As with the private sector, there are important questions about how national health priorities and standards are maintained in non-state providers, through regulatory, incentive, inspection and partnership systems.

In South Africa, for example, provincial health departments subsidize NGOs to provide a service. In so doing, they monitor and evaluate NGO performance and select those that are best organized and have the required skills. They aim to move towards contracts which contain service standards and to bring in NGOs through tenders (Klugman & McIntyre, 2000). For international NGOs, it is important to strengthen, rather than bypass, this link between the state and NGOs, in a manner that does not weaken the strengths or inputs of each.