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Health Alliance International


What is the role of international NGOs in health systems strengthening?

Posted: May 06, 2014 · Posted by: Julia Robinson, Technical Advisor for Country Programs

The role of international non-governmental organizations (NGOs) operating in countries around the world can be a tricky one.  Funded by external donors but operating in host countries, to whom are these organizations accountable?  In a new article published in the International Journal of Health Services, HAI’s Mary Anne Mercer and Susan Thompson teamed up with Timor- Leste’s first Minister of Health Dr. Rui Maria de Araujo to explore these and other questions related to how NGOs should support health systems.  Using post-conflict Timor-Leste as an example, they make a powerful case for local governmental authorities, not international donors, setting priorities for health programming and outline best practices for NGOs and MOHs to collaborate in building a sustainable health system.

Health Worker weighing a baby in Timor-Leste. Photo by: Jen Berthiaume

“HAI has been working with the Ministry of Health in Timor-Leste since full independence, for the past twelve years,” says Mary Anne Mercer, HAI’s Senior Maternal Child Health and Family Planning Advisor.  “We think that our model of solidarity and partnership with the MOH allowed for a type of collaboration not typically seen between international NGOs and host governments.”  Using concrete examples from this experience, the article describes the country’s process of moving from NGO-provided health care that emerged in the immediate post-conflict period to a system in which HAI worked with the new Ministry of Health to support the development of a truly Timorese health care system.  Read more about HAI’s current projects in Timor-Leste here.

Health Worker teaching families in Timor-Leste. Photo by: Jen Berthiaume

Ultimately, the paper concludes, “national health authorities need to define what is needed from health NGOs and must have the power to make decisions about the health system for their own country.”  NGOs and donors can play an important role in promoting health and health systems, but they need to respect this decision-making power in the quest for building strong, sustainable systems.

HAI is leading the way in defining best practices for health systems strengthening. Be sure to check out our efforts on the NGO Code of Conduct for Health Systems Strengthening and Advancing Global Health.

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Health Alliance International

We are a nongovernmental organization that supports governments in strengthening health systems and providing health care for all. We are affiliated with the University of Washington.


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