I have heard so many NGOs, regardless of size, country of origin, or location where they are working, say something along these lines: “the local government is a shambles, corrupt, and/or dysfunctional; we can’t work with it, we are here to help the people, we’ll just work around the government”. Yet, their sustainability plans frequently end up having a “handing over” process in which the key player is the same government everyone was complaining about.
We can’t have our cake and eat it, too. We can’t create a parallel health system, and then expect the government to take it over. We can’t build a giant hospital, with tiles up to the ceiling and huge wards, and expect the government to suddenly have 200 beds and nurses to fill the place up. If the government isn’t building health posts or hospitals in that tiny village that can only be accessed via boat through a lake, it’s probably because it isn’t a priority for them. But, when kind-hearted philanthropists land on the shores of said lake and see so much need, they may decide differently, and all of a sudden the government is asked to take over a huge project it never wanted.
This doesn’t only happen in health. For example, in Guatemala our most globally renowned pop singer Ricardo Arjona is building schools, which are gorgeous, large, and filled with guitars for the children. Yet, unless he hires the teachers and pays their salaries indefinitely, the government is not capable of increasing its budget from one month to the next based on Arjona’s whims.
Exacerbating these issues is the touch and go approach from international NGOs, for example, short term medical teams. Although they are capable of giving hundreds of people care and surgery for no cost, what happens to the follow up? Are patients given medical records they can show their regular doctor? How can they contact the person who did the procedure? What if there is a complication – who will attend to them? If they had a biopsy, where did the tissue go to for pathology? Where will the results be sent? A local doctor might not have any supplies, but they are capable of following up with the patients, keeping records and having long-term contact, often in the same language as the patient.
Granted, local health systems are also seriously flawed, but wouldn’t a project’s impact be larger, more significant, and sustainable if its objective was to strengthen local health services? We should be answering questions like: how can we ensure that people won’t steal the supplies we give them? How can we help make local doctors accountable to their patients? These issues should not be skirted around.
In most rural areas, the only entity providing education and health is the government, often free of charge. The government doesn’t need foreign entities to take its role and responsibilities, or to add more of these. Most local governments need support on improving the work they are already doing; that’s what our favourite buzzword “governance” should look like.
How do we go into an area, find a local official, and find out what the government needs to develop its systems? You may say that if I show up at a corrupt official’s door and ask them what they want, they will ask for a bribe. Although this is very probable, it’s also where we need to become critical; we will eventually find someone along the line who has a clear understanding of the area or nation’s needs who can point us in the right direction. Maybe they would like more training for their teachers, or help distributing school supplies to remote rural areas. How can we strengthen community participation and social auditing to ensure that people who should be receiving the services help guarantee its quality, with or without the support of a third party? How can we help government transitions?
Although you might say there are people already working on that, which there are, we need to recognise that by creating parallel systems to governments we are weakening the rule of law. We are not helping nationals hold their officials accountable. Lastly, we are transferring responsibility from elected national governments, which receive tax dollars, to foreign entities and individuals who do not necessarily know local laws, customs, traditions, history, or even hold nationals’ interests at heart. As NGOs and donors we are required to look at the bigger picture. We must realise the impact we are having, and recognise that the difficult and winding path of supporting local institutions is necessary. If we do not want to actively work on these topics, at least check that we are not weakening them further.
Featured image shows pop star Ricardo Arjona performing at a concert in Nicaragua. Photo from Wikipedia.