The CEO Who’s Turning the Global Development Approach on its Head

Global development needs some disruption.

When you grow up the daughter of two teachers — one a former Jesuit seminary student, the other an erstwhile do-gooder in Mexican villages — you’re bound to dream of bettering the world.

So it’s little surprise that Sacramento native Gina Lagomarsino speaks Spanish, has traveled extensively — she just returned from Jerusalem — and feels strongly about social justice. With a bachelor’s from Stanford in public policy and an MBA from Harvard, she’s secured formative gigs in domestic health care, business and public policy. At 43, she’s the newly appointed president and CEO of global development organization Results for Development, or R4D. The operation, founded in 2008 and backed in part by the Gates Foundation, is making waves, with $26 million in annual budgets for projects in more than 50 countries, focused primarily on health care and education. R4D’s signature quality: supporting local organizations and change agents with the analysis, connections and practical tools they need. R4D’s founder and Lagomarsino’s mentor David de Ferranti cites her “great combination of analytical strengths” and people skills as reasons the board promoted her last year.

Lagomarsino’s priority? Putting universal health care (UHC) on the map and advancing her global development organization beyond the usual stodgy bureaucracy. R4D’s office in northwest D.C. has a Silicon Valley vibe, complete with beanbags, a basketball hoop, a work-from-home-friendly policy and loads of intracompany clubs for things like yoga and soccer. There’s even a “chief people officer” in lieu of human resources. The command-and-control structure de Ferranti survived for 25 years at the World Bank is nowhere to be seen. Walking through the office, Lagomarsino presents as casual, and her employees seem friendly and admiring.

The laid-back vibe belies their serious work: Lagomarsino drove efforts to get UHC on the international agenda, and recognizes that many countries striving to achieve it, like Ghana and India, suffer from similar delivery problems, like reorganizing financing. She spearheaded a group of international donors and partners that set up the Joint Learning Network for Universal Health Coverage, a network of policymakers and government practitioners from countries working to make UHC a reality. The JLN helped Ghana, for example, rework how it pays public and private providers and to use funds more efficiently. In 2009, six countries were members; today there are 27.

De Ferranti points to other R4D successes: In 2011, the Global Fund’s Market Dynamics Committee commissioned R4D to come up with strategies to optimize “value for money” across its health commodities portfolio, focusing especially on $500 million in savings on HIV/AIDS drugs. In another case, R4D, the World Bank and a few other organizations quantified what the world was spending on key nutrition interventions — $3.9 billion (as of 2016) — and figured out that an additional $7 billion a year over 10 years could save 3.7 million children’s lives.

Providing support and encouraging home-bred solutions, rather than flying in fixers from overseas, is a fine approach, says George Ingram, senior fellow at the Brookings Institution, a D.C.-based think tank. R4D “emphasizes that more than other organizations,” he says, which “on balance, is good.” The main problem? Finding patient funders. “You’ve got to have a funder who’s willing to take the long view,” he says — in his words, supporting local and more “culturally appropriate” solutions is worth it, even if it means sacrificing some global technical expertise.

Health care became a focus early on for Lagomarsino. She remembers Bill Clinton’s health care plans in college. She spent a summer interning for Sen. Ted Kennedy when he headed the Labor & Human Resources Committee. It was 1994, and while Clinton’s plan “crashed and burned,” she reflects, she “got the bug.” Her first job at Kaiser Permanente was corporate stuff: customer satisfaction research, project management. But she also worked alongside clinical practitioners, getting “a real sense of the challenges of frontline delivery and also a lot of respect for what doctors and nurses had to go through to deliver,” she says. Afterward, she worked with health care organizations at McKinsey & Company and then in the office of D.C. Mayor Anthony Williams, where she helped redesign public health coverage for low-income residents, pre-Obamacare. The program achieved its goal, she says, of offering health care to every D.C. family who lived at up to twice the official poverty level. (It filled in for those populations the federal Medicaid program didn’t cover, like undocumented migrants or childless adults.)

After her years in the domestic sphere, Lagomarsino’s foray into global development came about by chance. Leaving the mayor’s office in late 2006, she took what she thought would be a short-term gig studying malaria health delivery systems at the Brookings Institution. There she linked up with de Ferranti — then a senior fellow at Brookings — who was thinking of starting his own organization. A grant from the Rockefeller Foundation made that possible, and Lagomarsino joined him in the first year. The grant, “believe it or not, was to work on the role of the private sector in health systems in developing countries,” says Lagomarsino — her area of geeky fascination.

Since then, in less than 10 years, R4D has grown to 120 staffers and has diversified funding, drawing money from the Gates Foundation, other private funders and the U.S. and even foreign governments, mostly in the form of grants. This approach is one most nonprofits strive for, Ingram says, but few achieve. Other organizations often rely excessively on U.S. Agency for International Development (USAID) contracts — dangerous, given the unpredictability of the new administration.

Lagomarsino sees R4D’s multipronged approach to funding as good preventive medicine. If you’re going to have strong, prosperous and peaceful societies, she says, “you need people who are healthy and educated. You need the human capital to make that happen.”

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