Donor dilemmas in a fragile state: NGO-ization of community healthcare in Guinea-Bissau

• Published in: Development Studies Research
• Main Authors: Baldursdóttir, Sigríður, Gunnlaugsson, Geir, Einarsdóttir, Jónína
• Other Authors: Félagsfræði-, mannfræði- og þjóðfræðideild (HÍ), Faculty of Sociology, Anthropology and Folkloristics (UI), Félagsvísindasvið (HÍ), School of Social Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: Informa UK Limited 2018
• Subjects: Aid effectiveness; Community healthcare; Fragile states; Guinea-Bissau; NGOs; Þróunarsamvinna; Heilbrigðismál; Alþjóðastjórnmál; Þróunarlönd; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/1084; https://doi.org/10.1080/21665095.2018.1500143

Publisher's version (útgefin grein) There is increased emphasis on donor engagement in the world’s poorest and most fragile states, but aid modalities tend to differ depending on the recipient countries’ governance. In fragile states, donors often bypass governments and collaborate with non-state development actors (NGOs) to prevent aid capture, improve effective delivery and increase effectiveness. Based on ethnographic fieldwork over 20 months in 2009–2012, the aim of this paper is to explore the role of NGOs in community-based primary healthcare vis-à-vis the Ministry of Health in Guinea-Bissau. Revitalization of Guinea-Bissau’s formerly extensive community healthcare services was initiated in 2010. The Ministry of Health, in charge of its implementation, emphasized ownership, harmonization and alignment that created tension with NGOs. However, as a result of a military coup in 2012, donors bypassed the Ministry and gave NGOs a central role. Through the voices of stakeholders, this paper outlines donors’ dilemmas in a situation of state fragility. They found NGO-ization reasonable to protect funds and secure implementation while some worried that it might counteract alignment, harmonization, ownership and sustainability. The paper argues that aid to the health sector in fragile states needs to be long-term and predictable. This paper is based on findings from the PhD thesis of the first author. We would like to thank the various actors that financed the PhD research: The Doctoral Grants of The University of Iceland Research Fund that funded the research for three years; the Faculty of Sociology, Anthropology and Folkloristics at the University of Iceland for a one-year teacher’s stipend; and the Nordic Africa Institute for a travel scholarship to visit Guinea-Bissau, as well as two months PhD scholarships at the Institute and for use of its excellent library. We would also like to thank all donor representatives, international and national NGO workers, Ministry of Health officials and local health ...