Thursday, February 21, 2019

Building Trust When You Work on the Dark Side

I remember the first time I learned that I worked for the “dark side.” I was working at the global pharma company Merck, where, up to that point, I thought I was working for a pretty good, if not great, company. It had a strong commitment to providing access to its medicines to the poor and under-privileged, practiced what it preached when it came to high ethical standards, and was doing what it could to reduce its environmental footprint.  This particular day, I was talking with a colleague who had just joined the company from the Harvard School of Public Health. While there, she had also worked at Jacaranda Health in Kenya, a social enterprise dedicated to safe motherhood. She was – and still is – a super star in the field of maternal health. She was lamenting that many of her former colleagues and even friends where questioning her move to the “dark side,” or, in other words, the evil, for-profit sector. 
Since this revelation early in my career, I have encountered similar bias many times from seemingly well-intended people working at NGOs, aid agencies, foundations and bi- and multi-lateral donor organizations. I sense this bias when I walk into a meeting room and see stares in the room that say, “Oh, she works for that multi-billion-dollar company that really doesn’t care about issue X. She is just here to make her company look good, to make it seem like it is a company that cares about more than making money…but we know that’s not true; it’s all PR and an attempt to buy social legitimacy.”
Maybe I’m paranoid, but I am sure someone else is thinking, “Ugg, another corporate type who really doesn’t understand this issue and will move on to another job in a few months anyway, so why bother.” Worse yet, I know that the person next to me is saying to herself, “She is just here to manipulate the project so that it increases sales of her company’s product and make her company even more money…she doesn’t really care about what is best for the people we are trying to help.”
To be clear, these are people I admire. I do. They have dedicated their entire careers – their lives -- to laudable and critically important issues such as domestic violence and gender equality, access to health, child hunger, and child mortality. But why does this mean that I can’t dedicate my life to the same pursuit just because I work at a for-profit company? 
The individuals staring back at me have seen the toll these issues take on women, children and the most vulnerable first-hand outside the shiny, air-conditioned conference rooms in Washington, DC, and Geneva. They have shared a meal with Syrian women who have been victims of gender-based violence in the Zaatari refugee camp in Jordan, walked along muddy, sewage-filled streets in the slums of Kibera, Kenya, with teen-age mothers, and held the hand of a mother in Chhattisgarh, India, whose toddler just succumbed to the ravages of rotavirus – a 100% preventable disease in the West. 
These are people too who have probably experienced the perceived negative side of multinationals. The company that swoops in with a commitment of $5 million to help build clean water stations in India, but, once the ribbon-cutting, photo extravaganza with smiling executives wearing suits despite the fact that the people before them earn less than $1 a day is over, go on to switch to a new cause the next year and leave the water station to rust and decay when no one is trained to repair it. Or the company that donates laxatives and appetite stimulants on the verge of expiration (but good for a tax benefit) to a world hunger program. Or the tech giant that donates hundreds of computers they couldn’t sell in the West to an East African country only to see them collect dust in the central warehouse and become the local’s problem to dispose. Wouldn’t they be grateful for computers? What, they really need bed nets? Not our problem, we already issued the press release. 
Maybe these examples are a little harsh, but we know they exist, albeit they are rare. Unfortunately, examples like these are the reason for the distrust and skepticism in the room when I attend my first meeting of the Implant Access Program in 2013 and explain that my company is excited to be working with all the organizations represented to expand access to our contraceptive product to women in developing countries. 
The Implant Access Program was a six-year public private partnership led by the Bill & Melinda Gates Foundation to make contraceptive implants—a previously less accessible family planning option—more available to women in the world’s poorest countries. Partners included the Clinton Health Access Initiative (CHAI); the governments of Norway, Sweden, the United Kingdom and the United States; and the Children’s Investment Fund Foundation (CIFF), with support from the United Nations Population Fund (UNFPA), and two pharmaceutical companies that manufactured contraceptive implants: Merck and Bayer. 
By the time I got assigned to the project, the partnership had already been formalized. Legal documents signed, press releases issued. Now the hard work began: building trust between the non-profit, NGO representatives and the representative (me) from “the dark side.” 
Failure was not an option. This program was too important not just to Merck and the Gates Foundation, but to the future of social business development, to show that a company can move beyond philanthropy to impact social change using business tools and make it sustainable. Ultimately, however, it was too important to the more than 200 million women – mostly in the developing world -- who wanted to prevent or delay pregnancy but did not have access to a modern contraception product like you or me do.
All of us in the room were embarking on an experiment to reshape global supply and demand by guaranteeing supply to the manufacturer, driving down costs for purchasers, and making markets more transparent. One problem: The people I was partnering with didn’t know Merck and didn’t know me. I had to get them to move beyond their perceptions of the private sector and see me. I had to gain their trust and respect and, in this way, the trust and respect for the company I represented.
There were some simple things I did to start. I showed up at the meeting not in a corporate suit that I’d wear to the board room, but in a dress with a scarf I had bought in Delhi and a necklace from Uganda. I was trying to show them that I had seen and experienced the world they were part of and were trying to help. I wasn’t the American who had never ventured further than the Avenue des Champs-Elysees.
Next, I listened and tried not to talk too much. When I did, I shared what my objective was and how I would measure success – not by media headlines, but by the number of women who had access to our product through this program. Yes, it was about increasing sales of our product, but also about the access that millions of women formerly did not have. I brought my Medical Director who could talk with the fellow public health experts about what they were seeing and hearing in local medical clinics and from community health workers.
One concern from community health workers was that the packaging of our product was too bulky…they needed smaller pack sizes to take with them in their rucksacks when they went calling in villages. What these community health workers couldn’t have understood – and couldn’t have cared less about – was that this would require major packaging changes back at the plant. If you have worked at a manufacturing site, you know that plant managers do not like major changes. They cost money and take time. I had to go back to them and ask them to make this change for a product we were selling at an incredibly small profit margin in the poorest countries in the world. Together with several of my Merck colleagues, we made a compelling argument, backed by data that showed it would not negatively impact the bottom line, and they agreed.
While this may not seem like a big breakthrough, it made an impression on the partners – it showed them that we listened and acted in the best interests of our customers, in this case, a 21-year-old community health worker with a 10th-grade education in rural Ethiopia.
We also helped where we had expertise such as providing technical guidance on unbranded health education materials that would be used to train health care providers in the use of the product and to counsel women on common misperceptions and concerns. We also shared information – good and bad – that our own local key account managers working in sub-Saharan Africa and South-East Asia relayed to us.
But more than anything, building trust required really getting to know one another. There was one person in the partnership who was a bit standoffish from the start. I won’t name the organization this individual represented but it was an important player. I heard that this person was not a fan of the partnership or of the pharmaceutical industry and thought Merck was making a windfall, which could not have been farther from the truth. My fear was that this person would be a “Darth Vader” – meaning they would be the person in the partnership who would block ideas and impede the program’s progress.
This individual was based in New York, so I scheduled time to meet with them privately, explaining that I wanted to better understand the goals of their organization and any concerns. I shared my background and personal objectives and goals and my desire to demonstrate to leadership at Merck that it is possible to make a positive impact on the world in a commercially sustainable way. I said I saw myself as an internal change agent…. And that it wasn’t always easy. I told her of my field visits to Addis Ababa, Mexico City, Manila, and Jakarta where I had a chance to meet the women and girls who needed my product, and how they made me proud of what I do. I shared how inspired I was by the work that this person’s organization does and envied the opportunities this person had had to work in the field. It was the truth. All of it. I was being sincere and authentic. At the end of the discussion that day, we both knew each other better and, I think, saw some common ground. This person understood I wasn’t the “evil” pharma representative only focused on promoting my product, but that I cared about the goals of the partnership. From that point on, we had a much more collaborative relationship.
In the spring of 2018, I was at one of my last meetings with the partners. Not only had we proved that our social business model worked (We had delivered 25 million implants to women in more than 50 developing countries, providing them with highly-effective, long-acting, reversible contraception they did not have access to before), but we had built a partnership based on trust and respect. I looked around the room and realized I had really gotten to know almost everyone, and they had gotten to know me. 
Although the partnership has ended (successfully, with the product and partners still working together today), I remain in close contact with many of them. They taught me a lot about their world and about what it takes to build trust within a partnership of strangers. Building and maintaining trust is a critical skill in corporate responsibility and social impact, but not one that is taught in text books or college classrooms. It’s one that takes experience and a few mistakes before you get it right and, even then, there is always room to learn. That’s what makes it so rewarding – and teaches all of us that there is no true “dark side.” 

