A partnership between NGOs and the state: An Illusion

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.

Discussion Questions:

  • 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?

Sources:

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.

 

26 thoughts on “A partnership between NGOs and the state: An Illusion”

  1. Hi Pauline!

    I really liked your blog post! Your criticisms toward NGOs demonstrated that these organizations have flaws, but have not yet been fully exposed and tested. I also liked the examples that you used as they related to our readings and to our discussions in section!

    I think your first question is very difficult to answer. I think that it’s sad that NGOs are trying to help people that are in need, but are potentially reaching suboptimal results by remaining under a donor’s agenda. In lecture in “Trying to Help” (10-7-15), we discussed the power of images. I think by incorporating such power images such as desperate citizens and lack of adequate infrastructures this could help gain sympathy from donors. I also think that donor’s feel that they must create agendas in order to see results. What if NGOs created agendas to present to donors, and they could come up with a compromise?

    Looking at your second question from an economic standpoint, I think government could create policy rules to which policymakers and state officials must abide by. Therefore, there is no incentive to change rules. States could have active policies by which they announce in advance to where and for whom funds go to. According to John Clark, there are many reasons as to why NGOs have not obtained a healthy relationship with the state: lack of dialogue and coordination, too much dependence on donors, political jealousy, and NGOs lack of accountability to name a few (Clark). It seems as though there has been a lack of communication and misunderstanding, which has destroyed their alliance.

    I think citizens would resist to the removal of NGOs because some people really do benefit from their work. The people on the outskirts of popular areas may not care because they weren’t going to receive the help they needed anyway. However, for the selective people that may have received care, they might strongly oppose this idea. In order to alleviate their resistance, I think it is important to show what the new plan of action conducted by the state or whomever. What do you think?

    Clark, John. “The Relationship Between the State and the Voluntary Sector.”The Relationship Between the State and the Voluntary Sector. N.p., n.d. Web. 14 Nov. 2015.

    1. Hi Samantha!

      Thank you for your thoughtful comments, I appreciate it!

      I agree with you in that presenting donors with images of desperate citizens and lacking infrastructure would help to elicit more donations from them. However, I do worry about what images such as those do for the citizens. I fear that my constantly representing citizens in developing countries as desperate, we don’t do justice to their resilience and their potential for innovation.

      You are definitely right in that some areas NGOs have a huge positive impact and their removal from the country could be perceived as a threat to its citizens. In order to alleviate this threat, I would ensure that the government services intended to replace NGO infrastructure has reached all areas before removing NGOs from the country.

      1. Hi Pauline!

        That is definitely true. I also recall in lecture we discussed how images can be misleading. I vividly remember the picture of the little bot who was struggling to crawl, and people criticized the photographer for focusing too much on his pictures and not on helping this poor child.

        Also, I like your second idea as this ensures that citizens get the help that they need while proceeding to make new plans for the future

        1. Hi Samantha!

          Yes that picture that you described is a perfect example of a concept called ‘Poverty Porn’ that I discussed with Alexis below. Such pictures do absolutely nothing to empower the individuals that were photographed, and only reinstate the power that the photographer has over them.

  2. Hi Pauline,

    Thank you for your response. I found your comments regarding the interplay between the state and NGOs very interesting, especially regarding your point about how the relationship obscures who is accountable. I think it’s a very powerful argument to separate the roles of any institutions in health care, although this may prove, as you and Pauline have mentioned, very difficult to do.

    I thought I would add another example of how devastating the “sharing” of accountability of individual health between two or more entities can be; this is a common problem, not only in developing countries, but also in the United States. In a book called Markets of Sorrow, Labors of Faith, an anthropologist named Vincanne Adams explored how, in the aftermath of Hurricane Katrina, citizens of New Orleans couldn’t get back on their feet and rebuild their lives, not because there weren’t enough resources to sustain the recovery, but because of arguments between the insurance companies and the government over who was culpable for the population’s health. The insurance companies were technically obligated to provide money to individuals who bought insurance, but instead they put blame on the government for not reinforcing the levees that the flood had breached (Vincanne 60). This created a stalemate in which citizens could not afford health care, nor materials to rebuild their homes.

