Nongovernmental organizations

A third key element in the international organization response network is nongovernmental organizations (NGOs). They include a wide array of groups involved in funding, advocacy, policy guidance, or service delivery. They can be professional and technical, community-based, faith-based, national, or international. Many play an increasingly significant role in global health. (Walt, 2005) Overseas development assistance from governments channeled through NGOs reached close to US$5 billion in 2004. Private funding for NGOs expanded by 37 percent, from US$6.9 billion in 2000 to US$11.3 billion in 2004, and government funding to NGOs rose to $5 billion. (OECD, 2005).

In some regions of the world where health services are limited, faith-based clinics and hospitals work with local NGOs as the main health providers. During disasters and complex humanitarian emergencies (CHEs), these local and international NGOs are usually the front-line emergency responders for refugees and displaced persons in isolated and insecure areas. The CDC defines CHEs as "situations affecting large civilian populations which usually involve a combination of factors including war or civil strife, food shortages, and population displacement, resulting in significant excess mortality" (Connolly, 2000; Toole et al., 2005). Much like the fragmentation already described on multi-lateral and bi-lateral levels, the services these NGOs provide frequently are not well coordinated either among themselves or with the host government. Particularly during emergencies, NGOs can have diverging priorities and approaches, and adhere to different standards of care. (Toole et al., 2005; Telford et al., 2006). While there are ongoing efforts to set standards and improve coordination across the board, a lack of accountability and transparency causes significant organizational disparities in human and material resources, and this further impacts the ability to provide quality health services (Toole et al., 2005).

As described elsewhere in this text, infectious disease outbreaks are a key concern during natural disasters and complex humanitarian emergencies (Connolly, 2000; Toole et al., 2005; see also Chapters 11 and 13). During July 1994, in the refugee camps of Goma in eastern Zaire, to which one million Rwandan refugees had fled following the genocide, mortality rates increased 30-fold over the rates in Rwanda prior to the conflict. During a period of three weeks, it is estimated that 45,000 people died of cholera in the camps. The main source of water in the refugee camps was Lake Kivu, generally considered to be the source of contamination (Toole et al., 2005). NGOs were the primary responders for people in the camps. While they faced the same challenges and fragmented response issues common at any disaster site, most glaring here was a lack of a single unified disaster response system, which resulted in poor communication and planning across responders. This in turn contributed to inadequate coordination among donors and responders, and led to some duplication of effort, ineffective or slow responses, and inequity of access to health services, culminating in excess morbidity and mortality (Millwood, 1996). Beyond the effects of fragmentation, NGOs face a host of operational challenges that derive from the narrow missions, protocols, and philosophies they must follow. Not only are they often operating in resource-constrained conditions; they also usually have to collaborate closely with (or at least get approval from) sometimes unenthusi-astic and ineffective local governments (Lam, 2001). They may go into a setting without clear guidance as to who is in charge (Connolly, 2000; Shoo, 2000), and there are almost always constraints related to funding and supplies (Shoo, 2000), including competition between NGOs for the same funding sources.

Considerable progress is being made by NGOs to develop technical field expertise, and to have their responses driven by performance indicators and codes of ethics. Like other groups working in global health, they must deal with fragmented planning, management, and implementation of programs, and a lack of funding for long-term preventive infrastructure development. Until this paradigm shifts, it is likely their efforts will result in sporadic success and ever-increasing spending on emergency response.

Emergency Preparedness

Emergency Preparedness

Remember to prepare for everyone in the home. When you are putting together a plan to prepare in the case of an emergency, it is very important to remember to plan for not only yourself and your children, but also for your family pets and any guests who could potentially be with you at the time of the emergency.

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