Abstract
BackgroundThe presence and influence of nongovernmental organizations (NGOs) in the landscape of global health and development have dramatically increased over the past several decades. The distribution of NGO activity and the ways in which contextual factors influence the distribution of NGO activity across geographies merit study. This paper explores the distribution of NGO activity, using Bolivia as a case study, and identifies local factors that are related to the distribution of NGO activity across municipalities in Bolivia.MethodsThe research question is addressed using a geographic information system (GIS) and multiple regression analyses of count data. We used count data of the total number of NGO projects across Bolivian municipalities to measure NGO activity both in general and in the health sector specifically and national census data for explanatory variables of interest.ResultsThis study provides one of the first empirical analyses exploring factors related to the distribution of NGO activity at the national scale. Our analyses show that NGO activity in Bolivia, both in general and health-sector specific, is distributed unevenly across the country. Results indicate that NGO activity is related to population size, extent of urbanization, size of the indigenous population, and health system coverage. Results for NGO activity in general and health-sector specific NGO activity were similar.ConclusionsThe uneven distribution of NGO activity may suggest a lack of co-ordination among NGOs working in Bolivia as well as a lack of co-ordination among NGO funders. Co-ordination of NGO activity is most needed in regions characterized by high NGO activity in order to avoid duplication of services and programmes and inefficient use of limited resources. Our findings also indicate that neither general nor health specific NGO activity is related to population need, when defined as population health status or education level or poverty levels. Considering these results we discuss broader implications for global health and development and make several recommendations relevant for development and health practice and research.
Highlights
Nongovernmental organizations (NGOs) have become increasingly important players in the realm of global health and development
This definition is similar in scope and tone to the often cited definition offered by Vakil (1997), who writes that NGOs are best understood as “selfgoverning, private, not-for-profit organizations that are geared to improving the quality of life for disadvantaged people”
The greatest proportion of NGO projects were classified in the health and agriculture sectors; each comprising twenty-four per cent of the total NGO projects and together accounting for nearly half of all NGO projects
Summary
Nongovernmental organizations (NGOs) have become increasingly important players in the realm of global health and development They operate projects in low and middle-income countries (LMICs) throughout the world. The dramatic rise of NGOs is related to an increase in funding to and through NGOs, which reflects the largely untested assumption that NGOs are more cost-effective and better than the public sector in reaching poor and vulnerable populations [10,11,12].This assumption is rooted in the neoliberal ideologies dominant during the 1980s that promoted privatization, marketization, and a reduced government presence [13,14] During this era, structural adjustment programs were imposed on indebted countries by international financial institutions in hopes of stabilizing economies and infusing neoliberal agendas into LMICs [13]. Greater space for NGO projects and increased confidence in the NGO sector relative to LMICs governments initiated the dramatic rise of NGOs throughout the world
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