Dr Foster persistently pointed to the intelligence and experience of front-line workers as an untapped resource in problem-solving. One of his favorite tactics involved arriving as a consultant with a Minister of Health for a country. Over tea, he would invite him to enumerate critical needs towards improving child survival. Afterward, he would then take the minister on a village-level site visit, often something the minister had never done. He would then invite some of the local workers to tea, and ask their thoughts about the minister’s main problems. Reliably, and extraordinarily for the Ministers, the workers had meaningful insights and solutions.
One classic case involved the monetary incentive in Bangladesh that was provided to any individual who provided information on a new Smallpox outbreak. A field worker noted that clinic staff didn’t always tell villagers about the incentive program. The problem was that if the staff member found the outbreak he would get the award. But if the program were publicized then other villagers would come forward and claim the funds instead. The worker suggested a new double incentive where both the villager and the clinic worker received the reward. Problem solved.
Whether designing incentives for reporting cases, improving vaccine cold chain reliability, or later in training public health students, Dr. Foster frequently returned to these scenarios where creating connections from bottom to top allowed a novel and powerful perspective.