Ground-Up Interventions and the Delivery of International Aid

Katie Nolan, Associate Editor

Constant funding issues and the never-ending logistical challenges of implementing interventions are serious constraints when working on international community development projects. Perhaps underestimated, implementation problems commonly occur at the ground level—where plans are supposed to come together to create solutions. In internationally-focused public health interventions aimed at reducing common preventable ailments, these issues can be exacerbated. Plans to improve the health of low-income community-dwellers often do not account for the challenges that are faced due to cultural and social differences. Inefficiencies of reconstruction efforts in post-earthquake Haiti[1] and post-tsunami Indonesia[2] are a couple of the many examples of aid attempts run by non-governmental organizations (NGOs) that have proved unfit due to incongruencies in the relationship between target communities and aid organizations.

Lower class communities in low-income countries’ already harbor some distrust of their governments, due to historic conditions that have fostered social immobility and injustice. In low-income democratic nations, including many Latin American nations, citizens experience a cyclical pattern of attention followed by ignorance from their governments. When elections arise, politicians and candidates begin their campaigns within the underdeveloped and disenfranchised communities. They make promises and cash in on votes; yet change rarely follows. This dynamic may foster the mistrust felt towards western aid, particularly in the form of NGO outreach.

Government distrust, along with failures of NGOs to accomplish their goals, often makes it more difficult for foreign aid to positively impact rightfully weary and cautious communities. With the increasing popularity of international volunteering, we need to question the amount of good we can do as outsiders visiting a community. Community involvement needs to be emphasized, not only in order to build trust between aid workers and community members, but also to ensure the continuation of the success of aid programs. Many public health interventions neglect the importance of sustainability in projects. Often, latrines and water reservoirs are left unmaintained and are slowly destructed until unoperational, spontaneous educational outreach fails to impress long-lasting healthful habits on students, and communities are left where they began. Supplies are needed to maintain prevent degradation of structures, and educational campaigns can leave students with unfostered ideas and demands that can’t be sustained once the education has also ceased. These are key factors of an intervention that cannot be ignored for the sake of “ethical tourism.”

Although best intentions are certainly at heart when an aid project is commenced, there is too commonly a lack of emphasis on community involvement and forethought about post-intervention sustainability. A greater emphasis on ground-up implementation of aid projects needs to be prioritized. By involving community members in the planning stages of the intervention, we can assure that we are initially focusing on the correct issue—that interventions will not be half-heartedly adopted because they are a secondary concern of a community. By getting community members involved in these projects during the intervention stage, we can also be assured that there will be a degree of cooperation and trust from the community. By educating community members on how to maintain programs or structures, deciding who is responsible to do so, and by providing the resources to do so, we can ensure that there is accountability for the success of the intervention felt in the community. Not only would bringing in help from communities aid in the implementation of projects, but it will also empower disenfranchised communities.

When considering the overall impact of a public health intervention, we need to be able to see it through the initial impact. We need to consider the impact that a program past generations, both through preventative health for individuals, and by promoting the social and political health of the community. We must avoid the feeling of “white man’s burden” and the compulsion to write off the knowledge, intelligence and worth of impoverished communities, as cooperation from communities during interventions is crucial. By incorporating a sense of community-inclusion in interventions, we can stand to build trust, ensure lasting results, and empower community members.


Katie is a senior at NYU Steinhardt majoring in Public Health and minoring in Public Policy and Management. She is interested in global health and service coordination. Contact her at


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