NGOs, Funding and Sustainability

12 October 2017

“Education is not the learning of facts, but the training of the mind to think” – Albert Einstein.

This quote basically sums of my week. Plus all the future weeks to come!! MSF is often thought of as an organization that comes in to “save the day”, so to speak, and in some aspects that’s true. The Emergency missions that it operates are that. But much of MSF is also focused on disseminating knowledge into the population because, eventually, MSF will leave.

Many people have heard my rant about NGOs, funding, and sustainability. Anyone who is considering donating time or money to humanitarian organizations, I would really encourage you to dig into how the resources are used: what percentage goes towards office work, what goes into the field etc.

Here is the link to the MSF funding page with the financial reporting, http://www.msf.org/en/our-finances, and here is the link to the Canadian MSF Donor Responsibility page, http://www.msf.ca/en/donor-accountability, if anybody is curious.

Here’s why the idea of disseminating knowledge is an integral part of any humanitarian organization, and also why people should think about who they support. Let’s take the example of building a well. A school group decides to go and build a well in a Central American village. They fundraise, go do it, and come back. Seems like a good thing, right? But there are some other questions to think about.

  • Did anybody ask the village if that’s what they needed? Maybe they do need a well, but maybe they need seeds to plant more urgently.
  • Is there already a well builder in the village? By them coming and building this well, have they taken away a job from somebody else?
  • Do they actually know how to build a well properly? Or will they build a well, and the villagers will actually have to fix it or repair it to fit the context?
  • If they used the latest technology to build this well, what happens when it breaks in the future? Who will fix it?
  • If they build it themselves, who will continue to build the wells in the future in the village, or the neighboring village?
  • Did they spend $5000 to fly down and build a well that cost $500, and could they have built 10 wells for all the money they spent, had they just given the funds to the well builder in the village and sent a technician to support him instead?

This is where aid gets murky, and the delivery of aid, and how aid is integrated into the context. So how does this relate to what I did this week and to how MSF usually operates. So I’ve outlined in my previous posts about the team I work with, and the goals we have in the project around addiction and TB adherence. But if we sent in a bunch of international staff to run around and actually do the work, we would be hoarding the knowledge and this wouldn’t actually lead to any sustainable change in the country. We would take the knowledge with us when we leave. In general, MSF tries to have those with the knowledge working with those that could benefit from the knowledge. A doctor works with a doctor, a nurse with a nurse and so on. Even our international HR staff have a team of local HR staff in the country to support. So the knowledge stays in the country hopefully over time, and eventually after MSF has left.

When I arrived, I had staff request some trainings, and I also saw an opportunity to refresh on some basic principles when we are doing integrated care. I proposed have an intensive 3 day workshop instead of doing it over a period of weeks, and the project agreed. Then they invited the medical team. Then the Ministry of Health staff in the hospitals. Then the outpatient units. The training how has to be given likely 7 times and the goal is to cover all the partners we work with. This training went from a request of the patient support department, to being rolled out across the TB partners in Minsk. What a great example of working together in the project, and supporting the disseminating of knowledge.

The topics covered were 8 modules. It started with Patient Centered Care, General Addiction Info, went into Motivational Interviewing, and then Treatment Strategies, ending with Burnout, with a few other topics in there. It was a marathon for everyone – me standing in the front of the room for 3 days, the translators having to interpret, and especially the participants who were thrown 3 days of intense material. The goal is not to have the memorize all the info, but rather, as Einstein said, to start to change the way care is delivered. The content will have to be reinforced and supported, but now when we incorporate goal setting, or harm reduction into care plans, they are not foreign topics. They are new ideas that we can turn over, and try out.

The other part of sustainability includes not having me do the same training 7 times. I want the staff here to be the ones doing it, driving it forward, and pushing the message. So next time, instead of me standing up there and blathering on for 3 days in a foreign language, the staff who work in TB from both the MSF and MoH side will be delivering the modules, with me playing a supporting role. And the next time, I will do even less. Until eventually, when the 3 day basic knowledge training is needed, staff can deliver it themselves. Technical areas, like motivational interviewing, might still need to be supported by somebody with advanced knowledge, or there might come a need to have more advanced training modules developed, but ideally, the staff here should be able to speak about patient centered care or assessment techniques.

I have to say, I was very impressed with the suggestions and learnings that came out of the training. It really reinforced that staff here are eager to learn, and when supported can thrive. Staff here want an app for adherence, they want to start family lecture series on TB, they want to create a peer support program, they want to have informational boards installed in the hospitals!

Also this week is Canadian Thanksgiving!! Or, as I like to call it, Thanksgiving!! There will be a nice dinner with a chicken masquerading as a turkey, stuffing, cranberry sauce, potatoes and squash.

The weather has turned colder and the heaters are now working in the bedrooms until the central heating gets turned on by the city. I am pretty excited to be taking another weekend trip coming up. I will be heading to Tbilisi for a nice getaway. There are direct flights from Minsk, and if I wanted to get there from Canada it will be a loooooong flight, so it’s nice to take advantage of that. Then, it will be time to think about end of mission. This comes with it’s own combination of anxieties but I am confident that things will move forward with only small interruptions. I am also fortunate because I think my replacement will be arriving before I go, so we can actually have a nice handover! What a luxury!!