Michael Kleinman — Sustainability is Not Just a Buzz Word
Somewhere, in a magical, mythical developing country, all aid programs are sustainable. Using participatory approaches, NGOs work with government ministries to design and implement projects which address various underlying causes of poverty, supported by donors who are committed to long-term engagement. It’s a development utopia; an aid worker Valhalla.
Reality, however, falls somewhat short. What does sustainability mean when the government lacks the capacity – or the will – to assume responsibility for service delivery? What does sustainability mean in a country like Chad, or the Congo?
There’s often a kabuki-element to coordinating with a government in a failed or failing state, the triumph of form over function. Consultations, permissions, endless coordination meetings, when everyone knows the projects will end as soon as the NGO leaves, or donor support disappears.
This is not to say that the situation is hopeless, or that the work serves no purpose. A mother doesn’t die in childbirth, a child doesn’t die of diarrhea, a girl learns to read. These are incredible things, even if the project itself isn’t sustainable in the long-term, even if the clinic or school will eventually sit empty.
Sustainability is a reasonable goal in some countries, and an empty promise in others. To that end, we need a new lexicon, a more accurate rhetoric. We need a way of describing our programs that describes – accurately describes – what we can realistically achieve, and what we can’t. It’s the least we owe to ourselves, our donors, and the people we serve.
Michael Kleinman spent a number of years working for aid agencies in Afghanistan, across east and Central Africa, and in Iraq.
Editor’s Note: Establishing a strong relationship with government can be a challenge in many sub-Saharan African countries, particularly in conflict settings. Luckily for the Touch Foundation, Tanzania has enjoyed more than a decade of political stability. For more on Tanzania’s political, economic and development situation, click here.
Kavisa Cyprian- Returned Peace Corps Volunteer in Tanzania 2006-2008
Imagine the sun rising over the desert ground in Mahongo, and the beauty of Tanzania. Lights scatter displaying colors not normally seen in a sunrise. In a place where electricity is sparse and unreliable, the sun dictates ones day. As the sky lightens I notice dozens of villagers lining up outside the mobile health clinic. They had walked hours in the dark, anxious to see the doctors and receive free medicine.
We leave the lush and fruitful town of Mbeya at 5 am. The Mbeya region, where I live in a hilly village called Tukuyu. It is a place where it rains so often that if you were to throw uncooked beans out your backdoor they would sprout days later. Three hours later, the bus drops us off in a place I did not know existed in Mbeya. The land is so barren I cannot fathom how the Tanzanians, 80% of whom are farmers, survive.
I watch as children as young as 4 arrive by themselves seeking medical help. I try as best as I can to explain complicated doses to these children, grateful when I see that some are accompanied by their grandparents only to learn their elders can not read either. The day alternates between heartbreaks and laughter; shocking things like a baby infected with herpes from birth or dozens of extremely malnourished people. I share jokes with one old grandma about the condom demonstrations I was giving. We light-heartedly discuss the cucumber I was using as a “model.” People are so happy to receive medical care that it puts them in an optimistic mood. This attitude of hope, I will never forget.
The need for accessible medical care in Tanzania is palpable. When I read articles in the NY Times about the high maternity related death rates, it makes my heart heavy because I know the stories are true. However, there is hope. For example, The Olive Branch for Children has expanded its mobile clinics and community services in Mahongo and organizations like The Touch Foundation are working to train thousands of health works. Medical care does not have to be determined by where you were born.
Matt Fitzpatrick- Personal Story by a Volunteer
Working with the Touch Foundation’s Young Leaders group has been one of the best experiences I have had since coming to New York City. I have had the opportunity to plan numerous charity events ranging from parties at nightclubs to performances at the Rose Theater. Through the Young Leaders group, I have met and become friends with numerous
intelligent, interesting, fun, and socially conscious people. But more than that, as a young person who spends much of my time on such mundane activities as editing spreadsheets in a glass cubicle, working for this cause provides an opportunity to help make a positive impact on the world, and to be a part of the solution for one of the great problems of our time – the health crisis in sub-Saharan Africa. I look forward to continuing my efforts with Young Leaders through the newly launched Who Cares? Campaign.
I first became interested in African healthcare infrastructure development, and African economic infrastructure more broadly, during a class I took in college called “The Politics of Developing Countries.” In a piece we read by Jeffrey Sachs, he argued that Africa’s economic development has been stagnated by a combination of a land-locked geography, a prevalence of diseases such as malaria, a harsh climate and large expanses of arid land, and the impact of European colonialism, among other things. These factors have resulted in a continent that lacks basic core infrastructure in several areas essential to economic development (e.g., healthcare, highways and roadways). For some reason this stuck with me more than anything I had read previously on Africa, as it so effectively explained the fundamental and systematic impediments to African economic development. I decided then that this was an area where I wanted to contribute in the future, but given the broad range of Africa’s infrastructure needs, and its complex web of public and private investment support, it was difficult to know where to begin to try and make a difference.
Two years later, fresh out of college, I was introduced to the Touch Foundation, the nonprofit that runs the Who Cares? Campaign, through a colleague at McKinsey & Company, and it seemed like the perfect organization to fulfill my earlier interest for 3 main reasons.
First: the cause. Healthcare is truly the most pressing and immediate need in Sub Saharan Africa. The health toll of HIV/AIDS, malaria, tuberculosis and other infectious diseases in the region is staggering, and perhaps most disturbing is their impact on children. Each and every day, over two thousand children in Africa under five years of age die of malaria, a preventable and easily treatable disease. To put that in perspective, since you began reading this note, almost 10 such children have passed away, never getting the chance to experience life or realize even the beginnings of their potential.
Second: the scope and approach. Many organizations aim big and accomplish little, as bureaucracy and a lack of accountability result in impact felt a mile wide and an inch deep. The Touch Foundation, on the other hand, focuses on a single country in Africa (Tanzania) where the healthcare infrastructure is particularly dire, with the goal of driving deep, lasting, and systemic change. In close partnership with the Tanzanian government, the organization is attempting to transform medical education in Tanzania and train a generation of new healthcare workers to serve as the foundation for an improved medical system, establishing a model that can be replicated throughout the rest of Africa in the future.
Third: the impact of my time and money. “Return on Investment” is a phrase used frequently in my field. The question is not simply whether every dollar spent will have an impact, but where will it have the greatest impact? In Tanzania, there is currently one doctor for every 33,000 people, compared to 1 doctor per 300 in the US. Training one doctor for a full 5 year program costs about $27,000, and training one pharmacist costs about $6,000. That means every event organized by the young leadership committee goes a significant way towards training a doctor that will be able to treat thousands of people that previously might not have received care, or covers the cost of training a pharmacist that will be able to distribute several thousand potentially life-saving medications. That means that every contribution by the young leadership team, big or small, can help to drive substantial, tangible, immediate impact.
And on top of all that impact, working with Touch has been fun. I’ve met a great group of smart and interesting people, and planned and attended several great events. It has definitely been one of my best experiences since coming to New York City several years ago.