This post is by Kirk Dearden. For more about Dr. Dearden, see here.
Are you starting your own NGO? Before you do, ask yourself these questions. If you answer “no” to most questions, maybe it would be better to work with an NGO whose programs do address these issues…
The broader health and development context
• Do efforts to promote health and well-being focus on a range of illnesses rather than specific diseases (e.g., HIV/AIDS, malaria)? NOTE: in many instances it is appropriate to focus on a single disease but a disease-specific focus shouldn’t be the norm
o What specifically does the NGO do to examine and address other (often larger) causes of sickness and death?
• Do program interventions focus on broad, long-term development or are they limited to a single cause (e.g., disaster relief after the Asian tsunami)?
• What models of development do NGO staff use as a means of framing their work? Are they largely Western in their orientation? NOTE: in some circumstances this may be appropriate
Program strategies including Information, Education and Communication (IEC) materials
• Has the NGO reviewed the “grey” literature for successful training manuals, counseling cards, job aids and any additional, relevant materials that others have already developed?
• Have project staff documented program successes and actively shared reports, training manuals and other materials with NGOs, cooperating agencies and donors?
• Has the project gone beyond “educating” (sharing information) to help individuals and institutions change their behaviors?
• To what extent are individuals and institutions allowed to “practice the practice” rather than simply hearing what they are supposed to do? NOTE: individuals must be given the opportunity to practice the optimal behavior over and over again before successfully adopting it
• Is the project tailored to the special needs of different groups or do staff adopt a one-size-fits-all strategy?
• Have successful local practices (i.e., “positive deviant behaviors”) been identified in every community—thus helping individuals gain ownership of their own development—or are successes in one community simply disseminated to other areas?
• Are interventions evidence-based? For example, the most effective child survival interventions include immunizations, exclusive breastfeeding, insecticide treated nets and so on. Do NGO staff identify and promote behaviors that are known to make a difference?
• Do interventions over-emphasize technology?
• Have NGO staff identified which social forces encourage/discourage individuals from practicing optimal behaviors? If so, how specifically do program activities address these facilitators and barriers?
Staffing and other institutional matters
• Does the NGO rely mostly on local talent or are staff “imported” from the US and elsewhere?
o Do US-based staff replace local staff?
o If staff aren’t local, how long have they been in-country? Long enough to appreciate customs, culture and program successes?
• Have staff from “northern” and “southern” countries received professional training in:
o public health?
o cultural sensitivity?
o cross-cultural communication?
o policy or other relevant topics?
• Have staff from “northern” countries brushed up on local politics and history?
• Do staff from northern and southern countries have job descriptions?
• Do staff have training and experience that is relevant to their job descriptions?
• Does the NGO foster “south-to-south” dialogue and learning? For example, are field staff from Haiti encouraged to travel to Mali to share program successes and vice versa? NOTE: too often, technical assistance is “north-to-south”
• If the NGO is working in industrialized and less-industrialized settings, are successful programs from “southern” countries (e.g., the use of oral rehydration salts and microcredit—both from Bangladesh) considered for use in “northern” countries?
• Does the NGO have adequate logistic and technical backstopping in-country as well as from a home office (if applicable) to truly offer state-of-the-art programming?
• Does the NGO have a strategic plan for 1, 3, 5 and 10 years?
• Is there broad agency buy-in for the strategic plan?
Local capacity building
• What long-term training is available to develop in-country talent and build institutional capacity?
• Do such training efforts capitalize on local knowledge? If so, is there an explicit effort to train “non-indigenous” staff (e.g., from the US) in locally identified best practices?
• What is the NGO’s exit strategy? (shorter isn’t always better but staying in a country 15 to 20 years or more suggests that the NGO might not have done enough local capacity building)
• How will program efforts be sustained once the NGO leaves?
• Is the NGO sufficiently committed long-term (in a given country or globally) to making a difference or are most activities short-term (i.e., weeks or months)?
• Have programs been implemented according to plan (for example, according to well-established protocols)?
• What efforts has the NGO made to assess the impact—both positive and negative—of their program?
• Are baseline, mid-term and follow-up assessments carried out…preferably among individuals with access to programs and controls?
• Are most/all other standard procedures for data collection followed? There are many standard procedures which should include the following:
o A careful assessment of target audiences
o The use of quantitative and qualitative data
o Randomization of respondents
o Use of experienced interviewers
o Adequate training for interviewers (usually 3-4 days)
o Expert data analysis
o Usable results
• Do locals participate in data collection and analysis/interpretation?
o To what extent are locals allowed to discuss the implications of findings?
• Does the program have an impact?
o If so, are results plausible (i.e., can we rule out most/all other explanations for impact, for example, simultaneous interventions from the government or other NGOs)?
o If not, why not? What adjustments to programs are needed based on results from the evaluation?
• How cost-effective is the program?
• Some program “failures” result from institutional culture (e.g., bureaucracy and ethnocentrism). To what extent has the NGO assessed how institutional policy and behavior negatively affect development?
• What efforts are in place to ensure program quality on a routine basis?
• Are the NGO’s program findings replicable in other contexts? If yes, what contributes to their replicability? If not, why not?
• Are programs reaching just a few individuals or many (perhaps tens of thousands or hundreds of thousands)?
