THE ROLE OF NGOs IN HEALTH CARE DELIVERY A PAPER PRESENTED BY DR. MOJISOLA ODEKU PROJECT DIRECTOR NIGERIAN URBAN REPRODUCTIVE HEALTH INITIATIVE AT THE ANNUAL GENERAL MEETING OF THE NIGERIAN MEDICAL ASSOCIATION, OYO BRANCH. IBADAN CIVIC CENTER, IDI-APE, IBADAN. AUGUST 9th, 2013.
Introduction Developing countries in Africa and elsewhere face severe challenges in improving health sector performance. The challenges are connected to access, efficiency and quality, calling for system reforms in the macro-organization, distribution and financing (World Bank, 1987; WHO, 2000). Civil society and non-state organizations have been contributing to public health for centuries. In more recent years, however, they have grown in scale and influence and are having profound impacts on health care delivery.
NGO Defined The increasingly accepted understanding of the term NGO is that of non-state, not- for-profit, voluntary organizations formed by people within the social sphere of civil society. These organizations draw from community, neighbourhood, professional, and other connections.
NGO Defined NGOs have become an increasingly common channel through which people seek to exercise citizenship and contribute to social and economic change. They cover a variety of organizational interests and forms, ranging from formal organizations registered with authorities to informal social movements coming together around a common cause.
NGO Defined • Due to their diversity, NGOs are often classified in terms of their attributes. For example, Gordenker and Weiss (1995) classify NGOs as private, self-governing, formal, non-profit organizations. • The omission of the word “voluntary” from this classification reflects the increasing professionalism of the NGO sector. • NGOs possess an organizational structure, such as permanent offices, members, employees, and a constitution. One of the main distinctions of NGOs is their self governing attribute. NGOs are private, autonomous organizations made up of individuals with similar social interests, and are not controlled by any government body.
NGO Defined The level of operation and sector attributes of NGOs are also important to note. NGOs are often classified according to their level of operation. Many NGOs are considered transnational organizations; meaning they operate in many countries around the world. Four levels of operation have been identified: • International, • Regional, • National, and • Local/Community.
Nomenclature The common nomenclatures are: • Non-profits • Non-Governmental, • Charitable organizations/Foundations/Endowments/Trust Their distinguishing attributes are that they either provide or receive support to implement population wide or case specific interventions by way of: • Donations • Grants • Gifts • Technical Assistance/Support
NGO Functions in Health Care Delivery NGO functions of relevance to Health Care Delivery include: • Action, research and training in service provision, outreach, technical and research inputs in specific areas; • Advocacy, lobbying and information sharing through networks and building wider alliances for health goals and sharing information; • Policy dialogue and development, policy strategy research and analysis • Monitoring and ‘watchdog’ roles and protection of consumer interests. • Fundraising, resource mobilisation and financial contributions.
What NGOS Contribute The capacities that a NGO brings to its work with States and partners in Health Delivery include its; • Technical resources, • Human resources, • Financial resources and; • Institutional resources.
There is some evidence suggesting that NGOs make successful contributions to health in certain circumstances. NGOs have made significant contributions to reproductive and sexual health in many areas in the developing world. Researchers have shown that effectively run NGO reproductive and child health services have decreased child and maternal mortality. Investigating NGO performance in the health sector is a daunting task for researchers. Much of the research on health NGOs compares the effectiveness of NGO run health facilities to government run health facilities.
NGO Roles on Health Care Systems The roles of NGOs in Health Systems usually border around; • Policy setting • Resource mobilization and allocation • Health services • Health promotion and information exchange • Monitoring responsiveness and quality of health services;
Policy setting • Representing public and community interests in policy; Promoting equity and pro-poor policies; • Negotiating public health standards and approaches; • Building policy consensus, disseminating policy positions; and Enhancing public support for policies.
