public health

2. Dr. Nabeela Basha
Seminar - 10
ALLPPT.com _ Free PowerPoint Templates, Diagrams and Charts

3. • Introduction
• History of NGO
• Types of NGOs
• Characteristics of NGOs
• Role of NGOs in Health
• Strengths & Weaknesses of NGOs
• NGOs in India
• NGOs & Health Insurance schemes in India
• NGOs & Primary Health Care
• NGOs & Global Health

4. • Few leadings NGOs – Nationally and Internationally
• Dental Volunteering & NGO
• Conclusion
• References
• Previous year questions

5. INTRODUCTION

6. Definition
NGO (Non Governmental Organization) is defined by
World Bank as ‘Private organizations that pursue activities to
relieve suffering, promote the interests of the poor, protect
the environment, provide basic social services or undertake
community development.

7. History of NGOs in India:
 NGOs have a long history in India. In the past, people in
this country have been found to have provided help to others
in trouble.
 Since centuries there exists the tradition of voluntary
service to the needy and helpless in the country. In the
beginning, these services were rendered by people motivated
by their religious feelings.

8.  Floods, fires, earthquakes, epidemic outbreaks and other
kinds of calamities were the occasions which motivated people
to voluntarily help those who were trapped in disastrous
situations.
 It is around the late 18th and early 19th century that
associations and organizations were being formed to render
such activities in a more organized and permanent profile.

9.  During 18th century: emergence of self help
• Friend-in-Need Society (1858)
• Prathana Samaj (1864)
• Satya Shodhan Samaj(1873)
• Arya Samaj (1875)
• The National Council for Women in India (1875)
 In 1916 : Mahatma Gandhi’s focus on Swadeshi movement,
Voluntary action. He reinvigorated civil society in India by
stressing that political freedom must be accompanied by
social responsibility.

10.  A significant growth of NGOs started after India achieved
independence.
 Democracy was established and people had started
understanding the meaning of freedom of speech, the charm
of equality and the value of humanity and brotherhood
 Also, on the other hand, the government started planning for
development and in this effort, launched among other things,
the schemes of Community Development Programme and
later on the Green Revolution.

11.  1965–1966: International NGOs entered India in significant
numbers
 1980: NGOs began to be formally recognized as developme
nt partners of the state

12. Types of NGOs:
Types of
NGO
Service Empowering
Charitable Participatory

13. Characteristics of NGOs:
 NGOs have following characteristics:
1. Engaging in suffering relief activities
2. Promoting interest of the poor
3. Protecting the environment
4. Providing basic social services
5. Advocating community development

14.  Areas (spheres) of NGOs activity and issues over which
they are created, are included in the International
Classification of Non Profit Organizations (ICNPO).
 This classification distinguishes 12 universal areas of
NGOs activity:
(a) culture and recreation,
(b) Education and research,
(c) health,
(d) social services

15. (e) Environment,
(f) Development and Housing,
(g) Law, Advocacy and Politics,
(h) Philanthropic intermediaries and Voluntarism promotion
(i) International,
(j) Religion,
(k) Business and professional associations and unions
(l) activities other than those mentioned above.

16. NGOs in India:
 31 Lakh NGOs, more than double the number of schools.
 Total no. of schools in the country is around 15 lakhs, as per
data compiled by the Planning Commission of India, 2011.
 250 times the number of government hospitals, one NGO
for 400 people as against one policeman for 709 people.
 In 7 UTs, more than 82000 NGOs are registered.
 UP tops the list with more than 5.48 lakh NGOs followed
by Maharashtra with 5.18 lakh. Kerala comes third with
3.7 lakh followed by West Bengal with 2.34 lakh.

17.  Less than 10% of NGOs have complied with the requirements
of submitting balance sheets & income expenditure
statements with the Registrar of societies.
 Of around 30 lakh NGOs, only 2.9 lakh have submitted
financial statements.
 In Kerala, none of the 3.9 lakh NGOs have filed since the
state law doesn’t mandate it.
Source: http://www.indianexpress.com/aug2015

18.  The Society For Participatory Research In Asia (PRIA)
survey 2015 reveals that
 26.5% of NGOs are engaged in religious activities.
 21.3% work in the area of community and/or social service.
 About one in five NGOs works in education.
 7.9% are active in the fields of sports and culture.
 6.6% work in the health sector.

