Forging Sustainable Programs Through Strengthening Local Leadership: A Case Study of Local-International Collaboration Among Community Health Non-Profits Working in San Ramón, Nicaragua

Successful global health promotion requires government leadership, foreign aid, and collaboration with non-profits and community-based organizations of varying size, legitimacy and organizational structure.  These small organizations can hinder or potentiate global health goals on a local level, but are often crippled by poor communication between international and local partners.  The rural, coffee farming communities of San Ramón have the highest density of NGOs in Nicaragua, and provide a laboratory for studying non-profit sustainability.  This presentation analyzes the local-global collaborations among non-profits working in San Ramón that have developed successful, lasting international partnerships. The authors (the local and international director of a health promotion non-profit based in San Ramón) interviewed the local and international directors of 5 organizations about strategies and barriers to achieving sustainability through empowering local leadership.  Barriers included differences in background leading to misunderstandings, perceived cultural imperialism, burn-out, lack of sustainable local funding sources, and international boards with decision-making processes disengaged from local leadership.  Strategies to increase cross-cultural understanding and train independent, effective local leaders will be discussed from both local and international perspectives. A stepwise approach to building sustainable programs with strong local leadership will be outlined, with attention to contextual factors such as organizational structure and funding strategies.  Finally, four models for leadership sharing will be discussed – the fund abroad and lead local approach; merging programs into existing local services; the local management and outside leadership approach; and the integrative shared leadership model, in which expatriates make long-term familial and professional ties with local communities.