There has been a dramatic increase in interest amongst North American NGOs in health issues in the developing world.  Often well intentioned actions create more problems than they solve.  According to those responsible for creating the NGO Code of Conduct for Health Systems Strengthening “It is now becoming clearer that NGOs, if not careful and vigilant, can undermine the public sector and even the health system as a whole, by diverting health workers, managers and leaders into privatized operations that create parallel structures to government and that tend to worsen the isolation of communities from formal health systems.”

The NGO Code of Conduct for Health Systems Strengthening will be of particular interest to organizations involved with health care but the principles are relevant to other areas as well. 

The basic principles of the Code include:

I. NGOs will engage in hiring practices that ensure long-term health system sustainability.
II. NGOs will enact employee compensation practices that strengthen the public sector.
III. NGOs pledge to create and maintain human resources training and support systems that are good for the countries where they work.
IV. NGOs will minimize the NGO management burden for ministries.
V. NGOs will support Ministries of Health as they engage with communities.
VI. NGOs will advocate for policies that promote and support the public sector.

For the full text of the Code:

A number of organizations are signatories to the Code including at the present time: ActionAid International USA, Africa Mental Health Foundation, African Cultural Exchange, African Medical and Research Foundation (AMREF), Afrihealth Information Projects / Afrihealth Optonet Association, American Public Health Association, Beijing Yirenping Center, Centennial International School, EQUINET, Family Care International, GIPEIT, Global AIDS Alliance, Global Health through Education, Training and Service, Health Alliance International. Health GAP, Heart to Heart International, Hesperian Foundation, International Civil Society Support, Kalna Health Awareness Society, Kenya Ambassadors of Change (Nakuru), Khmer HIV/AIDS NGO Alliance, Malawi Health Equity Network (MHEN), Mali Health Organizing Project, Mbarara Regional Referral Hospital, Medical Knowledge Institute, Padang Lutheran Christian Relief, Partners In Health, People’s Health Movement – USA, Physicians for Human Rights, Positive Action Foundation Philippines Inc. (PAFPI), Presbyterian Church of East Africa Health Group,
Sharan Nepal,  Social Welfare Development (SOWED) Programme Kenya,  Treatment Action Group,  UCLA Center for International Medicine, Universidad Autonoma Metropolitana / Unidad Xochimilco, WEMOS, and Youth Intercommunity Network.

Mark Blumberg is a lawyer at Blumberg Segal LLP in Toronto, Ontario.  He can be contacted at or at 416-361-1982 x. 237. To find out more about legal services that Blumbergs provides to Canadian charities and non-profits please visit the Blumbergs’ Non-Profit and Charities page at or

This article is for information purposes only. It is not intended to be legal advice. You should not act or abstain from acting based upon such information without first consulting a legal professional.