Role of NGOs in Health System Strengtheningby Francis Ohanyido
Let me recall that Dr Gro Harlem Brundtland, a former World Health Organisation (WHO) chief in her paper "Towards a strategic agenda for the WHO secretariat", a Statement to the 105th session of the Executive Board, January 2000, specifically said :
“We are dealing with the prime public health concerns of our time. We are focusing on conditions with a major impact on the poor and disadvantaged […] and we are working alongside a broad range of partners, maximizing what we can achieve together”.
This statement is very apt, since it states the NEED for all stakeholders to be part of a coalition of the willing to reverse the unacceptable trends in health indices of health systems, especially the low-income ones. It is worthy of note that in discussing the roles of Nongovernmental organisations (NGOs) in strengthening the health system.
One particular fact that I have noticed quite frequently around discussions on NGOs is the tendency towards mixing up various bilateral bodies and Donor-Funded Projects (DFPs) with NGOs. In some cases, some people tend to discuss these NGOs in abstracted reference as purely foreign, thereby forgetting that there are also local NGOs (LNGOs) in most countries of the world working alongside the international NGOs (INGOs). For this reason if we can have a good handle on this discussion by first defining NGOs and Health System Strengthening.
What is an NGO?
I find this definition of NGO very agreeable by virtue of the ambit of its reach;
“A non-governmental organization (NGO) is any non-profit, voluntary citizens' group which is organized on a local, national or international level. Task-oriented and driven by people with a common interest, NGOs perform a variety of service and humanitarian functions, bring citizen concerns to Governments, advocate and monitor policies and encourage political participation through provision of information. Some are organized around specific issues, such as human rights, environment or health. They provide analysis and expertise, serve as early warning mechanisms and help monitor and implement international agreements. Their relationship with offices and agencies of the United Nations system differs depending on their goals, their venue and the mandate of a particular institution”.
In other words, we can view NGOs irrespective of their origin as having the vital role as primary participants in the health system, legitimizers of the system processes, and key watchdogs of health system policy and infrastructure, as well as key non-state collaborators in national health system development for better health outcomes.
What is health system strengthening?
What we have come to know as health system strengthening approach for addressing the recurrent challenges that have bedeviled health systems, especially in low-income countries, débuted as a turnaround system reform thinking in the late 1990s, but gained currency and attention when the World Health Organization published its 2000 report showing how to determine health systems performance. System strengthening methodology became even more practical and measurable later on when the concept of the Six Building Blocks of a Health System. This acts as a fulcrum towards designing more effective strategies for strengthening health systems, in order to meet the needs of the population especially at the bottom of the pyramid. Hence most times, I have found it more convenient to define health systems strengthening as all activities that involve the identification of issues that interfere or impede the provision of services, and introducing changes that that are systemic so that the outcome is sustainable improvements.[Ohanyido 2011]
The six building blocks of the health system:
• 1: health service delivery
• 2: health workforce
• 3: health information systems
• 4: access to essential medicines
• 5: health systems financing
• 6: leadership and governance
Note that USAID, UKaid, JICA, CIDA and so forth are NOT NGOs, but rather State instruments for development termed “Bilateral Bodies” , just like the UN agencies are wider global instruments , and as such referred to as “Multilateral Bodies”. These bodies may through their procurement policies and country-level cooperative agreement in one country decide to fund a project like USAID|COMPASS project in Nigeria. Usually, these projects are ‘implemented’ by NGOs that win the right to the fund through some form of bidding processes. The NGOs are thus referred to as “implementing partners” and can be either local or international or a consortium of such NGOs. We should not lose sight of the fact that some professional health bodies being Civil Society Organisations too, have become more of NGOs in activities, please see :
2. NMA as a Potential Catalyst in Revitalisation of PHC; http://www.nigeriamedj.com/article.asp?issn=0300-1652;year=2010;volume=51;issue=1;spage=39;epage=51;aulast=Why has it become necessary to discuss the role of NGOs in strengthening of health systems?
a. Overtime the rules of engagement in all facets of the development process between the state and non-state actors has necessitated refocusing toward the fulfillment of human development through concerted efforts of the State, Citizens and their Organizations.
b. There is increased channeling of bilateral, international finance, and private financing, especially through philanthropy and cooperate social responsibility platforms to INGOs and LNGOs, giving them potential role in new modalities and strategic alliances for health system strengthening
c. There are growing demands on governments for democracy, accountability, transparency, community participation and compliance with human rights. These multifarious pressures on the state to decrease health inequalities and provide quality service delivery at the bottom of the pyramid necessitate collaboration with NGOs.
So what is the role of NGOs in Health System Strengthening?
I mentioned that there are six identified building blocks of the health system, as such the role of NGOs is actually dependent on their mandate or project charter which are in tandem with the overall programmes of the health system within which they operate. In line with these blocks some roles of NGOs are summarized below:
• NGOs can work to ensure that the Health services are efficient, effective, and accessible.
• NGOs can work within the health system to ensure that the number of well-trained staff is available through capacity building or advocacy to government etc.
• NGOs can help ensure that the Health information systems is able to generate useful data on health determinants and health system performance and also avoid creating parallel systems
• NGOs can work with all stakeholders to ensure that there is access to medicines, vaccines, and medical technologies in an equitable fashion.
• NGOs can help strengthen Health financing systems by exploring funding sources and advocating to stakeholders to raise adequate funds for health, ensuring that people can access affordable services.
• NGOs can strengthen the system by ensuring that the Leadership must guarantee effective oversight, regulation, and accountability.
However in order to work effectively in the health system in strengthening it, NGOs themselves must also be found to be transparent, accountable and representing the interest of the masses.