The real infrastructure was never the money

A few weeks ago, I sat on a panel in a room full of women, and I have not quite been able to shake it since. It was not the cameras or the styling, though we all showed up. It was something silent. You could feel a question moving around the room, even though nobody said it out loud.

Am I doing enough? Is any of this actually working? Does it count?

I know that question intimately. I have asked it of myself more times than I can count, usually in the long stretches when nothing on the outside suggested anything was happening on the inside.

What surprised me was how familiar it felt in a much larger context. Because it is more or less the same question many of us keep asking about development on this continent. We have spent years, and no small amount of money, building things that were meant to change lives. Some of them did. A good number did not. And when I look honestly at the gap between the two, it rarely comes down to the size of the cheque.

Anyone who has worked in health or technology in Africa knows the phrase “the graveyard of pilots”. It is where good ideas go to rest. A promising programme is designed, funded, launched with significant energy, and celebrated. Then the funding window closes, the partner moves on, and within a year or two the thing simply stops. Not because it was a bad idea. Often it was a very good one. It stops because it was built as a project rather than as part of a system, and projects, by definition, end.

“When a partner takes the time to understand a ministry’s actual constraints instead of arriving with a finished solution, trust forms, and trust is what carries a programme through the hard middle years.”

I have come to believe that the most important infrastructure we build is not the platform, the clinic, or the app. It is the relationships underneath all of it. The trust between a ministry and the partner it is working with. The sense of ownership a community feels over something that was built with them rather than delivered to them. The institutional memory that stays behind long after the launch event is forgotten. That is the infrastructure that decides whether anything lasts, and it is the part we are most tempted to skip, because it is slow and it does not photograph well.

Here is what I have learned, mostly by getting it wrong before I got it right. The systems that take root are the ones built from day one with the people who will have to live with them. That means government at the table as a co-creator, not a signatory brought in at the end to bless a finished design. It means young people helping shape the thing that is meant to serve them, because in a country whose median age is under twenty, a solution designed without them is already out of date. And it means designing for the day the donor leaves, from the very first meeting, rather than treating sustainability as something we will figure out later.

None of this is a criticism of how we have worked. We built the way the incentives asked us to build. Funding cycles are short, results are due quickly, and everyone involved genuinely wants to show that the money moved and the numbers improved. I understand that pressure well. But I think we are actually ready for a different conversation, one that measures success not by what we can launch, but by what still stands and still works after we have gone.

That shift is less technical than it sounds. It is really about how we treat one another. When a partner takes the time to understand a ministry’s actual constraints instead of arriving with a finished solution, trust forms, and trust is what carries a programme through the hard middle years. When we build something a government can genuinely own, operate, and eventually improve without us, we have not lost influence. We have created something that outlasts our involvement, which was supposed to be the point all along.

I keep returning to a simple idea from that room full of women. Someone spoke about the difference between giving to gain and giving to genuinely build something with another person and how easy it is to confuse the two. It struck me as true far beyond that setting. So much of what we call ‘partnership’ is really a transaction wearing ‘partnership’s’ clothes. Real partnership is slower and more generous. It asks what the other side actually needs, it shares credit rather than competing for it, and it is willing to be a co-author instead of insisting on being the author. Those are not soft skills. On this continent, they are the difference between a pilot and a system.

I do not think any of us needs another lecture on what is broken. We can all see it. What I find myself hopeful about is how much of the solution is already in our hands and how much of it is relational rather than financial. The capital matters; of course it does. But capital has never been the scarce resource in the way we tell ourselves it is. The scarce resource is patience, humility, and the willingness to build with people rather than for them.

The real infrastructure was never the money. It was always the people. The sooner we build as though we believe that, the more of our work will still be standing long after we have moved on to the next thing.

Ota Akhigbe is Director of Partnerships and Programmes at eHealth Africa. She writes on partnerships, institutions, and the future of health financing in Africa.