Seven years ago I got to be part of one of the coolest projects I might ever work on.

Through the Harvard Ministerial Leadership Program, my colleagues Matt, Yuki, and I were paired with Ethiopia’s Federal Ministry of Health as they rolled out the first-of-its-kind national Compassionate and Respectful Care Initiative. Also known lovingly on our team as the CRC. We spent about a month in and around Addis, listening at every level we could reach. Hospital staff. Community health workers. Birth workers. Patients. Our BFF ER doc Nahom. Nonprofits. Everyone who would lend their wisdom. Then we came back to Boston and turned what we heard into a strategy document to support the national rollout.

I sat down with Matt and Yuki recently to take a look back at what we did there. We  kept reminding ourselves and each other that, seven years on, much of that experience shows up in the conversations we continue to have now with organizations who tell me community listening is just too messy to do at scale.

Really? A whole country did it.

Here’s what stood out to me then and what stands out to me now.

The Ministry made subjectivity central to the plan

We kept being told that compassion and respect can’t really be measured. What feels compassionate to me might not feel compassionate to you. Person to person, bedside to bedside, it varies. The Federal Ministry didn’t try to reduce that to a metric they could report on a dashboard. Instead, they  accepted that the experience of care had to be a lived, told, place-specific thing. A rare, complex decision that made this work valuable and honest. 

Foundational work first, and the math got better because of it

There is intense pressure, especially on ministries of health and state-level bodies, to move fast and formalize. To be able to do the math on cost per intervention or whatever proxy fits the funder’s spreadsheet. What we witnessed in Ethiopia was different. We saw the FMOH commit in word and action to slowing down and building trust with the people doing the work before designing the system around them. Yuki said it well during our conversation: In order for care to be compassionate, the health system itself has to be compassionate. To its providers. To its institutions. Otherwise it doesn’t trickle down and it doesn’t sustain.

Distributed ownership from the start

The Ministry didn’t try to figure this out centrally and then hand it down. They set up incubation sites so that different regions, urban centers, small regional hospitals, corner health hubs could each figure out what compassionate care looks like in their context. For some sites the priority was clean facilities. For others it was addressing provider shortages. That variation is what hyper-local strategy looks like when you resist the copy-paste impulse.

Listening was already trust building

This is the thing I say all the time to the organizations I work with. Listening is the work. When the Ministry showed up in communities and sat with providers and patients, that act itself was proof of commitment. Communities, including the providers who live in those communities, need to see lived examples of leaders acting on what they say they prioritize. Ethiopia did that at a scale most would think wasn’t possible for a country-wide initiative. 

Affirmation can be the recommendation

When we got back to Boston, we spent months synthesizing what we heard into strategy recommendations. And there was a moment of confusion. Almost everything we’re recommending affirms what the Ministry is already doing. Was this even useful?

Matt reframed it beautifully. Sometimes the recommendation is to affirm and uplift. When a strategy is being built with the people who are doing the work, the deliverable often lands as confirmation of a direction that’s already emerging. It reads as consensus. It reads as the strength of the initiative itself. That reframe informed how I think about strategy deliverables to this day, seven years on. 

The trade-off is always there

There was an immense, urgent need not being fully met while this foundational initiative was being prioritized. That trade-off is present in every version of this work. When we’re only ever in reflexive response to urgent need, we lose the ability to look at what’s causing the need in the first place. Ethiopia was holding both. Meeting the right now while walking toward the future. Holding that complexity at an organizational – or even national – level is possible when done with intention. 

Seven years on

Every time I hear an organization say they can’t do community listening because it’s too messy or too slow or too resource-heavy, I think about Ethiopia. A federal ministry sat with every layer of its health system. It let subjectivity stay subjective. It gave regions autonomy to define compassionate care on their own terms. It moved slower at the start so the whole thing could move faster later.

This shows up in almost everything I do now. The story bank work. Community mapping and engagement. The insistence on listening before designing. The refusal to treat community strategy as a technical exercise. The trust that when you build the foundation right, the pace you want later becomes possible.

If you’re in an organization telling yourself you don’t have the time or the appetite to listen at scale, I’d love for you to sit with the Ethiopia example for a minute. It might just be one of the coolest examples of community-driven strategy I’ve ever gotten to witness up close.

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