Interview with Yale World Fellow, Saul Kornik
Conducted by Blake Smith
Saul Kornik is the CEO and co-founder of Africa Health Placements (AHP). AHP focuses on impacting healthcare in South Africa and nearby regions. Since its inception, AHP has provided technical HR support to the healthcare sector, reaching over 10 million people per year, and has placed more than 2,900 health workers. Kornik is a new kind of entrepreneur who conducts his business with a focus on social profit.
The Politic: Could you give me a brief background on yourself, your career path, and how you got here?
I got here by plane; it was too far to walk (haha)… Essentially I grew up in South Africa and I gained consciousness as an adolescent just as Apartheid was ending. So that experience was obviously quite formative for me. I initially worked in finance and got a number of graduate, post-graduate, and professional qualifications in finance but eventually realized that working to make somebody else rich wasn’t satisfying. I wanted to do something where the fruits of my labors weren’t for the benefit of those people who have disproportionately more than most. So I went into the NGO sector. Initially I had a different idea for what I wanted to start, but the need dictated its own course for AHP and I worked on building this organization that has lasted seven and a half years. Essentially we are trying to address a crisis created by the mal-distribution of human resources in health. The biggest issue for delivering healthcare in Africa, by far, is a shortage of human resources. And nobody really has a definitive answer as to how to tackle it – the whole world, bar a handful of countries, is short of health workers. Consequently, it is in some ways easier to build programs that deal with vertical issues, such as treating HIV or malaria. Sometimes health programs deal with the cross-cutting underlying issues that have to do with infrastructure, pharmaceuticals, and equipment – things that can often be solved with sufficient financial investment. However, the people issue persists. This is what we are trying to tackle. Approaching the shortage of these skills as an operational problem, AHP is trying to resolve it through three strategies. Firstly, we’re making sure that people are going to where they need to go to make the most impact. This is known as workforce planning. Secondly, we’re recruiting new skills into the system. And finally, we’re working with the custodians of the system to keep people in the system for as long as possible.
The Politic: Are the people that your organization dispatches from specific nations or regions and do you seek them or do they come to you with interest? How does your group do most of the recruiting?
Recruiting is only one of three operational strategies, as I mentioned. The recruiting we do is both locally and internationally. South Africa, in particular, has a strong private sector that has 75% of our doctors. But these doctors only deliver healthcare to about 20% of our population. And then there’s the public health care system that employs 25% of our doctors who then serve 80% of the population. What makes matters worse is that disproportionately fewer of those public sector doctors work in rural areas, where nearly half of our population lives. AHP recruits doctors from with South Africa for the public sector from one of two sources. Firstly, we source doctors from the private sector in South Africa and expose them to the opportunities available in the public sector or, secondly, we encourage health workers to move from urban to rural areas. Out of the 2,900 health workers we’ve placed, about 1,100 have been local South Africans. The remaining 1,800 who we have recruited have been sourced internationally. AHP actively recruits health workers from the developed world because we think it’s unethical to poach health workers from other developing nations that are suffering with the same shortages that we are. To illustrate the disparity between rich and poor nations – America, for example, has 550 doctors for every 100,000 people, while South Africa’s rural areas can have as few as two or three doctors for every 100,000 people. So we reach out to American doctors. We also bring a lot of doctors to South Africa from the UK, Scandinavia, Canada, Australia, and other developed nations. We do facilitate bringing other African doctors into the South African system, but we don’t actively recruit in Africa. However, if these health workers from other African countries come to South Africa to make a better life for themselves and contact us for assistance, we provide what help we can to get them into the system.
The Politic: Is your organization based in South Africa only or is it a sub-Saharan African, or even Africa-wide organization?
We’ve done work in Lesotho and Swaziland, but one of the things that I’m looking to do while I’m here is to find the funding and partnerships for a continent-wide expansion. There are actually some School of Management students currently helping me with this thinking as part of their independent studies.
The Politic: Why did you choose to apply to be a Yale World Fellow? You seemed to have mentioned a bit of what you’re getting out of it, but what was the application process like to you? Was it something that someone recommended to you or did you seek it out on your own?
You know, I continually find that life is lived within paradoxes. For example, there are these networks of leaders, leadership, African future leaders, global young leaders…all these little networks. As soon as you get into one of these networks, you pretty much just hook up into those other little networks. I suppose it’s basic human behavior. But it is actually very elitist, to be fair. There are many people who are leaders who don’t get access to such networks – I do try to help people get access where I can. A few years ago, I participated in the Archbishop Tutu Leadership Fellowship and one of the people who was on that fellowship was a Yale World Fellow last year. She told me about the program and nominated me. I had to write an essay and go to an interview, too, and then I was selected. In part, I really wanted to do it so that I could expand my social network and the people who I can access to help with the work that we are doing. I guess in some ways these networks are symbolic and in some other ways they can be productive. I do think that perspective is often lost once one is on the “inside” though. I want to keep working to maintain that perspective.
The Politic: On your website I noticed that some of your donors are very reputable international or supranational benefactors, such as USAID, DeBeers, among others. I’m curious: what was it like attempting to gain legitimacy as an organization when you were in your nascent stages and how you maintained a constant source of funding from organizations that high up?