Top Tips to Building Trust with NGOs and Civil Society Organizations 

1.    Listen and learn from them about the challenges they are addressing and where your organization can and cannot help.
2.    Be humble; they are most likely smarter than you are on this topic.
3.    Articulate your objective and how your organization will measure the success of the partnership. Ideally, your objective will be the same as those in the room or at least will be aligned.
4.    Understand what unique value-add you and your organization can bring to the table – this should be more than just financial support. Recruit people internally with the right skills to help when needed.
5.    Be upfront when you face challenges that could impact the success of the partnership. Don’t try to hide them in the hope they will go away.
6.    Be authentic. Don’t try to be what you are not.
7.    Peel back the onion. When your organization can’t do something that the partners are requesting, help them understand why by sharing the internal reasons and inner workings as much as possible. They may not like it but will better appreciate the decision when they are given an inside view.
8.    Put yourself in their shoes and understand why they do what they do. Take them up on their offer to visit their projects or sites in-country. Better yet, convince your management to come with you.
9.    Take their voice back into your company and share it with your leadership.
10. Be prepared. Study the issue. You won’t be able to equal their expertise, but you should know the terms, the issues, and the data.
11. Get to know them as people and understand their unique journey that brought them to where they are today. This doesn’t only help break down barriers, it creates friendships and makes your time together more fun.
12. Give them their space when needed. Understand the challenge it may pose to them to be too close to a multinational. This isn’t easy but sometimes necessary. 


  1. Wonderful blog and great first article. Having come from the non profit world to big pharma and back to the non profit world, I can very much relate. Rather than focusing on the differences, find common ground in things you can do together, leveraging the comparative advantages that each partner brings to the table.

  2. Maggie; your story resonates so well with what we at Novo Nordisk, also experience, and I really like (and subscribe to) your list of advice.
    This is an incredibly important area where we all need to learn from each other, as we forge real partnerships for sustainable impact.

    1. Thanks so much for your comment! Novo is doing great work in this area! We all could learn from you!

  3. Maggie - I had no idea that that was the first time you had heard that! So sorry but also I am so glad ... perhaps prepared you for those steely eyes in your first IAP meeting :)As you know I am a huge advocate of public private partnerships as I think when done well, thoughfully with everyone focused on the same goal and comfortable with additional agendas the various parties may have,they can scale and sustain like no other. I look forward to reading more from you.