Relaciones interpersonales

INGOS

INGOs should ensure that their work is complementing, not displacing or supplanting, the work of ministries of health and public sector as a whole in building strong health systems.

To the extent possible, INGOs should invest resources in analyzing the impact of their own work on health systems at all levels, on a project-by-project or country-by- country basis, or globally, to self-monitor their influence on health systems and ensure that they are not unintentionally creating distortions.

INGOs should consider developing internal codes of ethics, or modifying their internal codes of ethics, to ensure that they address ethical implications that may have an impact on health systems, issues such as hiring practices, conflict of interest, accuracy in results reporting, and advocacy.

INGOs should seek to create and invest in innovative partnerships, including partnerships with the private sector, to move beyond dependence on government donor agencies as their primary or only funding source.

INGOs should, resources allowing, advocate for change to ensure that health systems strengthening is supported by donor agencies and, at the country level, by ministries of health and other local entities.

INGOs also should engage actively in country-level working groups, both NGO-led alliances and health sector groups lead by ministries of health.

Donor agencies

Donor agencies should demonstrate their commitment to HSS while, at the same time, not developing mechanisms supporting HSS as a vertical intervention. Donors should consider devoting a percentage of funding of all INGOs projects to health systems strengthening, and require that project proposals include a situational analysis and a description of how the funding will be used to strengthen the health system and complement the work of the ministry of health and health sector as a whole.

Donors can and should including HSS-related metrics in their requests for proposals and applications, and in their evaluation of bids and of the success of the projects they fund.

Donors should include hiring practice and compensation guidelines, particularly concerning local staff, in their requests for proposals and applications.

Donor agencies, at the country level, should participate actively in donor groups that work, in collaboration with INGOs and other partners, and under the leadership of the ministry of health, in setting standard procedures for hiring and compensating health

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workers, as well as setting standard procedures for in-service short term training and associated costs, including per diem.

Donors should work with countries to help them, through the expertise of INGOs as needed, invest in short- and long-term planning to address health workforce shortages and distribution challenges.

Donor agencies should, both at the country-level and globally, continue to work, in collaboration with countries as represented by their ministries of health, on sets of common indicators and data to be collected through health information systems and standardized surveys

Donor agencies also, to the extent possible, should not ask INGOs to report on indicators that necessitate the creation of parallel data collection systems, which may lead to an inefficient use of resources as well as additional burdens on health systems at all levels, from point of care to the central level.

Ministries of health and other local government entities

Ministries of health should ensure that they demonstrate country ownership and ensure, and enforce as necessary, the compliance of all partners in supporting the health sector by following the same rules and regulations regarding hiring and compensation practices, per diem procedures, and other practices.

Ministries of health should negotiate with donors and INGOs to ensure that parallel systems of data collection are not created to meet the need of a specific project or agency.

Ministries of health also should develop and, as appropriate and feasible, request assistance in developing joint health sector plans that encompass the work of all partners and ensure that all INGO projects and other donor-funded programs are included in such national plans.

Ministries of health should conduct analyses of health systems strengths and potential weaknesses, or bottlenecks, if necessary requesting the support of donor agencies and others to do so.

Ministries of health should ask for specific support from donors and other partners to ensure that they have the capacity they need to effectively and efficiently manage and lead the health sector.

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