19. Strengths:
 Great variety of programs to meet many needs.
 Potentially very flexible with fast response times.
 Volunteers & non‐ profit status lower operational costs.
 Staff with high personal commitment to providing help.
 Less tainted by association with government.
 Lower corruption potential.
 Campaigns help educate the public to human needs.

20. Potential critiques:
 Limited accountability and ability to evaluate effectiveness.
 High motivation not necessarily matched by expertise.
 May compete or not coordinate actions with similar NGO
and country programs.
 Programs often narrowly focus on specific diseases or
problems, with limited attention to infrastructure
development.

21. NGOs in Health insurance schemes
in India:
 The quality of health care available to the poor population in
India is unacceptable. Services available through public
health care facilities, which are supposed to be free, are
often charged for.
 Moreover, private health care services available to the
population are of poor quality.
 So many non-profit NGOs operate in India to provide
preventive and curative health care services to the people.

22.  A small number of those NGOs also offer pre-payment
health insurance schemes. Such non-profit community based
insurers may offer the best hope of providing high quality,
affordable and sustainable health care to the poor.
 The need for involving NGOs in health insurance schemes i
n India arises due to the following four factors:

23. 1. In India, private expenditure accounts for roughly two-third
of total health care spending. Studies reveal that only 3 – 4
% of the total health care expenditure and only 9 – 13% of
hospital care expenditure of the Government of India is
incurred on the poor.
2. The quality of health care services available to the people in
India are of poor standards. Services available through
public health care facilities which are supposed to be free
but charged quite often. The private health care services
available to the population are unaffordable.

24. 3. Health insurance coverage in India was very limited
particularly among those who work outside the formal
sector. Most of the insurance schemes were in the form of
social security.
4. Government’s combined expenditures, at the national,
State and municipal levels accounted for only one-fifths of
all health care spending in India. A disproportionate amount
of government spending was on curative services in urban
centers. This allocative inefficiency was unlikely to be corre
cted.

25.  As per estimates, NGOs provide health care to 5 per cent of
the Indian population.
 Many researchers have documented innovative and
prepayment insurance schemes offered by some NGOs.
 Couple of studies have also looked into the experiences of
prepayment schemes run by NGOs in India. Pre-payment/
insurance schemes were usually contributions made by
individuals and households in advance for need based
services. Only the sick availed these services.

26.  Therefore, in such financing schemes risks were shared
between the healthy and sick. Schemes will provide
different level of coverage for community and hospital care,
varying from partial coverage to total coverage.
 Several of these NGOs run dispensaries, clinics and
hospitals which indicated that there is a lot of scope to
encourage and expand the role of NGOs in provision of
curative health care.

27.  The government promotes NGOs in health sector for two
main reasons:
(i) to train its functionaries and
(ii) to implement its programme in health care delivery.
• The Child In Need Institute (CINI), Kolkata; and SEWA are
good examples of such cooperation.

28. Role of NGOs in Primary health care:
 At all stages in the development of primary health care
programs, NGOs can be effective.
 NGOs can assist national policy formation in the areas of
health care and integrated human development. They can
present health care needs based on their contacts with
communities.
 NGOs can contribute to primary health care in many ways
through program implementation. They can:

29. a) Provide assistance to develop and/or strengthen local NGO
capabilities and activities with particular attention to local
community development groups; At all stages in the developme
nt of primary health care programs, NGOs can be effective.
b) Develop innovative programs placing primary health care i
n the context of comprehensive human development;
c) Conduct reviews and assessment of existing health and
development programs and assist communities in the exercise
of their own roles.

30. d) Ensure that the existing programs and new initiatives
promote full participation by individuals and communities in
the planning, implementation, and control of these programs;
e) Expand their training efforts to respond to the needs of
primary health care programs. e.g., training of health workers,
supervisors, administrators, planners, etc;
f) Extend their efforts to develop locally sustainable and
appropriate health technologies and use of resources, with
particular attention to energy, water, agriculture, sanitation, and
medical care;

31. g) Recognize the essential role of women in health promotion
and in the full range of community development concerns;
h) Further extend their capacity to work with poor,
disadvantaged, and remote populations, enabling them to break
the cycle of deprivation and in this way contribute to the search
for greater social justice.

