… and NGO services often fill gaps caused by state or market failure

Reducing the role of the state has often put civil society in a problematic position. The somewhat cynical assumption behind such downsizing is that the wealthy will pay in the market while private non-profit providers will offer services to the poor. This has put NGOs in the role of private providers for the poor people that the private for-profit sector finds commercially unattractive to work with.

Thus, civil society ends up filling a gap in access, equity or quality, rather than acting as a complementary component of a national health system. It usually finds itself working with the poorest health groups and compensating for the failure of state and market. It is not surprising that non-state services developed under these conditions can come into conflict with the state.


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