Last month, we hosted “Strengthening Health Systems: The Role of NGOs,” a virtual Expert Panel discussion on GHDonline.org with Dr. Agnes Binagwaho, Minister of Health of Rwanda, and practitioners from The Access Project, Health Alliance International, Partners In Health, and Tiyatien Health. We were delighted to see more than 100 contributions from over 50 participants, and were thrilled to have over 400 people from 64 countries sign up and follow the discussion.
Throughout the discussion, Dr. Binagwaho stressed the importance of leadership and planning at the national level: “First and foremost in the health sector is the process of developing a national vision, one that all policies of the Ministry and its NGO partners follow from. It is important for the Ministry of Health to have zero tolerance for any plan other than the national strategic plan for the country.” Dr. Binagwaho also pointed out that it’s ok to say “no” to partnerships that wouldn’t further the country’s goal for its citizens, “In Rwanda, we are always ready to kindly accompany NGOs to the airport when they are not willing to work with us towards our vision and our plan.”
Ted Constan, Chief Operating Officer at Partners In Health, agreed that “it’s the responsibility of the NGO to meet the Ministry where it works at the local, district, and/or national level.” Partners In Health has found that “flexibility and nimbleness when planning and implementing programs and activities help the partnership to grow.” As an example, Constan shared: “If in learning about district goals, we find that some of our activities are duplicating the Ministry’s, [...] we try to reallocate the budget to those activities which are more in line with the Ministry’s goals. If the Ministry asks us to support particular strategic items or projects such as purchasing ambulances or renovating a clinic, we try to accommodate these. Our aim is to be responsive to the Ministry’s plans and policies and not work in isolation, or in opposition to them.”
For Christina Bethke, Program Coordinator at Tiyatien Health, successful partnerships come from “a deliberate focus on the actual relationship,” adding that, “too often the interactions are reduced to a set of deliverables and reports and what is lost is the very sense of being partners in more than just name. Communication and coordination do not come naturally, fluidly or freely. […] And one important ingredient for these relationships to grow is time. While many health problems have a sense of tremendous urgency, if all efforts are put into doing, then something critical is lost. Quick impact projects can erect a building seemingly overnight, but as the cliché says, trust cannot be bought it must be earned.”
While the importance of a national vision and strategic planning were widely accepted amongst the panelists and participants, many wondered what to do in situations where this vision and plan had not yet been developed. As Rachel Jean-Baptiste of Oxford Epidemiology Services pointed out, “many NGOs enter this business to do good. This usually means reaching the unreachable and improving their health status. I think the point has been made that if this is done in an uncoordinated way, chaos is created. But on the other hand, particularly in countries where the MOH does not have the political power (often health is not a priority in the budget, for example), and sometimes not even the inspiration to envision a healthy population, how does an NGO strike the balance between providing life saving medicines to dying infants, for example, and nurturing the MOH’s inspiration? There should not have to be a balance, as these things should be the same. But let’s face it – in some settings, that is the starting point.”
For a full summary of this Expert Panel discussion, please download our peer-reviewed Discussion Brief. We hope you will consider adding your thoughts to this discussion by sharing examples of productive partnerships between NGOs and Ministries of Health, suggestions for delivering care in countries without a strategic plan in place, or recommendations for how efforts to strengthen health systems can be made more sustainable.
We also hope you’ll let us know what topics you would like to see addressed in future panels by taking our brief, 6-question feedback survey on this Expert Panel discussion.