Strengthening public health systems with an international NGO code of conduct

Background

Health systems in the developing world are often characterized by a severe shortage of human resources, inadequate infrastructure, and limited capacity. As foreign assistance programs like PEPFAR and the Global Fund grow, donors preferentially seek out non-governmental organizations (NGOs) partners. The rise of NGO-driven service delivery has led to a proliferation of different projects and approaches, often with poor follow-up, limited oversight, and varied levels of success.

Policy Overview

Consensus is growing that while increased investment spurred gains in areas like HIV treatment; other areas, like maternal and child health, have lost ground due to weak public health systems.  Even gains in HIV care are compromised by weak health infrastructure.  Without careful attention, international NGOs can undermine the public sector and the health system as a whole through the creation of parallel systems, “internal brain drain” of health providers, tension around differing priorities, a multiplicity of standards, and a growing management burden for the Ministry of Health. ¹

Implementation

In May 2008, a group of health-focused organizations launched the “NGO Code of Conduct for Health Systems Strengthening.” This voluntary strategy aims to ensure that NGOs “do no harm,” and contribute maximally to building public health systems. We will present the process of developing the code, key elements and rationale, and concerns that have arisen during the development and promulgation process. Mechanisms for implementing the code of conduct and evaluating its effectiveness in national health system strengthening will also be presented. ²

Conclusions

In the areas of hiring practices, compensation schemes, training and support, reduction of management burden, and assistance in integrating communities into the formal health system; International NGOs have an opportunity to support public-sector health system strengthening through sustainable practices promoted in a new code of conduct. Already, 36 NGOs and other institutions have become signatories to this important document.