As with any intervention that includes a distribution of goods or service, I always bear in mind the sustainability of the project. Although a certain program may have many beneficial short term outcomes, how can we be sure that the program will sustain these outcomes? In the Nepal program that we read about for this week, the idea of distributing clothing to mothers who give birth in the presence of trained health workers was presented. Although the authors cited many incredible outcomes, including that fact that over half of all births in the region were attended by trained health workers, I wonder about the long-term effects of the program. The authors stated that a private donor was needed to fund the buying and distribution of the clothes. What will happen when, inevitably, that donor decides to stop funding the project? What if the NGO is unable to acquire sufficient funds to buy clothes for the mothers? I worry about how this project can be sustained for the near future.
The key to providing a sustainable project would be finding a different incentive to have mothers change their behaviors towards maternal health that could be implemented by community members rather than NGO workers.
When it comes to public health initiatives, I often think of sustainability as well. While I agree that the clothing incentive may fade away over time, I think it was mainly used as a driving force to get the project going. Once the community members realized the benefits of having a clean, comfortable, safe place for the mother and newborn to stay for a month instead of the cowshed, they believed in this new practice. The incentive of a healthy mother and baby will be enough to keep them from reverting back to potentially harmful practices, especially when they can adhere to their cultural belief of isolation without using a cowshed (ex: separate room in the house, room restrictions, or indoor guest house).