Managing a faster pace of change

Upset with how slow public-health initiatives moved in poor countries, Josh Ruxin decided to treat them like the private sector.

Just weeks after the birth of his second daughter earlier this year, Josh Ruxin found himself thinking about Bolivia. He had worked there for a year after college, focusing on maternal and infant health among the very poor.

"In this village I worked in, I approached this woman who had a newborn infant who looked sick," he remembers. "I said, 'What's this baby's name?' She said, 'Oh, she doesn't have a name yet.' She was 5 weeks old. I asked, 'Why doesn't she have a name?' The woman said, 'Well, if she dies, I don't want to waste a good name.'"

The difficult lives of the rural poor have motivated Mr. Ruxin since his first trip to the third world. He was 17, and he visited Yifat, a remote village in northern Ethiopia. The teenager who dreamed of becoming a Silicon Valley entrepreneur saw dire poverty for the first time: "What hit me in Ethiopia was [that] this is not a documentary on PBS, this is not a news story, this is not a study ...­ this is reality."

The experience was so powerful that Ruxin abandoned his "great plans of being a really, really wealthy capitalist" and devoted himself to studying poverty and health problems.

But the spirit of capitalism never quite left him. In the 1990s, he was one of many impressed by the simplicity of a cure for dehydration: Combining sugar, salt, and water could save children from dying of dehydration from diarrhea, cholera, and other diseases.

"What could be simpler?" he asks. "Yet diarrheal disease is still one of the top killers globally."

The slow pace of international organizations infuriated Ruxin. "I realized it really comes down to smart management," he says. So he spent a few years in the private sector, at a consultancy in Cambridge, Mass. When he left, one of his private-sector clients – the government of Rwanda – became the focus of his public-sector work. Twelve years after his first trip to Africa, Ruxin now runs several public-health projects in Rwanda, which he praises for its efficiency and good governance. In 2008, he founded Rwanda Works. The profits from its "prosperity projects" fund the organization's social-change efforts, focused on health.

Rwanda Works draws on Ruxin's experience as founder of the Millennium Village in Rwanda, one of 80 experimental villages across Africa using community-based strategies to end extreme poverty. The village's success – malaria rates have dropped; healthcare has improved; and where for years there had been chronic hunger, farmers are now reaping bumper harvests – ­partly inspired the Rwandan government to roll out a similar grass-roots antipoverty plan across the country.

It's often called noble work, but Ruxin is less romantic about it: "I'm not Mother Teresa or Sisters of Charity ... who say we become better people or we get closer to God by doing these acts of charity. What I'm interested in is, at the very least in my lifetime, trying with colleagues to show that ... we don't need to live in the world that we currently inhabit. So let's figure out how to get it done."

For Ruxin, that task – improving the lives of the rural poor – encompasses even his family life. Unlike development workers, who rotate between countries every few years, Ruxin and his family live permanently in Kigali.

His wife owns a popular posh restaurant called Heaven, where a 10 percent service charge goes to the wait staff, in a country where waiters rarely make tips.

"Given that I've dragged my family into it – they live it – there's less and less separation between my passion and my life," Ruxin says.

The blurred lines between public service and private life can make both, at certain points, difficult. "We're close to lots of people who live in extreme poverty," he says. "The needs are infinite, and we're bombarded with them on a daily basis ... and we're workaholics, so we want to do everything we can to help. But the burnout for helping is high."