Integrating health services: the experience of NGOs in Ethiopia.
Many non-governmental organizations (NGO) remained in the Wollo region of Ethiopia following famine relief and emergency medical service efforts of 1984-85. Since then, these organizations have helped identify strategies and processes needed to implement Ministry of Health (MOH) policies, especially in the area of integrated maternal-child/curative health services. This paper discusses the strengths and weaknesses of 4 broad approaches to health development adopted by the NGOs over the post-famine relief period of 1986-88, and considers further strategic adaptation in later years. Under the themes of direct management, clinic adoption, impact area, and air-drop resources, earlier NGO approaches largely suffered poor sustainability, non-replicability, and inefficient use of resources. Moreover, these approaches distracted the MOH from pursuing its own viable approaches, effectively stymieing the development of district and regional health systems. Later NGO approaches support improvements in the MOH's priority health programs through the provision of technical and material assistance for analyzing, developing, and implementing improved systems of district health management and care. NGOs wishing to adapt their existing programs into a comparable health systems approach should build upon existing relationships with the MOH in support of district and regional health services, foster skill development among indigenous health personnel, seek avenues to improve efficiency, and promote activity-based training and regional and district health team management.