Search

Code of Conduct

Loading...

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

0 comments

Post a comment

    Post a comment
    Embed Video
    Edit your comment Cancel

    Notes on slide 1

    Doubled between 2001 and 2007 alone. With that, proliferation of NGOs and other “private” actors, as well as increased support through bilateral and multilateral channels. Gates Foundation itself was about 4% in 2007.Development assistance for health (DAH)Financial and in-kind contributions from channels of assistance to improve health in low-income and middle-income countries. DAH aims to achieve either country-specific health improvements or to finance health-related global public goods such as research and development, disease surveillance, monitoring and evaluation, and data collection. DAH does not include support for allied fields such as humanitarian assistance, food aid, water and sanitation, education, and poverty alleviation that indirectly affect health. DAH includes loans on concessional terms, which charge below-market interest rates. We distinguish gross DAH, which is the actual outflow of resources in a specific year, from net DAH, which is the gross amount minus repayments for DAH loans in previous years. Results in this Article are for gross DAH only. Research funded by DAH channels of assistance is counted as DAH, whereas health research by other institutions whose primary purpose is not development assistance is not included.

    Why is this a problem? As James has just illustrated, directing aid to NGOs often results in fragmentation of the health system and services, management burden on MOH to track and coordinate what NGOs are doing, brain drain from MOH to NGOs (clinical and management staff), potential inefficient use of resources (many orgs in one area and for one disease, while other parts of country and other diseases are neglected) and undermining/loss of services when direct-service NGOs pull out of a region.

    Factors: Macroeconomic/lending policies that limit how much govts can invest in health and education, tied aid and other aid restrictions, Western/U.S. preference for private sector, and in-country conditions – limited number of health workers being produced, etc.A few reasons to focus on NGOs:We are an NGO, and this is our sphere of influence. NGOs aren’t the only players, but they are significant – 25-40K international NGOs. If a critical mass of NGOs were to change the way they worked, that could be an impetus for change in funding and other higher-level policies and practices.Start a conversation about it.

    Code of Good Practice for NGOs Responding to HIV/AIDSCode of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster ReliefPrinciples of Accountability for International Philanthropy - The Council on Foundations and the European Foundation Centre (EFC) created a Joint Working Group to develop a set of principles (integrity, understanding, respect, responsiveness, fairness, cooperation and collaboration and effectiveness) and good practice options of accountability for international philanthropy. They address accountability to mission, grantees, and partners and, ultimately, to the intended beneficiaries of transnational philanthropic activity.Code of Ethics and Conduct for NGOs - It includes issues such as human rights, transparency and accountability, good governance, human resources and public trust, among others.Definition of code of conduct:"Principles, values, standards, or rules of behavior that guide the decisions, procedures and systems of an organization in a way that (a) contributes to the welfare of its key stakeholders, and (b) respects the rights of all constituents affected by its operations.“ -- the International Federation of Accountants, Defining and Developing an Effective Code of Conduct for OrganizationsOne World Trust: database of self-regulatory initiatives, from codes of practice/conduct, to certification schemes, self-assessments, reporting frameworks, working groups, and information services/directories.Initiatives can be principles or standards based. Codes of ethics/conduct/practice tend to be principles-based, while standards-based ones have specific guidelines or rules to be adopted. Codes can including a compliance or monitoring component, or not.

    And resolutions:World Health Assembly (2004)World Federation of Public Health Associations (2005)American Public Health Association (2006)

    Started as a discussion at the APHA conference, around aid effectiveness, and sparked a discussion of how NGOs can better support the public sector

    First 3 articles: HR related4th – management burden, planning and coordination5th – engagement with communities; accountability and transparency6th - advocacy

    1 Hiring:Avoid hiring from MOH and also avoid hiring expats (you can imagine tension there). Also, where there are qualified nationals, volunteer labor should not substitute for paid staff.Coordinate with MOH if there is a need to hire from the MOHAvoid where possible creating incentives for workers to migrate away / brain drainNOTE: we have to acknowledge the right of people to migrate and take up opportunities for themselves and their families. This is not contrary, rather saying we should all be focusing on improving the situations at home and in the public sector that “push” people to migrate, as well as being conscious of and limiting the “pull” factors.2 Compensation:Limit disparities btwn expat and national, rural and urban, ministry and NGO. Although incentives for rural work are encouraged.Offer salaries that are “locally competitive” and “not substantially more generous than the public sector while providing a fair and living wage to their employees.”Avoid top-upsEstablish benefits structures that meet the needs of employees, and attempt to match public sector practices, including retirement plans. Where public sector benefits are inadequate, NGOs will collaborate with the public sector to improve them.3 Training and support:Pre-service, rather than just short, one-off in-service trainingsIncrease the number and capacity of health professionals over timeBuild capacity in both service and management areas – goal is to transfer skills