    While this is between the government and insurance companies, not government and NGOs, I think the point is the same: when health care is provided by two different entities, it’s difficult to know when the responsibilities of one end and the where the responsibilities of the other begin. However, I agree with Samantha that many people would be very resistant to NGOs leaving, as NGOs are often the only source of health care around and people rightfully do not trust the governments. I think that, for now, it would be better to redefine and clarify the roles of NGOs and the state, instead of eliminating NGOs altogether.

    1. Thank you Benjamin for sharing the Hurricane Katrina example with me. Indeed I think your example only reinforces the idea that two entities providing the same services is not compatible with clear cut development. I really think that we gradually (as I said earlier, so as not to alienate citizens who benefit from NGOs) remove NGOs from developing countries so that ultimately only the government is responsible for the needs of its citizens. Also, in light of our readings from last week, I also think that more south-south collaborations would be a better substitute for NGO-governmental collaborations. South-south collaborations would be a way to continue the foreign investment needed to fund more governmental health care projects.

  3. Hi Pauline,

    Great post. You gave a thorough critique of NGOs and discussed a similar issue I’ve been thinking about in regards to them, the possibility that its large presence could divert attention away from the need for government reform. Yet, I echo you and the commenters above me when I say that removing NGOs might not be the best direction to take, especially when there are many people who rely on them. There needs to be simultaneous political changes. In addition, I agree with Benjamin; there should be clearer guidelines for the roles of NGOs. I mentioned in Jessica’s post, possibly limiting the issues NGOs attempt to tackle to those that are more individually-focused, like individual medical treatment, than tackling on issues that are more population-focused, like attempting to eradicate Guinea Worm or Malaria. The reason I say this is because many NGOs fail at addressing the latter, often causing more harm than good. They don’t or can’t address the larger political and environmental climate that contribute to population health issues. However, I could see funding for individually-focused projects being an issue. Donors seem more likely to fund projects that have a wider, population-based impact than those that only help a few individuals. Yet by presenting donors with images as Samantha suggested, and personal accounts/feedback from those helped, these methods could help elicit donor sympathy and support.

    1. Hi Jeanette,

      Thank you for your insight. I really like your idea about encouraging NGOs to rally behind more individually based goals. Also, given that as you said, donors would be more inclined to fund a project with a population based impact, I would say that that is a way to encourage donors to fund more governmental projects. If the shift for NGOs is towards making impacts at the individual level, donors will shift their interest towards funding existing governmental projects, which I think would be for the better. Although I would predict that an unanticipated consequence for this NGO shift would be an fortification of disparities within and between regions. An NGO that makes impact on an individual level may result in such individuals being targeted as ‘selfish’ by their communities. Additionally these individuals may feel resentment from community members that are not able to have such access. What do you think would be the best way to combat this?

  4. Pauline,
    Your post is directly addresses the problem at hand—though we don’t want to admit it, NGOs yield unintended consequences. I also agree that it is concerning that the consensus among people in the Global North is that NGOs are altruistic, and ultimately, something unnecessarily supplementary. It is absolutely true that they are merely delivering basic human rights to the underserved. This sentiment is considered again in the context of America’s welcoming of Syrian refugees—many people will gladly turn their backs on these people, when it is only right to let them in because they deserve to regain their human rights.

    You pose a tough question, asking the best way to prepare states for the eventual departure of NGOs. Of course, this is the ultimate question. Ultimately, a country must either internalize and embody the will for change or be constantly surveillanced and pressured by other powerful entities in order to keep them pushing in the right direction if NGOs will no longer be present. But how can we change the culture of a society to such an extent that they desire a complete political overhaul? With these tough options, it almost seems easier to keep sending more and more NGOs to these compromised areas. Perhaps it is in NGO’s influence among the citizens they help that we can convey the idea that their governments must change for the better.

