This section argues for the formulation of programme policies that take into account relations between NGOs and WHO. Programmes tend to emphasize the global view, in which NGOs appear to be of less significance. Thus, few programme policies reflect the fact that in some countries and regions, NGOs are very important in drug distribution and supply. WHO programme policies on NGOs are therefore unclear (see Table 2).

As can be seen in Table 2, a clear link exists between programme policies on involvement of NGOs at international level and programme policies on involvement of NGOs at national level. The information presented in Table 1, Table 2 and Figure 2 indicates a correlation between the attitudes towards NGOs (Figure 2), the actual number of NGOs in official or unofficial relations with WHO (Table 1), and formulated policy regarding NGOs (Table 2). Most programmes with a high rating in Figure 2 also collaborate with several NGOs (Table 1) and have a developed or partly developed policy on NGOs (Table 2).

When discussing the need for programme policies on NGOs involved in drug distribution and supply, a link must be made between such policies and overall WHO policy regarding NGOs. WHO has a policy governing official relations between NGOs and WHO,¹⁶ but none to guide informal relations with NGOs such as ECHO International Health Services Ltd. (ECHO), the International Dispensary Association (IDA), and MSF. These NGOs are heavily involved in drug distribution and supply and interact with WHO to quite a significant extent. The the lack of guiding WHO principles on informal relations with NGOs is significant, given that 25 of the 38 the NGOs listed in Table 1 are in informal relations with programmes.

Lack of overall programme policies on informal relations means that:

• there is no overview of the NGOs with which programmes collaborate in drug distribution and supply;

• no uniform policies exist on collaboration with NGOs either within programmes or between programmes;

• contacts with NGOs tend to operate on a personal basis and are therefore not highly sustainable.

These conditions, and the fact that none of the programmes has an officer who is responsible for NGO relations, means that interaction between programmes and NGOs tends to be ill-defined and uncertain. This undermines two major assumptions made concerning programme collaboration with NGOs: that agreements and knowledge accumulated at WHO/HQ level flow down to NGOs at international, regional and national levels, and that WHO/HQ programmes request involvement of NGOs at country level. The three country studies show, in fact, that WHO/HQ programmes rarely request NGO involvement and collaboration at national level.

A programme policy on NGOs, including a definition of what NGOs can expect from the programmes working in drug distribution and supply, could solve several problems relating to programme interaction with NGOs. It could:

• help ensure that agreements and knowledge accumulated at WHO/HQ level flow down to NGOs at international, regional and national levels; and encourage WHO/HQ programmes to request involvement of NGOs at country level;

• define what NGOs can expect from working with WHO programmes, thereby promoting transparency;

• provide guidelines on the establishment of a network overview of NGOs.^a

^a A network overview is a list of NGOs with which the programme has collaborated, either officially or informally, over the last two to three years.

Additionally, if locally-based NGOs were also to be covered by such a policy they would be entitled to seek more direct contact with WHO/HQ programmes. WHO's constitution would allow for such interaction.¹⁹ Programme policies, particularly if they incorporated an overview of NGOs involved in drug distribution and supply, could also be catalysts for closer interaction between NGOs and WHO at country level. Developing an overview of the NGOs involved in health in specific countries within the countries themselves, rather than establishing parallel lists within different HQ programmes might therefore be advisable. EHA argued for such an approach. Finally, a network overview of the NGOs with which the programme has collaborated over the last two years would create transparency within and between programmes.

Programmes such as GPV and PBD/PBL oppose a more laissez-faire and transparent policy on NGOs, however, arguing that loosening control of drug distribution could be dangerous. Indeed, several attempts have been made by semi-NGOs (for example, groups claiming to be NGOs but who are actually working for profit or even within government) and NGOs with very low capacity to obtain the drugs distributed by WHO programmes. Evidently, a cautious attitude towards NGOs helps prevent abuse of WHO programmes. The programme policy on NGOs should therefore also define what criteria must be met by NGOs who wish to develop informal relations with WHO.