Nongovermental Organizations

This report describes highlights from the Doctors We Trust Project in St. Petersburg and the Together We Are Stronger Project in Kaliningrad. Both projects focused onthe limitations of health care for vulnerable groups in St. Petersburg and Kaliningrad. The key strategy was to build cooperative links between government agencies and NGOs, uniting those who control public medical facilities and those who work most closely with vulnerable populations. The goal was to strengthen the NGOs’ capacity to provide care, while helping the governmental sector and medical personnel better understand and respond to the needs of people living with HIV and AIDS (PLHA) and other vulnerable groups.

Contracting with non-state entities, including non-governmental organisations, has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. [from author]

In 1999, Cambodia contracted out management of government health services to NGOs in five districts that had been randomly made eligible for contracting. The contracts specified targets for maternal and child health service improvement. The program increased the availability of 24-hour service, reduced provider absence, and increased supervisory visits. There is some evidence it improved health. The program involved increased public health funding, but led to roughly offsetting reductions in private expenditure as residents in treated districts switched from unlicensed drug sellers and traditional healers to government clinics.

Contracting out public services is a way for governments to complement their own delivery of services. It is particularly effective for high risk or hard-to-reach populations that can be more effectively served by private groups. It can also contribute to more efficient delivery of primary health care. [from introduction]

The objective of this document is to implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. [author’s description]

HIV/AIDS mainstreaming has traditionally been equated with adjusting programs to be more relevant to beneficiaries affected by HIV/AIDS. Bitter experience is demonstrating, however, that civil society organizations (CSOs) are not immune to the impacts of AIDS within their own organizations. Few local CSOs are responding adequately to this threat, partly because they simply do not know the extent of these costs. This paper suggests how CSOs in sub-Saharan Africa can build organizational resilience in order to survive the loss of valuable staff, time and money that HIV/AIDS will cause. It also concludes with practical recommendations for their donors in how they can move beyond being concerned bystanders. [publisher’s description]

During the past few years, a number of key donor programs have scaled up their global response to the crisis of HIV and AIDS… The goal of this paper is to begin a discussion among donors, international and local NGOs, and multilateral and U.S. government representatives on how to effectively engage indigenous partners and transfer much-needed resources. [from preface]

The handbook is a resource collection of information sheets and participatory activities for NGOs working on HIV/AIDS who want to work towards a greater involvement of people living with HIV (GIPA) in their work. It aims at sensitising NGOs, building individual skills and organisational capacities so that NGO management, staff and volunteers can discuss and plan together in a participatory way how to meaningfully involve people living with HIV in their organisation. [from introduction]

NGOs that provide basic health care to the poor must become less dependent on donor support by diversifying their funding. The NGO Service Delivery Program (NSDP), a USAID-funded health care program in Bangladesh, is working with NGOs to find corporate sponsorship. [publisher’s description]

Before the project began, 300,000 remote rural inhabitants in the Mayan highlands lacked basic primary care, the NGO civil society in health lacked cohesion, and the MOH NGO granting program needed revising. From 2000 to 2004, the NGO Networks Project implemented a grants program that helped form networks of NGOs, strengthening health services and testing innovations in service delivery, and improved monitoring and evaluation. As a result, by 2004, high-quality services had been extended to 317,000 rural people and surveys showed significant improvements in health care coverages, NGOs had been unified into networks, a national NGO federation had been formed, and innovations had been adopted by the MOH for improvements in the national MOH NGO program.

Human Resource Development (HRD) plays a critical role in creating and sustaining high performance organizations. A large percentage of the operating budgets of NGOs and Ministries of Health is devoted to staff salaries and wages. In an era of health sector reform, HRD issues must be addressed if organizations are to successfully manage decentralization, public/private partnerships, downsizing and expansion, as well as the drive toward organizational sustainability. As more and more NGOs and government organizations face these challenges, they are looking for HRD technical assistance and support.

The India Local Initiatives Program adapted a model used in Indonesia and Bangladesh to implement the government’s reproductive and child health strategy. From 1999 to 2003, three Indian nongovernmental organizations (NGOs) provided services for 784,000 people in four northern states. This model proved to be a suitable platform upon which to build health-care service delivery and create behavioral change, and the NGOs quickly found ways to sustain and expand services. [from abstract]

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

This report documents the efforts of the Institute for Reproductive Health (IRH) to integrate natural family planning methods into the health delivery system in the Phillipines. It discusses the venues used for implementation such as government and NGO partnerships as well as IRH’s training resources and activities for nurses and midwives on family planning. Finally, the report details best practices and lessons learned from the multi-year project.

This study aims to examine the range of impacts the [HIV/AIDS] pandemic has had on selected NGO partners of Oxfam operating in South Africa, Zambia, and Zimbabwe, and to make recommendations useful to NGOs, including Oxfam, donors, and policy-makers based on its results. [author’s description]

The primary objective of the study was to identify organisations/institutions that provide HIV and AIDS services at the sub-district level, the range of services they provide and their funding sources. This in turn will inform sub-district and district management teams of the progress and impact of services provided and furnish them with tools to monitor the performance and activities on NGOs in their sub-districts and districts. It is hoped that the report will serve as a baseline for ongoing monitoring of the country’s response to the epidemic. Data was collected through self-administered questionnaires, staff interviews and record reviews.

