Perspectives on NGOs Abroad: Critical care or colonial enterprise?

December 20, 2006 at 1:23 pm (AE Beacon's Posts)

    Non Governmental Organizations (NGOs) including foundations, non profits, individual donors and multi national organizations (to a lesser extent in this essay) have all seen unprecedented increases in healthcare sector influence abroad particularly in the last twenty to thirty years. As these groups extend their international influence, it is important that we consider the pluses and minuses of their work.

            From a practical perspective, NGOs are often the most nimble health providers available. Able to rally resources quickly around an initiative they can represent the sole provider of services in emergency situations where a government system is either non existent or debilitated. With their increasing budgets and on the ground staff, NGOs are rapidly becoming semi-permanent facets of the health infrastructure in many developing countries.

            However, the growth of NGOs abroad presents a new and hereto underappreciated threat to the autonomy of developing countries. Are international health workers the 21st century missionary? Particularly in Africa the conditions are certainly ripe for the subjugation of locale governance. Decimated by disease, inter ethnic war, famine and poor infrastructure, the western world has once again arrived with a self righteous hubris reminiscent of the 17th, 18th and 19th centuries. Touting medicine and food we’ve resurfaced in virtually every area of health (not to mention other aspects of education, agriculture, defense and countless others) to “save” the day.  Ironically, the most capable of these aid workers are often members of the colonial powers many African countries fought so bloodily to overthrow (see most of Sub Saharan Africa).  

The international health NGO has seen staggering growth in power in influence abroad throughout the past decades. Unbridled by bureaucracy, these players have shown their potential to enact change quickly and unilaterally even in the face of chaotic situations. However, NGOs simultaneously represent a growing threat to local governments. Their inherently undemocratic infrastructure, fervid staff, blossoming budgets and medical capabilities combined with low resourced and under structured health systems set the stage for the unfettered subjugation of local powers.  As we continue to insist on stepping in, do we even know when to step out? Perhaps that time is going to come sooner than we think.

A final note. A few months ago many around the world were outraged when Madonna adopted a small Malawian child. For many the concept of a western woman (undoubtedly exacerbated by Madonna being Madonna) removing a child from a developing country and, what later appeared to be an unwilling father, conveyed a disgusting sense of culturally imperialism. And yet this same image adorns the cover of countless international health books, webpages and brochures. Would we find her actions more acceptable if she was wearing a stethoscope? Conceptually we do. As we move forward whether on the ground, in our writing or even in checkbooks with international aid, it is important that we are as self critical as we are compassionate. Don’t get me wrong, people are suffering and need care, but let’s just make sure we’re creating history reminiscent of Achebe and not Conrad.

 Æ Beacon

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3 Comments

  1. emlsewhere said,

    I find this discussion a really interesting one…and could probably write a huge amount in response. I’m going to be starting health work with Peace Corps in Guinea in a few short weeks, and I’m sure that I will question my place/purpose many times.

    For the moment, I’ll just bring up a single point. You write that “Ironically, the most capable of these aid workers are often members of the colonial powers…”

    I will not deny that there are many aid/NGO workers from former colonial powers who do incredible and important work. Many of them are obviously dedicated and talented. But I think to say that outsiders are somehow “most capable” of providing aid or services is a bit simplistic.

    It is always interesting to look at who is hired to do aid work. Oftentimes, those brought in are people without much relevant experience (I was recently reading about this in a book called Lords of Poverty: the Power, Prestige, and Corruption of the Inter-national Aid Business by Graham Nancock. Another interesting– and newer– one to read on the topic of NGOs and aid would be Alex de Waal’s Famine Crimes.). There are actually quite a few incompetent people working in international health, aid, and relief.

    Aside from this, it usually costs *much* more for NGOs to maintain foreign employees. More often than not, European or American employees or contractors have salaries that are at least somewhat competitive with home. Not to mention relocation fees, travel costs, etc. It is one thing if no one is qualified locally. It is quite another if there is the assumption that someone from abroad is automatically “more capable.”

    Though it is not primarily an aid organization, the Peace Corps could make an interesting example. Am I, an American with a BA in Development Studies, somehow more qualified to teach people in Guinea about health than, say, someone in their own community with a bit of (much less expensive) training? Obviously, Peace Corps has other goals as well, which I think are relevant and very important. This just happened to be the first, somewhat imperfect example that came to mind.

    Just some food for thought…

    erin.

  2. aebeacon said,

    Erin,

    I think we agree on most points. However, reading carefully you might note that I’ve suggested that “the most capable of the aid workers” and not that “aid workers are most capable”, the later of which you’ve discussed in most of your response. I would not presume foreigners to be the most capable of addressing local concerns in any setting, whether international or domestic. While there is certainly an important role for international agents including yourself to play in underserved areas (see my previous essay entitled “On Medicine Abroad”) in most situations they should not be initially taking the lead on local problems.

    As to how qualified you are, you’d have to answer that question when you get there. I’ve been to areas of the world in which health officials promulgated messages about disease (such as AIDS) that bordered on criminal negligence. On these issues, an avid watcher of Discovery Health would be more qualified to inform local communities of the facts than the health officials. Here I think we can play an important role. Our resources and considerable understanding of disease can be very useful to communities that are coping with unknown or complex health conditions. Therein, you have tremendous potential to do good albeit with the lengthy caveats of my previous essay!

    I hope that clarifies and extrapolates sufficiently,
    Æ Beacon

  3. Further to AE Beacon’s Post, “Perspectives on NGOs Abroad” « Brown for Global Health said,

    […] a link to the original post by AE Beacon. Read it […]

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