When discussing MoH and WHO collaboration with NGOs, it is necessary to define what is understood as an NGO and to establish a typology of NGOs. Several commentators have discussed the issue of NGOs but none so far has established a clear, short definition. This is attributable to the fact that the NGO sector is very broad, ranging from small football clubs, to very large organizations employing thousands of people, to research institutes, churches, professional associations and advocacy groups.
The commonly used definition of NGOs working in health, which focuses on the fact that NGOs work outside and beyond the government sector, and the definition used in this study have their roots in the groupings and typology devised by Green13. Green generally defines NGOs as organizations that are non-profit-making and outside state control. More specifically, he identifies six different kinds of NGOs involved in the health sector:
• religious organizations;
• international social welfare NGOs;
• local/country-based social welfare NGOs;
• unions, trade and professional associations;
• other non-profit-making organizations;
• non-profit-making (but prepaid) health care NGOs.
The different kinds of NGOs will not be discussed further here since other sources can be consulted. (See Mburu, for example.14) Suffice to say that NGOs are present and very much involved in health provision and drug delivery in many countries, and that the importance of NGOs in health provision has been increasing over the last two decades. What is now more important, is establishing policy and standards under which NGOs should work. The key questions are, how have MoHs and WHO responded to the need for policy development in drug distribution and supply, and what follow-up actions should now be undertaken? This analysis of collaboration between NGOs, MoHs and WHO provides some answers to the first question, while Green and Matthias (1995) have already provided some ideas in response to the second question.12
The discussion and effort devoted to the classification of the different kinds of NGOs were considered necessary since many stakeholders involved in drug distribution and supply were unclear on this issue. For example, they were unsure whether the Danish International Development Agency and Gesellschaft für Technische Zusammenarbeit (GTZ) should be classified as NGOs.
When the value of NGO involvement in drug distribution and supply is discussed, two points of view emerge. One sees NGOs as innovative, able to identify new areas of potential activity, reliable, able to reach the poor, etc.11 The other sees NGOs as having little capacity, unsustainable and lacking in authority.14 In 1996, Matthias and Green reviewed the comparative advantages of NGOs in the health sector. They examined the available evidence and argued points of view for both sides.15 This indicates that no clear, single, overall conclusion may be possible. Instead, conclusions should be drawn only for specific situations and should therefore be context-based. This approach is in line with the conclusions of the OECD/DAC study on NGOs.5