Calling non-governmental organisations to strengthen primary health care: Lessons following Alma-Ata

Exploring the Funding Challenges Faced by Small NGOs: Perspectives from an Organization with Practical Experience of Working in Rural Malawi

Malawi is a small landlocked country in Southern Africa, which faces a number of development challenges. It is one of the world's poorest nations and over 70% of the population live below the International Poverty Line of $2.15 per day. Health inequalities are a well-documented problem and those most affected are women and children. Non-governmental organizations (NGOs) play a vital role in supplementing government efforts to provide health services to vulnerable people in areas that are difficult to reach. The World Medical Fund (WMF) is a small medical charity that operates in the central, rural, Nkhotakota region of Malawi where many children lack access to even basic health services. To date, WMF has successfully provided free care and treatment for over 400,000 sick children, but its initiatives, such as mobile clinics, rely entirely on external donations. Since 2000, the funding resources available to small NGOs have declined and efforts to attract funding have become increasingly competitive. Frequently, the criteria used for funding decisions are too rigid, and do not reflect the difficult operating conditions on the ground in rural Africa. As one of the world's most highly resource constrained healthcare environments, Malawi illustrates the need for more flexible funding criteria from donors so that NGOs can carry out their work to save children's lives.

The role of non-governmental organizations in strengthening healthcare systems in low- and middle-income countries: Lessons from Santé Diabète in Mali

Non-governmental organizations play a vital part in the achievement of the Sustainable Development Goals as defined by the United Nations. These Goals also include targets related to noncommunicable diseases. However, non-governmental organizations have played a limited role in this area despite such diseases causing the bulk of morbidity and mortality worldwide. Through their activities, non-governmental organizations should aim to strengthen health systems, yet they often only support these for a single disease. Mali, like many other low- and middle-income countries, is facing an increasing burden of diabetes and a health system not adapted to address this challenge. Santé Diabète, a non-governmental organization based in Mali since 2003, has been working specifically on diabetes, and has developed a wide range of activities to improve the national health system. This paper describes changes in the diabetes environment in Mali between 2004 and 2018 based on two health system assessments carried out using a Rapid Assessment Protocol. Over this period, the health system was strengthened with regard to financing and access to medical products. Leadership and governance, service delivery and health workforce were all improved but still partially rely on sustained support from Santé Diabète. The key lesson from this study is that to be effective in changing the management of noncommunicable diseases in a low- and middle-income country, non-governmental organizations need to play a variety of roles, many of which may change over time.