I’m interested in critiquing “the demonstration of success” that NGOs are forced to produce for donors as evaluation for their efforts. I also think that evaluating the success of global health projects using a business-like model can be problematic.
Fundraising for a specific epidemic is one way to mobilize resources for NGOs using a vertical model (Biehl & Petryna, 2013). Uniting behind one health issue is a benefit of the vertical approach but as we have seen with “magic bullet” case studies for malaria and guinea worm, these programs can fail. Vertically oriented programs have major drawbacks because they don’t consider the improvement of regional health in a holistic manner. NGOs are one way to tackle issues of global health but they are dependent on donor funding (Zaidi, 1999). There exists a patron-client relationship between donors and NGOs similar to something you would find in a business.
Donor investment fads are one issue in NGO funding because popular issues are prioritized over necessities (Zaidi, 1999). Donors also have the power to decide what specific objectives are being targeted (Biehl & Petryna, 2013) and what projects to create. This makes me wonder how often project choices are based on evidence of need in a particular region or just based on the opinion of the donor, which may or may not be the best way to spend the money. Communication with community leaders about health projects they view as most important in their region should play a major role in NGO program planning to have the most effective outcomes (Ooko, 2014).
NGOS have been known to fix data for donors so they see the outcomes they want to continue to invest in the projects (Zaidi, 1999). This information is incredibly troublesome because it doesn’t show real progress or improvements of a health effort. This is similar to the portrayal and understanding of a country’s GDP, or the size of their economy. While Mozambique’s GDP increased after structural adjustment showing economic growth, the wealth of the rich increased, the poor populations grew poorer and rates of child malnutrition haven’t improved (Biehl & Petryna, 2013). The rise in GDP did not necessarily indicate an increase in health.
Statistics are one way to illustrate the “success” of a global health program to donors and specific patient examples are another. Ugandan patients in ARV programs proselytize their programs and endorse the success of treatment with their voice and bodies (Biehl & Petryna, 2013). Brenda of the HBAC program is one example of a success story from USAID support. Her story of transition, once on the verge of death to currently enrolled in college, provides evidence of success to donors and patrons, which shows the NGOs accountability. Benton (2015) also discusses the idea of successful examples of health in the context of HIV in effort to erase the stigma associated with being HIV positive. While I think that in both cases the use of specific patient examples can be motivating for either the donor or other patients, the comparison that other patients make between themselves and the example can be damaging to their own morale. Everyone recovers differently and faces different obstacles in their lives and health so modeling after one “good example” may sometimes be unrealistic.
Using a business-like model, or donors investing money with the expectation of “success” in the form of fast-improved health statistics or case studies, forces NGOs to create quick fixes to health issues rather than investing in regional structural changes that are sustainable. I draw a parallel in the US education system as teacher salaries in Florida are dependent on their student’s test scores. Studies have shown that teaching quality is not related to test scores (O’Connor, 2014) and I think this follows similar lines with the expectations of NGOs. Sometimes health improvements are difficult to measure or there are lags in the results of efforts, but these reasons should not deter donor investing in important projects.
The effects of NGO global health projects should be measured and monitored in some way to evaluate community health improvement. I suggest this be done through continued data collection, effective communication between NGO leaders and community members a part of target populations, and the donor taking a more hands-off role in program planning. We might also think about the time frame for the outcome of these efforts and consider measuring success over longer intervals so that efforts of long-term sustainable projects have time to form (Sriskandarajah, 2015).
- How can success pressure be alleviated from NGO programs? Is this necessary, or are there any alternative ways to evaluate the effects of global health projects?
- What role should donors play in the planning of global health programs they invest in? Does this change based on individual donors vs. government donors or their respective experience levels?
- J. Biehl & A. Petryna, eds. 2013. When People Come First: Critical Studies in Global Health. Princeton: Princeton University Press.
- Zaidi, S.Akbar. 1999. “NGO Failure and the Need to Bring Back the State.” Journal of International Development 11(2): 259.
- Ooko, Sarah. “NGOs and Development in Africa: Lessons for Donors.” Thomson Reuters Foundation. 3 Mar. 2014. Web. 13 Nov. 2015. <http://www.trust.org/item/20140303151017-208vf/>.
- A. Benton. 2015. HIV Exceptionalism: Development Through Disease in Sierra Leone. Minneapolis: University of Minnesota Press.
- O’Connor, John. “Two New Studies Find Problems With Teacher Evaluations.” State Impact. NPR, 13 May 2014. Web. 13 Nov. 2015. <https://stateimpact.npr.org/florida/2014/05/13/two-new-studies-find-problems-with-teacher-evaluations/>.
- Sriskandarajah, Dhananjayan. “Five Reasons Donors Give for Not Funding Local NGOs Directly.” The Guardian. 9 Nov. 2015. Web. 13 Nov. 2015. <http://www.theguardian.com/global-development-professionals-network/2015/nov/09/five-reasons-donors-give-for-not-funding-local-ngos-directly>.