Dancing with the state: the role of NGOs in health care and health policy

This paper evaluates the possible relationships between Northern NGOs and Southern governments in light of the growing involvement of NGOs in social services in Africa. It draws on the specific case of Oxfam-UK's support to health care in Uganda, Malawi and Zambia. I propose a model for understanding NGO policy concerning the NGO–state relationship. I emphasize the importance of context in shaping NGO policy and the influence of other actors, particularly donors and Southern NGOs, on the Northern NGO–Southern government interface. In particular, the paper examines the possible consequences of NGO programming that is considered to be ‘gap-filling’, for the actual services provided, for the NGO, and for the host government. I will consider the strategic choices available as an NGO attempts to address these consequences.