Reflections on a Career: Health and Population in East Africa
Victor Masbayi was born in Nairobi, Kenya in 1951; he lived there with his family throughout his undergraduate college education at the University of Nairobi. While working for the African Medical and Research Foundation, Masbayi was sponsored to complete a Master’s Degree in Public Health at the University of Michigan at Ann Arbor.
After receiving his degree, he secured a job with USAID/Kenya, where he worked on a variety of different projects relating to health, population, and development. Later in his career, Masbayi had the opportunity to work again in Kenya with USAID’s Regional Program for East Africa.
Having now concluded his career with USAID, Masbayi offers in his oral history a series of thoughtful reflections on his career. These include what he is most proud of, what challenged USAID in East Africa, and what USAID was successful at there. Additionally, he shares what advice he would offer to future employees, and what recommendations he would make for USAID to improve its work.
During his career, Masbayi also worked for the Academy for Educational Development and the University Research Company.
Victor Masbayi’s interview was conducted by Marcia Bernbaum in January 2019.
Read Masbayi’s full oral history HERE.
Drafted by Ashley Young
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“I value my contribution to building the capacity of regional health management and training institutions in East Africa.”
Contributions: Q: What do you value as your most significant contributions over your career?
MASBAYI: I value my contribution to improving the health of children under 5 years. Especially children with preventable malaria and immunizable ailments – those have been very important to me. I have seen the difference we have made in under 5 child mortality.
Seeing communities change in terms of putting health as one of the topics they discuss, especially improving women’s health, maternal health, and getting men to appreciate that they have a role to play in discussing the issues that affect children and women. That was something that did not happen much in Eastern Africa at the beginning of my career, but it has been happening progressively. In Tanzania I saw men bring children to the clinic, which is unusual.
I have been an influence and mentor to many young men and women who are contributing to society today.
I value my contribution to building the capacity of regional health management and training institutions in East Africa that have contributed significantly to improving and changing health policies in the region.
I am proud of a generation of younger people from my community who meet me and say I was their role model.
Challenges in East Africa: Q: What were USAID’s greatest challenges in health/population in East Africa?
MASBAYI: One of USAID’s greatest challenges was its failure to effectively participate in “basket funding.” While other bilateral agencies put their funding into basket funding and forged closer working relationships with key staff of the Ministry of Health, USAID looked like an outsider even though they were accepted by the Ministry on the basis of its strong and diverse portfolio of support.
The Kenyan Ministry of Health (MOH) has always been of the impression that USAID wants to call all the shots on the projects they fund. Frustrated MOH staff could often be heard saying “Pesa in zao. Tufanyeje.” (It is their money. What can we do about it?)
The second challenge was the frequency with which programs were “re-engineered.” It seemed like every new office chief felt they knew better than their predecessor and wanted to “fix” the program even when it wasn’t broken. This would lead to disruption and delays in implementation.
Sometimes this was compounded by the tendency of some incoming American staff to assume the FSNs on board didn’t know much and needed “mentoring.” This was not necessary in most cases because most FSNs had vast experience. Some are much more experienced than their supervisors.
Successes in East Africa: Q: What do you see as USAID’s greatest successes in health/population in East Africa?
MASBAYI: USAID was a leader in reproductive health and family planning, HIV/AIDS treatment and prevention, and maternal and child health.
On the basis of its technical programs USAID achieved much success in assisting the ministries of health to change and improve their health policies based on evidence. The use of family planning contraceptive methods became acceptable, the HIV/AIDS stigma was significantly addressed, and new malaria policies significantly improved the management of malaria in children under five-years-old and in pregnant women.
Together with other agencies such as UNICEF, WHO, DFID etc., USAID led the lobbying for the Government of Kenya to increase its health budget. I recall a significant increase in the budget for vaccines that happened about the year 2000 or there about.
“Take time to make field visits and be observant… Be aware and be sensitive to cultural differences.”
Advice for Future Employees: Q: What advice you would give to incoming FSNs and U.S. direct hires in general and interested in working with USAID in health/population?
MASBAYI: Take time to make field visits and be observant about what you see and hear. Take time to talk to staff implementing projects at the grassroots level and ask strategic questions. This gives one a very good understanding of the public health challenges.
It is important for the field team to meet when they return from the field and briefly discuss their observations. Find like-minded organizations addressing similar issues and do workshops focused on potential solutions to problems identified. Get away from the attitude that “we can do it better than other partners.” This is where true collaboration lies.
Fair treatment for FSNs is paramount to the performance of USAID missions. When they get demoralized the organization performance slips. I was working for USAID Kenya when the embassy and USAID moved into their current Gigiri premises. FSNs were designated parking spaces a mile away from the building and were to be ferried onto the embassy compound by bus. After a few weeks it was noted that there were plenty of empty parking slots on the embassy compound. When FSNs asked to use these spots, the administrative office responded that they were reserved for spouses of American staff. Now spouses don’t work for USAID and don’t need all day parking space. Fortunately, this policy was changed.
Be aware and be sensitive to cultural differences and to the significant differences in income between FSNs and Americans. For example, when you celebrate birthdays at the office the American staff carry the burden of bringing the birthday cake. For the average FSN a birthday cake is not a priority and is an expensive proposition in their kitchen budget so they are unlikely to bring a cake to the office. In any case it might not survive a “matatu” ride to work.
“Develop the capacity of local institutions… move along with [changes towards decentralized government].”
Recommendations: Q: If you could share 2 – 4 recommendations to USAID on how to increase its effectiveness in general, and specifically in health/population, what would they be?
MASBAYI: USAID needs new approaches to develop the capacity of local institutions and to work through them. The current approach to institutional capacity building seems fret with issues of sustainability. It often happens that at the end of the project key staff find another donor funded project and move away with the skills developed thus far.
Due to the fact that most Ministries of Health don’t keep a good record of technical staff trainings, ministry staff often apply and participate in many trainings including those they have trained in already–the key motivation being per diems. This leads to much waste and overtraining. Because staff are away from work so often, they don’t have enough time to manage programs effectively.
I believe that donors can work with Ministries of Health to develop some key basic training in program implementation so that development partners don’t have to run separate training programs. Training often targets the same managers of the Ministry of Health. Take for example a District Health Management team. The team might receive training in say “quality of care” from three or more USAID funded programs. Each partner claims their training is different.
Many countries in Africa are buying into a decentralized system of government in order to move services and decision-making closer to the populations served. USAID needs to watch the pace and move along with the changes. There is a risk of USAID remaining engaged with national management at the Ministry of Health Headquarters and leaving the regional communication to junior staff. I think this would weaken the USAID impact at the regional level.
TABLE OF CONTENTS HIGHLIGHTS
BA in Sociology and Government, University of Nairobi 1973–1977
Master’s of Public Health, University of Michigan 1981–1983
Joined USAID 1987
USAID/Kenya Peace Corps Small Projects Assistance Program Manager 1987–1988
USAID/Kenya PVO Co-Finance Project Manager 1988–1995
USAID’s Regional Program for East Africa (REDSO) Maternal and Child
Health Specialist, Deputy Office Director 2000–2010