with an understanding that the Time Dollars are to be earned in a way that advances some shared vision of the world…. Note that this form of Co-Production does not require the professionals to stop being professionals. The lawyers do not have to become social workers, community organizers or volunteer coordinators. They are not even obli ged to alter the way they do what they do.” (147-148) Comment: The way something is earned makes a significant difference in how it is perceived by the earner. As I commented before, there is a difference between passive investment and active contribution. When we ask for community contributions for projects, the current policy is that any form of contribution is acceptable. Contributions of money, tools, equipment, supplies, venues, and land are common. They are all passive. People will sit back and let their contributed assets do the work; hopefully they will earn a return. People will be more concerned about how their own money, tools, equipment, supplies, venues, or land is doing than they will be about the project itself. There is community interest in the project, sure, but generating community ownership requires qualitatively different forms of contribution. When people contribute “things” to a project, those things become invested in the project, but not the people. For people truly to become invested in a project, they must contribute themselves to the project. Cahn also points out that when you replace money with Time Dollars or points as the medium of exchange, it creates a transaction relationship that “advances some shared vision of the world.” The sponsor has something the program participant wants. If the sponsor charges money for the wanted good or service, then the participant must go out and acquire money one way or another. When the transaction is made, the sponsor has no way of knowing how the participant earned the money to make the purchase. The money could have been earned honestly or illicitly. If the money was earned illicitly, it is possible the transaction generated a damaging effect on the community. In contrast, if the sponsor charges Time Dollars or points, the participant can only earn those i n mutually agreed upon ways that explicitly support community health and growth.

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“If there is a ‘payback’ then a single transaction can develop into an ongoing relationship that expands the scope of the service, the nature of the activity, the duration of the engagement and the role of the parties.” (149) “First come the individual savings. Those are largely anecdotal. But the anecdotes pack a fiscal punch. If there is no adequate support system at home, hospital stays must be prolonged even if the patient no longer needs hospital level care. Each day that a stay can be shortened because of the Time Dollar program saves Elderplan $1,000. One avoided nursing home stay saves $35,000. There are other forms of cost saving. If medication isn’t taken, regularly or in the right doses, there are costs. If a chronic condition worsens, the earlier the intervention, the better and the less expensive. Emergency room trips cost; hospital stays cost. Elderplan’s Member-to-Member program has built-in monitoring…. Studies are now documenting the presence of depression and related mental health problems as a major contributing factor in a significant percentage of physician visits. Practitioners, academicians, and researchers agree that there is a mental health component to one-third to one-half of physical ailment cases treated by physicians. Increasingly, hard data are emerging that demonstrate the positive corollary: that volunteering seems to promote wellness and even longevity…. Patients who want attention take time. And time is money. If nothing else, seniors have a choice as to how they get attention: they can be a hypochondriac, or they can join Member-to-Member and get anything from telephone bingo, phone quizzes, walking clubs, bereavement counseling and neighbors who know how to fix leaky faucets. When Elderplan received its presidential Points of Light Award, the accompanying citation noted that 400 members had contributed more than 4,000 hours of service to others.” (152-153) Comment: The dominant conceptual framework in which PCVs and their communities explore what is possible and strive to achieve sustainable development is insufficient. The incentives generated by that framework are misplaced, working against rather than reinforcing improvement. We need a new tool. We need to assert and reinforce the value of community-led development work. “Community-led” cannot mean community inspired, community consulted, or community assisted. It must be driven by community members with PCVs as facilitators. We all try to adhere to this imperative, but it is one of the hardest things for anyone working in development to achieve in practice . Often, people’s incentive and risk calculations focus heavily on money. If money is our default, primary measure of value, then we cannot empower our communities unless we consider a different measure of value that can compete, even just a little bit, with the dominating allure of money. We need to open up space and create realistic opportunities for volunteerism in our communities. Appendix A Aligning Neighbor-to-Neighbor Exchanges to Agency Mission “1. Supply a critically important missing element needed for a program to succeed

Examples would include: --Providing an informal support system for fragile families or in case of disability or i l lness --Generating an informal social group with social events to reduce loneliness and isolation --Creating a peer group that provides support and supplies critical motivation for doing ‘the right thing’ when one fears disapproval or rejection by one’s peers

--…. Enlisting clients to spread the word, raise awareness, impart critical knowledge --Rewarding prevention and changes in behavior that reduce risk or risk factors

2. Transforming the relationship between client and helping professional from one of subordination and dependency to one of contribution, mutuality and parity

This happens in different ways; each yields a distinctive dynamic: --Ending or preventing dependency is possible only if clients, by using their abilities, can get respect, attention and help more effectively than by having problems and needs that foster dependency --Rewarding strengths and contribution makes it safe to show capacity and reduces fear of abandonment if one improves

--Professional intervention alone is never enough to address chronic conditions associated with diabetes, obesity, depression, AIDS, high blood pressure or mental health --Payment or co-payment in Time Dollars turns the client into a ‘paying customer’

--Enlisting clients as ‘co-producers’ reduces no-shows for appointments, volunteer ‘burn-out,’ and failure to follow through on treatment or rehabilitation --Enhancing self-esteem by enabling a client to assert ‘I have really important work to do.’ --Client engagement can supply cultural competence and help overcome barriers of class and race that reduce effectiveness

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--Time Banking related incentives create a transparent system for conferring rewards untainted by favoritism 3. Securing critical resources for financially strapped programs

--Time Banking documentation provides the verification required by a funding source or the in-kind support promised in a grant application

--Time Credits earned provided an objective measure of Return On Investment for funders --Enlisting clients who ‘earn’ services can generate contribution by law firms, doctors, and businesses that feel their contribution generates reciprocal contribution in the community

--Enlisting clients can help provide back-up and support for professionals coping with multiple simultaneous demands --Enlisting clients as ‘co-producers’ creates a constituency that will speak up on behalf of programs --Allocating organizational resources for meaningful rewards can counter criticism that funding for the disadvantaged merely supports middle class professionals and contributes to the establishment of a ‘welfare class’

--Enlisting clients as ‘co-producers’ provides an answer to those who would ‘blame the victim.’ The victim’s engagement becomes a central asset in finding remedies.

4. Effecting System Change Time Banking can be used to create feedback loops, enhance accountability, document unmet needs, and transform clients from objects of pity to co-workers remedying social problems in the following ways: --Professionals can fail because they have no way of knowing whether their intervention is working and formal data systems do not necessarily capture critical knowledge --An assessment of the extent to which an agency actually engages clients as co-producers can be a major catalyst for

system change and can help enhance performance and job satisfaction --Neighbor-to-Neighbor client groups can function as an early warning system when a treatment isn’t working, when a case ‘falls between the cracks,’ or when a new complication calls for additional interventi on

--System change catalysts will emerge that provide important feedback on issues and problems that might otherwise have gone undetected

5. Advancing Social Justice --Involvement by clients who frequently are disproportionately non-white can empower disenfranchised and vulnerable groups. Time Credits earned by civic work and civic engagement can counter apathy, reduce alienation and generate

empowerment --Occupational, employment and income ladders can be developed using Time Banking as an avenue into paid employment. Bank statement provides a verifiable work record and references for those seeking entry into the job market --…. Enlisting clients as ‘co-producers’ can educate them as to causal conditions and generate activism to remedy

environmental and social issues --Valuing efforts by the impaired, handicapped, bed-ridden, underage and overage redefines the work force for social justice in ways that can impact public policy” (209-212)

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