Mobilizing the private sector is essential to closing persistent gaps in financing, infrastructure, and innovation.  While much of this capital and innovation originates in Western or global markets, its application and value must gear towards that of emerging economies, where health systems face the greatest climate risks. Done right, this approach can protect the most vulnerable from climate-health risks while also reinforcing economic stability, reducing long-term costs, and opening new markets for inclusive growth.

Private sector engagement must therefore be framed not only as a corporate social responsibility, but as a return-on-investment opportunity: healthier, more resilient communities reduce supply chain risks, stabilize workforces, and expand consumer markets. The report outlines four key domains where private sector action can strengthen health system resilience: 

• Innovative Financing, such as blended finance, green bonds, and outcome-based mechanisms.
• Infrastructure & Technology through renewable energy-powered facilities, and scalable digital platforms and solutions.
• Risk Management & Insurance, including climate-triggered insurance models; analytics, and protection products.
• Collaborative Partnerships that align commercial expertise with public health priorities and that build capacity to ensure workforce resilience.

Despite this potential, private sector engagement remains limited by misaligned incentives, regulatory uncertainty, weak impact measurement frameworks, and structural challenges. This report presents actionable solutions ranging from policy incentives to standardized metrics and inclusive investment models—to unlock meaningful participation.

The report calls for a shift toward more practical, results-driven collaboration between sectors, with equity—especially inclusion of women, youth, and local communities—as a core design principle for health system resilience.

Learn more about our Climate & Environment sector portfolio.

The post Report: How Private Sector Involvement Can Enhance Climate Adaptation within Health Systems appeared first on Camber Collective.

Around the world, 2025 was a year of unmistakable challenges. Cuts to foreign aid and development programs brought devastating human consequences. Wars and genocide continued, and governments used the most vulnerable at home and abroad as pawns in deadly political games. 

But amidst this darkness, we also witnessed meaningful progress. Across the social sector, partners, funders, and communities stepped up to fill gaps and adapt to uncertainty. At Camber, we found ways to meet the moment and drive impact for those most affected. 

In the spring, we launched a new strategy outlining our next chapter with a focus on field-building—a discipline aimed at breaking down siloes, cultivating shared agendas and collective action, and amplifying the impact organizations have across entire fields of practice. We also achieved B Corp recertification, executed our first Internal Equity Survey, welcomed six new colleagues, and celebrated nine promotions—including bringing our colleague and Shared Prosperity lead Marc Allen into the partnership.  

In 2025, we partnered with 27 organizations around the world on 42 projects. From women’s health innovation to climate resilience to income inequality, our work touched on some of the most important issues of our time. But don’t just take it from me. Below, we highlight work from across our sectors and the meaningful impacts each project has made. 

As a team, we found joy in personal accomplishments and milestones. We celebrated Camberians’ weddings and welcomed new Camber babies. We cheered on colleagues who became certified fitness instructors, one who earned a sommelier certification, many who ran full and half marathons, one who won a poker tournament, and several who completed new degrees. Our team also deepened their commitments to board and community service, volunteered locally, and directed $30,000 in nonprofit giving to make a difference. 

As we head into 2026, I’m holding the highs and lows with equal clarity and gratitude. The highs remind me of what we can build together, while the lows show me both why our work matters and why we must persevere. 

Read on for some of our most significant accomplishments from 2025. If you want to learn more about what we do and how we might work together, please reach out. 

With gratitude,  

Brian Leslie

Rethinking Resilience: Drawing Connections Between Climate and Health 

The Brief: Public health and climate change are inextricably linked—but too often addressed in isolation. In the fall, we partnered with Gavi and the Asian Infrastructure Investment Bank (AIIB) to challenge this narrative through a novel report: Protecting Our Future: An Investment Framework for Quantifying the Climate Adaptation Benefits of Health and Immunisation Investments establishes a first-of-its-kind framework that quantifies the value of health investments for climate adaptation.  

The Solution: The report was released at COP30, the United Nations Climate Change Conference in Brazil, in November 2025. Our findings highlight the often-overlooked role that health systems play in helping communities adapt to climate change, particularly around immunization.  

The Impact: The report has sparked new conversations among multilateral development banks, donors, and country actors by bridging technical evidence with advocacy and policy potential. Stakeholders have been equipped with shared language and tools to advance long-term systems change in vulnerable communities around the world.  

Read the full report here or via AIIB’s website. Additional thanks to the World Bank, Asian Development Bank, and our other collaborators for their support. 

Investing in Healthcare and Rural Economies: Strategic Planning for United Indian Health Services 

The Brief: Last year, we worked with the United Indian Health Services (UIHS) to help them chart a course for the organization’s future and determine how to make amplify their impact. UIHS is a coalition of nine American Indian tribes who focus on lifting up culture, community, health, and economic prosperity for their members—many of whom live in rural communities. 

The Solution: This was not a typical strategy project—it required careful and equitable systems thinking and expansive conversations across the region. We conducted research on comparable organizations, interviewed board members and community stakeholders, and laid out options to illustrate key trade-offs and strategic choices for UIHS. 

The Impact: After close collaboration, UIHS decided to establish a new foundation focused on investing in the healthcare workforce and care model innovation to improve tribal career opportunities in their rural communities. The result will go beyond healthcare—these investments will improve the health, economic opportunities, and quality of life for generations to come. 

Learn more about UIHS’s important work. 

Spotlighting Women’s Health Innovation: Pushing for Investments Around the World 

Photo Credit: Gates Foundation / Marlena Waldthausen

The Brief: For years, women’s health research and development (R&D) has been underinvested in and underrepresented, despite the $1 trillion opportunity that closing this gap represents. In 2023, we partnered with the Gates Foundation and National Institutes of Health to establish the Innovation Equity Forum (IEF), a group of more than 250 global experts in women’s health research and development. This diverse group is committed to advancing a more equitable, coordinated, and innovation-driven ecosystem for women’s health R&D. 

The Solution: We kicked off 2025 by publishing the 2024 Women’s Health Innovation Opportunity Map Progress Report, highlighting promising strides made in 2024 and areas for immediate action. In order to translate the data into action, we coordinated across the forum to develop actionable concepts to advance women’s health. Our efforts culminated in IEF’s global convening in October in advance of the World Health Summit in Berlin, bringing together more than 150 stakeholders to refine and align on these concepts and infuse them into the broader women’s health innovation ecosystem.  

The Impact: The Opportunity Map website, which launched in the fall, provides a new home for the IEF’s work and highlights tangible ways for stakeholders—from investors to policymakers—to drive meaningful advances in women’s health innovation over the next 15 years. These resources have strengthened awareness of critical R&D gaps across academia, philanthropy, the private sector, and policy circles. 

Learn more about the IEF and explore the Opportunity Map. 

Putting Data into Action: Informing Funding, Strategy, and Policy Development for Economic Mobility 

The Brief: Economic mobility is widely considered to be a cornerstone of American life – available to all who set their sights on it. But in reality, economic mobility has been declining steadily since the 1940s. Our Mobility Experiences initiative aims to support efforts across the country to ensure that future generations have the power to access opportunities that will advance prosperity and well-being for all.  

The Solution: In 2025, we converted our breakthrough Mobility Experiences research into action by equipping 15 place-based initiatives to apply the research in order to develop their strategies, mobilize capital, and improve their programs and services. We provided direct technical assistance to community organizations while also hosting broader public awareness events (like this one in Iowa). 

The Impact: Over time, our data reached more than 100,000+ people, helped inform several hundred million dollars in investments, and improved programs for tens of thousands of people. We supported 15 direct grantees to mobilize capital and improve programs improvement initiatives, and collaborated closely with key ecosystem actors like Harmony Labs and Fisher Strategy Partners to expand the reach and impact of our work. 

Explore the Mobility Experiences dashboard and this video unpacking the efforts. 

Scaling Up Health Campaigns: Improving Global Health & Wellbeing Through Collaboration 

Photo Credit: Federal Ministry of Health & Social Welfare, Nigeria / SWAp Office

The Brief: The Collaborative Action Strategy (CAS) on health campaign effectiveness is a first-of-its-kind commitment by the global health community to align in support of countries and their planning, implementing, evaluating, and financing of health campaigns in a more collaborative way. It is designed to bolster countries’ existing efforts while improving the effectiveness, efficiency, and equity of campaigns for a range of public health issues. 

