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NGOs and the health braindrain – help me resolve this dilemma

In this week’s Lancet, there is a very thought-provoking article about the way that research institutions, UN agencies and NGOs (non-governmental organisations) contribute to the “braindrain” by drawing health staff away from government employment.

This has long been a major worry of mine but there is not a simple answer to the question: who should NGOs employ?

We do employ what we call “ex-pats” (i.e. people from other countries) who bring many skills to working in a developing country programme, including global experience.

However they do not come from the same culture, stay shorter periods, rarely speak the local languages and their interest in the country’s development must be different from someone who grew up there.

Some NGOs, such as ActionAid and Acord, now mostly avoid using ex-pat staff from Europe and North America, although they still use plenty of ex-pats from other low-income countries.

Those who are not “ex-pats” are sometimes referred to as “national staff” (i.e. citizens of that country). I usually ask these colleagues what they did before working for NGOs. Many of them were employed by the government, health staff often as doctors and nurses.

They are always extremely committed to NGO ways of working with communities. However, as much as I admire them and benefit from working with them, a part of me regrets that they are not in the national health service or the Ministry where their training, knowledge and abilities could be leading major changes in their country.

In the UK, after working for a charity, a voluntary group or an NGO, one might aspire to go to work for national or local government. The skills that one has developed in a more informal setting or in a smaller geographic area should then be used to achieve benefits for a whole population or region.

In many low-income countries, especially African countries, it is the other way round. Staff leave jobs working for the government and go to work for NGOs because, in many cases, the salary and the working conditions are better in a big NGO with fewer limitations and frustrations than working for the government.

This braindrain (which UN organisations, health services in rich countries and the private sector also contribute to) is a major impediment to developing strong and effective government that can provide universal access to good quality services.

We clearly have to look critically at our own recruitment but this will only really change when governments have the money to pay better salaries than NGOs.

Hence why we call for more aid to support government budgets and fewer restrictions on salaries from influential bodies such as the International Monetary Fund.

This would then push NGOs to look towards talented and committed community activists and volunteers as possible employees. This would mean changing our recruitment criteria, prioritising local knowledge, connections and skills above qualification.

It would mean building different working cultures and different success criteria from the traditional donor-driven measures. As I said, this is a big, big question and I am not sure I have the right answers. What do you think?

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