Rachel Kiddell-Monroe

Rachel wants to reimagine humanitarian action. As part of a paradigm shift in global health, made even more critical given the cascading crises facing the world today, Rachel is leading her team at SeeChange to find practical ways to support communities to create their own strategies in responding to health crises. By promoting culturally relevant and co-designed solutions, she is championing a new model of humanitarian action that emphasizes community participation and ownership, promotes sustainability and climate-positive responses.

By placing communities at the forefront of emergency responses, Rachel is playing a leading role in radically transforming how humanitarian health crises are addressed. In the current humanitarian model, structurally oppressed communities are not effectively engaged in crisis responses, which results in a reliance on external aid that is often unsustainable and inadequate. The COVID-19 pandemic exposed the flaws of the existing humanitarian system, leaving those dependent on external support without adequate assistance and ill-equipped to develop their own strategies that consider their strengths, assets, and realities.

Through SeeChange, Rachel and her team have developed CommunityFirst as a framework that prioritizes the agency and resources of communities before, during, and after a crisis. Working closely with community leaders, SeeChange supports the co-design of strategic processes to respond to health crises that align with the community’s specific context, capacity, and realities. SeeChange also facilitates the establishment of health solidarity networks which include traditionally excluded participants, such as women, youth, elders and members of the LGBTQI+ community. The networks act as a valuable resource in times of crisis both inside the community and beyond, connecting communities with regional and international organizations capable of helping to fill the resource and capacity gaps.

The CommunityFirst approach enables communities to take control of their response, exercise autonomy in decision-making, and mobilize their own knowledge and strengths. By using this approach, Rachel is challenging the power dynamics prevalent in the current humanitarian system, which disproportionately favour Global North over Global South solutions, and proposes alternative paths of action.

With her team at SeeChange, Rachel is accumulating a wealth of evidence to support a reimaging of humanitarian action. To date, they have accompanied communities in Latin America, West Africa and the Inuit in Canada’s north to develop community-centred strategies to address COVID-19, tuberculosis, gender-based violence, and adolescent sexual and reproductive health. Collaborating closely with Médecins Sans Frontières/Doctors Without Borders (MSF), SeeChange is actively supporting a transformation in the operational methods of this influential humanitarian actor. The ultimate objective is to demonstrate to the broader aid system that it is possible to improve health outcomes without importing procedures and approaches from the Global North into contexts that do not operate in the same way. This could save costs but most importantly shift the power to where it belongs – in communities living at the frontlines of health crises.

Rachel recognised early on that to truly shift the power, there needs to be a shift in the way money is disbursed in the humanitarian system. She is pioneering a CommunityFirst Perpetual Fund as an alternative and innovative funding stream directly governed by and accessible to communities and community-based organizations. By championing this unique model, Rachel is paving the way for a more equitable and effective approach to humanitarian health interventions.

For numerous Indigenous and structurally-oppressed communities worldwide, responding to health crises poses significant challenges. When faced with a humanitarian crisis, most of them rely heavily on external humanitarian actors to provide emergency health care. While the provision of support is crucial for saving lives and alleviating suffering in times of crisis, the essential services are rarely sustained by communities after the external actors have left and cannot be mobilized by the community for the next crisis they will face. A key factor contributing to this is inadequate community engagement in co-designing responses to health crises.

Community dependency on external assistance was starkly exposed during the COVID-19 pandemic, with reports and news articles indicating that Indigenous peoples in Canada, the USA, New Zealand and Australia were experiencing mortality rates that were nearly twice as high as those of non-Indigenous people. Although historical and economic factors contribute to this complex issue, a report from the Economic Commission for Latin America (2021) explains that communication strategies failed to reach Indigenous communities due to dissemination approaches that prioritize dominant languages over Indigenous languages. As a result, many communities were left without the necessary knowledge and preventative practices to mitigate the spread of COVID-19. Whether regional or international, community members and organizations are often uncertain about where to seek support, and in some places, community-based primary healthcare is virtually non-existent.