    1. Hi Sarah,

      I really liked your last point. I absolutely agree that it is the responsibility of the NGOs to convey to the citizens they are helping that the only way their country will enjoy long lasting substantial development is through their government. I would even take it one step further and say that due to far-reaching extent of power NGOs have in some developing countries, it is also their responsibility to mobilize the citizens they are helping politically. What I mean by that is if a government is infringing upon its citizens basic human rights, NGOs need to help these citizens put political pressure onto the governments to enact change.

  5. Pauline –
    Good job with your post, especially your discussion of the role of accountability in subverting the role of NGOs. While, like you, I don’t think that eliminating NGOs is the best course of action, simply because I see doing some good as always preferable to doing no good, I agree in that they are very much an incomplete solution to a systemic problem. One way in which I see potential for alleviating this problem is through increased partnerships between NGOs and states, with the end goal of eliminating the necessity of the NGO providing the service. This would be different from bilateral aid we’ve seen before, where governments simply give money or resources to another government but don’t see the results they’re looking for because of problems with program administration, in that it would be a true partnership until the government has the necessary infrastructure in place to run a program by itself. I think that this kind of intervention would alleviate some of the criticisms of NGO interventions that collapse as soon as the NGO leaves, or programs that don’t address the problems that locals see as the biggest issues because they’re being driven exclusively by outside donor wishes rather than the wishes of those being helped.

    1. Hi Ruby,

      Thank you for your comment and bringing up a great viewpoint. I do see the benefits of increased partnerships between NGOs and the governments, however I really do worry about the brain drain effect this will have. I would ensure that a stipulation of such partnerships is that NGOs hire local workers to run the partnership on site. Last summer I worked for an interesting non-profit called GHETS- Global Health through Education Training and Service. The founder of this non-profit believes that the best policy to have as a western non-profit donating money to developing countries is ‘to do nothing.’ Meaning he believes that it is best to allow the recipients to do all of the planning, the organization, the prioritization and the execution of the project that is funded by the donation. I think that if partnerships between NGOs and states were increasingly of this nature, the governments would become more and more accountable to their citizens as they see this is no longer what the role of an NGO entails.

  6. Hi Pauline,
    I think you did a great job of balancing the dilemma that while NGO presence might undermine any efforts to create a robust public health infrastructure in a state, the solution is clearly not to remove all NGOs from their interventions immediately.

    I was particularly interested in your discussion of health disparities. While I suppose that it is true that NGOs perpetuate health disparities in many nations by ignoring those living in rural areas and those with some conditions, isn’t treating some people better than treating no people? I also agree that a state-led solution would be the ideal way to create lasting infrastructural change, but do you think that the absence of state support for any important public health measure is grounds for NGO intervention? Do you think that giving money to a state that may add a political agenda to the healthcare initiatives it undertakes is always acceptable?

    1. Hi Alana,

      Thank you for your insight, you raise some very valid points. Indeed I do believe that helping some people is better than treating no people- and that is one of the questions I struggled with the most during this class. It’s all too easy for me to sit here from the comfort of my desk and critique public health care interventions – what would my opinion be if I was instead working at an MSF run refugee camp right now and had just vaccinated a child against polio? I don’t mean to be so dramatic, but I think that it is important to bear in mind that sometimes our critique may overshadow the improvements that have been made over the years. So my answer is yes, I do believe that treating some people is better than treating no people. However, we must never be satisfied with that, and always strive to think of ways of how we can treat those who aren’t treated. I do not think that NGOs should just be immediately pulled out of developing countries, I think that they should continue to do the work that they are doing while they continuously evaluate their strategies to see if what they are doing is the best way to help as many people as possible.

  7. Hi Pauline! Thanks for your insightful post. I’m pretty much on the same boat with you–the degree to which NGOs have absorbed themselves as infrastructure within some countries is concerning. Imagine if an economic crisis emerged in the countries that fund these NGOs? The developing countries that depend on that aid will not be prepared to have the state run a role they never really played.

