Paradoxically, in many community
based health programmes, states have built stronger collaboration
with NGO service organizations, including international NGOs,
than with their own national, membership-based civic organizations,
such as trade unions.
This has weakened the involvement,
and the development of the capacity, of these important national
institutions in health sector work, including their possible
role in health financing and provision. In contrast to well funded
international NGOs, many national civic and grass-roots organizations
struggle, amongst other problems, with:
- how to access their own national
public resources;
- their capacity to manage and
sustain programmes;
- the negative attitudes and
non-participation of health workers;
- poverty and pressures on communities
from other social problems;
- difficulties in combining
and balancing the roles of health providers and traditional,
civic and elected leaders ;
- how to build strong and active
links with their own members (Loewenson,
2000).
(We explore this issue in more
detail in the next module.) |
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