The humanitarian aid industry reached an estimated worth of $31.3 billion in 2021. Yet, reports reveal that less than 2% of humanitarian funds reach local NGOs directly. In 2015, the head of UN OCHA acknowledged that local agencies are better positioned to deliver aid faster, at a lower cost, and with a deeper understanding of the cultural context. However, despite bearing most of the risk, local actors continue to receive only a minimal amount of international funding. Presaged on a model where external actors deploy the response with their own staff and resources, or through a range of local contractors, it becomes clear why this is the case. Aside from the overhead costs incurred by major INGOs and the plethora of other costs in the aid pipeline, the system is structurally designed to continue to support external humanitarian aid delivery rather than supporting locally-led crisis solutions. The current funding mechanism not only proves to be expensive and wasteful, but it also upholds an outdated system which is centralized, and top-down. This colonial system of financing demonstrably prioritizes responses benefiting the Global North, as seen in the responses to COVID-19 and Ebola.

At the regional level, many governments fail to adequately support remote and Indigenous communities in responding to health crises. Part of the issue lies in the lack of accessible medical care as well as infrastructure issues. However, the disengagement of communities from their own health care response has often come from continually coming up against a structurally colonial system which is unwilling and unable to recognise the agency and strength of communities, and to support them to be co-creators of health crisis responses relevant to their community.

Drawing on her three decades of experience in humanitarian action, Rachel understood the need for an innovative approach to achieve positive health outcomes for structurally-oppressed communities in times of humanitarian crisis. Her innovation is guided by three fundamental pillars that form the backbone of SeeChange’s efforts. Firstly, it emphasizes the co-creation of CommunityFirst solutions for health crises, working hand in hand with communities to address their health crises. Secondly, SeeChange actively builds partnerships with organizations and institutions to seed the principles and values of the model in other initiatives. Lastly, Rachel and her team advocate to reimagine humanitarian action, pushing for changes in the way crises are approached and managed. Acting as a ‘node’, SeeChange’s organizational structure and flexible team allows them to support grassroot efforts, gather lessons learned from CommunityFirst solutions across different contexts, and share best practices and principles to a variety of stakeholder groups to demonstrate that enabling community-led solutions is the path forward in humanitarian crisis response.

Since she founded SeeChange in 2018, Rachel and her team have accompanied numerous communities, especially Indigenous communities who are grappling with health crises, supporting the co-design of strategic responses and establishing emergency safety nets. A pivotal point in their journey came in 2020 when SeeChange created a comprehensive COVID-19 roadmap. This roadmap was made available online in six languages; English, Inuktitut, French, Spanish, Portuguese, and Swahili. This user-friendly digital tool served as a practical step-by-step blueprint for communities to create sustainable actions plans their way. The planning tool designed for community leaders is a meticulous guide that walks individuals through essential elements of organization, preparation, response, and how to sustain the work. By asking detailed questions, the guide helps identify community resources, knowledge, and skills, forming the foundation for effective organizing. During the pandemic, the site saw visitors from 102 countries. Depending on the needs of each community, on invitation, SeeChange provided support in strategic development, facilitating workshops, providing technical-medical expertise, and advising on early warning surveillance systems and procedures. In its first five years, SeeChange was invited to accompany and assist communities in 11 countries including Nunavut in Canada’s north, as well as in Honduras, Venezuela, Peru, Ecuador, Mexico, Brazil, Guatemala, Colombia, Sierra Leone, and Kenya. Most of this support and advisory was provided remotely.

