Meda Nicolas, Sombié Issiaka, Seck Ibrahima, Binagwaho Agnès
Sante Publique. 2025;37(1):21-35. doi: 10.3917/spub.251.0021.
Our work has examined the controversial role of NGOs in health development in Africa. NGOs are criticized for perpetuating the power structures of domination inherited from colonialism by appropriating development assistance for health (DAH) resources, thereby replacing national governments on the ground and imposing their own agenda in the provision of health services to populations.
We have utilized two sources of knowledge to address this concern. A review of the literature published after 2014 was used to explain the inappropriate practices of the development aid industry in relation to the health sector in Africa. Next, the authors' experiences in dealing with this situation were drawn on to define a new partnership for global public health that meets Africa's needs.
The strategy of Africa's Global North partners is increasingly to use NGOs as the preferred intermediaries for their support, accusing African countries of being corrupt and incompetent. With the resources they appropriate, the NGOs take the place of national governments on the ground and, in many cases, undermine four key pillars in the development of any health system: governance, financing, human resources, and the provision of services, thereby contributing to the ongoing weakening of healthcare systems in Africa. The accompaniment approach, in which donors transfer DAH resources to governments, who in turn choose the NGOs they wish to work with, would be a more beneficial partnership for Africa. The fight against corruption and the strengthening of Africa's capacity for health action would be technical-assistance priorities in a new partnership grounded in mutual trust.
The decolonization of public health in Africa is underway. Africa offers TFPs and NGOs a new partnership based on trust, in which it decides on the health agenda and the support model that will be most beneficial to it.
我们的工作审视了非政府组织在非洲卫生发展中存在争议的作用。非政府组织因挪用卫生发展援助（DAH）资源来延续殖民主义遗留的统治权力结构而受到批评，从而在当地取代了国家政府，并在向民众提供卫生服务时推行自身议程。
我们利用了两种知识来源来解决这一问题。对2014年之后发表的文献进行综述，以解释发展援助行业在非洲卫生部门方面的不当做法。其次，借鉴作者处理这种情况的经验，来定义一种满足非洲需求的全球公共卫生新伙伴关系。
非洲全球北方伙伴的策略越来越倾向于将非政府组织作为其支持的首选中介，指责非洲国家腐败和无能。非政府组织凭借挪用的资源在当地取代了国家政府，而且在许多情况下，破坏了任何卫生系统发展中的四个关键支柱：治理、融资、人力资源和服务提供，从而导致非洲医疗体系持续弱化。伴随式方法，即捐助者将DAH资源转移给政府，政府再选择与之合作的非政府组织，对非洲来说将是一种更有益的伙伴关系。在基于相互信任的新伙伴关系中，反腐败斗争和加强非洲的卫生行动能力将是技术援助的重点。
非洲公共卫生的非殖民化正在进行。非洲为传统基金会和非政府组织提供了一种基于信任的新伙伴关系，在这种关系中，非洲决定对其最有益的卫生议程和支持模式。