    And so, I believe the question you posed is one that’s really important to answer: what is the best way to prepare state-run entities for an independence from NGOs? Amidst rampant government corruption, how can we prepare governments to perform in areas they have never quite breached because of NGO dependency? Although it may seem tempting to shift the funneling of money to NGOs then to the governments of those countries, corruption will not always make that the best solution. And so, I wonder if steadily integrating existing NGO structures into governmental structures will decrease dependency while preserving the very things that help so many people. This may not run without it’s own issues, but I wonder what you think of such a strategy as a whole?

    1. Hi Lilian,

      Thank you for your comment. I definitely agree that a complete shift to full government accountability is not possible due to corruption. The integration of NGO structures into governmental ones has to be gradual. Sudden rupture and immediately ripping NGOs would yield negative consequences – the vacuum that forms with the departure of NGOs may never be filled. However, I would say that in order for the governments to really feel like they must be accountable to their citizens, there does have to be at least some funding that is channeled directly towards the governments. It may be naive of me to think this, but perhaps the more responsibility NGOs handed over to governments, the less corruption there would be?

  8. Thank you for the great post, Pauline! I appreciated how you substantiated each of your points with case studies from the readings.

    I was particularly drawn to your first question about how to maintain the integrity of potential beneficiaries but still evoke a desired emotion from donors. This is a very important point, because imagery can galvanize support for certain communities but often reinforce notions of the “other”. In “The Drowning Child and the Expanding Circle”, Peter Singer poses a hypothetical situation where a person walks past a pond in which “a child has fallen and appears to be drowning” (1). Our class discussion suggested that most people would feel morally compelled to save the child, especially because human nature kicks in most with face-to-face suffering. On the other hand, Singer suggests that distance factors into the degree to which people care about the suffering of others.

    Some types of images are important, because they can reframe “suffering masses” as individuals, in ways that popular media coverage fails to do. In addition, images can narrow literal and perceived distance between donors and potential beneficiaries. A positive example of global health imagery was that of a Haitian Farmer, St. Coeur Francois, who weighed 88 pounds in 2000. After starting antiretroviral therapy, his emaciated body filled out and he was able to live a comfortable life. Before and after pictures of him illustrated a positive and, overall, empowering narrative to donors, largely without compromising his humanity. Unfortunately, global health images run the gamut, with many that appeal to voyeuristic, privileged Euro-American audiences (3). For example, the New York Times headline and accompanying photo, “A Hospital from Hell, in a City Swamped by Ebola,” depicts a solitary Sierra Leonean child, who faces the camera, lying on a hospital floor covered in various body fluids (2). A similarly disturbing image is Kevin Carter’s Pulitzer Prize-winning photo of a vulture stalking a Sudanese child en route to an aid camp. As Arthur and Joan Kleinman explain in “Social Suffering”, this type of imagery is harmful because it “(justifies) colonialist, paternalistic attitudes and policies, suggesting that the individual in the photograph…must be protected, as well as represented, by others…Something must be done, and it must be done soon, but from outside the local setting” (4).

    In answer to your first question, I believe that it is essential to avoid “poverty porn” and other dehumanizing portrayals of people who the global health community is trying to help (5). While there is no perfect image, those that emphasize the benefits of treatment – rather than faceless people languishing in human waste, famine, or other undignified conditions – both encourage donors to help and maintain the integrity of individuals in need of help.

    1. Singer, Peter. “The Drowning Child and the Expanding Circle, by Peter Singer.” The Drowning Child and the Expanding Circle, by Peter Singer. New Internationalist, Apr. 1997. Web.

    2. Nossiter, Adam. “A Hospital From Hell, in a City Swamped by Ebola.” The New York Times. The New York Times Company, 1 Oct. 2014. Web.