    45 signatories today

    Contacted via email and phone. Of the 39 signatories as of Dec 2008, we established contact with 32; the other 7 had invalid contact info or never responded. Six orgs that we contacted did not participate either because they didn’t know who had signed onto the Code or no one could speak about it, refused b/c they had little to share, or the contact was unavailable when Anjali called.The 26 signatories that participated work in diverse work, ranging from direct health care, food security, water, sanitation, housing, policy advocacy. The LNGOs were from Africa (6), followed by Asia (5) and one Latin American (1) country (Mexico – Universidad AutónomaMetropolitana). Different structures: NGOs, networks, consortia.“Other” = prepared health-related documents, and organized conferences; so sort of international but not operating in specific countries?For non-signatories, we targeted 5 orgs that had participated in consultations or discussions, but did not sign. Only 3 participated in the interview.

    Signatories and non-signatories make efforts to avoid hiring from MOHRespondents noted that donors and UN agencies hire personnel away too.Rural posts harder to fill/find qualified staff than urban areas.Some respondents said they would hire from govt when other efforts failed, and project deadlines necessitated filling the position quickly.Some respondents mentioned that they get MOH applicants to open position announcements, and those public-sector job seekers argue that it is not ethical to discriminate against public-sector workers who are looking to grow, learn, and fulfill their career ambitions.

    Favorites, Groups & Events

    Code of Conduct - Presentation Transcript

    1. NGO Code of Conduct for Health Systems Strengthening: How is it working?
      Emily deRiel, MPH
      Based on thesis project of Anjali Sakhuja, MPH
      October 30, 2009
    2. Outline
      Why a code of conduct?
      NGO Code of Conduct contents
      Research into implementation of the Code
      Discussion
      How best to use this Code?
      Are voluntary codes of conduct good tools for changing practices?
    3. Why a code of conduct?
      Development aid for health quadrupled since 1990, to $21.8 bn in 2007
      About 25% now flows to NGOs
      Source: IHME/Ravishankar et al, 2009
    4. Why a code of conduct?
    5. Why a code of conduct?
      There are many factors contributing to weak public sector health systems – why focus on NGOs?
    6. Why a code of conduct?
      Lots of them already exist
      …NGOs Responding to HIV/AIDS, Disaster Relief, International Philanthropy, general codes of ethics and conduct, etc.
      One World Trust CSO Project: http://www.oneworldtrust.org/csoproject/
    7. Why a code of conduct?
      Specifically, codes have been used for health workforce and recruitment efforts
      WONCA’s “Melbourne Manifesto” (2002)
      Commonwealth Code of Practice (2003)
      Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the U.S. (2008)
      WHO Code of Practice on the international recruitment of health personnel (draft 2008)
      UK’s Code of Practice (2004)
    8. NGO Code of Conduct for HSS
      Coalition of organizations worked on drafting and consultations starting in 2007
      Launched in May 2008
    9. NGO Code of Conduct for HSS
      6 articles:
      Hiringpractices
      Employee compensation practices
      Human resources training and support to systems
      Impact of management burden on ministries of health
      Support of MOH engagement with communities
      Policyadvocacy for strengthening public sector
      ngocodeofconduct.org
    10. First 3 articles: Human resources
    11. Implementation so far
      Thesis research by Anjali Sakhuja (MPH 2009)
      39 signatories today 14 countries (Dec 08)
      Questions:
      How are signatories implementing the Code of Conduct?
      What are best practices?
      What are challenges to operationalizing the Code?
    12. Study design
      Qualitative Descriptive study
      I. Interview with signatories
      Experiences with implementation of Code
      HR policies
      Some promising practices
      II. Interview with non-signatories
      Practices in hiring, compensation and capacity building
      Reasons for not signing on the Code
      III. Case study: HAI’s Mozambique program
      Interviews with staff and MOH
    13. Respondents
      Imp = Implementing org Tr = Training org
      Adv = Advocacy org Res = Research org
    14. Findings: Hiring
      Most respondents make efforts to avoid hiring from the MOH
      Have hired in the case of
      Person already resigned from MOH
      With permission from MOH
      In “after-hours” setting (also with permission)
      Challenges:
      Rural posts
      Project deadlines/pressure
      Ethics of refusing to hire due to MOH employment
    15. Findings: Hiring
      “We needed a psychiatric doctor. It is very difficult to hire a full-time doctor in an NGO like ours. We have to hire from the government sector because only they have psychiatric doctor. But we have been working according to the government policy as the doctors can have part-time service outside.”
      -- Signatory respondent
    16. Findings: Hiring
      Expatriates are hired when special expertise is needed; try to make it the exception rather than the rule
      Challenges
      Can’t hire from MOH (nationals), can’t hire expats – what if there isn’t anyone else?
      Bureaucracy to hire expats
      Expats from non-Western countries fleeing conditions in home countries
    17. Findings: Hiring
      “In (this country), half of our health providers are Zimbabwean and this is working well. We realize that when they move out they leave a gap in their country. But they are moving out of Zimbabwe due to death threats, inability to work. Systems are being depleted by the repressive government. So not hiring expats in this situation is ideal but not practical.”
      -- Non-signatory respondent
    18. Findings: Compensation
      NGO salaries can be 10x greater, or more
      Some signatories do match government or university salaries
      Challenges
      Low salaries make hiring and retention difficult
      Market pressures
      Finding an elusive balance
    19. Findings: Compensation
      “I left my government job in 1991 and joined UN, and later an NGO. My two children went to private schools. I could not pay for their education if I was in the government job. I could not afford to pay even for the important daily supplies of food or even for gasoline. [In 1991] I was getting US$10 a month. In UN I got US$300. Today a medical officer in public health sector will get US$50 a month. An NGO would pay US$ 500-900. If you work with the public health sector, after seven to eight years of study you get so little that you cannot survive without additional income -- you know, under-the-table income.” -- Signatory respondent
    20. Findings: Compensation
      Some countries have regulatory bodies that decide salaries including for NGOs
      Mali – collective bargaining court
      Kenya – NGO Council (Ministry of Labor)
      Working conditions can be as important as salary considerations
    21. Findings: Compensation
      “Health care workers are leaving because the government doesn’t care. I know this surgeon in Uganda, gets a phone call at three in the morning that there is an emergency at a rural hospital. (…) Nobody can pick him up. He has a bicycle. So he goes to the local bus station from where one bus goes once every hour. He takes the bus, arrives in the village, walks to the hospital. By the time he gets there, the patient is dead. This happens in many, many countries. Everywhere! Everywhere! Over and over and over again! And this is something where the governments need to be held responsible as being unethical in not giving the health care providers the opportunity to save a person’s life.” -- Signatory respondent
    22. Findings: Training and Support
      Most signatories do some kind of training, but majority do on-the-job trainings (in-service)
      A few do university/pre-service training support
      Challenges:
      In-service trainings are seen by some as perks
      MOH unable to pay salaries even if more workers graduate
    23. Findings: Hiring
      “We recently trained 40 graduates just out of college in (this country) on M&E and seconded them in the Ministry [offices] across the country. We pay them [the same] salaries that the government pays.”
      -- Non-signatory respondent
    24. Case study: HAI
      Staff familiar with Code, and value the principles
      Similar challenges to other signatories
      Tension of adhering to hiring and compensation policies while trying to recruit quality staff
      Dilemmas when MOH colleagues apply for posted HAI positions
      Attempt salary equity with MOH (including perks)
      “The principle of not hiring from the MOH is good but how can you do it? How can you stop people who want to leave?” -- MOH official
    25. Suggestions and promising practices
      Visibility of Code
      Post in lobby, include in orientation
      Improve public sector opportunities
      Highlight value in setting policy, broader impact
      Invest in career path opportunities
      Second staff to the MOH
    26. Suggestions and promising practices
      Build workforce capacity
      Share good practices in primary care and scaling up interventions
      “Adopt a medical student”
      Organize NGOs locally or regionally
      Form coalition or union
      Advocacy
      More aid/funding for pre-service training
      Example: http://www.theglobalhealthinitiative.org/
      Donors should support/fund in line with Code
    27. Summary
      Awareness, but few changes to HR policies
      Commitment to principles, challenges with hiring and compensation items
      Testing ideas in the field
      Importance of more pre-service training
      Some efforts to coordinate amongst NGOs
    28. Discussion
      • How best to use the Code?
      • Is a voluntary Code a good tool for changing practices?
      • Other questions or thoughts?
      Thank you!
      Special thanks to Anjali Sakhuja, MPH
      whose work was presented here

    + UWGlobalHealthUWGlobalHealth, 2 weeks ago

    custom

    34 views, 0 favs, 0 embeds more stats

    Emily DeRiel, MPH
    HAI Program Manager

    More info about this document

    © All Rights Reserved

    Go to text version

    • Total Views 34
      • 34 on SlideShare
      • 0 from embeds
    • Comments 0
    • Favorites 0
    • Downloads 0
    Most viewed embeds

    more

    All embeds

    less

    Flagged as inappropriate Flag as inappropriate
    Flag as inappropriate

    Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details.

    Cancel
    File a copyright complaint
    Having problems? Go to our helpdesk?

    Categories

    -->
    Search
    RSS Feed
    What's new?

    © 2009 SlideShare Inc. All Rights Reserved