Lancet comment: The end of AIDS and the NGO Code of Conduct

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August 25, 2014

For more information, contact Julia Robinson, Health Alliance International,, (206) 543-8382

The end of AIDS: country ownership and the NGO Code of Conduct

Seattle, WA – More than 25 years into the fight against HIV and AIDS, the question of how to best implement prevention and treatment programs in low-resource countries is still hotly debated. Though total funding for HIV programs has reached historic levels and breakthroughs in HIV treatment have provoked rallying cries for an “AIDS-free generation,” the way in which these dollars are allocated does not always strengthen health systems. Furthermore, donor funding is often channeled to national and international non-governmental organizations rather than to government health sectors.

In a comment published in the August 23 edition of The Lancet, a consortium of public health researchers, physicians, activists and funders, led by the Seattle-based non-governmental organization (NGO) Health Alliance International, argue that this approach and the fragmentation of health services that often results from a proliferation of NGOs actually weakens the public sector by recruiting its best health workers away from the public sector. They are currently revitalizing efforts to promote the NGO Code of Conduct for Health Systems Strengthening, which sets ethical principles for health-related organizations working in resource-limited countries, including:

    • Engaging in hiring practices that ensure long-term health system sustainability
    • Enacting employee compensation practices that strengthen the public sector
    • Pledging to create and maintain human resources training and support systems
    • Minimizing the NGO management burden for Ministries of Health
    • Supporting Ministries of Health as they engage with communities
    • Advocating for policies which promote and support the public sector

“When the Code was first released in 2008, our focus was to get other NGOs on board and committed to a set of best practices to support public-sector health systems,” Dr. James Pfeiffer, the Executive Director of Health Alliance International said. “But over time we’ve realized that if we really want to make sure that NGOs aren’t harming public-sector health systems, we have to get donors on board.”

By asking donors and ministries of health to make signing onto the NGO Code of Conduct a condition for receiving funding or working in their countries, the consortium, which includes representatives from Health Alliance International, the University of Washington, Health GAP, the Doris Duke Charitable Foundation, the University of Colorado-Denver, and Jawaharlal Nehru University in New Dehli, urges a refocus on health systems strengthening. “The end of AIDS cannot be achieved through a patchwork of uncoordinated NGO projects, private providers, and underfunded public health systems,” the piece concludes. “Conscientious donors, using the NGO Code of Conduct, can help strengthen local services and build the public national health systems capable of producing an AIDS-free generation.”

The article can be accessed on The Lancet’s website.