Every time I hear the word sustainability, I cringe. It has not always been this way. I, like many others working in the development field loved this word; we throw it around to convince donors and partners that after they leave, the work will continue. That the very broken, power-hungry corrupt system we are trying to fix will miraculously pick itself up in five years’ time and do things perfectly. We all know this is a lie. I know this is a lie, and I am tired of telling it.
Five years ago, I sat in a room with 100+ global health young leaders at the Yale Training Institute for a two week long leadership program as a new recruit for the highly prestigious Global Health Corps one year Fellowship. I remember that one of the speakers sharing on the social determinants of health was asked if he feels the work he is doing is sustainable. I was impressed by this peer of mine asking this very pertinent question, which was the IT thing at the big tables back then and, still is I guess. What this man said in response has stayed with me until now, he said: “sustainability is a luxury.” He gave an example of programs that incentivize health workers to go to the most rural hard to reach areas and save lives. To some the main concern will be around how the government will sustain such efforts when the project ends while others will only focus on the lives saved regardless of the long-term plan. At the end of the day, that is what should matter, right?
In Malawi, reports have shown that there has been an increase in the reporting of child abuse cases to authorities but there are still challenges in the following up of cases by district authorities to ensure interventions and support are given to the victims. Following up of cases requires funds and the District Social Welfare Offices are heavily under funded. This limits the scope of their work. With this in mind, donors and funders have been the main source of support for these structures to fully achieve their mandate of following up on all cases, providing support to victims and doing referrals. So, how does one explain sustainability in this case, how do we choose whom to save? A small budget of fuel and allowances for the district goes a long way, but of course, this is not sustainable because it is a whole system that needs to be changed. In this case, do we use whatever means and resources we have to save the little girl that has been sexually exploited and ensure she gets justice and access to health services or do we ask whether what we are doing is sustainable?