The Distance Between a Room and a Decision
I founded Orpesi Collective because I have lived this problem, not because I read about it.
Four years ago, I worked with two donors who made a choice that remains less common than it should be. They did not arrive with a predetermined answer. They funded a process with enough trust to allow learning, and enough discipline to demand a serious outcome. The mandate was clear: go into the market, understand what was actually needed, engage the full ecosystem, and build a sustainable model from what emerged.
My team and I took that seriously. Over two years, we engaged funders, government actors, private sector partners, young people, health practitioners, researchers, evaluators, and organizations working close to the realities we were trying to understand. We used a human-centered design approach to listen carefully, test assumptions, and gather what stakeholders actually needed, rather than what the sector assumed they needed.
That process produced an investment case, a three-year strategy, and four viable business model options. The approach was unusual, and it worked. It worked because the donors were willing to fund the conditions for learning, not only the outputs. They trusted the process long enough to let it produce something real.
That experience stayed with me. It shaped how I think about funding, institutional resilience, and the distance between good intentions and decisions that change the trajectory of an organization. It also shaped what Orpesi is now being built to do.
The reason I am writing this now is that recent conversations about financing, localization, and sustainable development have made it difficult to stay quiet. Across conferences, published reflections, and sector convenings, the language has shifted in the right direction. The intent, in many rooms, feels genuine. Local leadership is no longer being treated as a side conversation. Equitable partnership is now part of the mainstream vocabulary. There is growing recognition that development architecture cannot remain sustainable if the organizations closest to the work remain structurally underfunded.
The distance between that intent and a decision that changes the trajectory of a local institution, however, remains significant. Naming that distance honestly is what this piece is about.
Across this series, I have tried to name what is still too often left unsaid. The money exists, but the path to it does not. The back-office burden is structural, not incidental. Outcomes-based financing has the right theory but often the wrong design. The old architecture has fractured and rebuilding it along the same lines will produce the same results.
The series has been building toward a simple and uncomfortable truth: the tools exist, the models exist, and the locally led organizations exist. What remains missing is not innovation. It is the willingness, from every actor in the ecosystem, to take responsibility for closing the gap between what is said and what is funded.
There are two sides to this coin, and both matter.
Funders who are serious about locally led development need to stop designing systems that make it structurally difficult to achieve. Due diligence processes built for large international actors, grant cycles that leave little room for organizational learning, and reporting requirements that consume the capacity they claim to be strengthening are not neutral features of the system. They are design choices, and they can be changed.
Flexibility and trust are not soft virtues. They are strategic decisions. The donors in my own experience made those decisions deliberately. They did not abandon accountability. They created the conditions for better accountability by allowing the work to be shaped by evidence, engagement, and learning before locking it into a fixed model. That is not charity. It is strategy.
Locally led organizations also have work to do, although that work must be understood within the reality of unequal power and constrained resources. The strongest case for a different funding architecture is not only a well-worded proposal or a powerful critique of the current system. It is also an organization that has built its own systems, documented its own outcomes, understood its cost structure, and arrived at the table with evidence that makes the argument difficult to ignore.
Advocating for a fairer system is legitimate and necessary. Building the institutional discipline to absorb and manage direct investment is equally important. One cannot replace the other. The sector needs more funders willing to change how they invest, and more local organizations supported to build the systems, evidence, and confidence required to receive and shape that investment on their own terms.
Evaluators, learning partners, and storytellers also carry a responsibility that is rarely named directly. The evidence of what works in locally led development exists. The stories of organizations that have built something durable exist. What remains thin is rigorous, accessible, and emotionally resonant documentation of those lessons at the scale needed to shift funder behaviour. Evidence does not always move people on its own. Evidence told well can. That is a craft, and it deserves investment.
Orpesi sits in the middle of this deliberately. Our work is not about helping locally led organizations fit into a system that was not built for them. It is about supporting the redesign of how strategy, institutional strength, learning, and financing come together so that these organizations can deliver, grow, and be trusted at scale. The conviction behind that work is clear: locally led organizations should not have to choose between doing the work and becoming fundable. Those two things should be the same project.
