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Abstract
Non-governmental organisations (NGOs) feature prominently in global health and development discourses. Such discourses often assume that NGOs provide a supplement to, and critical engagement with, struggling government health care systems. In contrast, interviews and ethnography with patients, health care providers, and NGO workers in Kebbi State, Nigeria, suggest a more problematic mode of state/NGO interaction. Focusing on larger NGOs, this research suggests that they are often politically impotent, a product of both a difficult political environment and their own inflexibility. In contrast, medical professionals are pursuing many of the same political goals with considerable success. The benefits and compromises of these contrasting strategies are explored. This article also offers an empirical contribution to debates on working ‘with the grain’ of patrimonial politics as an alternative to the ‘good governance’ agenda.
Acknowledgements
Support for this research was provided by the Economic and Social Research Council. The author would like to thank the anonymous reviewers and the editor as well as Kathy Dodworth, Elizabeth Olson and James Smith who all made valuable comments on drafts of this article.
Notes
1. Nigeria is divided into 36 states, which are in turn sub-divided into Local Government Areas. All three levels of government interact with NGOs and are involved in health care provision, but the intermediate level of state government is of most relevance to this study.
2. For example, ‘NGO hopes to benefit from failure’, Guardian, 17 January 2011, or a recent BBC World Service series (first broadcast 27 December 2011) ‘The Truth About NGOs’.
3. This material was gathered during 16 months of doctoral fieldwork between 2009 and 2011, in three spells. The fieldwork was principally ethnographic – supplemented by informal interviews – in hospitals, NGOs and various government agencies, as well as in the homes and workplaces of HIV positive people.
4. The Hausa phrase ‘mai katan jabu’ (fake workers) was often used. Opinions were split as to whether the revised system was a genuine effort to root out corruption, or merely a ‘changing of the guard’ as new clique took over.
5. Fees paid to officials to award contracts to a particular vendor. The scale of such schemes varies enormously. The former governor of Kebbi state was accused of systematic looting amounting to N10.2 billion (approximately US$68 m, Vanguard, Citation2009), whereas one doctor mentioned a colleague's rumoured scheme to supply hospital consumables, which was worth only a few dollars a month.
6. Interview with Dr Yusuf Sununu, 14 December 2010.
7. As discussed, political disputes in Nigeria can be highly contentious and unpredictable, so the doctors quoted are not identified, with the exception of Dr Sununu, the union representative, who asked to be identified.
8. Interview, 11 January 2011.
9. Again, this decision was made following a process of identifying the organizations most prominent in the lives of the HIV+ people that I researched.
10. The decision to conceal this organization behind a pseudonym is a difficult one, as identifying it would add useful contextual information. However, given that frank private views are reported it is necessary, as with the doctors, to protect research participants from potential political consequences.
11. Interview, 15 February 2011.
12. Interview, 13 February 2011.