The changing role of NGOs: no longer the eunuch in the harem?

The traditional role of non-governmental organizations (NGOs)has been to provide governments with support for locally-basedprojects which are either too small or too experimental to fallwithin the scope of the larger multilateral or bilateral agencies.However, the setting within which NGOs operate has changed considerablysince the Second World War. A growing appreciation of the influenceson health of social and economic factors has led to a senseof the inadequacy of small isolated projects; the difficultiessome developing country governments have experienced in eitherformulating or executing a consistent national policy has drawnNGOs into a more prominent role; and forces within NGOs themselveshave resulted in the adoption of a more campaigning style. Oneaspect of these changes is that NGOs are increasingly formulatingand advocating policies at a national and international level.But the traditional structure and management of NGOs does notequip them well to fulfil this new role, in which there is potentialfor conflict with both host governments and international agenciesand for a disparity between the intentions of supporters andthe uses to which their donations are being put. If they areto operate at this level, NGOs must maintain the highest professionalstandards. First, each NGO should develop a machinery throughwhich it can achieve an internally agreed position and thencirculate an explicit policy statement on the basis of whichpotential donors can decide whether to support the organization.Secondly, the diagnosis of problems, and policies advocatedto solve them, should be based on the best available informationwhich is analysed by experts in the field concerned. This willrequire considerable management skills, but is a goal for whichit is worth striving, as NGOs are in a unique position to makea disinterested contribution to issues of major internationalsignificance.     

Should we plan for contraction in health services? The Jamaican experience

Internationally a ‘standard scenario’ has been developedtreating the world economic recession since 1982 as the causeof declining health care and health in developing countries.Attempts to apply this scenario to Jamaica suggest that thedecline can be blamed equally on limitations of planning andmanagement. Existing planning procedures are associated withexpansion, and do not work well in situations of contraction;nor does the existing health service management system provideimpetus for contraction as it does for expansion. For planningand management under contraction, the required procedures mayinvolve greater privatization and decentralization. Part of the required impetus may come from external agencies,and part from emerging management groups within the health services.Both these sources present problems for developing countrieswhich remain to be solved. It is suggested that while the specificsof health care planning and management will differ from countryto country, the best prospect for improved management systemslies with a national merging of critical professional subgroups- health administrators at the local institutional level, andbroadly qualified epidemiologists and public health staff atthe national level.     

Whatever happened to public health?

In many rich and poor countries, recent health service developmentshave led to neglect of the traditional public health functions.For various reasons, however, the need for these functions isincreasing rather than diminishing. Developing countries shoulddevote more resources to them, but they should not necessarilyfollow proposals from developed countries such as those in theAcheson Report, when locating public health in their organizationalstructure.