32. NGOs and Global Health:
 Global health is essential for development.
 A major issue is the inequitable distribution of research
efforts and funds directed towards populations suffering the
world's greatest health problems.
 This imbalance is fostering major attempts at redirecting
research to the health problems of low and middle income
countries.

33.  Many U.S. based international non-governmental
organizations (NGOs) are actively engaged in international
health projects.
 The relief agency CARE, for example, participates in a
joint CARE-CDC Health Initiative (CCHI), which makes
best use of CDC's technical and scientific expertise and
CARE's on-the-ground capabilities to address critical
health issues in countries around the world.

34.  The eradication of Guinea worm and the prevention of
river blindness throughout the world top the Atlanta-based
Carter Center's list of global health concerns.
 Through The Carter Center's efforts, community-based
intervention programs primarily in Africa have greatly
reduced the burden of these diseases among some of the
world's poorest people.

35. NGOs and Global Health Research:
 NGOs are contributing at all stages of the research cycle,
fostering the relevance and effectiveness of the research,
priority setting, and knowledge translation to action.
 NGOs often play a critical role in interpreting the evidence
and translating its relevance for local communities.
 Assessing and evaluating opportunities for advocacy and act
ion occur as NGOs work with communities on these issues.

36.  Medecins sans Frontieres (MSF) was the first NGO to
both provide emergency medical assistance and publicly
bear witness to the plight of the populations they served.
 MSF is at the forefront of emergency health care as well as
care for populations suffering from endemic diseases and
neglect.
 MSF has undertaken an initiative on drugs for neglected
infectious disease which combines advocacy, research and
capacity development, and networking.
 In contrast with private sector research, it is need-driven
rather than profit-driven.

37. Examples of some NGO based research…
 World Vision (Canada) is active in research in Senegal fund
ed by CIDA – objective is to reduce micronutrient
malnutrition among women & children, to reduce illness
affecting micronutrient status.
 AMREF research study in 1995 in Gambia – compared
efficacy of insecticide – treated & untreated bed nets in
preventing malaria among children living in Gambia.

38.  ADI (Alzheimer’s Disease International), an NGO affiliated
with WHO supported population based study in Kerala to
evaluate a community dementia case finding program in
2002. Aim was to validate a training program where
community health workers (CHWs) were trained to identify
possible cases of dementia.

39. Leading NGOs in India:
1. Help Age India:
This non-governmental organization aims at the helping of age
d individuals who are bedridden and sick. They even won an
award called social welfare award. It also has won about 3
ICAI awards too for the excellence in financial reporting. The
corporate office of this organization is located at Delhi.

40. 2. Smile Foundation:
This organization was started in the year 2002 and it’s been
almost more than a decade it had been very much functional.
The corporate office of this organization is located at Delhi.
This aims at providing better status for child education in India.
They make sure that every kid gets a good education and also
he gets all his opportunities. The whole concept of its that to
abolish the child labor in the country.

41. 3. Goonj Limited:
This organization was started in the year 1999. This NGO was
started by a young journalist named Anish Gupta. This
organization aims at providing clothing for every poor kids
throughout the country. The corporate office of this
organization is located at Delhi. Thus making it a very special
organization and its placed in 3rd position.

42. 4. CRY:
This NGO was started in the year 1979. This NGO strongly
fights for the rights of the children. CRY is the acronym of the
name Child Rights and You. The founder of this organization
is Rippan Kapoor. The solo motive of this organization is to
provide the underprivileged children with better education,
food and health. The headquarters of this organization is
located at Mumbai and it has branches even in the capital city,
Bengaluru, Chennai and Kolkata.

43. 5. Give India:
This organization is founded in the year 1999. This NGO does
an interesting job of collecting financial funds from all over
the world and distribution of that raised fund for those NGOs
which work inside the India. This is a very efficient NGO.

44. 6. Lepra Society:
Lepra society or Andhra Lepra society was founded on 22nd
February 1989. The main motto of the Lepra society is to fight
against poverty, to provide better health and also
indiscrimination. They mainly target disease such as Leprosy,
malaria, lymphatic filariasis, tuberculosis, HIV AID and
blindness and other diseases. The central office is at
Secunderabad at Andhra Pradesh. The society even works in
other states like Bihar, Madhya Pradesh and also Jharkhand.

