Article on the Code of Conduct in the American Journal of Public Health – Dec 2008

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The American Journal of Public Health published an article on the NGO Code of Conduct for Health Systems Strengthening in its December 2008 issue.  The article, authored by James Pfeiffer et al, argues for supporting public sector health systems and warns against NGO practices that instead focus on vertical programs and hire health workers away from the public sector.  The authors propose the NGO Code of Conduct as a means of promoting a more effective role for NGOs working in developing countries.


The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked ‘‘brain drain’’ from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems.

Pfeiffer J, et al. Strengthening health systems in poor countries: a code of conduct for nongovernmental organizations. AJPH. 2008;98(12):2134-2140. Abstract, Full article (subscription may be required)

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