Why Mildmay builds for local ownership

For decades, Mildmay's approach to our international healthcare objectives has been guided by a simple principle: the real measure of success isn't how much money we have secured from donors, it's whether the services continue to serve the local community after international funding has stopped.

That principle has shaped every partnership we've built. We don't see ourselves as a grassroots movement or as saviours parachuting in with solutions. We're an institutional healthcare provider that aims to work within existing health systems, building capacity where need is high and specialist expertise is scarce. From the start, we build for local ownership.

What does local ownership look like in practice?

Mildmay has a long track record of handing over services to local partners, having successfully transitioned programmes in Tanzania, Rwanda, and Zimbabwe to local government or INGO leadership.

• In Uganda: When Mildmay first partnered with the Ugandan AIDS Commission to develop specialist HIV services, local governance was built in from day one. Mildmay Uganda opened in 1998, and the transition to an independent local trustee board in 2010 wasn't a sudden exit driven by funding shortfalls; it was the culmination of a long-term strategy. Today, Mildmay Uganda is entirely self-sustaining and has grown far larger in scope and reach than we in the UK ever envisaged.

• In Kenya: Most recently, at the end of 2024, Mildmay Kenya became fully independent, governed entirely by its own local trustee board.

• Our new Partner-led Small Project Fund, working in partnership with Mildmay Uganda, aims to support and strengthen local initiatives, rather than building parallel networks.

By operating within national health frameworks, our programmes maintain dual accountability: they meet the rigorous reporting standards of UK and international donors while remaining answerable to the communities they serve.

Why this matters: an inside view

A recent article in The Guardian by Mohammad Altaf Afridi confirms why this approach matters. After 25 years of managing millions of dollars in international aid, his conclusion is stark: donors systematically fund professionalised INGOs that can navigate complex paperwork, while overlooking local grassroots organisations.

Afridi tells of a bustling shopkeepers’ association electing its own leadership in an Islamabad market, which was off the radar of international donors. Instead, he argues, aid money often creates a "parallel universe" of professional groups that act more like corporate contractors than community representatives, accountable to London or Washington rather than the people on the ground.

His distinction between grassroots "civil society" and institutional "implementing partners" is crucial. Conflating the two causes organisations to chase shifting donor priorities rather than sustainably serving local communities.

Staying humble

The professionalised, English-language barrier that Afridi's article highlights remains a structural problem. Navigating international funding requires administrative capacity that disadvantages smaller, deeply-rooted local organisations. The risk that donor money might distort local priorities is a constant challenge.

Afridi suggests that sometimes the best thing international donors can do is leave genuine civil society alone to grow organically. That does not mean international funding is unimportant; charities like Mildmay rely on donor support to deliver essential healthcare programmes. The challenge is ensuring that support strengthens local systems and leadership rather than creating dependency. For Mildmay, this is a lesson in humility. It forces us to constantly ask: are we building lasting local infrastructure, or are we creating dependencies that will collapse when we leave?

The long-term success of Mildmay Uganda proves that a sustainable transition is possible. It also proves something else: that the model we've followed for years, integrating into health systems, building local governance from the start, planning for handover rather than perpetual dependence, is the model that works.

When a 25-year veteran of the international aid system concludes that much of what donors funded created dependencies rather than sustainability, we are happy to note that Mildmay's approach has always tried to be different. Ultimately, the true measure of success isn’t a well-written. fully-funded proposal - it is whether high-quality projects continue to serve the local community after international funding has ended.