While contexts vary widely from one place to another, the example of Tana River County, Kenya shows the extent of Rachel’s creative intervention. From January to September 2021, community members from a local Kenyan organization were supported by SeeChange to co-design a COVID-19 response plan that was highly adapted to them. The members were engaged in virtual sessions and were trained utilizing SeeChange’s COVID-19 roadmap. From there, the local organization crafted a plan to conduct community outreach through educative performances, practical drills simulations, and public announcements in schools, and key village locations. Over time, people taught themselves how to sew adequately fitted masks, make soap, and create signage for social distancing areas and safe hand washing reminders. By the end of six months, nearly all 16,000 community members were equipped with a mask, had access to soap to keep their hands clean, and understood how to minimize the spread of the virus. All it took was for SeeChange to host multiple online sessions and follow up on WhatsApp with the same few community members and coordinate the delivery of additional sewing machines and fabric to Tana River County. No one had to be flown across the world to generate this impact and it was accomplished at a fraction of the costs compared to an imported solution. Subsequently, the regional health system in Kenya approached the community members and requested that they deliver their COVID-19 roadmap workshops in other areas, resulting in cascading impacts. In Latin America, SeeChange successfully activated a solidarity network of partner organizations for communities they have worked with. This solidarity network serves as a “rolodex” of organizations that can be accessed by community members when public efforts fail to reach them. This further demonstrates the need to not only support local efforts but connect regional organizations and institutions together to strengthen relationships and establish safety nets to prevent and address future crises.

Over the past five years, SeeChange has been deeply involved in an initiative with several communities in the territory of Nunavut, Canada. This region bears the weight of a profound history marked by the prevalence of tuberculosis (TB) and its enduring repercussions, presenting a major health crisis in Canada’s north. During the mid-20th century, government policies resulted in the forced relocation of Inuit communities to southern TB sanatoriums, disrupting their traditional way of life. Unfortunately, TB has been a sensitive and often taboo topic due to the intergenerational trauma associated with the disease. In collaboration with the Ilisaqsivik Society of Clyde River, Rachel and her team have facilitated a program on trauma-informed TB empowerment. These workshops have provided a safe space for elders and youth to participate, fostered healing and supported individuals within the community. By destigmatizing TB through awareness-raising and open discussions, individuals are feeling encouraged to seek timely testing and treatment. This has strengthened the community’s connection to the health system. Recognizing the positive impact and the potential of SeeChange’s approach, government health authorities and other institutions have sought their collaboration in bringing the CommunityFirst approach and trauma-informed TB program to other Inuit communities.

In response to a request from Inuit elders who survived traumatizing confinement in southern TB sanatoriums, SeeChange partnered with Nunavut Tunngavik Inc, to bring a group of 35 elders, youth and Inuit counsellors from Nunavut to revisit the site of the former TB sanatorium in Hamilton, Ontario where many of them were treated, often for years. This visit supported individuals and their loved ones in their healing and closure journeys and drew broad public and media attention to the historical trauma resulting from failed government policies and practices. In highlighting this intergenerational trauma of TB, and the importance of addressing it in order to develop truly community-led TB responses, SeeChange has made valuable contributions to the Canadian government's goal of eliminating TB by 2030.

To expand the global reach of the CommunityFirst approach, Rachel has been actively collaborating with MSF as part of their Transformational Investment Capacity (TIC). The TIC project, aimed at enhancing MSF’s ability to tackle urgent health challenges worldwide, has provided a platform for SeeChange to work closely with MSF teams in Peru, Venezuela, and Sierra Leone. SeeChange has been showcasing the power of enabling community leaders to co-create and co-design adaptive, culturally appropriate, and locally relevant responses to health crises. The outcomes from these three locations yielded promising engagement and, consequently, Rachel and her team recently secured a second round of investment from MSF. This new investment will not only expand the partnership from three to five countries (now including Nigeria and Brazil) but will also strengthen MSF’s program delivery by incorporating operational improvements aligned with the principles of the CommunityFirst approach in the entire project cycle. In working with MSF, Rachel is demonstrating how this major humanitarian actor can operate in a way that transforms the role of the community. If such an approach can be adopted by MSF, it can trigger a wider adoption of the CommunityFirst approach in the humanitarian sector.

