Various agencies have been engaged with delivering healthcare services in the resource-poor countries. Generally, the state, the private sector, and the third sector have a role in the delivery of healthcare services. Since both state-driven and market-led approaches have often been ineffective, there has been an emergence of non-governmental organisations (NGOs) that include faith-based institutions to facilitate the delivery of healthcare programmes in resource-poor countries. Over the past several decades, NGOs have become major players in the arena of development and healthcare services in resource-poor countries. There has been a growing interest in the role of NGOs in the field of health and development, as they are frequently considered as more efficient and responsive than the state.
There has been duplication of the roles of the state and international agencies or NGOs in some countries’ health systems. It is noticeable that NGOs are taking greater involvement to help the state to address the objectives and statements made by Alma Ata Declaration and Millennium Development Goals. National health institutions are receiving resources and technical assistance from NGOs and international donor agencies. However, a policy paper of American Public Health Association (APHA), see link below, states that the health systems in the resource-poor countries suffer from insufficient financial resources, poor management and technical capacity, limited institutional framework and infrastructure, weak health information systems, inequity and discrimination in the distribution of available services, poor community participation and lack of transparency and accountability. Due to lack of robust health policy, weak health system and the shortages of capable health professionals, attempts of preventive and curative healthcare services and health promotion programmes have been insufficient and ineffective.
Professor Anne Mills (see link below) asserts that although contracting services to the private sector and NGOs is advocated as a solution to the problems facing governments in managing healthcare services, there is a need for developing the management capacity of governments to contract out service provision to other agencies. She further mentions that strengthening health systems is a long-term process that requires enhanced capacity of government institutions and local personnel. Hence, countries or governments need to identify the areas for improvements and develop policies and programmes to accommodate inputs or assistance from the private sector and NGOs. From the sustainability point of view, governments must develop institutional frameworks and policies, so that external agencies find their role as assisting the existing government policies and programmes.
APHA claims that heavy involvement of private sector, international agencies and NGOs may have adverse effect on the national health systems in terms of sustainability of the services and capacity building of government health institutions and professionals. It states that government’s national health systems may be deteriorated through international organisations’ project activities by diverting health professionals from the public sector and creating parallel structures to government services. There is duplication in the allocation of resources and the delivery of services, which tend to worsen the isolation of communities from formal health systems in one hand and waste of limited resources on the other. There is also an issue of sustainability, as the support from international NGOs and donors is project-bound and time limited. Hence, it is sensible that the role of international agencies and NGOs is to enhance the capacity and infrastructure of a state’s health systems, so that the government will be able to deal with meeting health needs of their country. APHA recommends that international NGOs include capacity building and strengthening of national and local health systems in their projects to ensure long-term sustainability after their support terminates. Further, it recommends that international agencies and donors commit support to government’s health sector, so that national workforce and institutions can be strengthened with an adequately trained healthcare professionals and workable national and local health systems in resource-poor countries.
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