The role of international NGOs is to supplement — not supplant — the public policy role of host country governments and local institutions to strengthen and expand health systems. The NGO role is to provide research, support and expertise to strengthen civil society and local academic and research institutions in informing public health policy development. We, the signatories to this code, view our role as time-limited; that is, as communities, local institutions and Ministries of Health become stronger and build capacity, the role of the NGO should diminish or evolve.

  1. In areas where trained personnel are scarce, NGOs will make every effort to refrain from hiring health or managerial professional staff away from the public sector, thus depleting ministries and their clinical operations of talent and expertise.
  2. When hiring staff, NGOs will make every effort to employ available national expertise, particularly where unemployment of highly qualified nationals abounds. Where qualified nationals are available, volunteer labor will not be used as a substitute for paid staff.
  3. In places of scarcity, on rare occasions when NGOs hire health staff already working in the public sector, NGOs pledge to do so in coordination and with the consent of local health authorities. This coordination will be accompanied by a commitment to expand overall human resource capacity in the public sector through pre-service training, salary support and/or other means. Governments and NGOs should work collaboratively to address the chronic underpayment of health workers in all sectors.
  4. NGOs recognize that they have had a historical role in creating conditions that lead trained and skilled personnel to work abroad in wealthy countries. NGOs commit to avoid creating incentives for the health workforce to leave their developing countries for work in international organizations or locations. Instead, NGOs will provide incentives to stay in the public sector, including better working conditions, and good compensation and benefit packages.


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