In recent years, Rachel has been dedicated to several key initiatives within the CommunityFirst framework. An important area of focus has been on consolidating its methodological guideline, which serves as a comprehensive resource for implementing the CommunityFirst approach. Moreover, she has been working on adapting the COVID-19 roadmap to encompass environmental emergencies, recognizing the interconnectedness of health and the environment in humanitarian settings. To further evaluate the impact of SeeChange’s efforts, Rachel is collaborating with researchers in academic and research institutions such as the University of Toronto, McGill University, York University and ISGlobal. While the aid sector traditionally relies heavily on quantitative approaches and numerical data, Rachel understands the importance of incorporating qualitative evidence that captures stories, lived experiences, and relationships. Through participation in university forums and as a Professor of Practice at McGill University (where she runs a course on Decoloniality and Humanitarian Action), she sheds light on this paradigm shift to inspire the next generation of aid workers. Her engagement with academic institutions has also allowed her to attract young talent, harnessing the creative power and passion of young leaders to reimagine health responses while working at SeeChange.

Finally, Rachel is working on the CommunityFirst Perpetual fund. Currently in the design phase, a white paper and business plan is being developed for the model to bring it to investment readiness.

Born in London, UK, Rachel grew up in a working-class household and became the first member of her extended family to finish secondary school and attend university. As a teenager, she joined Amnesty International, advocating for the release of prisoners worldwide by writing letters. Inspired by her passion for justice, she established an Amnesty chapter at her school, encouraging others to get involved. She has been a human rights advocate ever since. Uncertain about pursuing a legal career after obtaining her law degree, Rachel embarked on a transformative journey.

Taking a year off to travel to Australia, Rachel witnessed the harsh realities of racism and sexism faced by the Aborigines in the Outback. This experience ignited her curiosity about Europe's colonial history and the prevailing neocolonial agenda, which included the charity model. Motivated by her newfound insights, she then ventured to Indonesia where she met Indigenous peoples being harmed by logging practices. On returning to London to finish her law articles, Rachel established an organization aimed at supporting the Indigenous people she met to advocate for their land and rights. On qualifying as a practising lawyer, Rachel decided to return to Indonesia to campaign full time with an Indonesian grassroots organization to end the destructive practices of Indonesian logging companies. Planning to only stay for 6-months, Rachel spent three years in Indonesia. She extended her work to supporting East Timorese independence and joined an Indonesian human rights group.

Returning to England, Rachel joined MSF in 1991 to help launch the UK branch. She has since played significant roles in the organization, heading missions in Djibouti, Democratic Republic of Congo, Rwanda, and Uzbekistan. In the mid-90s when stationed in Goma, she witnessed both the resilience of communities in North Kivu, and the horrors of the Rwandan genocide, compounded by the wilful negligence of the international community. These experiences profoundly shaped her perspectives on the failures of the aid sector and the urgent need to decolonize health crisis responses. Rachel went on to work on access to medicines issues with MSF and later led the creation of the university-based student advocacy organisation, Universities Allied for Essential Medicines. Rachel was recognised as a leading advocate on access to medicines issues.

Rachel had been thinking about decolonizing aid since her twenties but often doubted her legitimacy in the sector. She joined MSF’s international board of directors with the hope to drive change from above. Change was coming, but it was slow. With humanitarian disasters accelerating due to geopolitical polarisation, climate change, structural racism and pandemics, Rachel felt she needed to work outside the system to push for change. She decided to leverage her 30+ years of experience in humanitarian action to found SeeChange, an organization dedicated to challenging the status quo and reimagining humanitarian action. Rachel firmly believes in the inherent power of communities to take charge of their own health and well-being, fostering virtuous cycles of learning, teaching, and knowledge sharing instead of relying on external solutions. Rachel believes the decolonization of our systems is central to being able to tackle the ongoing and looming crises facing our planet.