The Solution: In 2025, we helped the Health Campaign Effectiveness Coalition put the CAS into action. We supported the implementation of CAS in two focus countries, Nigeria and Ethiopia. In Nigeria, we piloted efforts in three states to integrate malaria and neglected tropical disease campaigns into the largest measles and rubella vaccination campaign in the country’s history, which aims to reach over 100 million children. We developed a customized strategy and provided hands-on support through workshops, stakeholder engagement, and project management. Our efforts culminated in a major integrated campaign in October and the official adoption of the Nigerian CAS in December. These efforts united global, country, and local stakeholders, including the Gates Foundation, UNICEF, World Health Organization, Global Fund, CBM, and Nigeria’s Federal Ministry of Health and Social Welfare and National Primary Healthcare Development Agency. We also coordinated closely with the Measles & Rubella Partnership, where Camber colleagues serve as the Project Management Unit, to coordinate across initiatives.

The Impact: Health campaigns are a critical way that countries like Nigeria tackle a range of public health issues, from measles to nutrition. For too long, these issues have been siloed. Taking a collaborative, interdisciplinary, and integrated approach through CAS is more cost effective, efficient, and less burdensome on communities and health workers than running separate, siloed campaigns. This is a particularly critical need given recent cuts to global health infrastructure. Through our work in 2025, stakeholders in Nigeria showed that future campaigns will be more integrated through early planning, shared calendars, strong collaboration, robust and integrated data systems, harmonized payment structures, and improved advocacy and communications. They have committed to advancing these objectives as they scale up this work across the country in 2026.

Learn more about the CAS and explore its resources.

The post Reflecting on 2025: A Year of Unmistakable Challenges and Deepening Impact appeared first on Camber Collective.

When we established Camber Collective more than 15 years ago, we wanted to build a social impact consultancy that put strategy into action. Over time, we came to recognize the need to think beyond individual projects and shape systems-wide change. Our resulting evolution toward field-building has helped fill critical data and evidence gaps for whole fields of practice, mobilize greater and more effective capital, and inform collective impact agendas supported by shared metrics of success.  

In recognition of this shift, I am excited to share that our colleague Marc Allen is stepping into a new role as Partner at Camber Collective. This comes after spending several years successfully leading and scaling our Shared Prosperity work in economic, civic, and democratic inclusion. 

Marc brings a wealth of knowledge and a vast network of leaders and organizations who drive change across the field. He has been instrumental in bringing our own field-building objectives to life, combining deep subject matter expertise and diverse partnerships to advance economic vitality through the lenses of income, wealth, and place. Marc is also spearheading Camber’s engagement with Public Interest Technology, a growing enabler of economic and civic inclusion.   

The impact of his work speaks for itself: more than 100,000 people reached by the groundbreaking Mobility Experiences research, several billion dollars in capital cumulatively raised or redirected toward income- and wealth-building opportunities, and a strategic footprint that spans many of the most eminent national institutions and place-based initiatives in the United States. Marc embodies the Camber ethos of converting data into an agenda, and an agenda into action.  

This promotion comes at a time of heightened uncertainty around the world. Now more than ever, we must align data, capital, programs, and communities to make a thriving future attainable for all. In the work led by Marc and other Camber colleagues, I see mounting evidence that this is possible.   

I am eager to see how our Shared Prosperity impacts — and Camber Collective as a whole — continue to evolve with Marc’s continued leadership.

With gratitude,  

Brian Leslie 

The post Marc Allen Named Partner, Expanding Shared Prosperity and Field-Building Portfolios appeared first on Camber Collective.

The post From Intention to Impact: Reaffirming Our B Corp Commitment and Deepening Our Equity Practice appeared first on Camber Collective.

As we celebrate Camber’s 15^th birthday, it is remarkable how much our nascent vision, team, and impact has evolved. Camber has grown from a small team supporting individual institutions to a collective that works across sectors, geographies, and stakeholders to help build the ecosystems that enable lasting change. We’ve had the privilege of partnering with over 110 organizations, across more than 400 projects. We’ve celebrated over 50 alumni who have grown to be social entrepreneurs, leaders, strategists, and contributors to making the world a better place. Through our work and network of partners and collaborators, we’ve seen what’s possible when insight, intention, and action align.

But we’ve also seen what stands in the way. Siloed efforts, ineffective translation of agenda to action, and structural inequities continue to limit progress across the social sector. And in a world facing compounding crises due to shifts in policy, funding, public discourse, and governance— the cost of inaction is growing.

We’ve taken this moment to reflect on our role and the needs of the sector — and to evolve with greater clarity and intention. We’ve refined our mission and strategy to meet what this moment demands: building the knowledge, infrastructure, and capacity of social and public sector institutions and fields.

This isn’t a departure. It’s a natural evolution — grounded in our history, shaped by what we’ve heard and experienced, and guided by what we know the moment demands.

At the center of this shift is the belief that institutions and fields must grow stronger together. That data and insights must be actionable. That shared agendas must lead to collective implementation. And that equity must move from intention to practice.

Our 2024 Impact Report showcases Camber’s new strategy in action —a collection of stories of insight, collaboration, and impact. They are proof points of what we believe: that when people, organizations, and partnerships are aligned, resourced, and supported, transformative change is not only possible — it’s inevitable.

Click here to read the full report

We’re deeply grateful to our funders, clients, partners, team, and alumni who continue to shape Camber’s path and impact. We’re excited for what comes next — and we look forward to building it together.

The post Evolving for Impact: A Look at 2024 and Beyond appeared first on Camber Collective.

This is not just a crisis of funding—it is a fundamental shift in how global health will be resourced and sustained in the years ahead. Across the global health community, people are feeling the weight of this shift deeply: most acutely in the communities served. Programs that once had stable funding are now in jeopardy. The UN is halving food rations for Rohingya refugees in Bangladesh; one of the only clinics on the Myanmar-Thai border has been closed, cutting off access to essential life-saving services; and a mysterious Ebola-like illness has broken out in the Democratic Republic of Congo, all following the cancellation of 90% of USAID’s international development projects. Colleagues who have spent their careers building critical health infrastructure are suddenly left without resources to continue their work. 

At the same time, within global health itself, a long-running shift toward decentralization and localization has been gaining momentum. For years, practitioners, policymakers, and leaders have argued that the global health system must transition from a top-down, donor-driven model to one that empowers national and local health systems to lead. The sudden withdrawal of funding is forcing an acceleration of this transition—whether we are ready for it or not. This crisis has exposed the vulnerabilities of a system that was built for a different era and has now been outgrown.

Change is no longer optional—it is imperative. This moment must be used not just to patch gaps in funding, but to rethink how we deliver global health—decentralizing decision-making, integrating efforts, and ensuring that national and local actors have the power and resources to lead.

The Consequences of an Incomplete Shift

Historically, the overconcentration of decision-making power in global institutions and donor agencies has led to misaligned priorities, inefficiencies, and fragmentation. Competition for funding, rigid mandates, and lack of coordination across organizations have contributed to duplication, wasted resources, and fragile health systems that rely too heavily on external actors. Meanwhile, efforts to strengthen national capacity have often lacked the structural changes and political will needed to transfer leadership—they have failed to establish the robust foundations and local ownership needed for countries to sustain their own programs – leaving countries dependent on outside interventions rather than progressing toward self-sufficiency.

These flaws are not theoretical—they have played out in real time. When the Ebola outbreak struck West Africa in 2014, affected countries struggled to respond due to fragmented global health coordination. In Haiti, multiple organizations launched competing cholera response programs, wasting resources and creating service gaps. The COVID-19 pandemic further exposed the weaknesses of global health dependency, as delays in vaccine distribution left low- and middle-income countries waiting for a slow, fragmented, and insufficient response.

The current global health model is no longer sustainable. While effective in delivering large-scale impact, it struggles to reach the last mile. More critically, it remains deeply exposed to funding cuts, shifting donor priorities, and geopolitical instability. Unless the system evolves, we will continue to face cycles of crisis, where essential programs collapse every time political or financial conditions shift.

The Way Forward: Collaboration, Adaptation and Resilience

The global health system is unraveling before our eyes. We do not have the option to preserve it as it was. Instead, we must adapt, reshaping global health institutions to function as true partners in a locally led ecosystem.

The international community must take this opportunity to not only shift decision-making power and resources to national and local levels but to do so in a way that fosters cooperation, alignment, and collective problem-solving. The shift toward decentralization cannot simply be a reaction to shrinking donor budgets—it must be an intentional strategy that strengthens health systems in the long run.

Not insignificant is the additional challenge of funding. Beyond the political will to increase collaboration and streamline programming, financial support will be imperative to translate this vision into reality. We don’t have a solution yet: we must come together and chart a path forward to meet this challenge.

This is not about abandoning the institutions that have driven decades of progress, nor is it about resisting change out of fear of uncertainty. It is about leaning into transformation—building a global health system that is adaptive, responsive, and truly aligned with the people it serves.

