Abstract
Non-governmental organisations (NGOs) feature prominently in global health and development discourses. Such discourses often assume that NGOs provide a supplement to, and critical engagement with, struggling government health care systems. In contrast, interviews and ethnography with patients, health care providers, and NGO workers in Kebbi State, Nigeria, suggest a more problematic mode of state/NGO interaction. Focusing on larger NGOs, this research suggests that they are often politically impotent, a product of both a difficult political environment and their own inflexibility. In contrast, medical professionals are pursuing many of the same political goals with considerable success. The benefits and compromises of these contrasting strategies are explored. This article also offers an empirical contribution to debates on working ‘with the grain’ of patrimonial politics as an alternative to the ‘good governance’ agenda.
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