I am increasingly frustrated by the short time frames imposed on global health projects by funders.

Donors & agencies want to see "impact" in 2-3 years, while everyone knows that ground realities might not even allow implementers to reach scale within such a short period.

To get any project going (research or service), it takes some months to get approvals, ethics, hiring of staff, setting up data systems, etc. Everyone under-estimates the time/effort it takes for just the start-up phase.

In some countries, national ethics approvals alone could take up to 1 year. But if we mentioned in this the grant proposal, it will likely never get funded!

Then comes the big task of reaching some coverage or scale to see the impact we are looking for. This takes time, especially if the project involves multiple geographies.

By the time the project is starting to reach some scale, everyone wants to see "impact"! There is little discussion on how much time is required before any impact is seen. This is rarely included in the "theory of change" or logic models by funders.

Prematurely looking for impact and not finding it, might then kill a perfectly good intervention, just because nobody has the patience to see it through. Funders move on to other big ideas; implementers and NGOs move on to where the next $$$ is; academics are on their next grant.

So, some of the major failures in global health (see: https://naturemicrobiologycommunity.nature.com/channels/303-journal-club/posts/51659-archive-of-failures-in-global-health) are more to do with not staying the course and prematurely killing an idea.

Would love to hear from others on this.

One clear issue with short-term projects is that there is virtually no time for learning and iteration of the model to achieve greater coverage or impact. In every large project, there are learnings that can and should be used to tweak the model. How does one do this in 2 years?

I am sure tons of time/effort are wasted on "no cost extensions" when everyone could have agreed upfront that the project will take longer and could have planned for it, from the start.

I don't have data to support this, but I suspect philanthropies and foundations are most likely to impose short-time frames and 'demand' impact.

I once got a 18-month grant and was asked to fill out an Excel spreadsheet which asked for 'how many lives would be saved' from the project (which was meant to demonstrate proof of concept)!

In short, everyone would agree that improving the health populations is a marathon, and not a sprint. But this understanding does not translate into how projects and grants are planned & funded!