Call for an International NGO code of conduct to support health systems strengthening

Recent tremendous growth in the NGO community has led to a proliferation of different projects and approaches, often with limited or even wide-spread success. Despite these advances, consensus is growing that gains in some areas, like HIV treatment, are severely limited while in other areas, like maternal child health, ground is being lost due to weak public health systems and most critically, the severe shortage of qualified health workers in the poorest countries. International NGOs work in a constrained environment, where governments' ability to address their own health problems may be severely curtailed while NGOs have more flexibility. NGOs can quickly hire more staff at higher salaries or acquire specialized equipment to satisfy vertical funding demands or create an idealized project serving one limited population in a small geographic area. Recent attention has been focused on the NGO contribution to the human resource crisis, dubbed “internal brain-drain,” which occurs when NGOs and other international institutions lure government workers away from front-line clinical, public health and managerial jobs into high-paid program administration positions, thereby exacerbating the very problems they are attempting to solve. Some NGOs, aware of these pitfalls, are exploring and implementing innovative ways to strengthen health systems and build public human resource capacity. This session will outline the risks and benefits of NGO-implemented programs and present the elements of a new International NGO code of conduct being proposed by several health-focused organizations as a voluntary method to ensure that these groups “do no harm” and contribute maximally to health system strengthening. The code addresses the problems of vertically funded programs, lack of joint coordination and planning with governments, parallel programming, internal brain-drain and pay equity, and standardization of policies.