Code of conduct would curtail ill effects of NGOs’ help

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Code of conduct would curtail ill effects of NGOs’ help

Bobbi Nodell

Health Alliance International has worked shoulder-to-shoulder with struggling nations for 25 years. Now it is now taking on one of the most vexing problems – uncoordinated care among nongovernmental organizations, commonly known as NGOs.

“NGOs stumbling over each other in a country is so counterproductive,” said James Pfeiffer, professor of global health at the University of Washington and executive director of Health Alliance International, an NGO affiliated with UW.

He outlined the problem: Poverty-reduction strategies instituted by the World Bank and International Monetary Fund have limited the funds that governments can spend on public health and education. Money for fighting diseases such as HIV has been funneled, instead, into nongovernmental organizations, which often are not required to work with local ministries of health. They draw donations from foundations, businesses and individuals and fund projects as they see fit, in disjointed efforts. NGOs also often weaken local health systems by hiring away public-sector workers.

“The Ebola epidemic happened because countries’ health systems were so weak,” Pfeiffer said. 

Health Alliance International is leading an initiative to persuade funders and donors to sign a code of conduct that seeks to minimize such damage.

Since 2008, 59 NGOs have signed the NGO Code of Conduct for Health Systems Strengthening. Signatories include Partners in Health, Oxfam, Health GAP, ActionAid, African Medical and Research Foundation and Physicians for Human Rights. One donor, the Doris Duke Charitable Foundation, has signed on. 

The Lancet in August published a commentary co-written by Pfeiffer and others that calls for donors and ministries of health to make signing the code a condition for the giving and receiving of funds. The code was featured at a health systems research conference in Cape Town, South Africa, at the end of September.

The code sets out ethical principles such as:

  • Engaging in hiring practices that ensure long-term health system sustainability.
  • Enacting employee compensation practices that strengthen the public sector.
  • Pledging to create and maintain human resources training and support systems.
  • Minimizing the NGO management burden for ministries of health.
  • Supporting ministries of health as they engage with communities.
  • Advocating for policies which promote and support the public sector.

The consortium also includes representatives from the University of Washington, Health GAP, the University of Colorado-Denver and Jawaharlal Nehru University in New Dehli.

“We can’t change the entire structure of global health financing overnight,” Pfeiffer said. “But we can offer a tool.”