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.