What sounds to be obvious – nongovernmental organizations working in the
field of international health cooperation support and strengthen health
systems – is not taken for granted. NGOs, “if not careful and vigilant, can
undermine the public sector and even the health system as a whole, by
diverting health workers, managers and leaders into privatized operations
that create parallel structures to government and that tend to worsen the
isolation of communities from formal health systems (…)” This assessment is,
at least, the starting point of the “NGO Code of Conduct for Health Systems
Strengthening” first published in May 2008. The code intends to offer
guidance on how international non-governmental organizations can work in
host countries in a way that respects and supports the primacy of the
government’s responsibility for organizing health system delivery.

A matter of course? Well, you can test it yourself, right now, if you like:
How many of the following statements taken from the NGO code correspond with
your organization’s standard?

1.      “In areas where trained personnel are scarce, we will make every
effort to refrain from hiring health or managerial professional staff away
from the public sector, thus depleting ministries and their clinical
operations of talent and expertise.” (yes? no? not sure? not relevant for
you?)
2.      “We commit to limiting pay and benefits inequity between expatriate
and national, rural and urban, and ministry and NGO workers. We encourage
compensation structures that provide incentives for rural service and
disallow gender-related disparities.” (yes? no? not sure? not relevant for
you?)
3.      “We recognize that management capacity in Ministries of Health is
often limited. Rather than building parallel or circuitous structures around
inadequate capacity, we commit to strengthening governments’ ability to
operate effectively and efficiently.” (yes? no? not sure? not relevant for
you?)
4.      “We strengthen the capacity of communities to take responsibility
for and ownership of their health development, and to become partners with
government in the health system, while holding governments accountable for
their human rights obligations.” (yes? no? not sure? not relevant for you?)
5.      “We actively advocate with civil society, local institutions and
donors for policies and programs that strengthen health systems overall.”
(yes? no? not sure? not relevant for you?)
6.      “We commit to designing their activities and programs so that they
reinforce primary health care, foster equity and community involvement, and
are generally replicable and financially sustainable over time.” (yes? no?
not sure? not relevant for you?)

So, are you happy with your score? 6 out of 6? Congratulations! But
nevertheless, you might be interested to further discuss the task of
contributing to building public health systems and doing no harm. The
members of the MMI Network members will meet on 5th November in Amsterdam in
a workshop on "Health systems strengthening", reflecting about the role of
NGOs and of their particular organization in health systems strengthening.
Join us, if you like!

Thomas Schwarz,
Medicus Mundi International Network