Adebimpe us to accomplish jointly something that one

Adebimpe Olalekan, Audu Anslem

The
mechanisms of international health cooperation revolve around mutual benefits,
prevention of spread of diseases and the need to execute public health work
among participating countries. The United Nations (UN) since her establishment
has been coordinating developmental programmes among member nations from all
walks of life. Prominent among these UN agencies are the WHO, UNICEF, UNFPA,
UNHCR, ILO, FAO, UNEP among others. However, inequalities still exist in the
ability of countries to ensure that all her citizens live a socially acceptable
and productive lifestyle over time, as the poor developing nations do not have
the funds and capability to do enough. Cooperation among countries has led to a
partial move towards equity and provision of assistance to developing nations
by the developed ones. The World Health Organisation (WHO) is the organ of the
United Nations handling public health matters including the strengthening of
health systems and coordinating health support and collaboration among member
countries

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Mechanisms
of health collaboration include multilateral (usually involving agencies in two
or more countries), bilateral (usually involving 2 countries e.g. USAID, SIDA,
DFID representing their country and collaborating with others), Non-Governmental
(e.g. Rotary International, ICRC collaborating with countries and agencies) and
Private collaborations (e.g. Bill and Melinda Gates, Ford foundation in
collaboration with government and other organizations etc.). Collaboration
enables us to accomplish jointly something that one agency alone could
not. Many funding agencies have recognized the power that inter-agency
collaboration can bring including better use of scarce resources, better
communication, conservation of capital and integration of cost and efforts.
With the global financial meltdown and economic crisis rocking the boats of
many countries of the world and dwindling funds from donor agencies,
collaboration efforts had suffered setbacks. It is thus important for agencies,
NGOs and other organizations receiving support and funds to judiciously manage
existing funds through effective programme management while striving to achieve
targets and organizational goals and objectives.

There
are numerous criteria to classify NGOs. The World Bank broadly classified them
into Operational (involved in design and implementation of relief and
development-related projects) and advocacy NGOs (with the purpose of defending
or promoting a specific cause mostly through raising of awareness). By orientation, NGOs could be classified into
charitable, service, participatory or empowering orientation type. By level of
operation, NGOs can be classified as community based, citywide, national or
international NGOs. Other terms related to the word “NGO”
are private voluntary organizations,
civil society, independent sector, self-help organizations, grassroots
organizations, volunteer sector, transnational social movement organizations,
and non-state actors

A Project is a planned set of activities usually under
a programme. It has a scope, time, cost, and quality and resource constraints.
A good programme manager is proactive and not reactive, decisive, good
communicator,
a motivator who leads by example. A program is a portfolio comprised of
multiple projects that are managed and coordinated as one unit with the
objective of achieving (often intangible) outcomes and benefits for the
organization; so program
management is the process of managing several related projects, often with the
intention of improving an organization’s performance. Major challenges
facing programme management include the scope, time, cost and quality of work,
the need to deal with multiple stakeholders with different needs and
expectations,

Common
programmes being executed by most NGOs in developing countries include HIV
control, TB control, Malaria control, family planning, Reproductive health,
Health education and promotion, gender issues, human rights, governance,
environmental protection, water and sanitation, nutrition and food security
among others. The NGOs in collaboration with stakeholders including communities
and Governments executes these programmes from their headquarters and branch
offices spread throughout the host country.

Regardless
of the motive of conducting public health work, every organization, be it
Government or Non-governmental, have the utmost objective of strengthening the
health system. Using organizational funds which could have been sources from
donor agencies, international partners etc., and host country resources need to
be improved. These include human resources- in form of new employment, and
their training, re-training of existing workers, on the job training for
existing workers and continuous mentoring of activities to ensure best
practices using already established standard operating procedure manual (SOPs)

Improving
availability of health commodities and proper logistic and supply chain
management are crucial to a successful health resource management. Fund is an
important resource that drives the affairs of an organization and its
availability is an important determinant of success. It is important for
organizations to determine her sources of funding, how to reach funders and how
to manage available financial resources judiciously. Many small organizations
have collapsed due to non-availability of funds or mismanagement of existing
funds.

Public
health programmes in developing countries are largely donor funded, and this
has to be discouraged or managed towards self-sustainability. Agreed
counterpart funding which many countries do not honor or pay is another reason
why many organizations lack money. With the global financial meltdown hindering
the operation of many donor agencies, fund available to developing countries
may continue to dwindle.

The
three basics of programme work are Project planning and development,
Implementation, Monitoring and Evaluation (M). According to the French writer (Antoine de Saint-Exupery 1900 – 1944), a
goal without a plan is just a wish. Successful organizations need to
plan their actions and work endlessly to stick to their plan towards
achievement of organizational goals and objectives.

It
is important to state the mission and vision of the organization and gives an
overall direction to its way-forward. During planning, it is also important to
analyze their strengths and build upon opportunity and determine organizational
core competencies. Then proper and well efficient management of time, money and
human resource becomes easier through effective strategic planning. NGOs can have
both short-term and long-term objectives and can conveniently work towards
achieving its goals. For effective management of Public health programmes,
large organizations should be divided into sections all of which are inter
related and work together. These sections are

1.     
Core
Programs unit

2.     
Finance
and administration: including accounts, office management, store and security
management, motor pool management, and human resources management

3.     
Medical
services

4.     
Referral
linkages and communication

5.     
M
and E

6.     
Laboratory
services

7.     
Logistics
management unit

8.     
Pharmacy
services

9.     
Knowledge
management units-working on research, diversification  of organizational outputs and interest

10. 
Communication
and documentation units handling dissemination and documentation of
organizational achievements

11. 
Health
system strengthening and quality assurance and control unit

12. 
Strategic
affairs units: handling issues or programmes that may not be common but
peculiar to the organization and her goals and objectives.