The post Beyond the Crisis: Why Global Health Must Evolve Now appeared first on Camber Collective.

The landscape of African agriculture is intricate, situated within a blend of diverse cultures, crops, and environmental challenges against the growing resilience and innovation of African farmers. Over time, three themes have shaped this narrative: a pressing call for climate action, the quest for expanded market access opportunities, and essentially uplifting smallholder farmers from poverty’s grasp. These themes are interwoven into the daily fabric of millions, illustrating a challenging yet optimistic path towards sustainable development and food security throughout Africa.

Central to this topic is the smallholder farmer, the cornerstone of Africa’s agricultural sector and on the frontlines of our changing climate, navigating the complexities of unpredictable weather patterns, market fluctuations, and barriers to global agricultural trade. Efforts to mitigate these challenges by African nations, NGOs, and local communities have largely focused on enhancing climate resilience, broadening market access, and implementing effective poverty alleviation strategies, reflecting the continent’s rich diversity and unwavering spirit.

Amidst this evolving agricultural landscape, cassava is emerging as a beacon of hope, particularly in Nigeria, Africa’s agricultural hub. Rather than just another cash crop, cassava symbolizes a future where climate challenges are met with resilience, market opportunities are diversified, and the fight against poverty amongst shareholder farmers is more effectively waged. With its exceptional adaptability to adverse climate conditions, cassava offers Nigeria a unique opportunity to showcase how agriculture can adapt to and mitigate the impacts of climate change. Cassava also holds promise in the industrial sector, potentially becoming a key player in the emerging biofuels & biomaterials industry. From bioethanol to starches and flours, emerging cassava derivatives underscore its versatility and potential to unlock new domestic and international market prospects. This potential in Nigeria not only addresses current climate and economic challenges but also paves the way for steady economic growth, poverty reduction, and sustainable agricultural practices.

The evolving case of cassava in Nigeria represents a new narrative, charting a potential future where agricultural sustainability and the well-being of smallholder farmers take center stage in Africa’s development agenda. As the focus shifts towards leveraging cassava’s potential in Nigeria, it illuminates the crop’s pivotal role in shaping not only the present agricultural landscape but also the future legacy of agriculture on the continent.

To read the article in a PDF, click HERE

Cassava in Nigeria

Cultural and Economic Significance

Cassava holds an important place in Nigeria, not only as a staple food, but as a cultural emblem and a significant economic driver. Deeply ingrained in the nation’s cultural fabric, cassava embodies resilience, versatility, and community unity, permeating Nigerian traditions, rituals, festivals, and daily life across diverse ethnic groups and celebrating the heritage & ingenuity of smallholder Nigerian farmers. Cassava-based dishes like garri, fufu, and pounded yam are central to Nigerian cuisine and culture, serving as symbols of identity and continuity across generations. The role of cassava extends into ceremonies and local economies, often involving community-led cultivation and processing efforts that strengthen social bonds and collective well-being, while the vibrant exchange of cassava products at local markets underscores its importance not just in economic terms but as a focal point for community interaction, where stories and cultural values are shared.

As the world’s largest producer of cassava, Nigeria’s reliance on this crop is profound, supporting over 30 million farmers and marking a crucial component of the global market[1]. Beyond its role in sustaining rural economies and supporting smallholder livelihoods, cassava’s vast industrial potential—from bioethanol to pharmaceuticals—positions it as a cornerstone of Nigeria’s agricultural and industrial strategies. However, the journey to harnessing cassava’s full potential is met with challenges, including low technical efficiency and suboptimal yields[2], necessitating efforts to enhance production efficiency and improve farmer livelihoods. Cassava’s adaptability makes it a key player in food security and nutrition for millions of Nigerians[3], with its potential to influence future production, industrialization, and food supply trends. The ongoing evolution of cassava as an industrial raw material and a staple in urban households indicates its expanding role in Nigeria’s agricultural and economic landscape[4]. Addressing production challenges, enhancing value chain processes, and leveraging its industrial potential are critical for tapping into cassava’s capacity to drive economic growth, ensure food security, and uplift millions of Nigerian citizens.

By embracing cassava’s cultural significance and addressing the challenges it faces, Nigeria can underscore the crop’s role not just in agriculture but as an essential part of the nation’s cultural identity and heritage. This holistic approach aims not only at economic growth and food security but also at preserving the cultural essence that renders cassava truly indispensable to Nigeria and its people, ensuring it continues to nourish, empower, and sustain future generations.

Climate Resilience

Cassava, known for its resilience to climate changes and extreme weather patterns, can play a vital role in Nigeria’s agricultural landscape in the face of increasingly acute climate change challenges. The crop’s adaptability to conditions such as drought, heat, and poor soil quality, is attributed to its robust genetic makeup and deep-rooting system[5] . This resilience is crucial in Nigeria, where erratic rainfall patterns and rising temperatures are increasingly prevalent. As traditional crops are increasingly vulnerability to these changes, cassava emerges as a sustainable alternative, ensuring more consistent yield rates and requiring lower inputs of fertilizers and pesticides as compared to other Nigerian staples, thereby promoting more stable income and more sustainable farming practices.

Expanding Horizons through Market Access

Current Market Conditions

In the Nigerian market, cassava plays a vital role in food security and economic activity across the country, however, markets for cassava and cassava-based products face significant fluctuations across seasons and changing consumer preferences. Seasonal variations, the effects of climate change on productivity rates, and limited preservation techniques for fresh cassava create significant price, and therefore profit, volatility within internal markets[6], contributing to supply inconsistencies, waste, and unpredictable income for Nigerian farmers. In the international market, Nigerian cassava encounters strong competition from other national producers who often have advantages in production efficiency, quality standards, international trade agreements, and infrastructure capacity due to stronger economies of scale and better access to capital. Despite Nigeria’s rank as a leading cassava producer by tonnes grown, challenges in production, scaling, and post-harvest handling hinder its ability to fully tap into these international markets and establish a consistent and reliable export demand for cassava and its derivatives. Current efforts to enhance cassava production and market penetration in Nigeria have been hindered by various constraints due to agronomic, technical, and financial factors, labor shortages, inadequate extension services, and high production costs[7].

Barriers to Market Access

Smallholder cassava farmers in Nigeria face complex challenges to accessing both domestic & international markets and ultimately, achieving sustainable profitability.

On Farm Challenges

The increasingly acute impacts of climate change, including droughts, excess heat, and unpredictable weather patterns pose a new challenge for smallholder farmers with limited resources to respond and pivot to changing conditions. This causes disruptions in agricultural output, unpredictable yields, and challenges farmers’ ability to plan and make accurate predictions. Additionally, over time, these climate-related impacts, alongside limited access to resources and poor soil quality can cause conflicts over land rights, displacement, and migration to urban centers.

Consumer & Labor Limitations

Changes in consumer preferences and a shrinking labor force put increasing pressure on the cassava value chain. As consumers increasingly seek diverse and higher-quality cassava products, smallholder farmers struggle to meet these demands due to limited resources and support. Concurrently, the agricultural labor market faces reductions from rural-urban migration and an aging workforce, leading to a gap that hampers cassava production and processing. Efforts to attract younger workers and align cassava outputs with consumer expectations are essential for the sector’s growth and sustainability.

Inadequate Infrastructure

The impact of underdeveloped transportation & storage infrastructure on capital costs and post-harvest losses for smallholder farmers is well-documented. Poor transportation infrastructure, particularly in the rural areas where cassava is grown, leads to elevated transport costs, increased travel times, and a higher risk of post-harvest loss. These issues are exacerbated during the rainy season when some regions become inaccessible, isolating farmers from their primary markets. Lack of adequate storage facilities force farmers to sell their harvests prematurely and closer to home, often at reduced prices, contributing to economic losses and diminishing the quality & quantity of cassava reaching the market.

Inequitable Access to Finance & Information

For smallholder farmers, limited access to essential capital resources such as credit, market information, and physical inputs, is compounded by high transaction costs and the absence of substantial government and institutional support. Information asymmetry is also a critical institutional barrier for these growers who often lack access to vital financial & market information as well as innovations that could better inform decisions related to crop choice, harvest timing, and market selection, leading to suboptimal farming practices, market engagement outcomes, and ultimately financial stability. While a few initiatives, such as Nigeria Incentive-Based Risk Sharing System for Agricultural Lending (NIRSAL) are now working to enhance credit support for smallholder farmers, more attention is needed.

Strategies to Strengthen Market Participation of Smallholder Cassava Farmers

Addressing the obstacles faced by smallholder farmers in Nigeria will require a holistic approach that includes improving infrastructure, enhancing access to resources like credit and information, implementing climate change adaptation strategies, and providing tailored support in conflict-affected areas. By integrating interventions into a cross-sectoral strategy, policymakers and stakeholders can create a sustainable enabling environment for the success of smallholder cassava farmers across the country.

