The purpose of this study was to:

• develop a list of specific WHO programmes/divisions working in drug distribution and supply;

• develop an inventory of the NGOs involved in drug distribution and supply (including which countries they are working in and what they are doing);

• analyse the experiences of NGOs, MoHs and WHO programmes when collaborating in drug distribution and supply;

• suggest how WHO can translate these experiences into recommendations for future WHO policy and programme implementation.

As the above analysis has shown, it was possible to develop a list of specific WHO programmes working in drug distribution and supply (Table 1), but not a complete inventory of the NGOs working in this area. This was because the individual programmes had not developed an overview of the relevant NGOs.

The experiences of NGOs, MoHs and WHO in collaboration in drug distribution and supply are diverse. Much of the work in WHO programmes and at country level is based on false assumptions about the downflow of information, and about whether WHO/HQ programmes request the involvement of NGOs. Little effort has been made by WHO to establish interaction between NGOs, MoHs and WHO itself. It is therefore recommended that WHO programmes involved in drug distribution and supply develop explicit policies on NGO interaction that can be used within the programmes, and at international and country levels.

This analysis can be seen within a broader WHO perspective. Meetings held in Ireland²¹ and Geneva¹⁷ included broader discussions on what the future role of NGOs should be within a WHO context. During the meeting in Geneva, the Director of AFRO invited NGOs to a regional meeting in Brazzaville. This was a signal to the NGOs and WHO representatives in the African Region, and to WHO/HQ, that NGOs working in the African Region could play a more central role in health care and provision.

This invitation can be seen in the context of the changing roles and importance of NGOs, as already discussed, and as recognized by many stakeholders in health (see Figure 1). During the Geneva meeting, national and international NGOs requested WHO to act as the mediator between NGOs and MoHs, to combine the strengths of NGOs, MoHs and WHO. This same request was heard when the country studies were conducted.

Other agencies such as the World Bank and UNICEF have explicitly recognized the new NGO situation and developed guidelines on how to establish contacts with NGOs at country level. Guidelines for NGOs working with UNICEF-Operational Issues for UNICEF and NGO Staff, Guidelines for UNICEF Zambia Staff on working with NGOs, and Partnership in Action, are just some examples. Additionally, UNICEF in Kenya has established an NGO profile that outlines specific criteria that must be met by NGOs collaborating with UNICEF (see Annex 5).

A new WHO policy on NGOs to cover the two-thirds of NGOs who are involved in drug distribution and supply, and who are in informal relations with WHO, would thus be very timely. A crucial first step in developing such a policy would be to establish more extensive evidence based on WHO collaboration with NGOs than is presented here.

Further research is recommended to:

• identify countries and initiate research in Asia, Europe, South America and West Africa for comparative studies;

• analyse the experience of NGO collaboration in drug distribution and supply of other UN agencies.