That’s a good question. It was a very interesting process. When we started, our work was all about the recruitment of British doctors for some rural hospitals. This concept was actually an idea of a professor at the University of KZN in South Africa. This professor pursued funding, but few were interested in donating because they questioned whether British doctors would want to work in rural South Africa when South African doctors don’t even want to work in these areas. I picked up on this shortly after he had initiated this work – at that time he was working with someone who is still my colleague today. I set to work institutionalizing the idea and conceptualizing, implementing and expanding our services into what is Africa Health Placements today – all with the input of many other committed health professionals in South Africa. At the start we were granted seed funding through Discovery Health, a corporate donor in South Africa who was willing to take a bet on the concept. Once we had this funding and had proved that the concept could work, fundraising for other sums became a lot easier. Later on we obtained a lot of money from highly reputable international donors, such as USAID and CDC, through subcontracts from the organizations that these institutions funded. Fortunately, there’s a massive amount of funding for health issues in South Africa and the region thanks, in a large part, to the U.S. government’s PEPFAR program. The focus on the health-related Millennium Development Goals and on the treatment of HIV helps a lot too. AHP has increasingly been able to raise funds because what we do is both addressing a critical need, and is easily measurable and quantifiable. Donors like that. They know that the lack of human resources in health is a massive issue and they can easily see the impact we make through to 300 to 400 health workers we place every year.
The Politic: I believe you touched on some of this before, but what were your biggest obstacles in establishing, promoting, and maintaining such a powerful organization along the way? You said that it started with an idea that a professor once thought of, but securing it to the level that it’s at now, it almost seems that, when you’re starting, at any point it could simply crash.
Yeah, in fact, at many points it could have crashed. And it might still do that (haha). First off, we’re not such a powerful organization. We’re doing a lot more work than people expect, but what we’re doing is just a drop in the ocean. We’re just a small organization and we rely on the government and other organizations with which we work to play their parts as well. I think with 20/20 hindsight, the biggest obstacles I’ve faced relate to my earlier complete inexperience in managing groups of people, my lack of experience in working with government, and my nil experience in fundraising. A big piece of advice that I’d give to anyone trying to repeat what we have built is to be very clear in articulating the culture of the institution they are building. This means clearly stating mission and values – but also translating these into a set of measurable behaviors that can be lived out on a daily basis. In this way every interaction internally and externally can create a consistent customer experience, which leads to a strong team and repeat business, so to speak. It’s kind of like the McDonalds’ concept. McDonalds manages to produce the same burger everywhere in the world and they’re making a lot of money out of it. McDonalds’ customers keep coming back because they know exactly what they are going to get. What we are trying to build at AHP is consistency in the positive experience anyone interacting with the organization will encounter. It shouldn’t matter if you’re an internal finance person, a government official, or a doctor being recruited into the country – you should always have the same experience when interacting with the team at AHP and that experience should always be delivering on what you need. However, that can only happen if people are behaving appropriately and those behaviors need to be based on a sound mission and clear values. I think if I had gotten that right – right at the start – we could have made more of an impact and been more widely spread on the map. That having been said, many other factors needed to be in place to allow us to define and build a culture.
The Politic: As CEO, do you suspect that it will be difficult for you and your organization that you are here for a semester? It seems like your organization is primarily ground-based, so I imagine it might be difficult being here.
It was quite difficult leaving! In many respects it feels like I’m just one of the many people working at AHP, each of us performing our role in getting the job done. At times, though, I feel quite inseparable from AHP, so that has brought a bit of separation anxiety! Yet, I think it’s really good that I’m gone for a bit. I feel like the organization is set up now to do what it needs to do and deliver on what it needs to deliver on. I think it needs to get used to doing things without me. I don’t want people to think AHP = Saul Kornik. No, I want them to think, AHP = AHP. So it’s a good opportunity for the organization to be the organization! Also, when I go back to AHP I don’t won’t perform the same kind of operational role I was acting in before. I need to work on business development and expansion of the work we do. So the organization needs to get used to me not being a part of the daily operations. The timing was actually good for me to take this break and come to Yale.
The Politic: What do you hope to get out of this Yale World Fellows program and what do you hope to get out of your time here? Are you taking classes, are you trying to meet with as many people as possible, or seeking out people at the School of Management for example?
I’ve kind of mapped out what I want to do with my time here and I’m trying to keep it relatively balanced. For one thing, I want to experience Yale: its social life, arts and culture, architecture, and people. I want to experience the place I’m living in. I joined the water polo team because that, too, is part of the whole Yale experience. Another part of this experience is about forming relationships – some for work and some for life. I am also hoping that my time here will open up opportunities and expose me to new things that can come home with me and flourish beyond the semester I am spending here. I consider myself to be an integrated and conceptual thinker. So I also want to expose myself to the liberal arts education that you guys have got here. I think the perspectives that such an education can provide may allow me to see what I’m doing in a way that straddles different boundaries.
The Politic: Are you taking any classes now? And, if so, which ones?
