ngo code of conduct for health systems strengthening julia robinson, mph msw april 8, 2014

NGO Code of Conduct for Health Systems Strengthening

Julia Robinson, MPH MSWApril 8, 2014

HEALTH ALLIANCE INTERNATIONAL

Outline

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?


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



Weak public sector health

system

Fragment-ation

Mgmt burden

Brain drainInefficien-cies

Loss of services



There are many factors contributing to weak public sector health systems – why focus on NGOs?



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/





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)


NGO Code of Conduct for HSS

Coalition of organizations worked on drafting and consultations starting in 2007

Launched in May 2008


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


First 3 articles: Human resources

• Avoid hiring away from MOH• Coordinate with MOH in hiring• Hire nationals where possible (rather than

expats)• Avoid creating incentives for migration

Hiring• 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

Compensation

• Invest in pre-service education to increase number of workers

• Build capacity of public sector workers (including mgmt)

Training and Support


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?


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


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


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


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


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?


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 pre-

service training Some efforts to

coordinate amongst NGOs


Discussion

How best to use the Code? Is a voluntary Code a good tool for

changing practices? Other questions or thoughts?

Thank you!

ngo code of conduct for health systems strengthening julia robinson, mph msw april 8, 2014

Documents

health workforce

code discussion

support slide

commonwealth code of

uks code of practice

international philanthropy

moh staff

moh coordinate