Challenges with Post-Harvest Loss

In Nigeria specifically, infrastructure limitations along the domestic value chain cause significant post-harvest challenges that trickle down into food security, economic development, and the livelihoods of smallholder farmers. These losses, estimated at 20-30% of the cassava yield, stem from inadequate storage facilities, inefficient processing techniques, and transportation delays[8]; the highly perishable nature of cassava, with a shelf life of less than 48 hours if not properly processed, exacerbates these issues. Consequently, not only is farmers’ income potential reduced but there are also higher rates of food waste from cassava harvests, with far-reaching environmental implications due to the wasted resources like water and land.

However, minimizing post-harvest loss is not simply an issue of physical infrastructure with impacts spanning beyond physical losses. Post-harvest losses represent a significant inefficiency in agricultural resource use across Nigeria as well as a lost opportunity for income generation and livelihood improvement. Nutritionally, cassava serves as a staple food for millions of Nigerians and reduced availability in domestic markets can exacerbate nutritional deficiencies and food insecurity amongst vulnerable populations. And, traditional practices of cultivation, processing, and consumption, while culturally significant, don’t always align with modern standards of efficiency and food safety. A transition to improved practices requires not just the introduction of new technologies but also respect for cultural norms, alongside education and training to facilitate this change. By combining strategic investments in cassava processing industrialization with efforts to overcome logistical, market, and cultural barriers, Nigeria could transform this critical sector.

Industrialization as a Solution

While culturally significant, the traditional processing methods for cassava are often inefficient and lead to substantial losses. The industrialization of the cassava processing value chain stands out as a key solution, promoting the adoption of modern techniques and investment in industrial-scale facilities to extend the shelf life of cassava products, reduce waste, and enhance the crop’s overall value. Introduction of these modern processing techniques—such as mechanical peeling, drying, and grating—have the potential to drastically reduce post-harvest losses and improve product quality; for example the use of solar or hybrid drying technologies can enhance the drying process, making it faster and less dependent on weather conditions, while better preserving the nutritional value and extending the shelf life. Derivatives such as starch, flour, bioethanol, and high fructose syrup could also open new opportunities for the cassava value chain in both domestic and international markets. Systemically, scaling up cassava processing will require significant investment in industrial-scale facilities that can handle large volumes of cassava with increased efficiency. These facilities, equipped with state-of-the-art machinery, can process cassava into various derivatives with higher precision and lower costs. The establishment of such facilities would not only reduce waste but also enable the production of cassava derivatives at a quality and scale that meets global market standards. Strategic investments in infrastructure, technology, and human capital, supported by conducive government policies, will be crucial to realizing the potential of industrialization.

However, achieving industrialization will require a concerted effort from both the public and private sectors. Strategic investments in research and development can foster innovation in cassava processing technologies and product development but require robust government policies and incentives to attract effective private investment and ensure systemic implementation. These policies might include tax breaks, subsidies for cassava processing technologies, and grants for research into new cassava derivatives.

Thoughtful development of physical infrastructure is also necessary to build out the sector without exacerbating other local issues. Establishing processing facilities in proximity to cassava farming communities will be vital to reduce logistical challenges and ensure that the benefits of industrialization reach the rural areas where cassava farmers live while spurring further local jobs and economic benefits. Embracing sustainable infrastructure, such as waste recycling and energy-efficient technologies, can ensure that industrialization does not come with negative environmental costs. By prioritizing the industrialization of cassava processing, Nigeria can transform a key agricultural sector, turning post-harvest challenges into opportunities for growth, innovation, and sustainability.

Considering Sustainability

With the development of Nigeria’s cassava industry, there is also an opportunity to better integrate sustainable farming practices that can increase production, reduce environmental impact, and promote long-term agricultural sustainability. Practices such as agroforestry, conservation tillage, integrated pest management, crop rotation, intercropping, and efficient water management are crucial for improving soil quality, biodiversity, soil health, and water retention, ultimately supporting robust cassava production long-term[9]. Moreover, the industrial demand for cassava can drive the development and adoption of climate-resilient varieties, supporting adaptation efforts, and ensuring a stable cassava supply under changing climatic conditions. Cassava industrialization can also aid in carbon reduction through sustainable bioenergy production like cassava-based bioethanol, offering a renewable alternative to fossil fuels with a lower carbon footprint. By focusing on climate-resilient ag development, sustainable practices, and industrialization, countries like Nigeria can become leaders in climate resilience, environmental sustainability, and economic development, setting an example for climate-smart agriculture and industrialization in tropical regions.

Improved Cassava Value Chain

Coordinated, intentional, and efficient investment in Nigeria’s agricultural infrastructure and policy landscape has the potential to drastically improve ecological and market outcomes for smallholder cassava growers across the country.

Cassava’s Systemic Spillover Effects

Aside from agricultural development, a richer cassava industry in Nigeria also holds a secondary potential to serve as a catalyst for broader economic development and community empowerment. At the heart of this transformation is the potential to create a multitude of jobs across the value chain—from the fields where cassava is cultivated to the processing facilities where harvests are transformed into valuable derivatives such as starch, flour, bioethanol, and high fructose syrup. This expansion would significantly bolster incomes for smallholders and entrepreneurs alike, offering them avenues to break free from the cycles of poverty that are prevalent in rural communities. Beyond the tangible economic and infrastructural benefits, the cultivation and industrial processing of cassava weave a thread of social cohesion and equity through communities. As women and youth often play significant roles in cassava cultivation and processing, their empowerment through these activities promotes gender equality and youth opportunities for employment, which are critical aspects of Nigeria’s equitable development.

The ripple effects of such economic empowerment extend deep into the fabric of communities, seeding resilience and fostering a robust foundation for sustainable development. It is proven that improved incomes lead to enhanced food security, as families can afford a more nutritious and varied diet, while spending locally and saving excess profits, better equipping agricultural communities to withstand the fluctuations of markets and the unpredictability of climate impacts. Furthermore, the industrialization of cassava processing paves the way for infrastructural development, including roads, storage facilities, and energy access, which are vital components for cross-sector rural development. These improvements not only facilitate the cassava value chain but also enhance the quality of life for the community at large, providing better access to markets, schools, and healthcare.

The integration of sustainable practices in cassava production—such as agroforestry, conservation tillage, and integrated pest management—underscore the commitment to environmental stewardship, ensuring that economic development does not come at the cost of the environment. These practices not only enhance the sustainability of cassava cultivation but also contribute to broader environmental goals by maintaining ecosystem health and biodiversity, which are essential for long-term agricultural productivity and community well-being. By continuing to invest in the cassava value chain, from enhancing production techniques to expanding industrial processing capabilities, and by fostering an enabling environment through supportive policies and investments, Nigeria can harness the full potential of cassava as a vehicle for transformative change, paving the way for a future where economic empowerment and sustainable development are inextricably linked, ensuring that no member of the community is left behind in the journey towards prosperity and resilience.

Cassava as a Tool for Sustainable Development in Nigeria

In the complex story of Nigeria’s farming world, cassava emerges not merely as a crop but as a beacon of hope and transformation. Its story, intertwined with the threads of climate resilience, market expansion, and poverty alleviation, shines a light on a path toward a more sustainable and prosperous future. Cassava stands at the forefront of Nigeria’s battle against climate change, offering a resilient crop alternative that can thrive under the duress of shifting weather patterns and environmental challenges. Its cultivation and processing, underscored by sustainable practices, not only mitigate the adverse impacts of climate change but also bolster the agricultural sector’s adaptation capabilities through increasingly harsh and unpredictable conditions. Simultaneously, cassava has the potential to significantly broaden market access, both domestically and internationally, by transforming into a plethora of value-added products. From starch and flour to bioethanol and high fructose syrup, these derivatives can unlock new economic opportunities, creating a ripple effect that enhances livelihoods, fosters industrial growth, and propels Nigeria onto the global stage as a key player in the cassava market. Most critically, the expansion of the cassava sector embodies a powerful vehicle for poverty alleviation. By generating employment, improving incomes, and fostering community development, cassava production and industrialization can uplift millions of Nigerians, weaving a stronger social fabric marked by resilience, equity, and prosperity. This transformative potential extends beyond economic metrics, touching the very essence of community well-being and environmental stewardship.