We are still in the early stages of building this, but the direction is not in question.
The donors in my story chose flexibility over control. The organization inside that process did not squander it. Something was built that the ecosystem valued enough to absorb and sustain. That outcome was not accidental. It required a certain kind of funder, a certain kind of team, and a process that took the question seriously before reaching for an answer.
None of those conditions are impossible. They are choices. The question this series has been asking, from the first piece to this final one, is who is willing to make them.
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This is the final piece in Orpesi's series on institutional resilience, locally led development, and the financing architecture that either enables or prevents both. To continue this conversation, reach Orpesi at info@orpesicollective.org
Global Conferences Are Talking About Local Leadership. Where Is the Direct Investment?
In May 2026, a particularly full week of international development convenings unfolded across several global spaces. The World Health Assembly was taking place in Geneva, the Global Partnerships Conference was underway in London, and several other forums were happening in parallel across the sector. For those of us who follow international development closely, it was a week filled with updates, session summaries, reflections, photographs of panels, and glimpses of side conversations. I followed from a distance, taking in the themes, the language, and the signals emerging about the future of development. Much of it was genuinely encouraging, particularly the growing consensus around local actors, equitable partnerships, and the need to rethink what a sustainable development architecture should look like going forward.
At the same time, I kept returning to a question I could not quite set aside.
When we consider the full cost of a week like this one, the flights, the venues, the staff time, the side events, the publications timed to coincide with each convening, a different kind of calculation becomes possible. The relationships formed in those rooms are real, the conversations matter, and commitments made at that level can move significant resources. That is precisely what makes the question worth asking: how much of the energy concentrated in those rooms this week translated directly into investment in a local organization that is trying to build itself into something durable?
The Global Partnerships Conference included a session framing local actors as designers of development's future and asking how traditional institutions could better support that vision. It is the right question. What I would love to see alongside it is a different kind of session, one where the people present make live, named commitments to specific local organizations, where the conversation moves from "how do we support local leadership in principle" to "here is what we are funding, who we are funding directly, and what we are trusting them to build." Those rooms carry that authority. The format does not always create space to use it.
There is also something worth sitting with regarding the sheer volume of simultaneous events. Each convening has its own logic and its own constituency, and I understand why the ecosystem looks the way it does. For local organizations working in the systems these conferences discuss, though, the fragmentation creates real costs. Tracking multiple agendas, preparing for multiple engagement opportunities, synthesizing multiple sets of signals about where priorities are moving: all of that absorbs capacity that smaller organizations cannot easily spare. The organizations with the least slack carry the highest cost of a sector that convenes itself frequently and across many rooms.
What I keep returning to is that there is genuine momentum right now. The language has shifted, the intent feels real, and weeks like this one are part of how that momentum builds. The question I am holding is how to close the distance between a commitment made in a conference room and a decision that changes the trajectory of a local institution in Nairobi, or Dhaka, or Kampala six months from now. That closing of distance requires fewer intermediary steps, longer funding horizons, more direct relationships between investors and institutions, and a willingness to fund the infrastructure of an organization, its governance, its financial systems, its ability to learn and adapt, rather than only the programs it delivers.
The conversations happening this week are the right conversations. What I am watching for now is how the commitments that emerged from them show up in the partnership agreements and budgets that follow.
Mental Health Is Already in Your Programs. Most Organizations Just Haven't Looked
A reflection on mental health, the silence we inherited, and the work that comes next.
I don't know where to start! That was my answer.
A friend, and a colleague I respect deeply in this industry, looked at me across the table and asked what I thought of mental health, and whether it was a topic I wanted to explore through my organization. I had walked in carrying a story I had not planned to tell. A few weeks before, a parent had shared in our school’s WhatsApp group that a friend’s daughter had taken her own life. The girl was young. She was not unwell in any of the ways we have been taught to recognize. The people who had loved her had no warning, no pattern to point at, no language ready for what had just happened to them.
It turned out my friend knew this family. So I told her about the girl first, before I answered her question, and I told her about the conversation I sat my own children down for the next morning. Because of where I have spent my career, in reproductive health, I do not believe in withholding hard topics from children when they are old enough to ask hard questions. I asked them what they understood about suicide. I asked them whether they had ever felt close to a place they could not return from on their own. I listened more than I spoke.