Sure, I’m taking three classes. I’m taking Psychology and Group Life. It’s fascinating. It takes a psychological look at how groups form, who’s included, who’s excluded, and why. Next is the Anthropology of Classical Social Theory, which is looking at how society is created in a more philosophical sense. I’m also taking Aristotelian Statecraft with Charles Hill. It looks at the practical arts of fishing and hunting and taking the metaphysical leassons from their practice.
The Politic: I know that you’ve only been here for a month or so, but what types of interactions have you had so far and what have your thoughts been of the program?
My interactions have been non-stop and exhausting, but I just keep going because it’s such a limited amount of time I have here! It’s taken many forms – everything from chatting with the New Haven community, such as the guy from downstairs from where I live who runs the local coffee shop, to talking with students, to socializing and playing on the water polo team, to interactions with professors who have been so gracious in linking me up with other people externally. Then, of course, the depth of interaction with the other Fellows on this program probably surpasses all the rest. I’ve also been fortunate enough to talk to some very senior people at this institution through the doors opened through the World Fellows program. I feel like I’ve talked to people at many different levels. In fact, every time I meet people I have a standard set of questions that I ask them about how they view the world and how they would like to change it.
The Politic: That’s extremely interesting; do you think that’s a singular view that people here hold? Or is it more varied?
No, not at all. The one theme that emerges is that each person answers in a way that is related to the field of expertise in which they work. So if I’m talking to a neuropsychologist, they would say that the way you save the world is through some feat of neuroscience. If I’m talking to a businessman or an institutional person, they believe in turning ideals into institutions or re-institutionalizing institutions. So these views are formed within the fields in which these people are involved.
The Politic: How do you see your organization, AHP, changing after your time here? You touched on this earlier, in that you almost wanted to be removed and see your organization function autonomously, so it may not change at all, but it also seems like you are here to make improvements to the organization.
Sure. I think both. I think the organization needs to sustain and there are certain areas for improvement, such as expansion. Expansion to other geographic areas, expansion of services, and expansion of the lessons we’ve learned and applying them to other sectors.
The Politic: Can you briefly discuss the time and the arduous work that it takes to build a non-governmental organization like AHP from the ground up? I’m mainly curious, since your background was in finance and not very related to this field. That being said, how did you get interested in healthcare?
Well, first of all, I think that it’s not just about building an NGO – it’s about building any institution. Beyond that, it’s building projects. In many respects life is hard work. Nothing comes easily without it. So, it’s been hard, hard work. I’ve worked many, many hours. I’ve probably shortened my own life massively in the process (haha)! I think that it just can’t happen without that hard work; you just have to put it in. If I’d known before hand what I’d have to do to make this happen, to get the organization to get to this point, I probably wouldn’t have done it. But having done it, I can say that, yes, it has been one of the greatest and most profound learning experiences of my life. I’ve learned so much about myself through the exercise of building this organization. Managing other people has given me massive insights into myself because in every situation where I’ve got to move people or in every situation in which people bring me something to deal with, my response has to be as free of my own personal issues as possible. I may feel anger or irritation sometimes – but responding from such a place won’t be in the best interests of the organization or its mission. I’ve often responded with anger, irritation, and frustration, and when I have gone home I have had to think about what happened. So in that sense it’s a very self-reflective exercise and I’ve learned a lot about myself as a person.
The Politic: Earlier you mentioned that you have no background in advertising, fundraising, HR, among others. Yet, you’ve been able to establish such an organization in seven and a half years based on that footing. How did you manage to surround yourself with the right people that you felt would help you execute your vision for this public health organization?
I must say that none of what we have achieved could have happened without the people who work within this organization. In many respects, I am symbolically the leader who stands up and describes what we’ve done or outlines the vision for the future because until I say it, it almost doesn’t get accepted. But the concepts and inputs and ideas and work underlying it all comes from the people with whom I work. It helps massively that I’m an integrated thinker, a synthesizer of information, and that I’m curious so I’m continuously seeking out information from other people. Attracting good people has been possible mainly because we’re doing something good, and this attracts experts who want to help. I hope people feel that I am open to listening to them, and that they know what we’re trying to and can see their ideas being incorporated into what we’re doing. That’s how my leadership role has been critical – in bringing people and their ideas together; and I really want to keep doing that. I never want to get so arrogant as to think that I know all the answers to the problems.
The Politic: Do you have a single, most important piece of advice that you’d like to share with any Yale student?
I’d have to say (as Homer Simpson once said), “it’s funny because it’s true.” If you can’t laugh at yourself, you’re taking it way too seriously. You’ve got to be able to see the humor in things. The world is a completely and utterly absurd place. By no means am I deluded into think that I am single-handedly changing the world or that things are getting massively and fundamentally better because of what we’re doing or that in my lifetime it will all be solved. But it doesn’t mean that because I view things in this way, that I won’t spend my life setting an example and trying to make a small change in a way that I think makes some kind of sense. But in the end, life is absurd, and it’s just quite funny. So I think that being able to laugh at yourself and laugh at what you do is a sign that things are going okay.