Yet, realizing this vision requires a concerted effort from all stakeholders. Policymakers must craft and implement supportive policies that nurture the growth of the cassava sector, encompassing research and development, infrastructure investment, and market facilitation. Investors are encouraged to see and seize the huge opportunities cassava offers, directing capital towards ventures that not only promise returns but also contribute to the broader societal good. Non-governmental organizations (NGOs) and civil society must continue to play their pivotal role in advocating for sustainable practices, facilitating knowledge transfer, and supporting smallholder farmers and communities in navigating the evolving agricultural landscape. The call to action is clear: by embracing the cassava sector’s potential and addressing the intertwined challenges of climate change, market access, and poverty, Nigeria can set a course toward sustainable development that honors its agricultural heritage while forging a future of innovation, inclusivity, and resilience. Cassava, as a catalyst for change, offers more than just a solution to immediate challenges—it presents a blueprint for a sustainable agricultural future that can nourish, empower, and sustain generations to come.

[1] Ikuemonisan et al., 2020

[2] Obayelu et al., 2021

[3] Ikuemonisan et al., 2020

[4] Ikuemonisan & Akinbola, 2021.

[5] Akinwumiju et al., 2020.

[6] Ikuemonisan et al., 2020.

[7] Inegbedion et al., 2020.

[8] Uchechukwu-Agua et al., 2015.

[9] Shackelford et al., 2018.

References

Adeagbo, O., Ojo, T., & Adetoro, A. (2021). Understanding the determinants of climate change adaptation strategies among smallholder maize farmers in south-west, nigeria. Heliyon, 7(2), e06231. https://doi.org/10.1016/j.heliyon.2021.e06231

Adejuwon, J. and Agundiminegha, Y. (2019). Impact of climate variability on cassava yield in the humid forest agro-ecological zone of nigeria. Journal of Applied Sciences and Environmental Management, 23(5), 903. https://doi.org/10.4314/jasem.v23i5.21

Adeoye, A., Oke, O., & Ogunsola, J. (2019). Assessment of safety practices in garri production among cassava processors in ido local government area oyo state nigeria. Asian Food Science Journal, 1-6. https://doi.org/10.9734/afsj/2019/v12i230081

Akinwumiju, A., Adelodun, A., & Orimoogunje, O. (2020). Agro-climato-edaphic zonation of nigeria for a cassava cultivar using gis-based analysis of data from 1961 to 2017. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-58280-4

BABATUNDE, A., Yusuf, S., Omonona, B., & Obi-Egbedi, O. (2022). Profitability analysis among actors of high-quality cassava flour in south west nigeria. International Journal of Sustainable Agricultural Research, 9(3), 129-139. https://doi.org/10.18488/ijsar.v9i3.3089

Burns, A., Gleadow, R., Cliff, J., Zacarias, A., & Cavagnaro, T. (2010). Cassava: the drought, war and famine crop in a changing world. Sustainability, 2(11), 3572-3607. https://doi.org/10.3390/su2113572

Chikezie, P. and Ojiako, O. (2013). Cyanide and aflatoxin loads of processed cassava (manihot esculenta) tubers (garri) in njaba, imo state, nigeria. Toxicology International, 20(3), 261. https://doi.org/10.4103/0971-6580.121679

Ikuemonisan, E. and Akinbola, A. (2021). Future trends in cassava production: indicators and its implications for food supply in nigeria. Asian Journal of Agricultural Extension Economics & Sociology, 60-74. https://doi.org/10.9734/ajaees/2021/v39i330546

Ikuemonisan, E., Mafimisebi, T., Ajibefun, I., & Adenegan, K. (2020). Cassava production in nigeria: trends, instability and decomposition analysis (1970–2018). Heliyon, 6(10), e05089. https://doi.org/10.1016/j.heliyon.2020.e05089

Ikuemonisan, E., Mafimisebi, T., Ajibefun, I., & Adenegan, K. (2020). Cassava production in nigeria: trends, instability and decomposition analysis (1970–2018). Heliyon, 6(10), e05089. https://doi.org/10.1016/j.heliyon.2020.e05089

Inegbedion, H., Inegbedion, E., Obadiaru, E., Asaleye, A., Ayeni, A., & Aremu, C. (2020). Cassava attractiveness in nigeria: a policy improvement approach. Journal of Agribusiness in Developing and Emerging Economies, 10(2), 157-175. https://doi.org/10.1108/jadee-05-2019-0068

Maass, B., Musale, D., Chiuri, W., Gassner, A., & Peters, M. (2012). Challenges and opportunities for smallholder livestock production in post-conflict south kivu, eastern dr congo. Tropical Animal Health and Production, 44(6), 1221Stre-1232. https://doi.org/10.1007/s11250-011-0061-5

Molnar, J. (2022). Building an inclusive value chain: gender participation in cassava marketing and processing in nigeria. Environ Sci Ecol: Curr Res, 8(1), 1-8. https://doi.org/10.54026/esecr/1078

Obayelu, O., Obayelu, A., & Awoku, I. (2021). Technical efficiency and socioeconomic effects on poverty dynamics among cassava-based farming households in rural nigeria. Contemporary Social Science, 17(2), 99-116. https://doi.org/10.1080/21582041.2021.1981425

Ojiako, I., Tarawali, G., Okechukwu, R., & Chianu, J. (2017). Household characteristics and market participation competence of smallholder farmers supplying cassava to starch processors in nigeria. International Journal of Agricultural Research Innovation and Technology, 6(2), 42-56. https://doi.org/10.3329/ijarit.v6i2.31704

Ojo, T., Baiyegunhi, L., & Salami, A. (2019). Impact of credit demand on the productivity of rice farmers in south west nigeria. Journal of Economics and Behavioral Studies, 11(1(J)), 166-180. https://doi.org/10.22610/jebs.v11i1(j).2757

Olarinde, L., Abass, A., Abdoulaye, T., Adepoju, A., Fanifosi, G., Adio, M., … & Awoyale, W. (2020). Estimating multidimensional poverty among cassava producers in nigeria: patterns and socioeconomic determinants. Sustainability, 12(13), 5366. https://doi.org/10.3390/su12135366

Osuji, E., Igberi, C., & Ehirim, N. (2023). Climate change impacts and adaptation strategies of cassava farmers in ebonyi state, nigeria. Journal of Agricultural Extension, 27(1), 35-48. https://doi.org/10.4314/jae.v27i1.4

Otekunrin, O. and Sawicka, B. (2019). Cassava, a 21st century staple crop: how can nigeria harness its enormous trade potentials?. Acta Scientific Agriculture, 3(8), 194-202. https://doi.org/10.31080/asag.2019.03.0586

Pérez, D., Duputié, A., Vernière, C., Szurek, B., & Caillon, S. (2022). Biocultural drivers responsible for the occurrence of a cassava bacterial pathogen in small-scale farms of colombian caribbean. Frontiers in Ecology and Evolution, 10. https://doi.org/10.3389/fevo.2022.841915

Shackelford, G., Haddaway, N., Usieta, H., Pypers, P., Petrovan, S., & Sutherland, W. (2018). Cassava farming practices and their agricultural and environmental impacts: a systematic map protocol. Environmental Evidence, 7(1). https://doi.org/10.1186/s13750-018-0142-2

Uchechukwu-Agua, A. D., Caleb, O. J., Manley, M., & Opara, U. L. (2015). Effects of storage conditions and duration on physicochemical and microbial quality of the flour of two cassava cultivars (tme 419 and umucass 36). CyTA – Journal of Food, 1-11. https://doi.org/10.1080/19476337.2015.1029524

The post Cassava as a Catalyst: Climate Resilience, Market Expansion, and Poverty Reduction in Nigeria appeared first on Camber Collective.

Outset and Origin Story

The challenge Camber Collective faces, as a consultancy for an equitable and regenerative world, is how to build a project delivery model that reflects its equity-forward values. The firm’s journey began nearly a decade ago, when one of the founding Partners, Hope Neighbor, collaborated with the Hewlett Foundation to understand how women and families in Niger make decisions about, and access, family planning services and products.

Working with local partners, the Camber team interviewed local stakeholders: women, providers, and other community members to assemble a broad prism into 1) what was needed by the community and 2) how to design for holistic, sustainable, and community-relevant outcomes. This first-of-its-kind project led to a segmentation analysis and design of new programs enabling local community health workers and the Ministry of Health to better meet the needs of people and communities.

From this initial foray into equitable design, Camber’s approaches and methods have deepened. A central tenet of Camber’s evolving theory of impact is to build upon the opportunity — and indeed, necessity — to instill localization and co-creation while elevating the constituents and communities most impacted.

Key Principles and Considerations

Positioning constituents and communities as key thought partners and participants would allow Camber to engender deeper, more authentic, and sustainable practices, and further its progress towards key equity-forward principles first adopted by the firm in 2021.

