Non-Governmental Imagination

Antidote for burnout: Power to the Peaceful Festival
September 6, 2006, 7:38 am
Filed under: Health, Visionaries

This upcoming Saturday is Michael Franti’s annual Power to the Peaceful Festival in Golden Gate Park. If you live anywhere near the SF bay area, you should definitely check it out. It’s free (suggested donation: $1), and there’s lots of great bands (check out Brett Dennen), orgs, people, artists and food.

One of the issues I’ve been wrestling with recently is burnout. I’m pretty much exhausted all the time, and I’m so busy trying to spend enough time with Erin, my friends, my family, Interplast, my hobbies, my reading, my softball team (The Matzah Ballstars) and my dreams that I end up doing all of them an injustice. I feel like I have a ton of acquaintances that I’ll never really become friends with because I just don’t have time. So I rush around trying to sqeeze everything and everyone in.

It’s not working. And it’s not healthy.

It’s important to take time out to take a breath, go to a park and just chill out. At the recent Craigslist Nonprofit Bootcamp, Van Jones of the Ella Baker Center for Human Rights gave an immensely inspiring talk (anyone wanna come with me to their gala on 9/14 in Oakland? I need a date) in which he mentioned the need to take breathers.

So this weekend I’m gonna take his advice. I’ll be at the park. I’m not gonna sweat getting there on time, I don’t care where I sit, I’m just gonna hear some music, talk to some people, eat some food, and get (re)inspired.

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Can NGOs Be Effective Substitutes For Government Services?
January 15, 2006, 9:51 pm
Filed under: Health, Imagination, International Aid

The New York Times had an interesting article about NGOs in Cambodia that have taken over large swaths of the health system. Apparently, Cambodia has hired a bunch of NGOs to run health districts to provide more efficient health care for its citizens:

“If childbirth is a miracle of nature, then the thriving, honestly run network of clinics and hospitals here is a human marvel, managed not by the government but by one of the nonprofit groups it has hired to run entire public health districts.

The approach is catching on in a growing number of poor countries around the world, from Bangladesh and Afghanistan to Congo and Rwanda, to Bolivia and Guatemala, reaching tens of millions of people.

These contracted services have allowed international donors and concerned governments to cut through dysfunctional bureaucracies – or work around them, and to improve health care and efficiency at modest cost.”

This absolutely fascinates me. Corruption is a huge problem in the global south, and I definitely know how corrupt governments siphon off resources from the intended benficiaries. NGOs can be more efficient by not having to deal with as many layers of intermediaries and bureaucrats taking their cut, but should they be real substitutes?

Cambodia is paying the NGOs as independent contractors. While this seems better for the patients in the short term, doesn’t it just make Cambodia more dependent on aid from the global north in the long term? I’d be interested in hearing about how much interaction the NGOs (such as Health Net International and Save the Children Australia) have with local administrators.

Health Net International has chosen a user fees system to work within the Cambodian Ministry of Health’s health coverage plan:

“The Cambodian Ministry of Health has designed a health coverage plan. The coverage plan describes a minimum package of services and activities (MPA) that should be carried out at health centre level. The MPA consists of basic preventive and curative services such as immunisation, family planning, antenatal care, nutritional support and simple curative treatment for diarrhoea, acute respiratory tract infections and tuberculosis.

The ADB money is a loan to the Ministry of Health to implement the coverage plan. With this loan the effectiveness and efficiency of contracting NGO´s is tested in order to find out which system works best;

Contractors that have complete responsibility for the total health care, contractors that work within the Ministry of Health system and have to strengthen the existing district structure or contractors that depend entirely on the services of the District Health Management Team and the Ministry of Health.

Within this project, HNI has designed and managed a user fees system. This system seems to have the potential to increase utilisation by the poor and decrease their out of pocket expenditures on health care….

The Ministry of Health, with financial support from ADB (Asian Development Bank) will contract in the near future the public health system in Mondulkiri to a private organisation. HNI´s intervention will assist the Provincial health Department to prepare for this change of the public health system. HNI´s partner NOMAD, is planning to turn its organisation into a Cambodian NGO, working with a team of locally based staff. HNI plans to continue the cooperation with NOMAD in the future and support their development.”

From the Save the Children Australia website, it seems like they’re trying two models with varying levels of local collaboration in order to decide which works best:

“No small affair, this project pilots two models for health service provision in Cambodia allowing a comparison of two management styles: contracting out in Memot, where we recruit, manage and train all district health staff and contracting in in Cheung Prey, where we train and manage the district health staff already employed by Cambodia’s Department of Health.”

There is a lot of debate about developing nations privatising public resources (ie water), with the loudest voices doubting the wisdom of moving control to foreign multinational companies. Does that apply to health as well? Does it matter if the contractor is a publicy held company or a nonprofit organization? How much control do local people have over their health now as opposed to before? How has accountability changed?

I am all for finding creative and effective ways to improve health care infrastructure in the global south. This idea is definitely creative, and sounds effective, although I haven’t heard from any Cambodians on the issue.

I am a little cautious about this because the potential for long-term dependency seems high. If Cambodia can snooker NGOs to providing its health care, why should it bother with improving its own system?

Nonetheless, I plan to watch this and try to learn more. If anyone has any opinions on this, I would love to be educated more on the issue, and I plan to invite Health Net, Save the Children, and the NYT author to respond to this post, so we’ll see what they say.