(Photo by iStock/Suljo)
Last year at Skoll, I went for an early morning run along the Thames with a founder who had won it all. Every award. Every fellowship. She’d graced every stage. And she was exhausted. Not so much from the late-night cocktails in an ancient, low-lit library the night before, but the world she herself had created. The world of a development darling.
As we started ducking willows and streaking past sketchy houseboats, she started venting. “At this point,” she said, “it’s past 10, and I can feel the 200 emails just breeding in my inbox. I’ve been standing there sipping the same lukewarm glass of Riesling for the better part of two hours. And it happens. I get cornered, and I can see the question coming from a million miles away ‘So, what’s your vision for scale?’ Rather than roll my eyes, I just let the talking points spool. I give him what he wants: I say the magic words: scale, RCT, and AI.”
In Oxford, those are the magic words: “AI, RCT, and scale.” They make a donor’s pupils dilate. Toss in “government adoption” like a sprig of rosemary, and suddenly you’re very interesting. The formula works, but everyone knows it’s theater—the preferred performance we pretend leads to impact.
But it’s Oxford, you gotta play the game. They say you don’t come to Skoll to scare the horses. But Paul Farmer, for all his grace and gentleness, loved to grab the gate and give it a good hard shake. Bringing Farmer’s ghost into Skoll means scaring those locked in their sanctified paddock, saying things that might make the room shift in discomfort, questioning conversations about sustainability, scale, and why we ask the poor to settle for less.
Imagining Otherwise
Imagine a world where, instead of playing games at Skoll, or Davos, or UNGA, the founder sits across from a donor and says, “Here’s the budget. Here’s the strategy. Here are the KPIs for the next 3 years. It works out to roughly $2 million USD. Do you want to underwrite 10 percent of this every year for 3 years—unrestricted?” Not a project. Not a pilot. But rather a stake in the ground.
And $2 million is really all you need. It’s not some magic made-up number. The only reason a reliable NGO that serves a million people would need more than a $2 million budget is because a donor wants to give it to them. And if they don’t take it, someone else will.
If you can build a focused, three‑year strategy with a real budget and a handful of sharp, honest KPIs—you don’t need to fill out 200 grant applications and chase 100 donors. You only need 20 people and institutions who believe in you and the vision enough to carry 10 percent each.
It’s not scale. But it’s sanity.
And imagine a world where you, as a founder or CEO, don’t have to fundraise all day, every day, because you built a fundraising strategy that guarantees the necessary annual dollar amount needed to achieve the organizational goals for three to five years, which in turn would allow you to focus on the actual work, rather than fundraising for the work.
The Problem Is Us
The uncomfortable truth is that the reason this world is imaginary isn’t donors. It’s us, all the founders and the CEOs, that keep selling the dream of scale. We’re the ones touting “national adoption by 2030” in our theory of change. We promise cost-per-beneficiary numbers that look like they were calculated by an actuary with a drinking problem. We drink the Kool‑Aid because we’re terrified that if we don’t, the money will go somewhere else.
The truth is that none of this is really “sustainable,” and it’s almost certainly not going to “scale.” But you do the work anyway. This is about acts of service. You do this because no one else will, because once you've actually seen the problem you can't un‑see it. People don’t become founders so they can swan around UNGA making small talk and searching for the last almond croissant, they do it because kids are dying of diarrhea and mothers are bleeding out from eclampsia. Everyone loves to gripe about donors, but it’s the founders and CEOs who keep promising scale, who keep drinking the Kool‑Aid. This isn’t a donor problem. It’s a doer problem.
This is the long defeat, a phrase Paul Farmer borrowed from Tolkien, who took it from the Bible. You’re fighting not because you think you can win, but because it’s the right thing to do. You can’t look away. And the goal is not to win, or defeat poverty, it’s to bring people along, and inspire them to fight the long defeat too.
Paul Farmer looked at a human being, understood the obligation, and then bent money, logistics, and politics until reality got closer to what justice required. Cost per beneficiary, in that frame, isn’t rigor. It’s a failure of imagination—the moment you accept that the only lives that count are the ones that are cheap.
The long defeat isn’t about giving up on impact; it’s about dropping the pretense that the work will neatly “pay for itself” or glide into government adoption.
Don’t look at the work from a cost-per-beneficiary standpoint, look at the work from equity of access, or even better, an equity of outcomes standpoint. That’s the only real indicator: I have kids, are the kids in this village getting access to the same vaccines my kids have access to?
That’s the only indicator.
Everyone loves to complain about donors. And a lot of that is earned—short horizons, unnecessarily forensic due diligence, the fetish for novelty. But donors didn’t invent the cult of scale on their own. Doers say, “Yes, we can go national in five years,” when we know that what we can honestly do is make three districts radically, irreversibly better—and then encourage the state to steal shamelessly from the model. We put “sustainable” in every other paragraph when we know full well that someone, somewhere, will have to keep paying salaries and supervision as long as we expect pregnant women to have the same level of care our wives did, and children on the island of Komodo to get rotavirus vaccines the way our daughters did.
Paul Farmer’s cardinal sin was not that he ignored money. He raised oceans of it. His heresy was that he refused to let cost‑effectiveness be the outer boundary of his moral imagination. He treated “What’s the cheapest way to do the minimum?” as the wrong question. The right question was “What if it was your daughter? What if it were your son?”
Then you figure out how to fund that, piece by piece, forever if you have to.
Embracing the Long Defeat
The long defeat doesn’t mean we abandon discipline. You still need detailed budgets where you can explain the price of soap, KPIs that mean something, and strategies that don’t burn your team out.