Among these considerations were:

• What is Camber’s role, as change-agents, or at least indirect purveyors of social impact, in integrating equity into project delivery?
• What nuances or contexts regarding cultural, community, geographical, racial, or other differences and distinctions risk being overlooked or unconsidered?
• How could the firm, from its advisory role, continue to lift up the voices and ideas of those whom our clients and we intend to serve?
• In what ways could models for research, analysis, and project conceptualization and design be more inclusive of differences (culture, community, class, race, income, education, etc.)?

These were just a few of the top-line considerations that fueled a series of team-wide conversations that began in earnest in September, 2022.  Camber sought to consider how, as a consultancy, the firm could live up to its aspirations and effectively assess, catalogue, normalize, incorporate, and amplify equity in project design, delivery, and dissemination. In so doing, the firm also identified opportunities to continue its deeply collaborative, trust-based, and non-extractive partnership approach.

Applying the Model to the Consultancy Sector

As a B-Corp consultancy committed to continued internal growth and learning in anti-racist and equitable practices, Camber also sought to integrate equity into its business model. The team embraced the mission-alignment around addressing injustice and systemic oppression that is deeply ingrained across societies, while recognizing the importance of developing strong client delivery.

Successfully partnering with community stakeholders while delivering upon client requirements, Camber Collective was able to successfully insert these new organizing frameworks and methods and tools under the moniker of Equitable Project Design.

Basics of EPD

Equitable Project Design (EPD) has its basis in the concept of Liberatory Project Design, a concept of the National Equity Project which seeks to apply an equity-focused lens to traditional Design Thinking principles.

In contrast to the mission of product designers, social movement organizations, or community-based organizations working towards direct service goals, Camber embraced the opportunity to refine the lens to more closely adhere with its purview and impact theses as a strategic advisory firm.

Equitable Project Design has five concentric spheres of activation:

Camber’s role as a consultancy requires approaching client work with curiosity, and using the talented staff’s capabilities to influence how clients consider and integrate equity into their research, analysis, strategy formulation, decision-making, and partnerships. Camber’s Director of Impact and Equity, Rozella Kennedy wrote about this aspiration in late 2022, as EPD was taking shape as an organizing principle:

As in all facets of the world and life, a 100% purity attainment goal is unrealistic. Not all clients and contexts will align with Equitable Design principles in uniform ways, and the journey is also iterative. To keep us anchored in our own values and vision of social impact and systemic change, we are establishing a team playbook of considerations across the entire project cycle that will help us execute the work with honesty, confidence, and equitable influence.

The ”MVP” of EPD

Camber Collective’s full Equitable Project Design framework includes over 130 questions and considerations across a typical project lifecycle. Distilling them down to ten top tenets, or an “MVP,” (minimally viable project) reaped these considerations.

Understanding the equity context and project parameters

1. Do we understand the context and equity issues at play within their field or those faced by their constituents? What do we want to change? Who can help us? Who/what stands in the way?
2. How much can we really influence, where/when do we agree to ease up? How does this flow fit into our overarching or long-term theory of influence and impact?
3. What do we know about where the client is in their equity journey? How will we push them or how might they push us? What’s the “give and take” we need to map between immediate impact and long-term influence?

Preempting potential equity “blindspots”

1. How are we aware of and ensuring we do not perpetuate white saviordom and the white, colonial, or male gaze in this project? How can we proactively discuss, codify, and navigate scope boundaries so we avoid becoming “white saviors”—even if we are asked (directly or indirectly) to play that role?
2. How will we avoid forcing or assuming a Global North (Western/US/EU) mentality into the project? What local power systems, brokers, influencers, and situations must we learn?

Navigating power dynamics

1. What balance can we strike between “capacity building” (which implies we know everything already) and “collaborative convening and co-design” (which is less assumptive)?
2. Who holds power and should/can cede some? Who holds power and is not in the room, and how can we bring them in?

Continuous learning and sustainability planning

1. To what extent can we ensure the work and our learnings are most accessible to the field, including communities who will most benefit? (publications, budgets, conferences, etc.)
2. What tactics, resources, and connections can we put in place to ensure that the relationships and levers we build do not shut down forever once our project is complete? What’s the “sustainability” plan for the project and the partnership?
3. What will we learn/measure/report out to the team at the end of the project that furthers our learning and growth in equity, and how?

Progress at the End of Year One

Over the course of 2023, Camber Collective integrated many of these constucts into client work, and continues to leverage EPD as its value and brand differential. A lookback, as the firm approaches the two-year mark of this concerted phase of its equity project delivery plan, illuminates several high-water marks of success, with tangible organizational tools and resources that anchor this continued work:

• A curated set of over 130 equity considerations and markers, sorted project phase, that can be incorporated into the full project lifecycle, from scoping to delivery to closeout
• Revised set of internal project tools with a focused embedding of equity considerations into the work
• In-progress library of resources, frameworks, and learnings for all of client serving sectors that incorporate equitable principles overall, and by sector
• Application of EPD into the firm’s own internal ways of working: learning, celebrating, building belonging, and leadership at all levels

Next Priorities for Equitable Project Design

The work continues for Camber Collective, with an attenuated focus in 2024 on developing a deeper focus on factors, both personal, interpersonal, sectoral, and societal that impact how “equity” is, and at times, is not integral to project and program design. This builds upon the Equitable Project Design mindset the firm had already been utilizing unofficially since its formation a decade ago. Some of these factors include:

• Consideration of historical/colonial contexts
• Removing barriers that marginalize or de-center “the voice” of the affected
• Valuing and centering local experts for their participation, including through compensation
• Deepening the application of cross-sectoral/intersectional framing
• Employing equitable sampling and data analysis
• Continually relying on storytelling and visual narrative, to underscore that narrative is a key component of systems change and collaboration, particularly across cultural, geographical, and other divides.

Camber Collective’s broader goal is to see ongoing and future work leverage EPD in ways that encourage innovation, equity, and co-creation—such that Equitable Project outcomes becomes the norm. In the words of CEO Brian Leslie and Director of Impact and Equity, Rozella Kennedy:

“As our firm becomes more deeply adept at authentically and systematically embedding and delivering equitable strategies and solutions for our clients, we can collectively galvanize equitable, transformative outcomes in constituent communities our clients serve. In so doing, Camber can meaningfully contribute to redressing the systemic injustices and oppressions that are so deeply ingrained in our society. This is our Grand Vision, and we are grateful to our clients, partners, associates, friends, and even strangers with critical voice, who help us continue to advance in this direction.”

Read more about EPD in action in Camber Collective’s 2023 Impact Report, published in February, 2024.

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In our new research series Mobility Experiences, published in partnership with the Bill and Melinda Gates Foundation, we tackle some of the most foundational questions pertaining to economic mobility in the United States, including:

• What drives upward, downward or no mobility for most Americans?
• What narratives or perceptions of economic mobility do Americans hold?
• How can resources be better deployed to address structural barriers to economic mobility for all Americans?
• What is the impact on income of interventions that promote certain life experiences?

Foundational to economic mobility is the prospect of experiencing economic success, being valued in one’s community, and having the power and autonomy over one’s life path. For many Americans, economic mobility has been replaced by perpetual economic precarity. Many are often just one unforeseen expense away from falling into poverty, whether that be getting evicted, experiencing a major health crisis, or incurring a car repair cost, a majority of Americans will experience poverty at some point in their lives.[1] Poverty rates remain stubbornly high in the United States compared to other OECD countries. For the vast majority of Americans, the United States is not by most indicators a “land of opportunity” where one can assuredly expect upwards mobility in their lifetimes.

In the first report of our Mobility Experiences research series, we summarize a meta-analysis of more than 230 academic studies, along with a survey of 4,000+ Americans, to provide a holistic understanding of what drives economic mobility. Key findings reveal the relative impact that 28 important life experiences have on lifetime income. These “mobility experiences” span across nearly every aspect of a person’s life, from education, career, and finances to health, community, and relationships. Economic mobility is partially shaped before a person is ever born and influenced by systemic and structural factors which often outweigh the impact of personal actions and endeavors.

Through this research, we have found evidence of value across these 28 experiences, with Americans experiencing them in unique ways across their lifetimes, leading to varying economic trajectories. Though each of these experiences has important impacts on economic mobility, four experiences in particular were found to have significant evidence of average impact on lifetime earnings greater than 20%. These experiences include:

1. Pursuing/completing postsecondary education
2. Graduating with a degree in a high-paying field of study
3. Receiving mentorship during adolescence
4. Obtaining a first full-time job that offers opportunity for advancement

For the first time, we have been able to quantify the relative impacts of certain life experiences on economic mobility. We hope these findings are affirming for practitioners in the field, while also adding to our collective evidence base. This knowledge is not only critical to aligning stakeholders around a fact-base, but also to supporting calls for funding, policymaking, and scaling interventions that will have the greatest impact on advancing mobility and opportunity across the country. When we build systems that allow people to access critical supports—and basic human rights—like healthcare, education, high quality jobs, and thriving communities, people have the power to live the lives to which they aspire.  