• Has the project been extensively pilot-tested before scaling it up?
• Is the NGO partnering with other organizations to widely disseminate successes?
o With which organizations is the NGO partnering? The Ministry of Health? Other NGOs (both local and international)? NGO networks? UNICEF? The World Health Organization? Other UN organizations?
• Has the NGO identified successful program strategies (both in-country and globally) that other NGOs and cooperating agencies are already carrying out? While there are no program strategies that are universally applicable, the following have been used successfully (and documented). NOTE: There are too many good strategies to list here:
o Community mobilization (for example, the WARMI project in Bolivia that mobilized families aroung maternal health)
o Negotiation (provides individuals several options they can try when adopting optimal behaviors)
o ORPA/FAMA for counseling cards (identifies context-specific facilitators and barriers to behavior change and commits individuals to trying a new practice)
o Positive deviance and other assets-based community development approaches (helps identify local successes then spreads them)
o Doer/Non-doer (similar to positive deviance)
o Support groups (for example, mother-to-mother support around breastfeeding)
o Social marketing to change norms and promote healthy products and ideas
o Pre-service and in-service training for clinicians and other health and development professionals
o Policy reform (for example, PROFILES, REDUCE, and ALIVE to improve national policies regarding complementary feeding and maternal and neonatal mortality)
• What is the funding source for activities?
o Is it large enough to make a difference (for example, does it allow the NGO and its partners to operate at the family, community, district and national levels)?
o Are there any conflicts of interest (e.g., promoting breastfeeding with funding from Nestlé)
• To what extent have donors been sensitized to health and development issues?
• Does funding come from an array of donors? NOTE: over-reliance on a single donor can unduly influence NGO direction (for example, sponsorship programs for children often lead to curative care for individuals rather than community-based prevention)
• Is funding sustainable?
• Is funding largely designed to address immediate (short-term) needs or is it for building systems (e.g., training development practitioners, improving quality of care, institutional capacity building, “mainstreaming” of program innovations)?
• Is seed funding available to test new ideas and start innovative projects…even if there’s a risk that things won’t work out?
Responding to local and global needs
• How do NGO staff determine what is needed? Do they conduct extensive needs assessments and if so, whose needs do they assess (are the poor, women, children and other marginalized groups given a voice?)
• Do NGO staff conduct a thorough review of the literature (local and otherwise) to determine prevailing problems (for example, acute respiratory infections kill 7 times as many children less than 5 years of age than HIV/AIDS)
• Does health promotion require project staff to better understand individuals’ specific circumstances before attempting to improve well-being?
• As part of program activities, do those with expertise in gender actively involved in planning, implementing and evaluating programs?
• Do NGO staff evaluate both the positive and negative impact of programs women, men, girls and boys?
• As appropriate, are programs sensitive to the special needs of adolescents (for example, offering separate clinic hours for family planning services)?
• As a result of the project, do women’s workloads become more burdensome (new “opportunities” to participate in micro-credit, adult literacy and health promotion may overtax women)
• Is the project largely focused on addressing practical gender needs (short-term activities that help women and men fulfill their already defined gender roles such as installing a pump to make water fetching easier)?
• To what extent does the project address strategic gender needs (helping communities identify unequal relations and changing power and control to benefit both men and women; for example, helping communities think through who should fetch water)?
• Does one sex, age group, race or ethnic group benefit at the expense of others?
• Does the project subject women or men to increased risk (for example, some studies show that offering women microcredit increases domestic violence)?
Treating others with respect
• Are locals seen as equal partners in development or simply the objects of pity? NOTE: programs that are meant to “serve” and “help” others are often patronizing
• To what extent has the NGO mobilized locals around issues they feel are important?
• Do NGO staff see current poor conditions as largely the fault of individuals (for example, because of laziness) or do staff account for the broader forces that keep people from reaching their full potential (i.e., corrupt governments)?
• Does the project focus on bringing about change at all levels (government, institutions, families, individuals)? NOTE: projects that address multiple levels are often more successful than activities focusing only on individual behavior change
• Are program staff largely driven by charity, justice or both? NOTE: William Sloane Coffin once said “Charity seeks to alleviate the effects of injustice; justice seeks to eliminate the causes of it. Charity in no way affects the status quo, while justice leads inevitably to political confrontation.”
• What “strings” are attached to programs? For example, do staff require that locals adopt certain beliefs (e.g., Christianity) in exchange for access to programs?
• Are community members encouraged to make a contribution to collective well-being or does the NGO provide handouts? NOTE: in Mali, Save the Children enters partnerships with the community. Community members build latrines, pay the salaries of local teachers, and provide rooves for village schools. Save the Children constructs schools, recruits students, helps communities develop school curricula and trains teachers
• Is training based on principles of adult learning theory (capitalizing on the life experiences of those participating in training; allowing individuals to see, hear and do, etc.)
• Does the NGO offer praise to individuals who change their behaviors?
• Do NGO staff adopt the same behaviors they promote (e.g., correct and consistent condom use)?
• Some staff members’ attitudes may have a negative impact on the program’s success. What staff member beliefs might jeopardize impact?
• Who ultimately is responsible for the success of the project? If not locals, why not?