There is an expectation that Non-Governmental Organisations (NGOs) have significant advantages over government in the provision of health care. Do NGOs live up to these expectations? This article, from the journal Health Policy and Planning, throws light on current practices and future opportunities, in order to inform the process of policy development with respect to the incorporation of NGOs within health systems. Current practice is characterised by a key perceived strength of NGOs, that is, like health professionals, they are primarily motivated by humanitarian concern. However, some NGOs pursue profits and this can affect their response to circumstances.
Overall, NGOs have four health sector functions: Service provision, social welfare activities, support activities and research and advocacy. How NGOs are funded to carry out these health sector functions is of primary concern to policy makers. In some countries, such as Papua New Guinea, large-scale subsidisation has resulted in NGO health care provision being considered as being part of the public health sector. However, there are problems related to reliance on government funding, including delays in disbursement, lack of flexibility in the use of funds, and lack of stability.
A major justification for the promotion of NGO services is that they are more efficient and of higher quality than either government or for-profit providers. However, available evidence is limited and variable. The strengths and weaknesses of NGO health care provision are considered in detail. Given these, the paper finds that to support appropriate policy decision-making the following research should be carried out:
- Strategies for strengthening and developing government capacity to co-ordinate and regulate at national and local levels
- Structures and mechanisms for coordination among NGOs, and between NGOs and government
- Evaluation of relative NGO efficiency in provision and management, and of factors influencing efficiency
- Evaluation of the potential functions for NGOs in different circumstances
- The development of quality monitoring procedures and tools.
The current, mixed performance of NGOs in relation to health care provision indicates that policy development should be cautious, building on strengths while being aware of the weaknesses. Four broad policy strategies exist with respect to NGO provision of health care: (1) Restrict their operations; (2) maintain the current level of service provision and existing, limited, government regulation; (3) regulate, co-ordinate and supervise; and (4) actively promote. The article outlines the potential of each of these options. As such, policy implications include that:
- The relative roles of governments and NGOs need to be clearly spelt out
- Current experience suggests that regulation is best tempered by incentives
- The active promotion of NGOs should be restricted to areas where they have a long-term, sustained advantage in provision and financing, and they can meet a need not otherwise met and use untapped potential in the community
- Mutual trust and willingness to coordinate is required for the development of the NGO sector towards national policy goals.
