Environmental, Social & Governance Briefs

Confessions of a Teenage Nonprofit

April 17, 2018

Nonprofits are like teenagers—they have difficult years, but with the right support, they can thrive and achieve great things in “adulthood.” The international nonprofit I co-founded, mothers2mothers (m2m), is now 16 years old, an awkward age for nonprofits, at least in the eyes of many donors. m2m employs HIV-positive women as community health workers. It started without much more than the conviction that, if trained, employed, and empowered, HIV-positive mothers could eliminate pediatric AIDS in Africa by acting as peer mentors to other women (we call them Mentor Mothers). The organization has grown from a start-up to a $20 million-plus organization operating across eight African countries.

Intrinsic to our model is paying the Mentor Mothers. My co-founder, Dr. Mitch Besser, and I firmly believed that no one feels valuable unless they are treated as if their time has value. We also saw the potential to economically empower women who might otherwise have been unable to earn a steady income. This was an enormous shift for countries that traditionally relied on women as a volunteer workforce. It was controversial and innovative, but as we demonstrated that it worked, more people started paying attention. 

First, we received funding from corporate partners like Johnson & Johnson—a steadfast supporter to this day—which not only funded our early efforts but guided us to have more effective monitoring and evaluation methodologies, key to demonstrating impact to our funders. Then, the U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) New Partnership Initiative provided grants for our first international expansion outside South Africa to Kenya, Zambia, and Rwanda in 2007 and 2008, starting a long-term relationship with USAID, which is still one of our major funders.

Those were heady days, but once we entered our “adolescence,” the dramatic growth in funding came to a stop.  No longer a startup, we weren’t as appealing to funders and it was increasingly difficult for any single funding partner to claim our success. Yet we were also not one of the big boys, like CARE and Save the Children, that carry a certain cache due to their size and widespread brand recognition. Donor interest in HIV was dropping and shifting into areas such as climate change and migrant crises. And so, although our impact numbers continued to improve and we achieved virtual elimination of mother-to-child transmission of HIV among our enrolled clients for the third consecutive year, the growth in funding that we had taken for granted plateaued. We were considered too big, and too successful, or funders thought we didn’t need them anymore.

We have been fortunate because our major funding hasn’t decreased, and we’ve taken deliberate steps to diversify our funding sources. And like other “adolescent” nonprofits, we have learned to do more with less, and in some cases it has made us better, more innovative, and more responsive.

We are also evolving our model to meet the changing nature of the HIV pandemic and the health crisis on the African continent—m2m Mentor Mothers now provide family-centered support for a range of related health and social issues. We are applying our peer mentorship approach to help adolescents make healthy choices and reduce the serious incidence of HIV/AIDS among that age group, reaching 220,000 adolescent girls and young women in 2016 alone. And we are making sure that children have an opportunity to thrive, not just survive, through early childhood development services that in 2016 benefited more than 14,000 children.

In 2016, m2m and its partners reached almost 2 million new clients—not just mothers and babies, but also children, adolescents, and men. Moreover, our model has empowerment and sustainability at its core. We currently employ around 1,600 HIV-positive women as Mentor Mothers, and we have partnered with governments and other nonprofits to spread the Mentor Mother Model and its benefits.

But there is so much more to do. The World Health Organization estimates that today there are 4.2 million too few healthcare workers in sub-Saharan Africa, a figure that will rise to 6.1 million by 2030. Mentor Mothers help fill that staffing gap, providing health education and support so that overstretched medical staff can focus on clinical care.  There are so many areas that the discerning funder could “own,” for example, mHealth systems to help retain women in care, innovative approaches to keeping adolescents healthy, and advocacy efforts to put community healthcare workers on the forefront of health system change. 

Unrestricted funding is the most critical of all. It delivers a number of benefits to organizations such as ours, including the ability to

• Leverage some large government and bilateral grants that don’t cover full costs (nothing is worse than turning down grants because we can’t afford to take them).
• Promote innovation and the kind of experimentation that leads to solutions (such as a family-centered club that allows mothers to bring their infants in for post-natal care, while they receive viral load tests and antiretroviral refills, as well as helping them access services for their older children, adolescents, and even male partners).
• Scale to reach more families.
• Invest in the research and development and vital infrastructure that will get us through these teenage years and onwards into adulthood and long term financial sustainability.  

Adolescent children continue to need guidance and support to achieve their full potential.  So do adolescent nonprofits. Small start-ups may be exciting to work with, but adolescent nonprofits have survived growing pains, demonstrated impact, and emerged stronger. The fact is, adolescent nonprofits can provide the ultimate in donor satisfaction and make wonderful partners. My advice is to find one that is doing work you admire and whose leadership you respect and stick with them through their journey to “adulthood.” Without funding partners, they could never have come this far. Now that they are proving themselves and achieving their mission, they need you more than ever.