In
smaller organizations, some of these sections may not exist as a separate
entity, but rather merged under programmes and every technical officer becomes
his or her own programme officer. Common cadres of positions employed by health
based NGOs in developing countries include the Chief of Party, Director,
Advisors, Technical officers, Technical Assistants and Managers. The NGOs
usually key into host government scheme or arrangements and opening new
opportunities through strengthening of the health system of the host country.
In order to encourage ownership and sustainability of project outputs, large
NGOs may sublet part of their funds and functions to local registered NGOs,
mainstreaming and working with other NGOs, forming alliance or networks all
towards improving stakeholder’s participation is key. After planning, the next
stage is project development and implementation, which would be evaluated over
a period of time. These topics will be dealt with in subsequent chapters of
this book. It is important for programme stakeholders to answer the following
questions in order to have a fore knowledge of programme implementation,
monitoring and evaluation

1.     
When
do we start and where do we start from?

2.     
How
are we starting and who is starting what?

3.     
What’s
the baseline before commencement using SMART indicators?

4.     
Are
targets being met over a specified period of time?

5.     
Do
we need to re-view the plan, modify the plans or re-strategize?

6.     
What
are our outputs and outcomes compared to initial plans and targets set?

7.     
What
are the plans for end of project evaluation and dissemination of projects
achievements?

Basic
elements of programme management include proposal writing, resource
mobilisation, programme planning and development including budget, HR and
office management, plans for strengthening the health system and linkage to the
other components of the health systems, the communities and governments.
Technical basis includes medical services provision, logistics management (e.g.
in the lab and pharmacy), referrals and communication, M and report writing
among others. 

The
role and use of ICT is central to public health work. Data are generated
routinely and needs to be analyzed in order to inform decision making. In a
NGO, the ideal situation is for every staff to have free access to the computer
and internet system. This facilitates communication, exchange of ideas and
working towards organizational goals and objectives. Tele-conferencing may
facilitate scheduled discussions between programme managers in different
location. When funders release programme documents, targets are set and
deliverables stated. It is the role of programme managers to work towards
achieving these targets.

Knowledge
management is a very important component of programme work as projects are
being executed. Deliverables and achievements should be well documented, and
the generated data analyzed to bring about an understanding of current health
situation and the predictions of future events. This could translate into
production of newsletters detailing organizational evidence-based achievements,
contributions to science and knowledge as well as publications in scholarly
journals. NGOs would benefit immensely from collaboration with other NGOs most
especially those executing similar projects. There may be a need to leverage on
the strength of one to assist the other achieve their aims and objectives.
Ideas and best practices could also be shared through collaborations among NGOs
executing projects. Linkage with the community who are end users in most cases,
and the host governments are equally important. Without support from these two
important stakeholders, behavioural changes may not occur, and sustainability
of programme ideals and outcomes may not become entrenched in the practices of
the community.

Government
of host nations could provide counterpart funding, could make favourable
policies towards easy programme implementation, may make existing resources
available to funders or collaborators, and may provide enabling environment for
project take off. Thus mentoring of supported health facility staff from time
to time, monitoring of their activities, supportive supervision to them at work
site, on the job training are some of the skills that programmers acquire in
their daily course of work such as site activation, site assessment, site
mentoring, data quality assessment among others.  Prospective managers who wish to work in
projects could start by volunteering to work for NGOs where they could acquire
practical experiences, assist the host countries in deliverables as well as
preparing him or herself for eventual serious programme work. Experiences are
not bought overnight in the market but acquired.  Your academic qualifications are relevant but
your experience and expertise are much more important, as it is an index of
what you can deliver towards achievement of organization goals.

Prospective
NGO staff should be available for traveling. Every NGO states the required
extent of traveling in their job description. There may be a need to leave
one’s family, or change locations as the case may be. This is an important part
of project work. Project executors and programme planners need to work in a
team in order to achieve results. They should turn to like minds where one mind
actually works for the other. Every programme planner has a supervisor to which
he or she reports, and who gives direction to planned activities. Supervisors
usually work in the same field as the subordinate, as they guide subordinates
on their Terms of Reference (ToR) and job responsibility.

Evaluation is a vital component public health of
programmes. The organization is interested in the extent of achievement of
organizational goals, and meeting targets over time. Usually a baseline
evaluation is done before commencement of programmes, a midterm evaluation of
plans and achievement, and an end of project evaluation during which the
overall achievements of the project under various programmes would be
documented and disseminated.

Public Health programmes must adopt the
concept of the ‘health team’ in order to effectively accomplish set goals which
are better delivered through inter disciplinary cooperation. The objective of
PH practice are too broad for an individual to achieve hence, there is a need
to engage health care professionals who are ready to work together. Inability
to work together would bring conflicts and inter-professional rivalry leading
to programme ineffectiveness. The health team approach uses combined skills of
experts, reduces cost of health services and brings quality health care to
under-served communities. The composition of the team may differ at different
levels of government, size of the NGO, the extent of the programme being
implemented, and even in the face of different types of problems. The
determinants of successful accomplishment of targets include team unity,
communication, pattern of decision making and leadership. Autocratic leaders
usually achieve less compared to democratic leaders.