HealthRight is a relatively small nonprofit, with a roughly $6 million budget, that partners with communities to train, equip, and improve existing healthcare systems facing health and social crises made worse by human rights violations. The organization has worked in more than 30 countries and has particular expertise in HIV/AIDS, TB, malaria, women's health, and at-risk youth, as well as care and support for survivors of human rights violations such as torture, trafficking, and domestic violence.

Sostena Romano MBA-e '07, HealthRight's executive director, points out that the organization needs more than good intentions and a worthwhile mission to thrive in a competitive environment. Development is a field in flux. Many countries are insisting on greater control of the assistance they receive and prefer a focus on capacity building as opposed to short-term problem solving that doesn't build individual or institutional capabilities.

At the same time, the mix of funding for development efforts is changing. The OECD forecasts a decline in foreign aid from governments in coming years. But other sources of funding are often larger than foreign aid. Isobel Coleman, a senior fellow at the Council on Foreign Relations outlined the relative size of development money using the United States as an example. In 2010, the U.S. gave $30 billion in official assistance while U.S. philanthropy to emerging countries was $39 billion, remittances totaled $96 billion, and private capital flows, largely in the form of investment, reached $161 billion. While the proportions vary by donor country, this range of funding sources has fostered an emphasis on diversification and collaboration across nations, sectors, and organizations.

We talked with Sostena Romano about how her organization can survive and make a difference in this shifting landscape. She points to the importance of smaller NGOs being able to differentiate themselves from the giants, often through bypassing national-level work to focus on local clinics that might have a single clinician, working without the most basic infrastructure.


Q: What is the state of global health now and in the near future?

Sostena Romano: Global health currently has become extremely political. It has become quite political. Very, very—it is moving fast. It’s very different from how it was and in some ways, for instance in my current organization, we’re very small and the question is how do—there’s thousands of us—how do these small NGOs survive in the land of these giants and that is a real valid question. What’s going to happen is many will fail because it’s all going to be—it’s competitive beyond description, there is a finite amount of money that’s happening, and quite frankly, countries are not stagnant. What’s going to happen is the needs are going to change dramatically and so the days of pouring tons of money in are gone and they should be. These countries are capable and want to take ownership for it.

So it’s going to be much more competitive in the short term because it’s going to be finite dollars and the big players—it’s their livelihood as is it ours. For me, it’s all a question of what is my value add? What is my value add? and that is what I have to really look hard to define because I am a small organization and I want to survive.

So I think that you’re going to see huge numbers shift over the next five years in terms of numbers of NGOs. NGOs have to become more efficient, much more effective, money has to be used in a much better way that’s strategically smart, overheads have to come down dramatically.

Q: How will changes among organizations impact healthcare delivery where it's needed most?

Romano: The large players tend to stay at the national level and don’t necessarily get out to where it actually has to happen. That’s where I think an organization like mine is helpful and will be useful because we’re taking those policies and seeing whether they work. What will happen is, I think, that over time some of these health issues will get better and then as you see fewer of the players on the ground and these heavyweight players on the top not really getting to the ground, you’re going to start to see things get worse again and then there’ll be a call to religion, so to speak. There’ll be a recognition that we have to do things at the ground level and, I like to say, get our hands dirty.

Q: What are the challenges on the ground for your organization?

Romano: I go to these countries and you have one staff member who is supposed to do everything for 80 patients that have no appointments, they’re just showing up for their visit. That is a stark reality. Forget about the fact that everything is paper based, that there are no pencils, that there is no electricity, that there are no roads. Just even at the very basic, you have one clinician who has to figure it all out. So how do you cope with that? That’s what I mean by you have to step out. Right? When I went there and, in some ways, I expected little Yales everywhere. Right? Or little hospitals or even community clinics and I realized that to be successful in this, I had to let go of all of that stuff and maintain my core belief in the ability to achieve what we wanted to achieve and figure out how to use their strengths.