Resource Mobilization and Allocation • Financing or subsidizing health care services; • Raising community preferences in resource allocation; • Mobilizing and organizing community co-financing of services; • Promoting pro-poor and equity concerns in resource allocation; • Building public accountability and transparency in raising, allocating and managing resources • Monitoring quality of care and responsiveness
Health Services • Service provision; • Facilitating community interactions with services; • Distributing health resources such as condoms, bed nets, and informational packs and • Building health worker capacity, morale and confidence
Health Promotion and Information Exchange • Obtaining and disseminating health information; • Building informed public choice on health; • Implementing and using health research; • Helping to shift social attitudes; • Mobilising and organizing for health; • Triggering and creating community initiatives and action
Monitoring responsiveness and quality of health services • Giving voice to marginalized groups and empowering community directed actions, and promoting equity; • Representing ‘patient/clients’ rights in quality of care issues; and • Channeling and negotiating patient complaints and claims • Informing policy on quality, access and equity
Nature of NGO Interventions • There are two sides to every intervention: • supply-side and demand-side interventions that are intended to improve the health services to achieve the following: • Efficiency & Access • coverage of health services; • access to health services; • quality of health services; • equity in the use of health services; and • morbidity and mortality reduction
How Interventions Work • Identification of issues, service or policy gaps • Undertaking root cause analysis and surveys • Inform policy makers and the policy decision-making process bycharacterizing the alternative approaches that could be deployed to improve the delivery of health services by front-line workers, and by synthesizing the evidence on the effectiveness of these approaches • Implementing Targeted Interventions
Simple Intervention Framework Increased access to health services Increased coverage of preventive and treatment services Reduced incidence and prevalence of disease Improved quality of preventive and treatment services Health System Strengthening Mortality Reduction Improved equity of preventive and treatment services
Roles of NGOs in Service Coverage • NGO Roles • Increased clients accessing health services • Increased awareness on health issues • Better health seeking attitudes • Better equipped health facilities • Better informed health personnel • Increased number of qualified personnel Increased access to health services Increased coverage of preventive and treatment services Improved equity of preventive and treatment services
Roles of NGOs in Systems Strengthening • NGO Roles • Policy Setting • Resource mobilization & Allocation • Direct Health Care Services • Health Promotion, Education and Information mining and exchange • Quality Reviews, surveys and assessments • NURHI Approach • Service Integration • Quality Improvement • Pvt - Public Partnership • Demand Generation • Advocacy Increased coverage of preventive and treatment services Increased access to health services Improved quality of preventive and treatment services Health System Strengthening Improved equity of preventive and treatment services
NGO Outcomes/Impacts Increased access to health services Increased coverage of preventive and treatment services Reduced incidence and prevalence of disease or effects Improved quality of preventive and treatment services Health System Strengthening Mortality Reduction & Wellness Improved equity of preventive and treatment services
Take Away Points The role of NGOs in the health sector was impacted by changes in the thinking regarding development and health policies in the last two decades. One such shift was the introduction of primary health care policy. Primary health care (PHC) was launched by the World Health Organization in the 1987 Alma Ata declaration with the goal of improving health for all by 2000 (WHO, 1978). PHC stresses the importance of community involvement and development as a means of improving health!
Take Away Points The Alma Ata declaration transformed the traditional understanding of health by recognizing health as a human right, and overhauling the service delivery system to incorporate all stakeholders in health. Primary health care policies shifted the focus of health care from the biomedical model and placed priority on combating all the causes of poor health by engaging sectors outside of health care.
Conclusion There has been an explosion of civil society actors in recent years. Competing interests and rapid change have created a more complex environment but have also contributed positively to improving human health and development. There is great potential for improving public health through systematic collaboration between governments and NGOs. Harnessing the energy of these diverse voices to improve public health is both a challenge and an opportunity for Nigeria. The NMA has tremendous role to play in the interdisciplinary approach to health that NGO works represent.
The overall impression and conclusion however, is, that the benefits of collaboration for both the State and NGOs outweigh the risks of possible tensions in NGO-state interactions. Strategic alliances offer opportunities for enhancing the legitimacy of health policies and programs, improving public outreach, advocacy of health goals, information exchange and increasing resource inputs to health programs.