Valid International Ltd.

Interview by Jeremy Shoham

CTC training workshop participants

The ENN interviewed Steve Collins, cofounder of VALID in a coffee bar near Farringdon in the City of London. Steve established VALID with Alistair Hallam in March 1999. They originally met while working on the multi-donor Rwanda evaluation in 1995. Their first encounter involved an argument over agency responses in the Great Lakes region with Steve assuming Alistair to be 'a desk-bound pen-pusher' and Alistair seeing Steve as one of the "loud mouthed done it once before so I'm an expert brigade". The frank exchange of views seemed to sow the seeds of a friendship. Both ended up sharing a flat and working together on a number of evaluation consultancies and setting up humanitarian operations together. During this period Steve and Alistair talked a lot about their frustration with the lack of humanitarian agency learning, the poor evidence base for practice as well as the generally low level of professionalism amongst humanitarian agency staff. These discussions led to the idea of setting up an agency which would primarily aim to strengthen the evidence base for practice, support professional development and also allow them to follow through projects working as partners with agencies ('unlike consultancies where project reports are often left to gather dust').

Material used in CTC training.

Incredibly, Alistair signed up for medical school in 1998 and continued his studies to qualification while co-directing and managing the work of VALID. Steve remembers Alistair's agonising over whether to go to medical school -in fact the only time he remembered beating Alistair at tennis was when Alistair was totally preoccupied on the final day for sending in the application form for medical school.

VALID ticked along for a year or so with Steve and Alistair doing a number of consultancies/ evaluations in the humanitarian sphere. Initially the focus of Valid work was evaluation and they performed a number of evaluations including the DEC evaluations of the response to the floods in Mozambique, the DEC evaluation of humanitarian response in the Balkans (jointly with ODI), and more recently the evaluation of the DEC agencies response in Southern Africa. The Community based Theraputic Care (CTC) work for which VALID is most renown began in Ethiopia in 2000 when after the regional government in Woliyta forbade agencies from setting up TFC, Valid worked with Concern and Oxfam to set up community based programs to treat severe malnutrition. Steve took the findings from Ethiopia, which were generally positive regarding CTC, to the annual SCN meeting in Nairobi arguing that this was the future of treatment for severe malnutrition. Some agencies bought into this while others were either ambivalent or downright hostile. Steve recognises that going in with all guns blazing (as was his style at the time) may not have been the best approach and probably set back the cause for a while. Soon however, Concern Worldwide agreed to fund the development of CTC for three years working with Valid in a number of countries to test and develop the model. Several experts were assembled, e.g. Andrew Tomkins from ICH, Jeya Henry from Brookes, Johan Pottier from SOAS and Mark Myatt from UCL. These individuals provided high level technical support in the design phase of CTC projects. Additional staff were taken on with VALID helping a number of agencies to implement these programmes, e.g. SC UK in Darfur and the DRC, Tear Fund in South Sudan,. The funding from Concern allowed VALID to pursue a coherent and well structured research program aimed at systematically developing a strong multi-discipline evidence base for CTC. CTC is now being adopted by many agencies while donor interest and support has spiralled. In Steve's words, 'we have changed a lot with CTC and I don't think I'm just bigging it up because it was Valid that did it'.

Training of outreach workers

Steve plans to extend the CTC model to deliver other types of services, i.e. health care. VALID are now moving into the HIV/AIDS arena. With the strong linkages between health, malnutrition and HIV, Steve argues that CTC provides the perfect entry point for interventions to address HIV/AIDS. CTC is in many ways analogous to Home Based Care (HBC). However, external agency support to HBC runs the risk of undermining the community ethos, while the CTC experience shows that by starting off treating acute malnutrition CTC interventions gives agencies a non-stigmatizing entry point that gives them time and space to build confidence in the approach at community level whilst gradually expanding to complement informal support networks rather than usurp them. Another planned development for CTC that relates to HIV is the use of pro-biotics and micronutrients supplementation in RUTF. Pro-biotics can be delivered in RUTF and have a marked impact on diarrhoea - the lacto-bacilli remain dormant until delivery. Furthermore, recent research shows how vitamin B, C and E supplementation can delay the development of stage four HIV from stage 3 by up to 30%. RUTF can therefore provide treatment for diarrhoea and essential additional macro and micronutrients for those suffering from HIV/AIDS.

Volunteers being trained to use MUAC in Ethiopia

Perhaps inevitably, the interview turned to a discussion about agency institutional issues. Steve mused on his opinion of INGOs towards whom he sometimes has an ambivalent attitude. Mostly, he admires the generosity of spirit behind NGOs and their desire to effect positive change for the disadvantaged. However, at times, he is disturbed by their appetite for profile and positive PR to facilitate fund raising. He worries that this requirement for positive spin erodes the ability of agencies to be truthful and can lead to overly defensive behaviour and resulting inability to be transparent about mistakes. This obviously translates into failure to learn. He feels that VALID have a culture where owning up to mistakes and activities which have not worked out has allowed much learning. Steve explained how VALID is legally a company with share-holders and does not have fund raisers. Instead, funding comes from contracts with donors or INGOs and means that Valid has to be really efficient in terms of it's income and expenditures as ultimately money is raised on the basis of results not profile. VALID are not a charity so cannot guarantee income by appealing to a humanitarian ethos. At the same time VALID do not operate like a normal profitmaking company and although clearly financial survival is important, money is not the central driving force. The fact that VALID disseminate and develop expertise on CTC by assisting agencies to run these programmes on their own is effectively doing VALID out of work. CARE, SC US and SC-UK, who previously contracted VALID to design, set-up and evaluate CTC programs for them are now doing CTC on their own without any VALID support'. 'This however is fine and what VALID are largely about'.

Training in screening criteria

VALID currently have 15/16 employees with some staff doing non-CTC related consultancies. Steve acknowledges that this may increase in the future as the need to diversify activities increases, i.e. as other agencies develop expertise in CTC. Steve reckons that the best direction for VALID in the future is quality control and validation. He argues that accreditation and quality control by VALID would be better than an evaluation report. Both Alistair and Steve are optimistic about the future of the organisation. Staff are increasing and acquiring expertise. Many are producing publications and some are enrolling on Phds.

Steve says that he dislikes too formal a structure/organisation and hopes to keep the 'vibe' of VALID fairly informal. As he quipped, there haven't been any resignations as yet. He wants VALID to grow but not to become a monolith. At the same time he sees the potential for more experienced staff to 'bud off' and form groups which they manage more autonomously. There is no question that VALID has a unique institutional culture - probably a reflection of the individuals responsible for setting it up. There is also no question that VALID has made a unique and valued contribution to the humanitarian sector through its work on CTC.