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[afro-nets] NGOs and health systems strengthening (or weakening)

What sounds to be obvious – nongovernmental organizations working in the field 
of international health cooperation support and strengthen health systems – is 
not taken for granted. NGOs, “if not careful and vigilant, can undermine the 
public sector and even the health system as a whole, by diverting health 
workers, managers and leaders into privatized operations that create parallel 
structures to government and that tend to worsen the isolation of communities 
from formal health systems (…)” This assessment is, at least, the starting 
point of the “NGO Code of Conduct for Health Systems Strengthening” first 
published in May 2008. The code intends to offer guidance on how international 
non-governmental organizations can work in host countries in a way that 
respects and supports the primacy of the government’s responsibility for 
organizing health system delivery.

A matter of course? Well, you can test it yourself, right now, if you like: How 
many of the following statements taken from the NGO code correspond with your 
organization’s standard?

1.      “In areas where trained personnel are scarce, we will make every effort 
to refrain from hiring health or managerial professional staff away from the 
public sector, thus depleting ministries and their clinical operations of 
talent and expertise.” (yes? no? not sure? not relevant for you?)
2.      “We commit to limiting pay and benefits inequity between expatriate and 
national, rural and urban, and ministry and NGO workers. We encourage 
compensation structures that provide incentives for rural service and disallow 
gender-related disparities.” (yes? no? not sure? not relevant for you?)
3.      “We recognize that management capacity in Ministries of Health is often 
limited. Rather than building parallel or circuitous structures around 
inadequate capacity, we commit to strengthening governments’ ability to operate 
effectively and efficiently.” (yes? no? not sure? not relevant for you?)
4.      “We strengthen the capacity of communities to take responsibility for 
and ownership of their health development, and to become partners with 
government in the health system, while holding governments accountable for 
their human rights obligations.” (yes? no? not sure? not relevant for you?)
5.      “We actively advocate with civil society, local institutions and donors 
for policies and programs that strengthen health systems overall.” (yes? no? 
not sure? not relevant for you?)
6.      “We commit to designing their activities and programs so that they 
reinforce primary health care, foster equity and community involvement, and are 
generally replicable and financially sustainable over time.” (yes? no? not 
sure? not relevant for you?)

So, are you happy with your score? 6 out of 6? Congratulations! But 
nevertheless, you might be interested to further discuss the task of 
contributing to building public health systems and doing no harm. The members 
of the MMI Network members will meet on 5th November in Amsterdam in a workshop 
on "Health systems strengthening", reflecting about the role of NGOs and of 
their particular organization in health systems strengthening.

Join us, if you like!

Thomas Schwarz,
Medicus Mundi International Network

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