NGOs and the transfer of global maternal health policies - NGOMA

One of the clearest trends in recent history of global health is the stronger role for non-state actors, whether corporations, philanthropic foundations, public-private partnerships or non-governmental organisations and civil society groups. The NGOMA project set out to addresses this trend. NGOMA has focused specifically on role of health-related NGOs in transferring or diffusing global norms, policies and programmes targeting women?s and adolescent?s health to the national health and education system and local communities in Malawi. The project has developed a unique research focus on the role of such actors. Throughout the project, NGOMA has applied critical ethnographic methods in order to understand civil society?s impact on policy, governance and practice. Through a multi-sited ethnographic study, the project has examined how policies and programmes made by global communities of practice work themselves out, and to what effect, within national policy circles and local practice. The maternal health field has recently been going through a rapid policy shift. At the end of the MDG era, the focus in maternal health was primarily on skilled birth attendance. At the end of 2014, the policy discourse had narrowed down to teenage pregnancies and how to prevent them through keeping girls in school. The influx of NGOs in health development enabled this profound rapid shift, by bypassing the time consuming and bureaucratic process of going through national policy channels. NGOs, on the other hand, as channels for these global norms are faced with the reality of competing for short-term funding, within an increasingly competitive environment. NGOs find themselves under constant pressure to produce success, which hinders a more critical view of learning and the fault lines in the implementation process. This was further intensified when the newly elected President Trump reinstated and expanded the Mexico City Policy, or the global gag rule, banning foreign NGOs from providing abortion services, lobbying for abortion or even informing women about abortion. This lead to a further shrinking of the political space for civil society that heavily affects the ability of civil society to have a distinct political voice. In local communities, the vast number of NGOs implementing all kinds of small-scale projects is met with distrust and resistance. NGOs are at present unable to voice needs of communities, but are instruments for the implementation of global policies. As such, they have lost the profound role of civil society as intermediaries between policy makers, be they governmental or global, and local communities. The fact that donors bypass governmental structures, favoring NGOs as implementing actors, further weakens already fragile national health and education systems. The NGOMA project has clear policy relevance, given that bilateral donors, including Norway, direct substantial funding to non-governmental organisations, primarily international NGOs. Today, the information of these implementing practices is produced by NGOs themselves that is heavily limited by a strict reporting system and the pressure to produce success. The NGOMA project is very timely as we are at the forefront in describing and analyzing these profound changes in the health development field. The NGOMA project takes note of this timeliness by publishing in leading social science and public health journals in order to engage both the social sciences as applied to health, and public health research, policy and practice. In addition, the project is committed to knowledge exchange beyond the academic sphere, by providing scientific input at policy-related conferences, panels of donors and nongovernmental organisations and popular press. The last year the NGOMA project has been in the writing and publishing phase. The findings from the project has been published in various international journals and two PhD thesis are close to finalizing. The NGOMA project is working on a book manuscript together with partners at Chancellor College, Malawi: Climbing the aid ladder: local perspectives on development aid in the 20th century. University Alabama press. NGOgraphies series. Edited by David Lewis and Mark Schuller.

This project is relevant to GLOBVAC's objective to provide knowledge seeking to improve MDG 5 on maternal health and health policy research on how to improve the way societies organize themselves in order to achieve health goals. Focusing on Malawi in Southeast Africa, the project will provide knowledge that will enhance understanding of how policy transfers operate across diverse contexts, from local to national and global levels, and what linkages there are between policy implementation and policy-making processes. NGOs have become key actors in the proliferating creation and transfer of maternal health policies. The term 'maternal health' is interpreted differently by different institutions and actors. The current imperative role of NGOs in health is part of the emergence of a new global health landscape containing new power structures and interests in which states play a less dominant role. However, policies often fail to work as intended due to an increasingly remote policy-making process, far removed from the realities and contexts in which they intervene. NGOs are mediators between communities, states and global institutions as they relate to all in their work. This study will therefore investigate the transfer of global maternal health policy approached through the actions of international NGOs. Through a multi-sited ethnographic study, the project contributes to addressing the question of how policies made by global communities of practice work themselves out, and to what effect, in highly variable local settings and contexts. The research will consist of an in-depth case study of an international NGO, a case study of the Presidential Safe Motherhood Initiative in Malawi, and a local-level ethnography of the impact of global-level policy discourse on conceptions of maternal health.