1. Ethics & the Work of NGOs/FBOs in Developing Countries Joseline M. Bruce (BSc) josbruce@hotmail.com Presented at Faith-Based Organizations as Pioneers and Partners in Health Systems Development, May 31, 2005, Omni Shoreham Hotel, Washington DC

2. Introduction Helping those in need cuts across all religions A challenge of scarce resources Need to maximize Utility Not to avoid paternalistic in our zeal

3. Case 1 – Local Front Community ‘A’ in Africa in dire need of good source of drinking water NGO drills a bore hole Inhabitants of community did use borehole Why? …built on football park

4. Ethical Issues Was the decision paternalistic? Was the decision paternalistic? Was utility maximized? Was utility maximized? Can the resources channeled into this project be justified in the face of scarce resources? Can the resources channeled into this project be justified in the face of scarce resources?

5. Case 2 – Local Front Community ‘B’ is in a rural setting Community ‘B’ is in a rural setting No public toilet facilities nor in their homes No public toilet facilities nor in their homes Resorted to using the bush Resorted to using the bush NGO builds public toilet facilities NGO builds public toilet facilities Community refuse Community refuse Facilities become a white elephant Facilities become a white elephant

6. Ethical Issues Paternalism on the part of the NGO? Paternalism on the part of the NGO? Was utility maximized and the greater good achieved? Was utility maximized and the greater good achieved? Can the scarce resources invested in the project be justified? Can the scarce resources invested in the project be justified?

7. WHO, 2004 Case 3 – Global Front Globally, HIV/AIDS = highest number of deaths by any single infectious disease Globally, HIV/AIDS = highest number of deaths by any single infectious disease E. g in an Eastern African country : E. g in an Eastern African country : 20.4% ; perinatal & maternal related conditions 20.4% ; perinatal & maternal related conditions 15.4% ; malaria 15.4% ; malaria 10.5% ; acute lower respiratory disease 10.5% ; acute lower respiratory disease 9.1% ; AIDS 9.1% ; AIDS

8. Case 3 However: Maternal & Perinatal related deaths twice AIDS related deaths Maternal & Perinatal related deaths twice AIDS related deaths A lot of donor funds to this country going to HIV/AIDS related activities A lot of donor funds to this country going to HIV/AIDS related activities

9. Ethical Issues Paternalism? Paternalism? Maximization of utility? Maximization of utility? Can allocation of scarce resources be justified? Can allocation of scarce resources be justified?

10. …In Conclusion To maximize Utility, there is need for: To maximize Utility, there is need for: Dialogue with communities Dialogue with communities Dialogue between countries and donor agencies Dialogue between countries and donor agencies Less paternalistic approach Less paternalistic approach

11. THANK YOU