Given that many developing countries are exceedingly dependent on NGOs for health services (Zaidi, 264), it is important to examine this dependency and evaluate whether or not it emerges as a sustainable relationship. I will argue that there are three fundamental issues with this relationship that prevent it from attaining sustainability. Firstly, as long as NGOs are present in developing countries, healthcare will never be accessible to all citizens. Secondly neither entity is ever held fully accountable to its citizens. Lastly, and perhaps most worryingly, over the years, the work of NGOs has been painted as altruistic, when in reality they are providing health services that all humans have a basic right to.
A poignant example that points to the limitations of NGO accessibility can be found in the approaches toward disclosure of HIV status. Benton recalls a skit that demonstrates how disclosure of one’s status to their family could turn out positively (Benton, 75). However, Benton notes that ‘successful disclosure…hinges upon whether the ‘disclosed-to’ have internalized NGO…messages delivered through NGO communication channels’ (Benton, 76). Consequently, while there may be a safe way to disclose one’s status and ultimately reduce the anguish that endures from suffering in silence, only a few have access to this possibility. Whyte et al. further paint this image of NGO networks by claiming that Saddam’s decision to join an AIDS program was through a ‘trusted social connection,’ (Biehl, 146). Saddam, as a citizen of Mozambique, is not guaranteed any health services. However, as long as he can locate an NGO through various networks, he is guaranteed health services. This dichotomy is disconcerting as it suggests that individuals living in more isolated areas (e.g. rural areas) are at a huge disadvantage to their urban counterparts where such a network of NGO knowledge exists. In this way, NGOs buttress already existing disparities by only being available to a select number.
One would hope that the NGOs are at least held fully accountable to the citizens that they do manage to serve. Nonetheless, this does not seem to be the case – the donor’s priorities come first (Zaidi, 265). Insofar as donor power extends to such a degree, even Presidents of countries find themselves first appealing to international donors when speaking publicly about their nation’s progress (Benton, 119). The absurdity of this situation is made more explicit when making a comparison with the west. A western government’s success is not measured by its control of infectious disease (Benton 122), yet the culture of NGOs and their presence in developing countries over the years has engendered this double standard. Furthermore, NGO presence has lead governments to assume that they need not be held responsible for the welfare of all their citizens, as some of them are receiving healthcare from NGOs. Such a dangerous belief can be attributed to the well-known mystique associated with NGOs, in which they are seen as the ‘panacea for all the ills’ (Zaidi, 260). As a result of this aggrandized image, a President that is aware that x number of NGOs are present in their country would have a hard time arguing for the funneling of state funds into public health infrastructure. Additionally, this co-existence of NGOs and the state allows both entities to assert culpability to the other in times of crises. An unfortunate instance in which this cross-talk played out was in Sierra Leone at the height of the Ebola Crisis; a reporter recalls that “there was no coordination,” between NGOs and government officials (Inveen, 2015). If state-run institutions were the only existing entities, it would be much harder for them to disseminate the blame onto others and thus would be faced with no other option but to be held fully accountable to their citizens.
Along with problems of accountability, the excessive presence of NGOs corrupts the mentality the west has towards developing countries. As many NGO workers are volunteers, the work done by NGOs can be perceived as generous, and individuals who receive such aid need to ensure that they are deserving of it (Benton 133). If health services were provided by the state, its citizens would no longer be under this pressure and simply believe that they have a right to such services in virtue of being a citizen.
Despite my criticism of NGOs, I recognize that the solution cannot be to simply remove them from developing countries. Instead I think the solution would be to encourage donors to make investments in already existing state infrastructure as opposed to donations to NGOs and hope that overtime this shift in economic support leaves the state as the dominant provider. As it would be much harder to incentivize large donors to make investments into struggling state entities, perhaps more of an emphasis on obtaining multiple, smaller donations would allow for this shift in investment.
- How do you balance trying to elicit sympathy from donors with ensuring that you are not debilitating the image of the very people you are trying to help?
- What is the best way to prepare state-run entities for an independence from NGOs? How do we solve problems such as government corruption?
- Would citizens in developing countries resist to the removal of NGOs? If so, why and how could we alleviate their resistance?
Benton, Adia. HIV Exceptionalism: Development through Disease in Sierra Leone. Minneapolis: U of Minnesota, 2015. Print.
Biehl, João Guilherme., and Adriana Petryna. “Evidence-Based Global Public Health.” When People Come First: Critical Studies in Global Health. Princeton: Princeton UP, 2013. Print.
Inveen, Cooper. “Sierra Leone Officials Say Flawed Aid Strategies Hamper Ebola Recovery Efforts – Humanosphere.” Humanosphere. N.p., 02 Nov. 2015. Web. 11 Nov. 2015. <http://www.humanosphere.org/global-health/2015/11/sierra-leone-officials-say-flawed-aid-strategies-hamper-ebola-recovery-efforts/>.
Zaidi, S. Akbar. “NGO Failure and the Need to Bring Back the State.”Journal of International Development J. Int. Dev. 11.2 (1999): 259-71. Web.