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Everwell’s Mission for “Sustainability” in Public Health

Everyone talks about sustainability - it’s an essential part of project plans, speeches, mission statements, funding proposals, and a word we use so often it almost loses its meaning. But what does it mean?

There are many definitions of sustainability which all have some flavor of answering the question: Can this good thing that is working now continue working and continue being good? At Everwell, we see two components of sustainability, or two necessary outcomes of something that is sustainable:

  1. Impact that lasts beyond our input

  2. Impact that grows beyond our input

The first component around impact that grows beyond our input is an acknowledgment that we only have limited resources (time, energy, money, etc.) and there are far more challenges than those limited resources can address without amplifying partnerships. Sustainability means building such partnerships that magnify impact beyond what we alone can do. When we started digital adherence technology interventions, we had a small team that judiciously followed up with every person when they missed a dose. While we learned so many things with that high-touch model, it was not scalable and therefore not sustainable for us. By partnering with the government and NGO field partners, we could magnify the impact far beyond what limited resources we had available. To us, that is impact at scale and an essential part of sustainability.

For the second component of sustainability, one might wonder why would someone leave something that they are positively impacting? To us, sustainability is about building ownership and reducing dependency on external agents, including ourselves! Fostering dependency can increase inequality, prevent development, or obstruct someone else’s capacity building. When building out technology platforms like the Hub or Ni-kshay, we view our role as helping initiate the systems because we bring expertise to the table, but also building capacity to ultimately transition the system. Transitioning the system enables ownership and independence for our partners rather than reliance on external factors to determine priorities.

The other aspect of impact that lasts beyond our input means having the maximum impact possible across all the many (many, many) neglected or challenging domains that could benefit from our intervention. If you start something which has a positive impact and are able to transition that to someone else without losing the impact, then you can shift your attention to another area that can benefit from your time. We’re very passionate about supporting people’s adherence to medication, but there are other public health challenges such as providing financial subsidies at scale, ensuring a regular drug supply chain, or supporting vaccine trials or rollouts. While we want to remain focused on areas we can uniquely impact, we want to make the most of our resources.

Growing and lasting impact are also a function of financial sustainability, and ensuring organizations like ours have robust business models to amplify their impact beyond their input and ensure the ability to continue having impact well into the future. As an organization, we want to have a balanced portfolio of work that ensures we can hire the best people, work on the most essential problems, and still have a large-scale impact even with the inherent unpredictability and “seasonality” of funding mechanisms. Transitions take time, funding cycles can be uncertain, global events (like COVID) heavily influence our ability to have impact, and sustainable business models and financing help us weather changes and continue supporting our partners.

Sustainability is easier to describe than achieve, but we pursue it every day as one of our core values. We intentionally plan with funders and partners for “what happens after the project,” we release code as open source for others to pick up, we document meticulously our technology, protocols, and learnings, and we devote immense time to capacity building. We want to have an impact that lasts and grows beyond our input to leave a better world than we found - that is what sustainability means at Everwell.

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