45. 7. Nanhi Kali:
This organization was started in the year of 1996. The main
motto of this organization is to encourage girl education. This
organization was founded by Anand Mahindra. Their corporate
office is seen in Mumbai. They are supported by KC Mahindra
trust and also by Nandi foundation. They have now reached
a point where they are successfully educating more than 5000
0 girls in the country.

46. Leading NGOs Internationally:
1. Wikimedia:
It was in the year 2003, Jimmy Wales, an internet entrepreneur
established this charitable organization. It is headquartered at
San Francisco. It owns the internet domains and hosts sites
such as Wikipedia. It goals at maintaining open source content,
wiki based projects and provide full sight of those projects to
the public that too free of charge.

47. 2. Heifer international. :
This non-profit organization based at Little Rock, Arkansas
was established in the year 1944 by Dan West. It carries a
motto of “Ending Hunger, Caring for the Earth”. Its works are
mainly focused on sustainable development, agro ecology and
bringing self-sufficiency. The organization distributes animals
along with agricultural training to provide self-sufficiency to
the families in need around the world. It has reached over 105
million people across the globe.

48. 3. Clinton Health Access Initiative:
• Former President of USA, Bill Clinton founded this
humanitarian organization in New York City, USA.
• It employs over thousands of people around the globe and is
missioned at bringing people together to take challenges.
• The organization launches several health improvement
programmes, immunization programmes and supply of
second line drugs at cheaper rates.

49. 4. Mercy Corps:
Ellsworth Culver gave a start to this venture in the year 1979.
It happened at a place known as Portland, Oregon. No it has
grown to a huge global organization. It is a global
humanitarian aid agency engaged in transitional environment
that have experienced some sort of shocks: natural disaster,
conflicts etc.

50. 5. Ashoka:
The organization was named after Emperor Ashoka, the ruler
of the Maurya Empire during the 3rd century BC. Emperor
Ashoka recognized the suffering that he had caused by
unifying his empire, and he promoted religious and
philosophical tolerance and the paramount importance of
morality when working for the public

51. • In 1990 Bill Drayton established this organization. It has its
headquarters in Roslyn, Virginia, USA. It has its motto
‘everyone are change makers’. As inspired by Mahatma
Gandhi, it is working on shaping a global entrepreneurial
and competitive citizen sector.

52. 6. Oxfam International:
• It is an international confederation of eleven autonomous
NGOs committed to working together to fight poverty and
injustice around the world. Each shares the commitment to
end waste and the injustice of poverty, in long-term develop
ment work and during times of urgent humanitarian need.

53. 7. CARE (Cooperative for Assistance and Relief
Everywhere)
• It was founded in North and is one of the world’s largest
independent, non-profit, international relief and development
organization.
• Originally organized in the United States in 1945 to help war
-ravaged Europe, CARE soon expanded its program to
include developing nations in Asia, Africa, and Latin
America.
•

54. • Famous for its "CARE packages" of food and other
necessities, CARE in now also involved in population,
health care, land management, and small economic activity.
• CARE's goal is to build self-sufficiency by helping families
meet three basic needs: income, education, and health and
population services. Its work in education includes
promoting literacy, numeracy, and school attendance,
particularly among girls who are often denied schooling.

55. Non governmental Foundations:
• Foundations are institutions through which private wealth is
contributed and distributed for public purposes. They are
institutions financed by charitable contributions or
endowments and can either be for-profit or nonprofit
entities depending on the manner in which their money is
invested and managed.

56. The Ford Foundation
• Established in 1936 by Henry Ford, the founder of Ford
Motor Company, and his son Edsel, the Ford Foundation is
one of the most important and prominent foundations in the
field of education.
• It is a private philanthropic institution, which seeks to
improve the well-being of people around the world by
funding "experimental, demonstration, and developmental
efforts that give promise of producing significant advances
in various fields."

57. • The Ford Foundation has sixteen offices overseas.
• Programs include agricultural development in Latin Americ
a, Africa, and Asia; a training program for judges in China; i
nternational studies in Chile; and philanthropy in Egypt.

58. Rockefeller Foundation
• Based in New York City, the Rockefeller Foundation is a
knowledge-based, global foundation with a commitment to
enrich and sustain the lives and livelihoods of poor and
excluded people throughout the world.
• The foundation's approach to current global challenges
focuses on poor people's daily existence, and how the
process of globalization can be turned to their advantage.

