Nonprofits, Failure, and Efficacy

I want to write about failure. People seem to be very afraid of the word, but I became enamored with it at one point. I wanted people to celebrate failure rather than brush it under the rug. Through my broad exposure to nonprofit work in many different settings, I became very disappointed with the effectiveness of nonprofit work in general. At least with for-profit work, if something is not working, you’ll run out of money soon enough and it will end. As long as a non-profit can create a good story and reach out to donors, they can continue doing what they’re doing. Even if their work sucks.

If there is a culture of celebrating failure amongst non-profits, at least we can more broadly know what doesn’t work, not repeat the mistakes others have made, and move on to more effective solutions at a quicker pace. I was at the Business Innovation Factory here in Providence for a talk with Brown alum and President of Babson, Len Schlesinger. He said Babson (a school well noted for Entrepreneurship) prepares students to fail quickly and cheaply. I loved the idea.

But I guess failure is a very harsh word. People were always concerned with my idea for a Failure Report to chronicle aspects of student nonprofit projects that simply didn’t work well – primarily with what I wanted to name it. I heard Len speak again last semester at the Faculty Club, and he did concede that you don’t want to call it failing. Parents don’t like it when you tell them you’re teaching their kids to fail quickly. You say that you’re teaching them to get to a better solution quicker. Essentially the same thing as what he was saying before, but less harsh I suppose. It’s the economic principle of creative destruction at a very micro level.

Moving to a new project doesn’t even need to mean the old project was a failure. In fact, the old project could have been wildly successful. Maxwell House makes fine coffee. In fact, they sold the most coffee amongst all companies in the US for much of the 1980s. They continued doing what they were doing, and look at how much of the coffee market that Starbucks grabbed away.

Milana’s clinic in the Medak district is doing fine – we’re seeing between 80 to 85 patients a day and we’re providing care in an area that didn’t have direct access to care before. The Milana clinic is indeed beneficial to rural health. But I still want to shift Milana’s focus. It is not realistic to think that we can build and run clinics to serve the 800 million people in rural India. It’s not realistic to think that we can bring the equivalent of MD doctors to reach the entire rural population. It will be a very time and resource intensive undertaking, and it’s something only the government is really in the position to do. And they’ve clearly failed at it.

We want Milana to grow by providing education and certification for existing rural health practitioners (who don’t have any formal education yet are the most popular source of healthcare throughout rural India). The improvements in health outcomes can be staggering if these practitioners were brought up to a basic standard level of education and training. This program can ideally be done in a financially sustainable way that is very quickly scalable. We can achieve improvements with this course of action that will take an incredible amount of time and resources to do if we were actually creating new sources of healthcare access. And quite honestly, continuing to create new access to care at a large scale would probably be a disruptive, expensive, and ineffective mess.

The lack of progress for a proposed Bachelors of Rural Health initiative shows the general unwillingness to accept the notion that effective healthcare can be provided by anyone below an MD degree (MBBS in India). This is a dangerous viewpoint to have, as it is very clear that there is no way MBBS doctors can be available to all of rural India anytime soon(over 70% rural Indians depend on unqualified practitioners). The best realistic solution is being pushed to the wayside for an ideal yet impossible situation. This is similar in nature to the well-intentioned but very misguided arguments against sweatshop labor, highlighted by this great video by Nicholas Kristof.

Milana’s RMP upskilling program is an attempt to privately achieve the benefits of a Bachelors of Rural Health degree program in a leaner and more fast-paced package. I want it to be the Starbucks in the rural health space.

I want this transition by Milana to highlight the importance of constant self-assessment and a willingness to pursue new paths in nonprofit work, even when it may be difficult. And oftentimes, the many different viewpoints of donors and supporters will make it difficult. I respect those who celebrate failure, even if we all agree that we don’t quite have to call it that. The fast-paced innovation of the private sector will need to vibrantly exist throughout the non-profit world for non-profit work to continue to be of any significance.

-Nikilesh

This post originally appeared on the Milana Foundation's Blog