Then I answered her. I told her I would love to do more in this space, but I did not know where to start. And as soon as the words were out, I wondered whether that was a strategic thing for someone in my position to say. Strategic people are supposed to walk in with a thesis, an entry point, a positioning statement. I think the truth, especially in mental health, is that the people who pretend to know exactly where to start are the ones we should be most cautious about.
What follows is not a strategy memo. It is me thinking out loud, on the page, about a problem I am no longer able to set down.
What I grew up believing
When I was growing up, suicide existed. It was almost certainly underreported, but the more important fact is that it was almost never discussed. There was an embarrassment around it, a shame that landed on the family of the person who had died. People did not say the word out loud. They said “she passed” or “he was sick for a long time,” and the rest was implied through silence. What that silence taught a generation of us is that mental anguish is a private failure. That feeling unwell in your mind is something you manage in the dark, on your own, until you cannot anymore. That asking for help is the same as admitting to a flaw in character. We have moved less far from that than we like to believe.
What the numbers actually say
The World Health Organization estimates that close to one billion people globally live with a mental health condition. In low- and middle-income countries, between seventy and eighty five percent of those who need care do not receive it. Across much of sub-Saharan Africa, there are fewer than one psychiatrist per one hundred thousand people, with some countries reporting extremely limited specialist capacity. Suicide remains among the leading causes of death for young people aged fifteen to twenty-nine globally, with growing concern about rising mental distress among adolescent girls and young women in several contexts.
The treatment gap is the headline. The gap underneath the gap is harder to capture in a statistic. It is the distance between the language we use for mental distress and the languages people speak at home. It is the distance between formal services and the people who would never walk into them. It is the distance between a clinical diagnosis and a young woman who simply could not see a way through her week.
What has already been tried
It would be unfair, and inaccurate, to pretend that nothing has been done.
The WHO’s mhGAP programme has spent more than a decade translating specialist mental health knowledge into protocols that non-specialists, including primary care nurses and community workers, can use. The Friendship Bench in Zimbabwe, designed by Dixon Chibanda, trained grandmothers to deliver problem-solving therapy on wooden benches outside clinics, and produced outcomes for depression and anxiety that rivalled clinical care. StrongMinds in Uganda has scaled group interpersonal therapy through lay counsellors. BasicNeeds has worked across Africa and Asia to integrate mental health with livelihoods and rights. The Lancet Commission on Global Mental Health put serious intellectual weight behind reframing mental health as a development priority rather than a niche specialty.
These are real efforts, designed by serious people, and many of them work. But they sit inside a global ecosystem that still treats mental health as a vertical, a side programme, a thing that earns a paragraph in a national health plan and less than two percent of the health budget. They have not been brought to the scale the problem demands. And they are not yet woven into the systems that touch most people’s lives most often: schools, workplaces, primary care, social protection, faith communities, and families.
Where the real gaps are
If you spend any time looking honestly at this field, three gaps come into view. The first is a workforce gap. There will never be enough psychiatrists in Africa and Asia to meet the need through specialist care alone. This is not a temporary shortage. It is a structural reality. It means any serious mental health response has to be built around task-shifting, lay providers, and trusted community figures, with specialists held in reserve for the most acute cases.
The second is a systems gap. Mental health is treated as a thing that lives in clinics, when in fact it shows up in classrooms, in employment offices, in police stations, in maternal health visits, in refugee camps, and in almost every social service interaction a person has. The systems that touch people are not equipped to recognize mental distress, let alone respond to it. Teachers are not trained. Frontline health workers are not trained. Managers are not trained. Parents, like me, are mostly not trained.
The third is a conversation gap. Even if we built the workforce and re-engineered the systems, we would still be left with the silence I grew up inside. The shame. The suspicion that something is wrong with you if you cannot manage on your own. The belief that the people in your life would think less of you if they knew. This gap is cultural, and it does not close from the top.
