The purpose of this Code of Conduct for Health Systems Strengthening is to offer guidance on how international non-governmental organizations (NGOs) can work in host countries in a way that respects and supports the primacy of the government’s responsibility for organizing health system delivery.

The last two decades have ushered in tremendous growth in political will, funding support and organizational structures to improve international health. While gains have been achieved in some areas such as the HIV epidemic, ground has been lost in basic primary care and maternal child health. It has become clear that NGOs, if not careful and vigilant, can undermine the public sector and even the health system as a whole, by diverting health workers, managers and leaders into privatized operations that create parallel structures to government and that tend to worsen the isolation of communities from formal health systems.

This Code is intended specifically to address international NGOs and their roles in training, securing and deploying human resources in the countries where they work. There are six areas where NGOs can do better:

1) hiring policies;

2) compensation schemes;

3) training and support;

4) minimizing the management burden on government due to multiple NGO projects in their countries;

5) helping governments connect communities to the formal health systems; and

6) providing better support to government systems through policy advocacy.

This Code offers sustainable practices in each of these areas of concern.

Signatories to this Code of Conduct recognize the role of voluntary ethical codes and country-based codes of conduct that have come before us. Those codes, such as the Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief (1992), the Code of Good Practice for NGOs Responding to HIV/AIDS (2004), the Paris Declaration on Aid Effectiveness (2005), the Accra Agenda for Action (2008) and the Busan Partnership for Effective Development (2011) offer practical ethical standards for NGOs and donors engaged in development work. These standards aim to improve the quality and impact of their work.

The original drafters of this code are representatives of international NGOs with implementation and advocacy experience in a variety of developing countries; we ourselves have made many of the mistakes that we address.

We hope that our Code of Conduct standards will prove useful for NGOs, governments, local institutions and donors by establishing principles to strengthen health systems. Our commitment helps ensure that “health for all” is not a thousand-year project, but well within our reach.

The code is intended to be clear, direct, succinct and action-oriented.

(Please note that the term “NGO” in this code refers to international NGOs.)

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