We anticipate that stakeholders across the economic mobility field will benefit from Mobility Experiences research in four primary ways:

1. Frontline service organizations can utilize the findings to demonstrate the potential impact of their interventions when seeking funding support
2. Funders can utilize the findings to prioritize investments in economic mobility
3. Local decision makers can utilize the findings to prioritize policymaking and identify high potential interventions
4. Communication organizations can utilize the findings to shift widely held narratives about the drivers of economic mobility in the United States

Throughout 2024, Camber Collective and the Bill and Melinda Gates Foundation will be releasing three reports as part of the Mobility Experiences research series. The reports will explore both the quantified impact of life experiences on lifetime income as well as the perspectives of thousands of Americans on what matters to advance individual and collective economic mobility in the United States. We will also dive into the current state of funding for economic mobility and common features of successful interventions.

The research can be found on the Mobility Experiences website. We encourage you to sign up for updates to stay up to date with upcoming releases. Read the Report

[1] Mark Robert Rank, Lawrence M. Eppard, and Heather E. Bullock, Poorly Understood: What America Gets Wrong About Poverty, Oxford Academic, 20 May 2021. https://doi.org/10.1093/oso/9780190881382.003.0001

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Introduction

Despite the fact that the US spends approximately 18% of GDP on healthcare—almost twice as much as the average Organization for Economic Cooperation and Development (OECD) country—our healthcare system is riddled with problems, from widespread inequities to poor outcomes to barriers to care (see Figure 1).[1] In this tripart series, we discuss three specific types of barriers to care for those living with severe mental illness—macroeconomic, legislative, and capacity—examining the nature of these access barriers and how they impact overall outcomes. In this second installment of the series, we highlight a legislative barrier to accessing mental health services that is deeply rooted in the Medicaid program.

Overview of the IMD Exclusion

Authorized under Title XIX of the Social Security Act and signed into law in 1965, the Medicare and Medicaid Act was designed to help create a social safety net for the most vulnerable members of American society, providing health coverage to adults over the age of 65, younger adults with disabilities, and low-income adults.[2] While this social safety net is far from perfect, one of the most pronounced gaps involves the institution for mental diseases (IMD) exclusion, which has been in place since Medicaid’s inception.

Medicaid is a joint federal-state insurance plan whereby states administer the program in accordance with federal regulations and the federal government makes matching payments to the states in a cost-sharing arrangement. However, the exclusion prohibits the federal government from making these matching payments for services provided in certain types of settings to Medicaid beneficiaries between the ages of 21 and 64, notably IMDs.[3] An IMD is defined as a hospital, nursing facility, or other institutional setting with more than 16 beds that is primarily engaged in providing psychiatric treatment and care to people living with mental illness, including substance use disorders, where the “primarily engaged in” threshold is met when more than 50% of a facility’s patients receive mental health services.[4] The exclusion applies to both behavioral health- and standard medical-related care as well as to services that happen to be provided outside an IMD to a current IMD resident.[5]

A New Model of Care: The Combined Impact of the IMD Exclusion and Deinstitutionalization

The IMD exclusion was designed to shift the cost of psychiatric care from the federal government to the states as well as discourage the treatment of mental illness via large institutional settings like long-stay state psychiatric hospitals.[6] The enactment of the IMD exclusion coincided with and likely helped accelerate deinstitutionalization, the movement popular in the 1950s and 1960s to redefine mental health treatment, with the intent of replacing care in long-stay psychiatric facilities with community-based care. This marked shift in perspective regarding the best approach to treating mental health issues and the subsequent change to the accepted model of care was aided by the development of first-generation antidepressant and antipsychotic medications.

For context, between 1970 and 2018, the number of state psychiatric beds decreased by 84% across the US, though these losses have been offset to a small degree by the increase in private psychiatric hospital beds in recent decades.[7] Currently, the US has approximately 12 state psychiatric hospital beds per 100,000 people compared to nearly 340 beds per 100,000 in the mid-1950s.[8] This drastic decrease in the number of beds available in state psychiatric hospitals reflects the historical reliance on institutionalization juxtaposed against the current focus on providing more community-based care.

Impact of the IMD Exclusion

It is estimated that more than 14 million American adults suffer from severe mental illness (SMI) such as bipolar disorder or schizophrenia that significantly interferes with their ability to partake in major life activities and sometimes requires hospitalization.[9] Approximately one-quarter of US adults living with SMI are covered by Medicaid.[10]^,[11] The IMD exclusion thus holds the potential to impact the care received by the approximately 3.6 million adult Medicaid enrollees living with SMI (see Figure 2).

The very nature of the IMD exclusion has created significant barriers to care, with its critics deriding it as discriminatory because it can prevent Medicaid patients with severe mental illness from being able to access the full range of treatment options they may need, specifically inpatient behavioral health services. This exclusion is the only aspect of federal Medicaid law that prohibits payment for medically necessary services simply due to the facility type providing the care.[12]

The impetus behind the move to deinstitutionalize mental health patients was noble in many ways, grounded in a desire to treat people with greater humanity; however, cost saving considerations cannot be ignored as a driving force behind the movement. Regardless of the motives, the implementation was flawed, chiefly because the community-based care infrastructure was simply not robust enough to support the nation’s mental health needs (and many would argue that it is still not robust enough).[13] As a result, many patients discharged from state mental hospitals were simply relocated to other institutional acute care settings, diverted to the criminal justice system, or directed to homeless shelters, an outcome that is indicative of a community-based system ill-equipped to serve this vulnerable patient population.[14] It is estimated that up to one third of those incarcerated and up to 25% of the homeless population has a serious mental illness, compared with 6% of the general population (see Figure 3).[15]^,[16]

The flawed implementation of the deinstitutionalization movement that the IMD exclusion helped accelerate is also apparent when examining the availability of inpatient psychiatric beds state by state. Nearly one-third of states provide fewer inpatient beds than the estimated need. [17] While the IMD exclusion is not the only contributing factor to the state-level mismatch between inpatient bed supply and demand, it likely plays a contributing role in the undersupply of beds (weighted for relative state population) evident in states such as Illinois, Michigan, Ohio, and Wisconsin, among others. A 2020 Government Accountability Office (GAO) survey found that 47 of 50 state Medicaid officers reported that the exclusion impedes their ability to provide the full continuum of care, including the provision of sufficient bed capacity (see Figure 4).[18]

The IMD exclusion is one of the key drivers behind the “boarding” problem plaguing hospitals where patients with psychiatric symptoms are admitted to a hospital, but left in the emergency department, for example, because no suitable psychiatric care beds are available. In a 2008 survey of 328 emergency department directors conducted by the American College of Emergency Physicians, nearly 80% reported boarding psychiatric patients; the number of public psychiatric beds has declined since the time of that survey, likely exacerbating the boarding problem.[19]

Ways to Navigate Around the IMD Exclusion

During the last decade, certain avenues have become available for states to secure reimbursement for care provided in an institution for mental diseases. For example, states have leveraged IMD exclusion workarounds such as the use of “in lieu of” authority to access federal Medicaid funds to cover IMD inpatient services in those states with capitated managed care delivery systems or the use of lump sum disproportionate share hospital (DSH) payments to help cover uncompensated care at IMDs.[20] Additionally, between October 2019 and September 2023, an additional option was made available to states under the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) ACT. This state plan option provided up to 30 days of coverage over a 12-month period for adult Medicaid enrollees with at least one substance use disorder (SUD) treated at an IMD.[21]  

Furthermore, the Affordable Care Act established a pilot program—a section 1115 demonstration in Medicaid parlance—that removed the exclusion for certain facilities to assess whether reimbursing psychiatric services provided in an IMD setting could deliver improved care at a decreased cost. The demonstration proved successful and in 2016, the Centers for Medicare & Medicare Services (CMS) finalized a rule that allows Medicaid managed care organizations (MCOs) to receive federal reimbursement for short-term care (e.g., less than 15 days per month) provided to non-geriatric adults in IMDs.[22] However, it is important to note that the section 1115 demonstrations are often time-delimited and state-specific and thus, do not provide a long-term solution to the IMD exclusion.