    3. Kleinman, Arthur, Veena Das, and Margaret M. Lock. Social Suffering. Berkeley: U of California, 1997. Print.

    4. Dasgupta, Sayantani. “America’s Vile Ebola Voyeurism: Why the Outbreak Taps into Our Worst Instincts.” SALON. Salon Media Group, 16 Nov. 2014. Web. 25 Nov. 2015.

    5. Roenigk, Emily. “5 Reasons ‘Poverty Porn’ Empowers The Wrong Person.” The Huffington Post. TheHuffingtonPost.com, 16 Apr. 2014. Web. 2015.

    1. Hi Alexis,

      I am really glad that you brought up the issue of ‘poverty porn,’ it is something that I feel very strongly about also. Actually if you are interested, I first read about this term on a great global health called ‘Humanosphere’ : http://www.humanosphere.org/basics/2015/07/op-ed-is-natgeos-new-endpoverty-contest-just-more-poverty-porn/

      I certainly agree that images should focus more on the positive impacts that treatments have. However I would also argue that the best image would be one that portrays the ingenuity and resilience of individuals. I think there should be more of a move towards encouraging donors to view their donations as an investment into very bright individuals.

  9. Hey Pauline!

    I appreciate your teasing out of the structural inequality inherent in the NGO structure — that a few villages or communities can receive aid through most NGO models re-perpetuates the same unequal access that established health inequalities in the first place, and the chosen villages might be selected based on need. If this is the case, then the “sickest” people (in the eyes of the west) are thus afforded an international attention, allowing illness to serve as a commodity in the numbers-driven model that health programs are unfortunately wedded to.

    I think that your suggestion to “encourage donors to make investments in already existing state infrastructure,” serves as the devil’s advocate against bolstered funding for NGO presence, and I’m not sure it’s the solution, either. I think that there is something dangerous both in providing financial support to potentially corrupt government institutions as well as establishing direct means for the western wealth to disseminate their money (i.e. power) to “worthy” countries and “worthy” peoples in need.

    1. Hi Dolma,

      Thank you for your comment I couldn’t agree more. One of the things I struggle the most with in the NGO debate is government corruption, there is no denying that it exists. As I was writing this I thought that it would be useful to think of developing countries where corruption isn’t as rampant and so I decided to look into Cuba (which has an impressive primary health care system) as I know that there aren’t that many NGOs there – certainly not US based ones. However, when I googled ‘corruption in Cuba,’ a book titled ‘Corruption in Cuba’ was one of the first things that came up. So I suppose that my earlier comment to Lilian stating that perhaps a decreased NGO presence may lead to less government corruption as government’s feel more responsibility for their citizens isn’t a valid argument.
      I suppose one way to combat corruption would be to mobilize citizens politically and help them put political pressure on their governments to end corruption. Perhaps NGOs should not only offer medical help, but political help also.

  10. Hi Pauline!

    I think the argument you made in this post is a very valuable one. NGOs are so often associated with the kind of altruism of non-profits, that they are stepping in to help where governments have failed their people. However, you have extracted from the readings some powerful criticisms that could justify the elimination of NGOs – except that we know this process would induce such a major shock to the system that it would not be ethical or constructive. How can we encourage state building so health care systems can be improved and NGOs be rendered less important? This is a really difficult question that I’m not sure I have any answers for. It seems to me that NGOs should be in communication with local governments and the national government because health care needs to be coordinated, but context specific dynamics often hinder or restrict these communications. I think I’ve always wondered, how “non-governmental” do these organizations actually have to be?

    Your third question is an essential matter, and I don’t think there is a good way of answering. If the plan for the removal of NGOs requires the State to replace the need for those NGOs so that the people who have been benefiting from them can maintain their benefits, this would assume that the State is now running a very successful health care system. But how can you build a successful health care system in the presence of so many NGOs, which is the first question you asked in your post… this I do not have a solution for. I would think that bringing the NGOs and government officials into concert through consistent, ongoing discussions could better inform both parties of how to coexist in a way that can do the best for said country.

