Capacity building in Nepal*

There’s an old saying: “Give a man a fish, feed him for a day; teach a man to fish, feed him for a lifetime.” But do we believe this? Many health care providers sacrifice their time and money to provide medical aid to underserved populations in remote environments. But is this helpful? Underserved populations need more than just another doctor. Short-term medical aid, with the exception of disaster relief situations, is often resource intensive for relatively little impact on the target population. Treating one patient at a time, though it matters to that one person, is like pouring water into a leaky bucket without patching the holes, since so many others remain untreated and underserved. Such an approach is unsustainable. Public health measures are crucial to sustainable disease-prevention and keeping the water out of the bucket in the first place. However, for those who do get sick we need to find a way to patch the holes and build capacity for health care. Sustainability in health care is rising to the fore. Clinicians, educators, researchers, administrators and policy-makers are looking for ways to move beyond clinical care into capacity building. There’s a problem with the health care system’s capacity to meet the health needs of our domestic and international underserved populations, and capacity building is emerging as a core value in global health. That capacity building should indeed improve access to clinical care, but that does not necessarily mean the solution is for us to provide that care ourselves. Rather, we must address the question: How can we make a lasting contribution to the underserved populations we want to help? How can we help teach them to fish?