Looking Ahead

While such exemptions to the IMD exclusion have proven helpful in recent years, too many people suffering from chronic and acute mental illness still cannot access the care they need. Since the exclusion is codified in the federal Medicaid statute, an act of Congress would be required to either eliminate or otherwise make any changes to it such as increasing the bed limit so that the regulation would no longer apply to larger facilities. There has been an uptick in legislative activity related to the IMD exclusion in recent years, with ten bills introduced that would either fully repeal the exclusion or amend it in some way during the past two Congresses, providing some hope that a meaningful change to this discriminatory rule is on the horizon.[23]

The removal of the IMD exclusion would significantly impact the federal Medicaid budget. The Congressional Budget Office (CBO) estimated that eliminating the IMD exclusion would increase federal expenditures by approximately $38 billion between 2024 and 2033, though some of this outlay would likely be offset by decreased emergency department and general hospital inpatient spending.[24] The state dollars previously spent on emergency and inpatient care could be reallocated to support the expansion of community-based services.[25] The CBO also projected that it would cost between $155 million and $560 million on net to make the SUPPORT Act state plan option a permanent fixture over the same ten-year period; the range of estimates reflects multiple implementation pathways for making the state plan option permanent.[26]

Eliminating the exclusion or amending it in a substantive way would not only remove a discriminatory policy from the Medicaid program, but also would effectively eradicate a key barrier to accessing mental healthcare that disproportionately impacts more vulnerable patient populations. It is important to note that if the IMD exclusion is overturned, providers would likely need to add capacity to ensure that the barrier to access does not simply evolve from one that is legislative into one that is infrastructural. Though the budgetary impact must be considered, many experts in the field firmly believe that eliminating the IMD exclusion and enabling states to more easily access federal Medicaid funds for inpatient mental health and substance use treatment could help successfully address a barrier to accessing care and greatly improve the overall health and wellbeing of people living with mental illness.[27] 

Read Part One

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Notes

[1] Gunja, Munira Z. et al., “US Health Care from a Global Perspective, 2022:  Accelerating Spending, Worsening Outcomes,” January 31, 2023, https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022#:~:text=Since%20then%2C%20spending%20has%20slowed,as%20the%20average%20OECD%20country.

[2] “Program History,” Centers for Medicare & Medicaid Services, Accessed January 5, 2024, https://www.medicaid.gov/about-us/program-history/index.html#:~:text=Authorized%20by%20Title%20XIX%20of,coverage%20for%20low%2Dincome%20people.

[3] “Budgetary Effects of Policies to Modify or Eliminate Medicaid’s Institutions for Mental Diseases Exclusion,” Congressional Budget Office, April 2023, https://www.cbo.gov/publication/59071#:~:text=Under%20a%20policy%20known%20as,certain%20types%20of%20inpatient%20facilities.

[4] “Payment for services in institutions for mental diseases,” Medicaid and CHIP Payment and Access Commission, Accessed June 5, 2023, https://www.macpac.gov/subtopic/payment-for-services-in-institutions-for-mental-diseases-imds/.

[5] Eide, Stephen and Gorman, Carolyn D., “Medicaid’s IMD Exclusion:  The Case for Repeal,” February 23, 2021, https://manhattan.institute/article/medicaids-imd-exclusion-the-case-for-repeal#notes.

[6] “The Psychiatric Bed Crisis in the US:  Understanding the Problem and Moving Toward Solutions,” American Psychiatric Association, May 2022, https://www.psychiatry.org/getmedia/81f685f1-036e-4311-8dfc-e13ac425380f/APA-Psychiatric-Bed-Crisis-Report-Full.pdf.

[7] Lutterman, Ted, “Trends in Psychiatric Inpatient Capacity:  United States and Each State, 1970 to 2018,” National Association of State Mental Health Program Directors Research Institute, September 2022, https://www.nasmhpd.org/sites/default/files/2023-01/Trends-in-Psychiatric-Inpatient-Capacity_United-States%20_1970-2018_NASMHPD-2.pdf.

[8] “The Psychiatric Bed Crisis in the US:  Understanding the Problem and Moving Toward Solutions”.

[9] “Mental Illness,” National Institute of Mental Health (NIMH), March 2023, https://www.nimh.nih.gov/health/statistics/mental-illness.

[10] Zur, Julia et al., “Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals,” Kaiser Family Foundation, June 2017

[11] McMullen, Erin K. and Roach, Melinda Becker, “Behavioral Health in Medicaid,” MACPAC (Medicaid and CHIP Payment and Access Commission), Sept. 24, 2020.

[12] “Medicaid: IMD Exclusion,” National Alliance on Mental Illness, Accessed February 6, 2024, https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Medicaid-IMD-Exclusion.

[13] ibid

[14] “The Psychiatric Bed Crisis in the US:  Understanding the Problem and Moving Toward Solutions”.

[15] Ornstein, Norm and Leifman, Steve, “Locking People Up is No Way to Treat Mental Illness,” May 30, 2022, https://www.theatlantic.com/ideas/archive/2022/05/mental-illness-treatment-funding-incarceration/643115/.

[16] “Mental Illness and Homelessness,” National Coalition for the Homeless, Accessed June 2023, https://www.nationalhomeless.org/factsheets/Mental_Illness.pdf.

[17] González-Caballero, Juan Luis et al., “Benchmarks for Needed Psychiatric Beds for the United States: A Test of a Predictive Analytics Model,” International Journal of Environmental Research and Public Health, November 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625568/#B1-ijerph-18-12205.

[18] “Medicaid:  State Views on Program Administration Challenges”, Government Accountability Office, June 2020, https://www.gao.gov/products/gao-20-407#:~:text=Officials%20from%2027%20states%20identified,payments%20than%20for%20other%20providers.

[19] Eide, Stephen and Gorman, Carolyn D.

[20] Musumeci, MaryBeth et al., “State Options for Medicaid Coverage of Inpatient Behavioral Health Services,” Kaiser Family Foundation, November 6, 2019, https://www.kff.org/report-section/state-options-for-medicaid-coverage-of-inpatient-behavioral-health-services-report/.

[21] Houston, Megan B., “Medicaid’s Institution for Mental Diseases (IMD) Exclusion,” Congressional Research Service, October 5, 2023.

[22] “The Medicaid IMD Exclusion and Mental Illness Discrimination,” Treatment Advocacy Center, August 2016, https://www.treatmentadvocacycenter.org/component/content/article/220-learn-more-about/3952-the-medicaid-imd-exclusion-and-mental-illness-discrimination-.

[23] Houston, Megan B.

[24] Budgetary Effects of Policies to Modify or Eliminate Medicaid’s Institutions for Mental Diseases Exclusion,” Congressional Budget Office, April 2023, https://www.cbo.gov/publication/59071#:~:text=Under%20a%20policy%20known%20as,certain%20types%20of%20inpatient%20facilities.

[25] Musumeci, MaryBeth et al.

[26] Budgetary Effects of Policies to Modify or Eliminate Medicaid’s Institutions for Mental Diseases Exclusion.

[27] Ibid.

Notes

Kim Langenhahn draws on more than 15 years of consulting, operational, and startup experience in the domestic and international health and nonprofit sectors to help organizations navigate complex issues, operate more effectively, and deliver greater impact. During the course of her career, Kim has helped numerous healthcare organizations tackle a variety of strategic challenges such as scaling Terrapin Pharmacy’s remote medication adherence system, launching a MENA-focused healthcare incubator, devising system-wide strategy for the Saudi Arabian Ministry of Health as part of PwC’s consulting practice, and developing a market forecast for a pharmaceutical company alongside her L.E.K. Consulting colleagues.  She is also the Cofounder of a small social enterprise that she runs with her family

Kim earned a Master of Business Administration and a Master of Public Policy from the University of Chicago as well as a Master of Science in Quantitative Management and a Bachelor of Arts from Duke University.  An avid traveler, reader, bread baker, ice cream churner, and (aspiring) cheese maker, she also enjoys helping her husband tend to their rooftop garden and vermiculture operation.  She currently resides in Washington, D.C.

As Camber Collective’s Director of Impact and Equity Rozella Kennedy helps direct the firm’s internal Impact, Equity, and Belonging work as well as the external practice. Her theory of impact seeks to leverage equitable values to influence and impact the humanitarian, development, philanthropic, and social impact sectors. The long focus is to expand awareness and practice in local and global post-colonial contexts. Rozella is also the creator of Brave Sis Project, a lifestyle brand using narrative and social engagement to uplift BIPOC women in U.S. history as a tool for learning, growth, celebration, and equity allyship; her book “Our Brave Foremothers: Celebrating 100 Black, Brown, Asian, and Indigenous Women Who Changed the Course of History” was published by Workman Press in Spring, 2023.

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