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Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations
Open accessAbstract
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.
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“It has been noted in other sub-Saharan African contexts that systems weaknesses, gaps in local capacity, and perceived lack of transparency have been found to contribute to the decision for external actors to implement parallel structures and vertical programmes that introduce health sector fragmentation [1, 4, 29, 32, 38, 42].”
From Health sector fragmentation: three examples from Sierra Leone (2019) · cites this paper as [32]
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Abdalla, S. I. A., Weng, Y., Mehta, K. M., Mahapatra, T., Srikantiah, S., Shah, H., Ward, V. C., Pepper, K. T., Bentley, J., Carmichael, S. L., et al. (2020) · Europe PMC (PubMed Central) · doi:10.7189/jogh.10.021003 · Cited by 4
Metadata
- Authors
- Pfeiffer, J., Johnson, W., Fort, M., Shakow, A., Hagopian, A., Gloyd, S., & Gimbel-Sherr, K.
- Affiliations
- University of Washington (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2008-12
- Volume
- 98
- Issue
- 12
- Pages
- 2134-2140
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC2636539
- OpenAlex
- W2127281163
- Cited by
- 163
- References
- 35
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 4 · 2020: 9 · 2019: 10 · 2018: 18 · 2017: 9 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 9 · 2012: 15
- FWCI
- 28.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (P30AI027757)
- Topics
- Social Sciences › Development › International Development and Aid
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Political Science and International Relations › Public health and occupational medicine
- Keywords
- non-governmental organizations, codes of conduct, health system strengthening, brain drain, primary care, Africa
- MeSH terms
- Africa, Delivery of Health Care, Developing Countries, Emigration and Immigration, Humans, International Agencies, International Cooperation, Organizations, Poverty, Global Health, HIV Infections, Public Health Practice, Guidelines as Topic, Anti-HIV Agents, Benchmarking, Codes of Ethics, Public-Private Sector Partnerships
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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