Partnering with governments: a key to success at scale

Next year, Bangladesh-based BRAC, the largest NGO in the world, will celebrate a remarkable anniversary – 50 years since it was established and 50 years since it began what is likely the longest and deepest NGO-government collaboration in global health history.

The partnership, which spans many initiatives, has transformed health outcomes across Bangladesh, demonstrating the value of government-civil society collaboration.

We spoke with BRAC and other leading NGOs about how to effectively partner with government to magnify impact.

BRAC’s journey towards impact at scale illustrates the benefits of working with governments, and offers instructive guidance on how to establish and maintain effective partnerships. Its alliance on community health worker (CHW) programs, in particular, is illustrative of this strategy and approach.

To support the government’s goal of delivering primary health care in rural settings, the organization worked in three ways. First, BRAC provided the government of Bangladesh with technical support, including helping expand and strengthen the government’s own CHW programs by testing new approaches and helping the government understand delivery gaps and challenges. Second, BRAC supplemented the government’s CHW services by developing its own parallel CHW programming to complement government services. And third, BRAC CHWs regularly served as government contractors, addressing geographic and programmatic gaps in the government’s program.

Today, the government and BRAC's CHW programs are so intertwined that it's impossible to tease out the impact of the government’s program alone without considering the impact, at every step of the process, of partners like BRAC.

Their partnership has produced and maintained a robust and effective government CHW program that has expanded over more than 40 years and helped the country achieve among the longest life expectancies, lowest total fertility rates, and lowest under-five mortality rates in South Asia, despite spending less on health care per capita and experiencing more severe human resource shortages than neighboring countries. These improvements have been achieved amid persistent poverty, periodic political turmoil, and frequent natural disasters, all which have severely affected Bangladesh’s ability to respond to the needs of its people.

"Without a doubt, BRAC’s relationship with the government of Bangladesh is unique," said Dr. Mushtaque Chowdhury, former vice chair of BRAC. "After all, the NGO’s leadership came out of the same independence movement that gave birth to the country of Bangladesh. That shared history is nearly impossible to replicate."

Still, there are useful lessons and guiding principles in BRAC’s approach that can help NGOs establish rich and productive relationships with governments. And the benefits are hard to overstate. Because "the government has greater reach than any NGO,” Dr. Chowdhury added, “there are real benefits to working with them and through them.”

He provided five recommendations for NGOs looking to establish fruitful partnerships with governments:

1. If the government isn’t delivering on its responsibilities, don’t just criticize. Instead, help the government reach its goals.
2. Crises are opportunities. Step in to help the government when it needs it most.
3. Collect good evidence. This will establish you as a resource and help the government better understand the nature of the problem to be addressed. Partnerships need harmonized interests and a common understanding of the problem and solution.
4. Always remember that the government is in charge.
5. Advocacy is an art. The same data can make the government into a hero or a villain depending on the tone and framing. If you want to get things done, be positive, show improvement, a commitment to improvement, or the potential for improvement.

Of course, a shared heritage and background also helps, said Dr. Chowdhury. For example, BRAC has expanded to a dozen other countries but not achieved quite the same success. “Frankly, we haven’t been as successful and as integrated with the other governments as we are in Bangladesh. Even though we are already the largest NGO in some of these countries. But we haven’t been able to translate that into scaled impact – yet.”

This may point to another key take away, according to NGOs: invest in local staff who can help provide your organization with both local insight and credibility.

One mistake organizations seeking to partner with governments too often make, said Dr. Djoumé Diakité, Mali Country Director for Muso, is that they often wrongly believe they're starting from scratch. “You are always building on something. And you insult the government and local people if you think you are building from the ground up,” he said. “The owner of the system is the government. It will always be the government. And you must see yourself as helping the government strengthen their system.”

Another common mistake, said Dr. Diakité, is trying to impose your vision on the government. “Some organizations want to replicate something that has worked elsewhere, without doing the local research, and without partnership or conversations,” said Dr. Diakité. “Financial resources can often attract interest and attention in the short term. But that approach is not sustainable.”

Muso’s partnership with the government of Mali, aimed at strengthening access to primary care throughout the country, has survived two coups and an ongoing insurgency in the north of the country over the past 15 years. A key to the resiliency of the partnership, said Dr. Diakité, is not seeing the government as a monolith. While there may be changes at the top, committed and eager partners often remain throughout other levels of government.

Partners in Health (PIH), meanwhile, has highlighted the benefits of collaborating with ministries beyond the Ministry of Health in their primer on partnerships. For example, PIH has collaborated with the Ministry of Justice in Russia to treat Tuberculosis in prison and with the Ministries of Education in Rwanda and Malawi.

The promise of impact at scale has attracted many NGOs to seek partnerships with governments. Tellingly, Exemplars in Global Health research is rich with examples of productive partnerships that have produced transformative results, from CARE’s leadership in Peru helping to jump start the government’s campaign against stunting, to NGO partnerships in Bangladesh that reduced under-five mortality, and Last Mile Health’s partnership supporting the launch of Liberia’s CHW program.