59. The Rockefeller Foundation's central goal is to "give full
expression to the creative impulses of individuals and
communities in order to enhance the well-being of societies
and better equip them to interact in a globalized world."

60. Dental Volunteering & NGO:
 In dental sector, the traditional model of volunteering
focusing on short term clinical treatment provision has little
or no long term benefit to host population.
 Based on this, it is suggested repeatedly that there is a need
to re-orient dental volunteers & their NGOs to make the
outcomes of their actions more effective while minimizing
any potential dangers to the local infrastructure.

61. Weaknesses of traditional approach to dental volunteering/NGO:
1. Lack of coverage and sustainability
• For the most part dental volunteers will visit a host community
for a matter of a few weeks and deliver care. While such
action addresses the immediate individual oral health problems
for those who receive care, the continuity of care once the
volunteers have returned home is usually a major problem.
Since the period spent by the volunteers in the host community
is limited, the number of people who receive care is relatively
low.

62. 2. Inappropriateness of volunteer actions
• The first-time volunteer usually has either very limited or no
experience of working outside the confines of a fully equipped
modern dental clinic. But working with NGOs, the volunteer
is confronted with many new challenges including difference
s in climate, societal structure, language, people’s expectations
and the healthcare system itself.
• And volunteers predominantly focus on clinical care rather
than on prevention.

63. • Moreover, there is little or no knowledge about alternative
methods of sterilization that can be used when an autoclave is
not available, on how to extract teeth with a limited number
of instruments, dispose of medical waste in the field, or how
to restore teeth using only hand instruments.

64. 3. Evidence-based volunteer actions
• In low-income countries like India, where limited resources
are available any intervention to improve oral health must
have a maximal effect. Its not affordable to
distribute toothbrushes and toothpastes to communities,
scaling and polishing, etc. Evidence based interventions are
built on research conducted in high income countries under
highly controlled conditions and these are not applicable to
other resource poor environments.

65. 4. Lack of accountability of volunteer and NGO actions
• Accountability within dental volunteer organizations is
evidenced by the lack of quality assurance and performance
control. Goal setting and the monitoring and evaluation of the
outcomes of interventions are only applied few organizations
and that is also seen only in developed countries.

66. 5. Lack of integration and devaluation of the existing local
healthcare system and its workers
• In many developing countries the healthcare system is often
weak, particularly so in rural areas.
• Instead of working to strengthen the local healthcare system,
dental NGOs are often disconnected from it with little attempt
at integration.

67. • The services offered by volunteers may be perceived as
superior to those provided by the local healthcare system and
may be cheaper or even provided for free. This may lead, at
best, to a devaluation of the status of the local health worker
and system.

68. 6. Creating a dependence on volunteers and their NGOs
The work within countries by NGOs and the provision of care
by volunteers has the potential for communities and countries
to rely on outside assistance rather than developing their own
effective care systems.

69. Conclusion….
 The work done by NGOs goes a long way in nation building.
 The importance of good governance and leadership of NGOs
cannot be overemphasized. NGOs must strive to collaborate
with relevant departments of government by playing roles
both complementary and supplementary.
 In countries where the NGO/government collaboration is
strong, the impact of the activities is greater and more
sustainable.
 NGOs need to be transparent in their work and ensure that the
funds raised, benefit those for whom they are intended.

70.  Regardless of all the problems and limitations, the activity of
NGOs in the contemporary world is essential.
 NGOs are already proving to be agents of change. In times
to come, they will continue to play a significant role in
helping large sections of the Indian society come out from
the quag of poverty and distress.

71. References:
 K. Park. Park’s Textbook of Preventive and Social medicine.
23th ed. Jabalpur: M/s Banarsidas bhanot; 2015.
 Hiremath SS. Textbook of Preventive and Community
Dentistry. 3rd edition. Elsevier Publishers, New Delhi; 2016.
 CM Marya. A Textbook of Public Health Dentistry. 1st
Edition 2011. Jaypee Brothers Medical Publishers, New
Delhi.

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74. Previous year questions:
 Role of NGOs in oral health care in India. (SDM mock-10
marks, RGUHS MDS Examination- Oct 2010 – 10marks)
 Non governmental agencies dealing with global health.
(RGUHS MDS Examination- Nov 2013 – 7marks)