Why a human-centered approach is not optional
A great deal of what has been tried in mental health, across Africa and Asia and elsewhere, has fallen short for a single reason. It was designed without enough listening. Programmes get built around a clinical category, a screening tool validated in another context, a manual translated into a local language but not adapted to a local logic. They are launched with the assumption that if we hold a community sensitization meeting and put up a poster, people will walk in. Most of the time, people do not. And when we ask why, we discover that the architecture of the programme: who delivers it, where it is delivered, what it is called, how it is paid for, was decided in a room that did not include the people the programme was meant to serve.
A human-centered approach starts in a different place. It begins with the question of what mental distress actually looks like in this community, in this school, in this workplace, and in this family. It asks who people already turn to when they are unwell, and whether those people, the aunt, the pastor, the form teacher, the WhatsApp group, the grandmother on the bench, can be supported rather than replaced. It treats stigma not as a target to be reduced through messaging but as a design constraint to be engineered around.
Designed this way, mental health programmes look less like clinics and more like seams in everyday life. A maternal health visit that includes a real conversation about how a mother is sleeping and feeling. A school where teachers are supported to notice the child who has gone quiet. A workplace where managers can name what they are seeing without reaching for a referral form. A WhatsApp group where a parent can share the news of a death by suicide and receive something other than silence.
Why mental health has to be an intersectoral conversation
This is where I find myself returning to my reproductive health background. We learned, slowly and at significant cost, that reproductive health could not be solved as a vertical. The most consequential work happened where reproductive health intersected with education, with adolescent development, with gender, with livelihoods, with rights, and with the way young people moved through the systems around them. The technical interventions were necessary but not sufficient. The integration was where the change actually lived.
Mental health is the same shape of problem. Treating it as a stand-alone health issue makes it harder, not easier, to reach the people who need it. The integration points are everywhere if we are willing to look. Adolescent girls’ programmes that already operate across Africa and Asia are a natural home. Primary care platforms, where pregnant women and new mothers are already showing up, are a natural home. School systems are a natural home. Workplace wellness, in formal sectors and increasingly in informal ones, is a natural home. Social protection programmes, faith institutions, and community-based organizations are all natural homes.
An intersectoral approach does not mean adding mental health to everyone’s job. It means recognizing that mental health is already in everyone’s work, often unrecognized, and helping the systems around it become competent at noticing and responding. It means designing partnerships across ministries, across sectors, and across the artificial boundary between health and not-health.
So what, for Orpesi
This is the question we ask ourselves at Orpesi about everything we work on. So what. Why does it matter that we, specifically, take this on. What do we add that is not already being added.
What I have come to believe, over the last few weeks of thinking about this, is that the gap in mental health is not primarily a knowledge gap. The evidence base is real. The models exist. The policy frameworks are written. The gap is a translation gap. It is the distance between what is known in academic and donor circles and what is actually built and sustained inside organizations on the ground.
That is the work Orpesi was set up to do. Designing programmes that fit the contexts they will run in. Strengthening the institutions that will carry those programmes after the funding cycle ends. Turning what has been learned into what others can act on. We do not need to become a mental health implementer. We need to help the organizations we already work with, in adolescent health, in education, in livelihoods, in social protection, in primary care, recognize the mental health that is already inside their work and respond to it well.
The call to action is therefore not for Orpesi alone. It is for funders, for governments, for INGOs, and for the locally led organizations that already serve the communities where mental distress is rising. Stop treating mental health as a separate problem awaiting a separate solution. Bring it into the work you are already doing, the people you already trust, the systems you already hold. Do that with the discipline of listening first, designing with people rather than for them, and staying long enough to see whether what was built actually held.
Where I am starting
I told my friend I did not know where to start. I think I was wrong about that, in a small way. The starting place was the conversation we were having. The starting place was the conversation I had with my children. The starting place is every WhatsApp group, every staff meeting, every school assembly, every clinic waiting room where someone has the chance to break the silence and chooses to.
I do not believe Orpesi will solve mental health. I do not believe anyone will. But I do believe that if we apply the way we already work, listening hard, designing with rather than for, building institutions that can carry what is started, and translating what is learned into what others can use, to a problem this big and this human, we will be useful. And that, in the end, is a strategic thing to say.