Stake Holders in Health Care Sector

Question 2: Write notes on any two: b) Types of NGOs

NGO types can be understood by their orientation and level of operation. NGO types by orientation:
1) Charitable Orientation often involves a top-down paternalistic effort

with little participation by the "beneficiaries". It includes NGOs with activities directed toward meeting the needs of the poor -distribution of food, clothing or medicine; provision of housing, transport, schools etc. Such NGOs may also undertake relief activities during a natural or manmade disaster.
2) Service Orientation includes NGOs with activities such as the provision

of health, family planning or education services in which the programme is designed by the NGO and people are expected to participate in its implementation and in receiving the service.
3) Participatory Orientation is characterized by self-help projects where

local people are involved particularly in the implementation of a project by contributing cash, tools, land, materials, labour etc. In the classical community development project, participation begins with the need definition and continues into the planning and implementation stages. Cooperatives often have a participatory orientation.
4) Empowering Orientation is where the aim is to help poor people

develop a clearer understanding of the social, political and economic factors affecting their lives, and to strengthen their awareness of their own potential power to control their lives. Sometimes, these groups develop spontaneously around a problem or an issue, at other times outside workers from NGOs plays a facilitating role in their development. In any case, there is maximum involvement of the people with NGOs acting as facilitators. NGO Types by level of operation:
1) Community-based Organizations (CBOs) arise out of people's own

initiatives. These can include sports neighborhood organizations, religious are a large variety of these, some international NGOs, or bilateral or

clubs, women's organizations, and or educational organizations. There supported by NGOs, national or international agencies, and others
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Stake Holders in Health Care Sector

independent of outside help. Some are devoted to raising the consciousness of the urban poor or helping them to understand their rights in gaining access to needed services while others are involved in providing such services.
2) Citywide Organizations include organizations such as the Rotary or

lion's Club, chambers of commerce and industry, coalitions of business, ethnic or educational groups and associations of community organizations. Some exist for other purposes, and become involved in helping the poor as one of many activities, while others are created for the specific purpose of helping the poor.
3) National NGOs include organizations such as the Red Cross,

YMCAs/YWCAs, professional organizations etc. Some of these have state and city branches and assist local NGOs.
4) International NGOs range from secular gencies such as Redda BArna

and Save the Children organizations, OXFAM, CARE, Ford and Rockefeller Foundations to religiously motivated groups. Their activities vary from mainly funding local NGOs, institutions and projects, to implementing the projects themselves.

C) Role of NGOs in Public Health:

Stake Holders in Health Care Sector

The provision of health care in the country is grossly inadequate and therefore NGOs can assume various roles in Public Health which can be classified as:
1) 2) 3) 4) 5) 6)

Service Delivery Health Promotion Monitoring and Research Advocacy Resource allocation Capacity Building.

Service Delivery: NGOs have been primarily involved in provision of health care services for a very long time now as was elucidated in the historical note. Now with a policy decision on Public Private Partnerships as a means of increasing the provision of services to the population, NGOs have increased scope for participation in the sector. These have been formally classified by the government under the following heads
Contracting in-government hires individual on a temporary basis to provide

services. Contracting out-government pays outside individual to manage a specific function. Subsidies-government gives funds to private groups to provide specific services. Leasing or rentals-government offers the use of its facilities to a private organization. Privatization-government gives or sells a public health facility to a private group. Under the scheme therefore there is a vast potential for individuals and organizations to involved in the provision of services at various levels including

Primary level care including diagnosis and treatment. Referral for secondary and tertiary care. Follow up of services.

Specific areas that can be undertaken by individuals and organizations include

Management of Primary Health Centres and Urban Health Posts. Provision of Outreach services.
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Stake Holders in Health Care Sector

Provision of specialized diagnostic and treatment services. Counseling services Transport for referral services.

NGOs may also undertake programmes as demonstration and research programmes in case they wish to examine the efficacy of service provision models. Health Promotion: NGOs by virtue of their close contact with people and flexibility and wide variety of personnel are in a unique position to assume the responsibility of Health promotion. This would entail the production of Behaviour Change Communication (BCC) material and provision of BCC to the population. A number of NGOs participate in health promotion activities related to Cancer, Tobacco etc. prominent among these are VHAI, Cancer Aid Society of India etc. Monitoring and Research: NGOs are actively involved in the monitoring of services provided by the government. This provides the civil society oversight that ensures that reports provided by government agencies are verified. NGOs also participate in research programmes that critically examine the impact of policies and initiatives on the health of the population as whole and special groups in particular. These may be programmes initiated by the government, and also new programmes that the NGO may wish to assess as a model for replication. Prominent among organizations involved in monitoring government services are Urban Health Resource Centre, SATHI, CEHAT, MASUM etc. organizations such as Institute of Health Management, Pachod and SEARCH, Gadchiroli have been involved in the development of specialized models of health care delivery which have then been adopted by the government as policy. Advocacy: A number of organizations are engaged in advocacy the lobbying for the rights of the marginalized and the provision of services to all. This entails the collation of evidence, presenting it in the appropriate for a to the right people and bringing about social change. As was elucidated in the historical note this is one of the essential functions of NGOs and has been an essential role for a long time. Various NGO networks like Jan Swasthya Abhiyan, BPNI, etc have been involved in this activity.
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Stake Holders in Health Care Sector

NGOs have been responsible for some far reaching laws and policies e.g. the MTP act 1971 and the amendment of 2003, the PCPNDT Act and the NRHM and the soon to be announced National Urban Heath Mission (NUHM). Resource Allocation: NGOs roles in resource allocation work at two levels. At one level being funding agencies the NGOs can decide which initiatives and issues deserve to receive more funding. At another level the NGOs by virtue of their advocacy initiatives can arrange for the government to allocate resources to specific areas within the health sector. Capacity Building: One of the policies mooted to fill the gap in availability of skilled health workers has been the deployment of competent auxiliary staff. However the problem is the development of adequate numbers of centres for the training of these staff. Specialist institutions for this purpose are not feasible as these requirements are meant to be short term and require extensive training for short periods over a sustained period of time. This is an appropriate situation for NGOs with their experiences at the grass roots and abilities to train persons with limited capacity at the grass roots level.

Future trends for NGO involvement in Health: India has an enormous population and an economy that is growing at a rapid pace. Thus even as a section of the population is gaining in material gains and health status another section is getting to be even more marginalized with passage of time. The government is not in a position to deal with this situation and will require sustained support from the Non-Governmental Sector for years to come. Further even if the government were to be in a position to take on the responsibility of provision of health care for all the requirement for a civil society oversight will ensure that NGOs will remain relevant and necessary for a long time to come.