NGO Code of Conduct for Health
Systems Strengthening
Julia Robinson, MPH MSW
April 8, 2014
Outline
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Why a code of conduct?
NGO Code of Conduct contents
Research into implementation of the Code
Discussion
 How best to use this Code?
 Are voluntary codes of conduct good tools for
changing practices?
HEALTH ALLIANCE INTERNATIONAL
Why a code of conduct?
 Development
aid for health
quintupled since
1990, to $27.7
bn in 2011
 US flows more
than 50%of aid
through NGOs
Source: IHME/Murray et al, 2011
HEALTH ALLIANCE INTERNATIONAL
Why a code of conduct?
Fragmentation
Loss of
services
Weak public
sector
health
system
Inefficiencies
Mgmt
burden
Brain drain
HEALTH ALLIANCE INTERNATIONAL
Why a code of conduct?
 There are many factors contributing to weak
public sector health systems – why focus on
NGOs?
HEALTH ALLIANCE INTERNATIONAL
Why a code of conduct?
 Lots of them already
exist
 …NGOs Responding
to HIV/AIDS, Disaster
Relief, International
Philanthropy, general
codes of ethics and
conduct, etc.
One World Trust CSO Project:
http://www.oneworldtrust.org/csoproject/
HEALTH ALLIANCE INTERNATIONAL
Why a code of conduct?
 Specifically, codes have been used
for health workforce and recruitment
efforts
 WONCA’s “Melbourne Manifesto”
(2002)
 Commonwealth Code of Practice (2003)
 UK’s Code of Practice (2004)
 Voluntary Code of Ethical Conduct for
the Recruitment of Foreign-Educated
Nurses to the U.S. (2008)
 WHO Code of Practice on the
international recruitment of health
personnel (2010)
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NGO Code of Conduct for HSS
 Coalition of organizations worked on drafting
and consultations starting in 2007
 Launched in May 2008
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NGO Code of Conduct for HSS
 6 articles:
 Hiring practices
 Employee compensation
practices
 Human resources training and
support to systems
 Impact of management burden
on ministries of health
 Support of MOH engagement
with communities
 Policy advocacy for
strengthening public sector
ngocodeofconduct.org
HEALTH ALLIANCE INTERNATIONAL
NGO Code of Conduct for HSS
 6 articles:
 Hiring practices
 Employee compensation
practices
 Human resources training and
support to systems
 Impact of management burden
on ministries of health
 Support of MOH engagement
with communities
 Policy advocacy for
strengthening public sector
ngocodeofconduct.org
HEALTH ALLIANCE INTERNATIONAL
First 3 articles: Human resources
Hiring
• Avoid hiring away from MOH
• Coordinate with MOH in hiring
• Hire nationals where possible (rather than
expats)
• Avoid creating incentives for migration
Compensation
• Fair monetary compensation, limit disparities
• Strive for salaries not substantially greater than
public sector
• Avoid top-ups to MOH staff for outside work
• Try to improve public sector benefits/pay
Training and
Support
• Invest in pre-service education to increase
number of workers
• Build capacity of public sector workers (including
mgmt)
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Implementation so far
 57 signatories today in 14 countries
 Thesis research by Anjali Sakhuja (MPH 2009)
 Questions:
 How are signatories implementing the Code of Conduct?
 What are best practices?
 What are challenges to operationalizing the Code?
HEALTH ALLIANCE INTERNATIONAL
Findings: Hiring
 Most respondents make efforts to avoid hiring
from the MOH
 Have hired in the case of
 Person already resigned from MOH
 With permission from MOH
 In “after-hours” setting (also with permission)
 Challenges:
 Rural posts
 Project deadlines/pressure
 Ethics of refusing to hire due to MOH employment
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Findings: Hiring
 Expatriates are hired when special expertise is
needed; try to make it the exception rather than
the rule
 Challenges
 Can’t hire from MOH (nationals), can’t hire expats –
what if there isn’t anyone else?
 Bureaucracy to hire expats
 Expats from non-Western countries fleeing
conditions in home countries
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Findings: Compensation
 NGO salaries can be 10x greater, or
more
 Challenges
 Low salaries make hiring and retention
difficult
 Market pressures
 Finding an elusive balance
 Working conditions can be as
important as salary considerations
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Suggestions and promising practices
 Visibility of Code
 Post in lobby, include in
orientation
 Improve public sector
opportunities
 Highlight value in setting policy,
broader impact
 Invest in career path
opportunities
 Second staff to the MOH
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Suggestions and promising practices
 Advocacy
 Donors should support/fund in line with Code
 Make signing on to the Code a condition of receiving
funds
 Why not get the big players on board?
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Summary
 Awareness, but few changes
to HR policies
 Commitment to principles,
challenges with hiring and
compensation items
 Testing ideas in the field
 Importance of more preservice training
 Some efforts to coordinate
amongst NGOs
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Discussion
 How best to use the Code?
 Is a voluntary Code a good tool for changing
practices?
 Other questions or thoughts?
Thank you!
HEALTH ALLIANCE INTERNATIONAL