Today, the 1000 Days Fund works intentionally across the province of East Nusa Tenggara, (think Komodo), home to 1.4 million women of reproductive age, 700,000 children under 5 and 54,000 community health workers. These numbers are on par with Liberia. The projected budget for 2027 is $1.8 million USD. And 1000 Days Fund delivers.
But a donor will read this and say, “Yeah, but what’s your vision for scale?” To which I would respond, “Name me one NGO in the last 20 years that has scaled the way its donors prophesized."
I’ve done it a few times, asked a donor to give me the name of an organization that has truly scaled in the mythic way we all romanticize—government payer, national coverage, boring budget‑line‑items. Their eyes drift toward the ceiling as I wait for the inevitable, “Well… it’s complicated.”
And it is complicated.
Scale is something donors love to talk about; government as payer is something they purport to be perpetually on the horizon. But it’s the Emperor’s New Clothes. It’s not going to happen. We’ve been waiting 40 years and it hasn’t happened. If you spent 40 years failing to do the thing you said you would do, don’t you think, in all your grace and wisdom, you would try something different? But you don’t. You just do the trendy thing which is sell yourself the idea of scale.
If you were smart you would consider seeding the next generation of local founders—the ones who can push the government’s hand through credibility and proximity. That’s what leverage looks like. Leverage is scale on fire. Scale is one darling NGO chasing Bigfoot. Leverage is a dozen $2 million USD NGOs all fighting for the same thing, the formalization of community health workers in Indonesia, for example.
But we don’t have these conversations. We don’t want to scare the horses.
The harsh reality is that we’re chasing ghosts. The government as the payer is a myth, now more than ever. Scale as it is being sold right now is a myth. The mythical handover to government funding remains perpetually on the horizon, always promised but never delivered. Rather than acknowledging this reality, the sector continues to pursue ever-larger budgets that distance organizations from the communities they sought out to serve.
Scale Is the Responsibility of the State
In health and development, only the state can truly scale. NGOs can prototype, de‑risk, even deliver beautifully, but only the state can convert innovation into everyday service delivery. The state is the only actor with the fiscal architecture, mandate, and legitimacy to transform pilots and programs into public goods. But the state is not going to absorb a $20 million USD budget.
If the state knows an organization is running on $20 million and providing a service like school lunches or health care for free, the government would be acting against its own interests to absorb that budget. Until donors accompany doers to the government offices and see behind the curtain, we’ll continue to sell the myth every year in Oxford. And if the state isn’t ready, for whatever reason—weak governance, corruption, sharp inequality or the hard facts of archipelagic geography and infrastructure—then the organization fueled by righteous indignation and dedicated to ending decades of abandon and neglect can’t just pick up and move to Sweden. They have to stay and fight the long defeat.
The $2 Million Thesis
Imagine if an organization, instead of chasing its next zero, simply said: “We’ve done the math. We know the price of soap. Two million dollars a year is enough.”
This isn’t moral math, it’s simply easy. Put simply, if you’re running an organization with a budget north of $2 million, you’ve got an obligation beyond your own growth curve. The real mark of leadership isn’t just about raising more or scaling, it’s about using your position and reputation to pull others up. Start writing checks out of your operating budget and seed the most promising smaller orgs you can find. Then put your name and reputation to work lighting their path, opening doors, and making sure the next generation gets further, faster. That’s how you build an ecosystem. Anything else is just posturing.
More importantly, if you can find 20 donors to cover 10 percent of your budget with multiyear unrestricted funding, you can do the work, you don’t have to chase money and schmooze at UNGA. You can just do the work. That’s why $2 million is the perfect number. For some orgs, it might be $5 million. But the founder has to ask themselves this question: When was the last time I was in the field? Have I lost my edge? How close to lukewarm is this Riesling?
Every dollar above that line would go toward seed funding local organizations—the ones institutional donors admit are “too expensive" to do the due diligence on and “too early” or “too risky” to take to committee. Instead of a $20 million juggernaut, you build a network of $2 million ones—each competent, rooted, and context‑aware.
Over time, what emerges isn’t a network of unicorns, but an ecosystem of healthy organizations Paul Farmer would be proud of. Together, they embody something that looks a lot like actual systems change: distributed, resilient, and capable of lasting without being dependent on the charisma of any single founder.
The health sectors of places like Komodo, East Timor, and West Papua don’t need another glossy unicorn with a keynote slot at Davos. They need a coalition of $2 million founders and CEOs who can sit in sweltering heat and argue for why community health workers deserve a line item in the district budget.
When the run ended that morning, and we stood with our hands on our hips in the hotel parking lot, I asked the question that had been smoldering the whole time.
“So, what happened,” I said. “With the donor. The one you fed the line about scale and the RCT and AI.”
She blinked once. A pirate’s smile appeared. “Oh, he lapped it up,” she said. “Loved every word. Said that as soon as he got back to Chicago, he would suggest to his committee with a $10 million grant.”
Then she winked like an actress stepping offstage and disappeared into the hotel, ready to perform development’s most enduring illusion: that chasing scale is the same thing as fighting the long defeat.
Later that day a donor listened to the whole idea of raising enough unrestricted funding to sufficiency and seed an ecosystem, before finishing his coffee and ending the meeting by shaking his head and straightening his tie, “Gutsiest move I ever saw, man.”
“Zack,” he said as he stuffed his notebook away in his leather attaché, “I gotta tell you this, you know, you’re a lot like black licorice. Not a lot of people like black licorice, but the people who do, really like it.”
Which is, among other things, a pretty good name for an NGO.
Read more stories by Zack Petersen.