Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations

• Published in: American journal of public health (1971) 2008-12, Vol.98 (12), p.2134-2140
• Main Authors: Pfeiffer, James, Johnson, Wendy, Fort, Meredith, Shakow, Aaron, Hagopian, Amy, Gloyd, Steve, Gimbel-Sherr, Kenneth
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Africa - epidemiology; AIDS; Anti-HIV Agents - economics; Anti-HIV Agents - supply & distribution; Benchmarking; Biological and medical sciences; Brain drain; Codes of Ethics; Comparative advantage; Compliance; Delivery of Health Care - ethics; Delivery of Health Care - organization & administration; Developing countries; Developing Countries - statistics & numerical data; Disaster relief; Emigration and Immigration; Funding; Global Health; Guidelines as Topic; Health Policy and Ethics; Health services; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Human rights; Humans; Infrastructure; International Agencies - ethics; International Agencies - organization & administration; International Cooperation; LDCs; Malaria; Medical sciences; Miscellaneous; NGOs; Nongovernmental organizations; Organizations - ethics; Organizations - organization & administration; Poverty; Primary care; Public health; Public Health Practice - ethics; Public Health Practice - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public sector; Public services; Public-Private Sector Partnerships - ethics; Public-Private Sector Partnerships - organization & administration; Wages & salaries
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2007.125989

The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked "brain drain" from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems.