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APHA Scientific Session and Event Listing

Recorded presentation

James Pfeiffer, PhD, MPH, School of Public Health, Department of Health Services, Univertsity of Washington, Box 357660, Seattle, WA 98195, 206-543-8486, jamespf@u.washington.edu

In recent years, USAID and the World Bank have adopted policies that increasingly channel aid to the health sector in poor countries through NGO's, based on the assumption that NGO's can reach poor communities more effectively than public services. Promotion of NGO's over state services has also been ideologically driven, linked to privatization and free market policies while IMF/World Bank Structural Adjustment Programs have reduced state social spending. However, the impact of NGO promotion on the health sector in Africa has yet to be examined closely. Mozambique provides a valuable case study since it experienced rapid growth of NGO activity over the last decade. Based on key informant interviews, participant-observation, and ethnographic research over a recent four year period, the research findings reported here assess the impact of NGO proliferation on the Mozambique health sector. NGO arrival undermined the National Health System in unanticipated ways by fragmenting services, promoting brain drain, diverting resources, and disrupting coordinated planning processes. Foreign NGOs contributed to greater social inequality by creating sizeable communities of well-paid expatriates and Mozambican cadres with dramatically higher salaries than public sector counterparts. Public employees became increasingly demoralized and service quality was challenged by loss of talented personnel, decline in motivation, and systemic dysfunctions. The role of NGOs in the health sector should be re-examined and donors should rechannel aid through the public sector to maximize coordination, planning, service integrity, and national ownership. A more constructive role for NGOs in mobilizing communities and civil society should be debated and redefined.

Learning Objectives:

• Identify three ways in which NGOs can be disruptive to public sector health planning.
• Describe why the number of NGOs has grown so dramatically in the previous decade.
• Describe donor rationale for supporting NGOs rather than public sector health systems.

Keywords: International Public Health, Health Reform

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation