Chapter 19: The Role of Donor Agencies and Non-Governmental Organisations
White Paper for the Transformation of the Health System in South Africa

1.1 Introduction/Background: Donor Agencies

Since the 1994 democratic elections, international donors have been approaching the DOH in increasing numbers to offer aid. International experience, especially in developing countries, have indicated that donor relationships can be problematic if not directed by sound policy guidelines. For example, it could lead to unco-ordinated and fragmented financing, financing of projects which do not address the health priorities of the recipient country, and financing of projects which are not sustainable. Thus, the Department has drawn up policy guidelines for donors to ensure that donations will optimise the benefits to local health needs.

1.2 Principles and Guidelines for Donations

• All donations should be supportive of the health priorities of the RDP and the Department of Health.

• Donations should be used to support integrated programmes. They should create an enabling environment in which sound health policies can be implemented. In addition, the donations should enable health system reform.

• Conditions which are attached to donations should:

i) be acceptable to both the donor agency and the Government;

ii) be in accordance with broad Government policies;

iii) assist and support the sound planning and management of health services;

iv) be aimed at making an impact on the health services;

v) promote intersectoral collaboration and co-ordination; and

vi) develop capacity at the national, provincial and/or local levels.

• Intersectoral collaboration among health, education, agriculture, housing, water provision and sanitation and other relevant Government departments must be fostered by donations.

• Donations should be in accordance with South Africa’s priority health needs.

• Donations should promote and encourage self-reliance and community development, rather than dependence.

• The sustainability of donor support must be ensured in the short, medium and long term.

• Finally, all donor projects or programmes must advance the following principles:

i) Sustainability:- Donations which have cost implications for the Government must be evaluated to ensure that the required financial resources are available to sustain the projects.

ii) Equity:- In this regard, donations must address the shift to primary health care, the inequalities between and within provinces, underserved rural areas, and the needs of specific groups, such as women and children.

iii) Accessibility:- Donations should be directed at making health services accessible to all.

iv) Efficiency:- Donations should promote the efficiency of the health services. This could include providing training programmes for health workers, establishing sound information systems, and strengthening community involvement in health service delivery.

v) Acceptability:- Donations must be acceptable to Government structures, as well as to the communities for whom the donations are intended.

 

1.3 Categories of Donations

The White Paper also sets out certain guidelines which relate to specific types of donations.

1.3.1 Financial Donations

• Acceptance of donations must be in keeping with South Africa’s fiscal policy and financial legislation.

• The donation of funds should be focused initially on supporting initiatives for the reconstruction and rationalisation of health services.

• Funding for projects or programmes which are ongoing should focus initially on priority areas, as identified in the RDP and other government policies.

1.3.2 Donations of Technical Expertise

• The Department will solicit and accept contributions of a technical nature. However, this will only occur if there is shortage of such skills in South Africa, or if the contributions are aimed at enhancing local skills.

• The costs related to providing such expertise will be supported by the donor agency, as agreed upon with the Department.

1.3.3 Donations of Equipment

• Donations of equipment will be judged according to the appropriateness and the need for such equipment in South Africa.
• Donations of equipment will also be judged on whether there are adequate and available support structures. This will include the availability of expertise and/or training to use the equipment, the availability of an adequate maintenance service and infrastructure.
• Donations of equipment which will replace existing equipment should take preference over the provision of new equipment.
• Donations involving capital projects should facilitate job creation and community development, and should place emphasis on disadvantaged communities.

1.4 Co-ordination of Donations

All offers of assistance to the Department of Health should be co-ordinated at the national level. The provinces will be responsible for the co-ordination of offers of aid made to them, or to specific local communities. However, the national Department should be informed of all offers accepted. It is envisaged that this will ensure equity between the provinces. It should also ensure that all offers are in keeping with Government priorities and needs.

2.1 The Relationship between the Department and Non-Governmental Organisations

The Department has identified community participation in health as one of its key objectives. NGOs have an important part to play in this regard because they work closely with communities, and often provide services to the most underserved communities. NGOs are also able to support the government in service delivery. For this reason the White Paper indicates that the Department will nurture the relationship with NGOs. The Department has also drawn up a list of guidelines for funding NGOs.

2.2 Guidelines for the funding of NGOs by the Department of Health

NGOs approaching the Department will be evaluated according to the following guidelines:

• The NGO should address national and/or provincial priorities.
• The NGO must adhere to the RDP’s principles of integration and sustainability, nation-building, peace and security, linking of reconstruction to development, and democratisation of the country.
• The NGO must be non-racial and non-sexist.
• It must also be non-profit-making.
• The NGO must be accountable in terms of its mission, organisational structure, and finances. In relation to it’s mission, the NGO must serve the interests of the community.
• The NGO should be able to provide evidence of its financial stability, together with a summary of its current financial situation. Further, it should have not history of financial mismanagement.
• The NGO must be a legally constituted body.
• It should also be duly constituted, including having a functioning committee and must be managed by a management committee.

The Department will also use the following guidelines for assessing funding:

• The project should be evaluated against the criteria for the national health budget for the financial year concerned.
• NGOs which would be preferred for funding are those which extend the Government’s activities. Examples of this include hospice care, certain forms of training and advocacy organisations.
• The NGO should have a potential capacity and proven track record for executing the proposed project.
• It is preferred that an NGO should request funding for a specific project, with defined outputs. This is easier to evaluate than the provision of global funding.
• The NGO must declare other bodies which provide funding to it, or those which have been approached. This will be required because the NGO concerned must demonstrate its ability to obtain external funds, as Government rarely subsidises a project in its entirety.
• In situations where media messages are produced, close attention should be given to content, literacy and language.

3. Some Issues Raised by the Chapter

• The Department states its commitment to nurture relationships with NGOs. Currently there are various initiatives underway, such as the National Health Consultative Forum, which provide a structural aspect to this relationship. However, the chapter does not address how the Department hopes to continue such relationships with NGOs.

• There are currently various government initiatives looking at the role of NGOs. For example, the Department of Welfare's proposed legislation addressing the Not-for-Profit Sector, the Green Paper for Public Procurement, and the process to establish a National Development Agency. How does the Department see its role in all these initiatives, and is there co-ordination between the various departments and within the department itself?

• What strategies are envisaged to involve smaller NGOs and Community-Based Organisations in service delivery and funding opportunities of the Department. Are there any strategies for building capacity or enabling these smaller organisations?

For more information, please contact Carnita Ernest at telephone (021) 696-4954, or by fax at (021) 696-9308, or by e-mail at philaw@wn.apc.org . PHILA is supported by a grant from the Henry J. Kaiser Family Foundation.

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