1. NGO Code of Conduct for Health Systems Strengthening Julia Robinson, MPH MSW April 8, 2014

2. HEALTH ALLIANCE INTERNATIONAL Outline  Why a code of conduct?  NGO Code of Conduct contents  Research into implementation of the Code  Discussion  How best to use this Code?  Are voluntary codes of conduct good tools for changing practices?

3. HEALTH ALLIANCE INTERNATIONAL Why a code of conduct?  Development aid for health quintupled since 1990, to $27.7 bn in 2011  US flows more than 50%of aid through NGOs Source: IHME/Murray et al, 2011

4. HEALTH ALLIANCE INTERNATIONAL Why a code of conduct? Weak public sector health system Fragment- ation Mgmt burden Brain drain Inefficien- cies Loss of services

5. HEALTH ALLIANCE INTERNATIONAL Why a code of conduct?  There are many factors contributing to weak public sector health systems – why focus on NGOs?

6. HEALTH ALLIANCE INTERNATIONAL Why a code of conduct?  Lots of them already exist  …NGOs Responding to HIV/AIDS, Disaster Relief, International Philanthropy, general codes of ethics and conduct, etc. One World Trust CSO Project: http://www.oneworldtrust.org/csoproject/ http://www.oneworldtrust.org/csoproject/

7. HEALTH ALLIANCE INTERNATIONAL Why a code of conduct?  Specifically, codes have been used for health workforce and recruitment efforts  WONCA’s “Melbourne Manifesto” (2002)  Commonwealth Code of Practice (2003)  UK’s Code of Practice (2004)  Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the U.S. (2008)  WHO Code of Practice on the international recruitment of health personnel (2010)

8. HEALTH ALLIANCE INTERNATIONAL NGO Code of Conduct for HSS  Coalition of organizations worked on drafting and consultations starting in 2007  Launched in May 2008

9. HEALTH ALLIANCE INTERNATIONAL NGO Code of Conduct for HSS  6 articles:  Hiring practices  Employee compensation practices  Human resources training and support to systems  Impact of management burden on ministries of health  Support of MOH engagement with communities  Policy advocacy for strengthening public sector ngocodeofconduct.org

10. HEALTH ALLIANCE INTERNATIONAL NGO Code of Conduct for HSS  6 articles:  Hiring practices  Employee compensation practices  Human resources training and support to systems  Impact of management burden on ministries of health  Support of MOH engagement with communities  Policy advocacy for strengthening public sector ngocodeofconduct.org

11. HEALTH ALLIANCE INTERNATIONAL First 3 articles: Human resources Avoid hiring away from MOH Coordinate with MOH in hiring Hire nationals where possible (rather than expats) Avoid creating incentives for migration Hiring Fair monetary compensation, limit disparities Strive for salaries not substantially greater than public sector Avoid top-ups to MOH staff for outside work Try to improve public sector benefits/pay Compensation Invest in pre-service education to increase number of workers Build capacity of public sector workers (including mgmt) Training and Support

12. HEALTH ALLIANCE INTERNATIONAL Implementation so far  57 signatories today in 14 countries  Thesis research by Anjali Sakhuja (MPH 2009)  Questions:  How are signatories implementing the Code of Conduct?  What are best practices?  What are challenges to operationalizing the Code?

13. HEALTH ALLIANCE INTERNATIONAL Findings: Hiring  Most respondents make efforts to avoid hiring from the MOH  Have hired in the case of  Person already resigned from MOH  With permission from MOH  In “after-hours” setting (also with permission)  Challenges:  Rural posts  Project deadlines/pressure  Ethics of refusing to hire due to MOH employment

14. HEALTH ALLIANCE INTERNATIONAL Findings: Hiring  Expatriates are hired when special expertise is needed; try to make it the exception rather than the rule  Challenges  Can’t hire from MOH (nationals), can’t hire expats – what if there isn’t anyone else?  Bureaucracy to hire expats  Expats from non-Western countries fleeing conditions in home countries

15. HEALTH ALLIANCE INTERNATIONAL Findings: Compensation  NGO salaries can be 10x greater, or more  Challenges  Low salaries make hiring and retention difficult  Market pressures  Finding an elusive balance  Working conditions can be as important as salary considerations

16. HEALTH ALLIANCE INTERNATIONAL Suggestions and promising practices  Visibility of Code  Post in lobby, include in orientation  Improve public sector opportunities  Highlight value in setting policy, broader impact  Invest in career path opportunities  Second staff to the MOH

17. HEALTH ALLIANCE INTERNATIONAL Suggestions and promising practices  Advocacy  Donors should support/fund in line with Code  Make signing on to the Code a condition of receiving funds  Why not get the big players on board?

18. HEALTH ALLIANCE INTERNATIONAL Summary  Awareness, but few changes to HR policies  Commitment to principles, challenges with hiring and compensation items  Testing ideas in the field  Importance of more pre- service training  Some efforts to coordinate amongst NGOs

19. HEALTH ALLIANCE INTERNATIONAL Discussion  How best to use the Code?  Is a voluntary Code a good tool for changing practices?  Other questions or thoughts? Thank you!