The Feasibility of Government Partnerships with NGOs in the Reproductive Health Field in Mexico

Abstract

In 1995 the Mexican government began to develop policies on establishing collaborative agreements with civil society organisations, and there is currently interest in Mexico in government and NGOs working together. This paper analyses whether the conditions exist in Mexico for successful partnerships between the public sector and NGOs in the reproductive health field. In-depth interviews were carried out with key informants in the public sector at national and state level and the NGO sector in six states in Mexico. Partnerships were found to be an option for the provision of reproductive health services in geographical areas where the population is under-served, and for services the government does not provide. While the contribution of NGOs to the reproductive health field is recognised, at least at federal level, there are still very few public agencies that collaborate with NGOs, and agreements are often limited to short-term financing of projects. The future of NGOs in Mexico will depend largely on their ability to obtain funding from within the country. More effective mechanisms are needed by government to generate resources for health care. Government must recognise the specific contribution of NGOs, including inputs of social capital and creation of community networks, and must share decision-making more equitably with NGO for partnerships to succeed.

Résumé

En 1995, le Gouvernement mexicain a commencé à réguler les accords de collaboration avec les organisations de la société civile, et le Mexique s'intéresse actuellement à la collaboration entre l'É tat et les ONG. Cet article se demande si le pays réunit les conditions pour des partenariats réussis entre le secteur public et les ONG dans le domaine de la santé génésique. Des entretiens ont été menés avec des informateurs clés dans le secteur public au niveau national et des É tats, et dans des ONG de six É tats mexicains. Les partenariats sont une option pour la prestation de services de santé génésique dans des régions où la population est sous-desservie et pour des services que l'É tat n'assure pas. Alors que la contribution des ONG à la santé génésique est reconnue, au moins au niveau fédéral, rares sont encore les organismes publics qui collaborent avec les ONG, et les accords sont souvent limités à un financement de projets à court terme. L'avenir des ONG au Mexique dépendra largement de leur capacité à obtenir un financement auprès de sources nationales. Il faut des mécanismes plus efficaces qui permettront au Gouvernement de créer des ressources pour les soins de santé. Afin que les partenariats ré ussissent, l'É tat doit reconnaı̂tre la contribution des ONG, notamment les apports de capital social et la création de réseaux communautaires, et il doit partager plus équitablement la prise de décisions avec les ONG.

Resumen

En 1995 el gobierno mexicano empezó a formular polı́ticas para colaboració n con las organizaciones de la sociedad civil. Actualmente, existe interés en Mé xico por que el gobierno y las ONG colaboren. En este artı́culo se analiza si existen las circunstancias en Mé xico para establecer alianzas exitosas entre el sector pú blico y las ONG en el campo de la salud reproductiva. Se llevaron a cabo entrevistas a profundidad con informantes clave del sector pú blico a nivel nacional y estatal y en el sector de las ONG en seis estados de Mé xico. Se encontró que las alianzas son una opció n parala prestació n de los servicios de salud reproductiva en las zonas con sectores desatendidos de la població n, y para brindar servicios que no son prestados por el gobierno. A pesar de que se reconocen los aportes de las ONG al campo de la salud reproductiva, por lo menos a nivel federal, aú n existen muy pocas instituciones pú blicas que colaboran con ellas, y los acuerdos con frecuencia se limitan al financiamiento de proyectos de corta duració n. El futuro de las ONG en Mé xico dependerá en gran parte de su capacidad de obtener fondos nacionales. El gobierno necesita mecanismos má s eficaces para generar recursos para la prestació n de servicios de salud. Ademá s, el Estado debe renocer la contribució n de capital social y la creació n de redes comunitarias de las ONG, y debe compartir la toma de decisiones de manera má s equitativa con las ONG a fin de que las alianzas tengan éxito.

Key Words:

• non-governmental organisations
• government–NGO partnerships
• public sector
• reproductive health services
• Mexico

Acknowledgements

Some of the information in this article was presented at the Society for Latin American Studies conference, Manchester, April 2003. That paper will be published with all the presentations of the panel on social policy. This article is taken from my PhD thesis in Public Health which was directed by Dr Mario Bronfman and funded by the Consejo Nacional de Ciencia y Technologia. My thanks to Blanca Rico and Laura Reichenbach for their comments and Laura for help with editing. I am grateful to all key informants interviewed and to Dr Michael Hirsch for this Patient support throughout the research. The research received financial support from the International Programme of Financial and Academic Support for Research from a Gender Perspective in Reproductive Health and Health Services, based at the National Institute of Public Health in Mexico City, financed by the Ford Foundation. Scholarship ID: CISS FF/DBSSC/PSYSR/BECA01/2002. The research was also funded by the Alliance for Health Policy and Systems Research, an initiative of the Global Forum for Health Research in collaboration with the World Health Organization.

Notes

* Non-governmental organisations (NGOs) are civil society organisations that are formally established; are private and independent from government (although they might receive its support or collaboration); are non-profit-making and self-governing (with internal decision-making structures); and have a meaningful voluntary content (income, labour or management).⁷⁸⁹

* FEMAP and CIDHAL were created in the 1970s, CAM in the 1980s, CREO and CIAM in the 1990s, and SHSSR in 2000. Although all of them have activities in reproductive health, some also carry out other activities. FEMAP and CREO work on general development issues; CAM, CIDHAL and CIAM focus on women's issues more broadly; while SHSSR works mostly in provision of reproductive health services. FEMAP is located in the north, CAM, CIAM and CIDHAL in the centre, and CREO and SHSSR in the south. CAM has collaborated with the government at local level and CIAM, CIDHAL, CREO and FEMAP at local and national level; SHSSR has not done so.