    1. Hi Elena,

      Thank you for your insight! I really loved your idea that more active discussions between NGOs and government officials is a way to start the process of more governmental accountability. Taking your idea further, perhaps it would be useful to induce laws in which government representatives have to regularly visit NGO sites for a sort of informal assessment where the main objective would be to have the NGO workers talk at length with the government representative about their work, and how their work could be expanded to a larger – perhaps national – scale.

  11. Hi Pauline,

    Your blog post was very interesting and informative, and you truly highlight many of the unintended consequences of NGOs. As you mention, NGOs can have serious negative effects on the countries and societies they are working with; however, they also provide relief of pain and suffering for those who need it most. Unfortunately, the successes of NGOs are often outweighed by the consequences of their work. As you mentioned, dependency on donors prove to be one of the most significant challenges that NGOs face. To answer your second question, I think the best way to prepare state-run entities for an independence from NGOs (as you mentioned above), is to encourage donors to put their money towards infrastructure and resources of those countries being helped.
    As part of your first question, I think it is very important to balance sympathy from donors with ensuring that you’re not debilitating the image of the people you are trying to help. It is extraordinarily difficult to refrain from a sense of patriarchy over those NGOs are helping, but this is very important, as you want full attention and accordance from those you are helping. To balance this, it is essential to be culturally sensitive and aware of the daily struggles and battles that the people you are helping try to combat each day.

    1. Hi Julianne,

      Thank you for your comment. Your last point brought up some very important issues. While NGOs may go somewhere with the intent of fixing a certain a problem – and sometimes that ‘fixing’ involves changing something about the community in a way – it is vital that ultimately it is the NGOs that listen more to the community members than it is the community members that listen to the NGOs. I think that foreign NGO workers need to understand that they will never fully understand what those who they are helping are going through. I think that once this acceptance has been made, foreign NGO workers will understand that there are some things that you simply just cannot change and it would be far more productive to work in tandem and alongside the community as opposed to exerting some sort of patriarchal sense of authority over it.

  12. Pauline,
    I thought your post was very insightful and did a great job of analyzing the various issues associated with NGO intervention in developing countries.
    I agree with your claim that the altruistic nature of NGO’s detracts from the recognition of health as a basic right for all human beings. In my opinion, the emphasis on altruism also evokes historical concepts of colonialism and the notion of generous Western intervention to aid ‘inferior’ and ‘uncivilized’ developing populations. NGO’s, in this sense, may even dehumanize the populations they are trying to help and, like you mentioned, therefore widen the divide between Western interventionists and recipients of such intervention.
    In response to your third question, I believe that support or resistance to the removal of NGO’s would depend upon the region. As you described, rural populations that do not really benefit from NGO aid would likely be indifferent to their removal, while urban populations who benefit far more from NGO intervention would, in my opinion, still resist NGO removal, as the presence of NGOs, in spite of its many dilemmas, is still a far better alternative than lack of intervention and thus the continued abuse and exploitation of local populations by unchecked and corrupt government structures. However, it may also be difficult for local populations to trust NGOs, and therefore to cooperate with intervention efforts , due to their colonialist connotations; individuals may thus be supportive of NGO removal. In my opinion, the only way to diminish resistance to NGO removal is through the establishment of a secure government structure that will ensure the healthcare of all citizens so that NGO presence would not be necessary.

  13. Hi Alex,

    Thank you for your comment. And thank you for drawing the very interesting parallel to colonialism. Indeed your comparisons – sadly – ring true. The far-reaching presence of western NGOs in the developing world could certainly be interpreted as a western ‘civilizing mission.’ This is why, as I have said before, that I am a strong advocate of more south-south collaborations between governments and education institutions in the developing world.

    In terms of resistance to NGO removal your distinction between the reactions of urban as opposed to rural populations was a very important one to make. Indeed before any NGO withdrawal citizens must be reassured that their governments would be able to provide them the services the NGOs were. Which is why the removal has to be gradual and happen alongside increasing investment in governmental healthcare infrastructure.

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