Was glad to read Massimo's reply on the 'privatisation' of health care in South-Darfur, Sudan. It reminds me of the period that I worked in Nyala for an international NGO in 2005/2006. I reflected at that time that humanitarian assistance had become big business while responding to a disastrous conflict situation. This analysis can be found here:
http://www.phmovement.org/en/node/250
We should indeed be careful how we position ourselves as non-state actors in both humanitarian crises and while working in more stable health systems. The NGO code of conduct for health systems strengthening that we discussed last month is a clear effort to that. It is now up to us to walk our talk. This would imply
(a) To be humble in the way we relate ourselves towards the people we work with, not only in ownership and priority setting for health improvements, but also *how *we present ourselves. Even beyond salaries; the big cars, fenced compounds and sometimes 'exclusive' behavior will add to the divide between 'us' and 'them'. It is indeed not so strange that it pulls high skilled health workers to be part of it, or to try via both public and private sector to reach a similar status.
(b) To be conservative with consultancy fees for international short term assignments, M & E and capacity building programs. Domestic assignments, with a moderate budget and with less initial capacity might be implemented for a longer period and in the long term prove more sustainable.
(c) To refrain ourselves from blaming governments to be corrupt and non-trustworthy in health development. This agenda is often 'hidden' in international health cooperation. We must first be introspective and transparent on how we allocate our budgets and what our own agenda is. The global health market is a competitive one, and each of us has to 'sell his brand approach or particular organization'. This leads to fragmentation and further undermining domestic health systems. We should have the courage to cooperate beyond our program frameworks on strategies for basic health systems strengthening. There is no magic bullet to it, but it is no magic either. Supporting integrated primary health care with clear community involvement; in coordination with stakeholders working on the six building blocks for health systems, intra- and inter sectoral coordination, providing stewardship and capacity on health systems reforms, listen and responding to local priorities in global contexts...In theory it is so clear, but health as a public good does provide friction with those having vested financial interests both at the local and global levels. Health cooperation (or its derivative medical aid) is too often a trade-off that accompanies economic and business deals. We as health community should understand and position ourself in the politico-economic context we work in. We are too often used as trade-offs while we actually want to improve health and rights of the people.
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Remco van de Pas
mailto:remco.van.de.pas@wemos.nl