Intervention Sustainability in Lessor Developed Countries by Tom Clarke

Sustainability is an inherent part of all Development Interventions, but more often than not it is merely an afterthought without any real substance or historical successes. Real Sustainability takes Real Household Income to translate into sustainable development interventions. Not dissimilar from the Developed World, people in Lessor Developed Countries must have access to Household Income in order to maintain interventions in Health, Education, Water, Sanitation, and other Development Interventions. Our on-the-ground experience demonstrates people are willing to pay for basic services when Household Income is available. When you are a large Portfolio NGO, you take the $50 Million USAID or DFID Grant, complete your 3-5 year Intervention, and hope for the best. Because Kissito and our close partners are funding our Interventions we constantly focus on Sustainability and generating Real Household Incomes.

Three Kissito initiatives are being designed to employ 31,000+ people in Ethiopia and Uganda and we want these initiatives to serve as Models for creating: JOBS and Economic Activity. Our first and most difficult intervention will engage 10,000 Small and Medium Size (“SME”) farmers in both Ethiopia and in Uganda. Unfortunately, most Ready-to-Use Therapeutic Foods (“RUTF”) are produced in France with Argentinian Peanuts and then air-shipped to African Countries in need. Kissito has invested in RUTF production facilities in Ethiopia and Uganda with the specific intent of creating SME farmer activity and eliminating Toxins from the African peanut supply chain. Difficult…yes… Impossible…Absolutely Not with determination and persistence!

Our Ugandan Improved Cook Stove program is expected to engage 1,000+ people in Stove manufacturing, Maintenance, and Distribution. Kissito and our partners are committed to environmental actions such as Reduce greenhouse gas Emissions from Deforestation and forest Degradation (“REDD”) and Climate change Mitigation and Adaptation initiatives which will engage 10,000+ people in South Sudan and Uganda. The creation of Household Income must raise above all other interventions if we really expect anything to be sustainable without continued donor transferred funding.

Doctors dedicated to sustainable change

In the operating room at the local regional hospital Dr. Judy and Dr. Mark Gustafson worked side by side, on a mother who had just given birth to a baby girl. Dr. Judy, an anesthesiologist and Dr. Mark, a gynecologist were in the O.R. for about two hours with the mother and child. They spoke of the story with mixed emotions.

The mother had been in labor for hours, possibly surpassing a full day. When it was finally her turn in the operating room the lack of supplies almost delayed the delivery again. Luckily, Kissito has a supply stock, and Tyler, the supply chain coordinator, was able to retrieve some of the necessary items and bring them to the hospital.

Dr. Mark Gustasfon during a c-section at Mbale Regional Referral Hospital

Dr. Mark Gustasfon during a c-section at Mbale Regional Referral Hospital

They were able to do the delivery through a caesarean section, but the baby came out with the umbilical chord wrapped around his neck, and was not breathing. The operating room only had one oxygen mask and it was needed for both the baby and mother.

Dr. Judy kind of chuckled at the level of intensity her and her husband felt during that moment in the operating room. Mark was taking care of the mother while she was taking care of the newborn.

“I need the oxygen now!”

“NO! I need it now!,”  they urgently called out to each other, trying to make sure both patients were able to breathe.

After about ten minutes the nurse looked at Judy and the baby and said “I think now we pray”. Judy did not give up though, and a few minutes later the baby finally started breathing on its own.  Even after the surgery they could hear the baby in the next room. The nurses were shocked. “Can you hear it? The baby’s crying, the baby’s crying!” they exclaimed, joyful and astonished that the child had made it.


It was a completely different setting than the one you would find in Virginia, at the Carilion Roanoke Memorial Hospital where Judy practices, or the Lewis Gale Hospital where Mark is located.

In the U.S. facilities are spotless, sanitation is mandatory, medical supplies are always present, and protocols are followed with care and precision. Unfortunately, in East Africa, none of this is true.

The biggest disparity they noticed between U.S and the East African health facilities was the lack of training. Instead of intense schooling, most of the medical staff members receive on the job training.

According to Dr. Judy there are three main components that need to be addressed, in a particular order:

  • Training
  • Equipment and Supplies
  • Protocol

They are all intertwined, but the latter cannot work without the former.

Mark and Judy are being included in addressing these issues and are in the process of designing protocols and training programs for the healthcare workers.

Their first trip to Uganda only lasted two weeks, but they have already planned a return trip in April, to do more in-depth training , and to help put protocols in place!

Their education programs, along with all of the donations from their hospitals have the ability to single-handedly change a hospital, and possibly even a culture.

It’s not always easy to find doctors willing to stay in less than comfortable conditions, and work in less than practical environments. It’s even harder to find doctors willing to come back time and time again.

Drs. Judy and Mark however, are a rare gem and we are so glad to have them as part of the KHI team. Knowledge is truly the most important donation you can give, and we are incredibly grateful for their dedication to the sustainability of the education given to the people in Eastern Uganda!

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