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Panelists of Strengthening Health Systems: The Role of NGOs and GHDonline staff

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The Role of NGOs in Strengthening Health Systems

Added on 14 Dec 2011
Last updated on 11 Jul 2014

Authors: By Marie Connelly; Reviewed by Sophie G. Beauvais and Peggy Creese.

The growth in international nongovernmental organizations (NGOs) working in health care around the globe raises questions on how they can best support governments to strengthen local health systems. Documents like the NGO Code of Conduct by Health Alliance International and Partners In Health’s Program Management Guide set forth ideas and suggestions for best practices for NGOs. The goal of this Expert Panel discussion was to extract key lessons learned from these documents and to engage health professionals from a wide range of perspectives to share their experiences.

The panelists included Dr. Agnes Binagwaho, Minister of Health in Rwanda, and practitioners from The Access Project, Health Alliance International, Partners In Health, and Tiyatien Health. Panelists and members addressed: the necessary elements of partnerships between NGOs and Ministries of Health; the challenges of administering joint programs; ways NGOs can build local human resource capacity; partnering with the public sector to meet infrastructure needs; and examples of successful partnerships.

Partnerships between NGOs and Ministries of Health:

  • A true partnership means that NGOs and MOH work towards the same goals. A strong national vision and strategic plan from the Ministry of Health can lay the groundwork for success.
  • If a country does not have a vision or plan, NGOs should offer their support and share their particular expertise to assist in their development.
  • Focusing on communication, transparency and flexibility when implementing programs can help develop trust and clarity in partnerships. NGOs should be prepared to adapt their plans to align with MOH goals, existing programs, and newly identified areas of need.
  • To build strong partnerships, NGOs should work with all levels of the government, from local to national authorities, and “meet the ministry where it works.” One example from Tiyatien Health in Liberia showed that hiring a full time policy advisor to participate in MOH meetings in the capital had a significant impact on the relationships between Tiyatien Health and the MOH at the national level. It also helped strengthen ties with local MOH colleagues who were likewise removed from the national discussion by nature of their location. For example, the policy advisor was able to identify opportunities for the county’s health team to receive additional equipment it would not otherwise have known about.
  • NGOs can strengthen their relationships with MOH by tailoring their work to the specific needs of the community they serve – insisting on a “one-size fits all” approach can result in less effective and less equitable care.
  • Donors also play important roles in these partnerships, as short-term results are often prioritized and incentivized over, and at times at the expense of, longer-term projects that strengthen health systems.
  • In addition to Rwanda, Liberia, Malawi, Afghanistan and Mozambique were also cited as countries whose governments have successfully partnered with NGOs to strengthen health systems.

Administering joint programs:

  • Some of the particularly burdensome challenges cited include: aligning all parties with the goals of the program; overcoming religious, political and other differences between parties; creating channels for true communication and a sense of solidarity between partners; training and retaining staff to implement the program; managing finances; meeting the requirements of multiple donors; making evidence-based decisions; and ultimately delivering care equitably and effectively.
  • Strategies for overcoming these challenges vary, but ongoing communication (about priorities, responsibilities and roles) is integral for all parties hoping to implement joint programs.
  • Memoranda of Understandings (MOUs) are an important first step to outlining responsibilities assigned to each organization, but communication about the responsibilities they outline should continue throughout the course of the program, as flexibility and the ability to adapt are vital elements of successful partnerships.

Building human resources capacity:

  • Governments should have a national strategic plan for human resources (HR) in the health sector and incentivize professionals to stay in-country and work in the public sector.
  • In Rwanda, all NGO care providers are paired with a Rwandan provider to ensure that capacity is transferred. Partners In Health embeds its programs within the public health system and its staff work in government hospitals and health centers.
  • Decentralizing training can also play an important role in building capacity, particularly in rural settings. One example from Liberia shows that a new midwifery school in the rural southeast is now graduating 50 new midwives a year from southeastern counties.
  • Task-shifting programs that train Community Health Workers (CHWs) to perform specific tasks or procedures typically performed by doctors or nurses can also strengthen local capacity. Partners In Health collaborates with the MOH to ensure that its training programs focus on the skills and knowledge the government requires for CHWs.
  • While financial incentives are only one component necessary for building HR capacity, NGOs can provide salary top-ups or cover funding gaps for government counterparts to help harmonize salaries between NGOs and public sector employees.
  • Hiring from within the community and providing staff members with ongoing educational, training and mentorship opportunities are also important ways that NGOs can build sustainable workforce capacity.

Addressing infrastructure needs:

  • Governments should include engineers and technology professionals in their human resource plans, not just doctors and nurses, because their technical expertise is necessary for constructing IT networks, valuable buildings and maintaining medical equipment.
  • Large infrastructure projects require strong partnerships between the government, NGOs, and civil society. NGOs should work to support the capacity of the MOH, and local communities must also be involved in decisions.
  • NGOs should work with local health system officials to transfer the knowledge and skills necessary to provide the long term support necessary to maintain most infrastructure projects.
  • Time for training staff members on should be accounted for early on in budgets and project plans.
  • When budgeting and working with donors, NGOs should include funding for upkeep and upgrading of facilities, and strive to improve the public sector buildings where they work. One Health Alliance International Preventing Mother-to-child Transmission program in Mozambique was able to rehab entire health centers, not just antenatal care sections, by working with donors this way.
  • Providing care in a resource-limited setting shouldn’t be an excuse for “small thinking.” Through partnerships, governments and NGOs should encourage each other to innovate and dream big. Tiyatien Health creates three budgets for every project: a dream version, a comfortable version, and a bare essentials version.

Key References

Enrich the GHDonline Knowledge Base
Please consider replying to this discussion with:

  • Examples of productive partnerships between NGOs and MOH
  • Suggestions for NGOs delivering care in countries without a national vision and strategic plan – how can they balance support for the government as it develops these plans, with their mission to provide care to those in need?
  • Recommendations for how efforts to strengthen health systems can be made more sustainable
  • Download: 12_13_2011_Role_of_NGOs_in_Health_Systems_Strengthening__.pdf (173.9 KB)