Changing relations can also be seen at country level. During the WHO consultation with NGOs in May 1997, in Geneva, Figures 1A and 1B were presented to illustrate the changing relations between WHO, MoHs and NGOs at country level.
Figure 1A shows that in the past, polices and strategies were ideally established by the relevant government/MoH, with the support of WHO. The MoH then implemented the policies through programmes run by its government. As part of the implementation process, NGOs were guided as to where they could apply their resources and where to offer services. However, experience has shown that such a top-down approach is not necessarily entirely practical since the MoH may lack resources, and the goals of the MoHs and the NGOs may differ.
Yet given the growth in NGO resources, the role of NGOs in health provision is becoming more important in many countries. Many now have the capacity to work more actively with MoHs on policy formulation and implementation (Figure 1B), becoming what Korten calls "third-generation NGOs."11 In such cases, the government/MoH contintues to be supported by WHO and is perceived by WHO as the stakeholder responsible for securing drugs, while NGOs are seen as valuable partners in implementation and policy formulation.
Increasing interaction between MoHs and NGOs is thus supported directly by WHO, but WHO itself also interacts with NGOs at country and global level more than in the past.
Figure 1. The changing relations between NGOs, MoHs and WHO
1A. The new NGO situation at country level
1B. The new NGO situation at country level
If Figure 1B is accurate and more structured collaboration with NGOs in the countries is required, how can increased interaction with NGOs be managed? Green and Matthias12 describe seven tasks that ideally should be undertaken when developing collaboration with NGOs:
• define what constitutes an NGO;
• survey the NGO sector to gather baseline information on NGOs;
• assess and categorize the different types of NGOs;
• assess strengths and weaknesses of the NGO sector relative to other sectors;
• identify and analyse relevant government policies;
• examine the role of coordination bodies;
• velop policies relating to the NGO sector.
As necessary preconditions, Green assumes that the relevant government has previously recognized that NGOs have a role to play, that the government is responsible for enabling this to occur, and that NGOs are prepared to work with the government. Yet as highlighted in the three country studies described in Section 4, these three preconditions do not always apply owing to a lack of resources among the stakeholders involved in drug distribution and supply.