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One of my favorite parts about attending USC is the Trojan network—not only do we have access to a diverse set of professionals, but we are also offered countless opportunities to learn directly from the pioneers spanning many industries. Yesterday, thanks to USC’s Institute of Global Health, I had the privilege of hearing global health leader Purnima Mane speak on campus.

Dr. Mane is currently the CEO/President of Pathfinder International, an NGO that works on sexual and reproductive health. Prior to entering the health field, she worked as a professor in India. Since then, she has worked at both the United Nations and The Global Fund to Fight AIDS, Tuberculosis and Malaria.

During her lecture, titled “Ideals and Pragmatism in the Global Sexual and Reproductive Health Field: Can They Coexist?,” Dr. Mane touched on a number of important points. Her first statement attacked one of the deepest conflicts that all NGO professionals face, and can be summarized as follows:

One of the perennial challenges we face in the field of global public health is balancing our passion for what we call universal well-being by working frequently with the most marginalized communities and understanding the reality that we live in a world with finite resources for which there is constant competition.

This first critical insight drove the rest of her talk; each point listed below reflects the above theme in some way, shape, or form:

1. The balance between acknowledging the cooperation with other institutions/organizations and definitively measuring how much your organization has individually contributed. The non-profit world is ever expanding, with NGOs popping up with increasing frequency. While these organizations understand the benefits of partnering with and accrediting one another, it is also important that they remain sustainable. Dr. Mane brings up the experience she has had in Ethiopia, where Pathfinder has been working with a number of NGOs as well as the government. She enjoys giving credit to many of these other actors, but realizes that she also needs to actively track and report the exact contributions that Pathfinder has made for the purpose of informing the organization’s donors. This leads to the next point.

2. Changing donor priorities. Keeping donors happy with an organization’s impact, Dr. Mane mentions, is critical. Another challenge that NGOs face is donors that frequently change their priorities. Some donors will alter their goals based on political shifts and accordingly change the terms of their funding. In this case, NGOs face the difficult decision of giving up funding or ending programs in countries that often need them the most. Dr. Mane states that the donor-NGO relationship needs to shift, where donors have less power to make changes in operations that usually take aid away from the most marginalized communities.

3. When and how to focus a program. The issues that NGOs work to remedy are extremely broad—HIV/AIDS, water & sanitation, sexual & reproductive health. It is easy for any organization to try and solve all facets of a global health problem. Such is the current situation with Pathfinder International. To be clear, this is not a problem that organizations face, merely an observation. Dr. Mane stresses that focusing a program has benefits both for global health as well as the organization. Programs that are more focused are “most likely to catalyze (the good that comes about in) providing sexual and reproductive health to the most marginalized communities.” In addition, a narrow focus effectively carves out a niche for an organization, thus better securing sustainability.

4. Why pulling out of a country/region is sometimes necessary. This difficult decision draws from the previous three points. Sometimes, NGOs will comply with donor demands to pull out of regions. Other times, civil conflict or other extraneous circumstances will force leaders to reconsider their operations in a region. Dr. Mane finds this decision as painful as any of us would. However, she notes that leaders must realize that their pulling out of one region may save the rest of the organization. In five years, she says, you still want to be around and be able to make a difference. This question is where compromise, however unfortunate it may be, must come in.

5. Taking on unpopular, emerging trends of work. Being truly innovative in any field requires being able to “see what is ahead of the curve…what is beyond the horizon.” In the case of sexual and reproductive health, cervical cancer prevention and safe abortion care are these emerging projects. However, these issues are unpopular if not controversial, and we find ourselves in yet another clash of idealism versus pragmatism. This becomes a problem in terms of funding. Should organizations push the envelope with these necessary but controversial programs or should they remain in the safe zones and guarantee funding (and thereby their sustainability)? Dr. Mane notes that donors who claim to seek “innovation” often refer to creative growth in technology, not program development. The path of pioneering these new areas in global health is difficult without international recognition, and can lead to an NGO’s downfall if not approached correctly.

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These five points are by no means the only problems that NGOs face. However, they are the major themes in the dialogue about balancing ideals and pragmatism, and will be important to consider as the global health playing field continues to shift. I spoke with Dr. Mane after the event and was able to thank her when I had to leave, but I would really like the chance to meet her again in the future because she is so inspiring. I’m excited to have heard from her yesterday, and I’m looking forward to using what I’ve learned from her as I move forward in shaping my own career. I hope you all can do the same.