The NGO Code of Conduct for Health Systems Strengthening is a response to the recent growth in the number of international non-governmental organizations (NGOs) associated with the increase in aid flows to the health sector. It is intended to be used as a tool for service organizations and eventually for funders and host governments. The code serves as a guide to encourage NGO practices that contribute to building public health systems and discourage those that are harmful. [from introduction]

Many NGOs providing reproductive health (RH) services are facing reductions in donor funding, requiring them to generate more of their own resources. Prosalud, CIES and APSAR, Bolivian NGOs, wanted to build skills in costing and market research to support efforts to improve financial sustainability. Staffs attended a one-week workshop, followed by implementation of three operations research (OR) studies designed to reinforce skills and generate information for decisionmaking. The Prosalud and CIES studies included the calculation of unit cost per service; measurement of client willingness to pay (WTP) higher prices for services, and a market segmentation assessment in selected areas where Prosalud clinics are located.

The NGO Service Delivery Program (NSDP) developed a system ensuring better access of the health services to the poorest segment of the population, along with raising revenue by providing fee-for services to the better off population. The former strategy highlights a safety net policy for the poorest segment, who are identified by participatory rapid appraisal technique and handed out a health benefit card. The latter strategy helps the NGOs to revise their service charges according to local demand and other factors. This report analyzes this pilot effort and its drawbacks and makes recommendations based on lessons learned. [adapted from author]

The Lesotho apparel industry is the country’s largest private sector employer. By providing employment for poor and relatively unskilled workers, most of whom are women, this industry is combating two of the key long-term drivers of the HIV/AIDS epidemic: poverty and gender inequity. However, it is precisely this sector of the community, young women, who have the highest prevalence of HIV infection. Studies within the apparel sector show that around one third of employees are HIV-positive. Apart from the huge toll in human suffering associated with this high infection level, the epidemic also lowers productivity and increases costs to the employer. The Lesotho government is committed to providing a comprehensive response to HIV/AIDS, including the provision of antiretroviral treatment (ART) but, because of a lack of financial and human resources, only about 8 000 Basotho are receiving treatment at present. It is estimated that about 60 000 Basotho require ART. For all these reasons, a range of stakeholders wished to determine the feasibility of a private sector led long-term intervention (LTI) to reduce the HIV-infection rate among apparel workers and to provide care and support for those already infected. Towards this end consulting company HLSP was contracted to conduct this feasibility study and this report and specific recommendations are the outcome of the project. [author’s description]

This case study provides details of a partnership that emerged in Georgia following the initiation of health sector reforms in 1995. It mainly focuses on describing the details of how and why the public purchaser contracted a non-governmental provider to deliver a set of health services in Georgia. The case study is discussed with proper attention to the context within which this arrangement developed. The nature of the services provided was paediatric cardio-surgery, which can hardly be considered a basic essential health service. Notwithstanding this, the case study provides a sufficient body of evidence to facilitate policy discussions about public–private partnerships (PPPs) and their potential role in reaching the poor.

This report focuses on HIV/AIDS home and community care projects and programs that have been able to scale up or reach out, and in doing so have brought an improved quality of life to people living with or affected by HIV/AIDS. The initiatives are widely spread geographically, with five from Africa, two from Asia, and one from Latin America. The final chapter of this report revisits some of the main lessons learned through the practices, and examines both commonalities and differences. [adapted from author]

Contracting NGOs to manage the primary health care system was found to be an effective means to increase service coverage and achieve a more pro-poor distribution of services in rural areas of Cambodia. The Ministry of Health (MOH) proposed contracting NGOs to manage the public health care system at the district level using a results-based contract to monitor progress.

This brief reports on a project through Cambodia’s Ministry of Health which contracted health services to NGOs. Contracting NGOs to manage the primary health care system was found to be an effective means to increase service coverage and achieve a more pro-poor distribution of services in rural areas of Cambodia. [adapted from introduction]

The NGOs that comprise the USAID-funded NGO Service Delivery Program must control costs in order to improve their cost recovery rates. Costs associatied with high staff turnover are an important variable operating expense. An NSDP study of staff turnover has produced interesting findings contributing to new staff retention strategies. [introduction]

This document outlines the outcome of three franchising projects implemented by Partners of Marie Stopes International (MSI) in Honduras and Nicaragua. The projects were designed to pilot full and partial social franchising models as part of an initiative to test and develop alternative forms of delivering quality sexual and reproductive health (SRH) services by a non government organisation (NGO). [abstract]

In the majority of low and middle-income countries, the private sector presents significant opportunities for expanding the reach of essential child health services and products. Through better coordination with the private sector, governments and donors can improve the availability, quality, and effectiveness of child health services…This document assesses the current importance, and potential, of the private sector in contributing to child health. [author’s description]