A call for mandatory aid project registration: Who’s doing what and where?

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Vol 53: noVember • noVembre 2007 Canadian Family Physician•Le Médecin de famille canadien

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Editorial

A call for mandatory aid project registration

Who’s doing what and where?

Diane Kelsall

MD MEd CCFP FCFP

Carsten Hennings

MSc MBA MDiv But when thou doest alms, let not thy left hand know what thy right hand doeth.

Matthew 6:3 (KJV)

I

n 1839, the Anti-Slavery Society became the first registered international non-governmental organization (NGO). By 1914, there were 1083 registered NGOs. The United Nations Development Program estimated in 2002 that there were more than 37 000 NGOs working inter- nationally. Almost one-fifth were formed in the 1990s, with a 50% increase in international NGOs working in the health sector from 1990 to 2000.¹

Non-governmental organizations play a critical role in international aid and development. At the Earth Summit in Rio de Janeiro, the United Nations confirmed that NGOs “possess well-established

and diverse experience, exper- tise and capacity in fields which will be of particular importance to the implementation and review of environmentally sound and socially responsible sustain- able development.”² The United Nations Development Program estimates that 250 million people in developing countries around

the world are helped in some way by the work of NGOs.³ The amount of money flowing through NGOs (both national and international) is staggering. The Comparative Nonprofit Sector Project at Johns Hopkins University found that the total operating expenditures for NGOs exceeded

$1.6 trillion (US) in 2002. If NGOs were a country, they would have the fifth largest economy in the world.⁴ International aid has been on the rise since the 1940s. In 2004, donations for international aid hit $78.6 billion (US).⁵

The problem

The number of NGOs working in individual countries can be very high. In 2000, a World Health Organization report estimated that the total number of NGOs working in the health sector in Africa was between 200 and 300 for a country of average size. Between 25% and 50% of these were international NGOs (the others being national NGOs). In countries in emergency situations, the number of international NGOs rises dramatically because of the influx of organizations providing emergency relief.⁶

Registration requirements for NGOs differ by country.

Some countries have extensive registration requirements,

while others have none. In those countries with registration requirements, the information acquired is not nec- essarily public. Even if NGOs are registered, individual projects might not be.

Given the large number of NGOs and the differing registration requirements, it can be difficult to know who is working where and what they are doing. In our experience, NGOs can be unaware of similar projects and even duplications of programs within a relatively small geographic region. As a consequence, opportu- nities for collaboration and synergy are lost.

It has become increasingly clear that the Millennium Development Goals⁷ will be difficult to achieve without stronger integration of the various development efforts being carried out by the diverse array of national, international, and non-governmental organizations. In this light, there is substantial work being done on harmonizing aid in order to promote efficient, effective, and sustain- able development work within developing countries. The Paris Declaration on Aid Effectiveness emphasizes that donors need to “[w]ork together to reduce the number of separate, duplicative, missions to the field and diagnostic reviews; and promote joint train- ing to share lessons learnt and build a community of practice.”⁸

One key aspect of this drive for aid effectiveness is the need to get a clear picture of development projects currently under way and planned for the future. Such a picture would allow for more efficient allocation of scarce resources and would substantially strengthen the overall development planning process by national and local governments.

A possible solution

In 2004, the International Committee of Medical Journal Editors published an editorial calling for clinical trial registration in order to address concerns

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If NGOs were a country, they would have the fifth largest economy

in the world

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that the results of clinical trials might be selectively reported.⁹ They called for trials to be enrolled in a registry that was accessible to the public at no charge;

open to all prospective registrants; managed by a not- for-profit organization; able to ensure validity of the research data; and electronically searchable. Since then, many journals, such as Canadian Family Physician, require clinical trial registration before publication,¹⁰ and some funding agencies insist on registration as a condition of funding.¹¹ Some ethics review boards also require clinical trial registration before granting ethics approval; ethics approval is necessary for publication in most journals.

Currently, databases of official development aid are maintained both by national and international donor organizations. For example, both the Canadian International Development Agency and the World Bank maintain databases, which can be viewed by the public, of projects they fund (www.acdi-cida.gc.ca; www.

worldbank.org). Most of these databases provide information on development projects’ timing, funding, and sectoral activity. Some databases also include information on implementing agencies and abstracts of projects’ scope and objectives. Efforts have begun to gather this information into consolidated international repositories (eg, Accessible Information on Development Activities at http://aida.developmentgateway.org/).

While these databases taken together form the basis of a reasonably complete picture of official development aid funding by the participating major donors, they fail to capture the large amount of NGO activity not funded through these mechanisms. A registry of NGO activities complementing or integrated into the consolidated repositories currently being built would substantially aid the process of development harmonization. Such a registry would need to have similar qualities to those described by the International Committee of Medical Journal Editors for clinical trial registries. The content of the registry should be determined by stakeholders.

Most important, however, registration of aid projects by NGOs should be mandatory.

Mandatory registration

There are several ways to ensure that registration of aid projects is mandatory, as one method will not cover all NGOs. These include the following:

• Funding bodies, small and large, governmental and non-governmental, should require registration as a condition of funding for aid projects. Some organizations, however, rely on individual donors and would not be affected by this requirement.

• Non-governmental organizations wishing to work in partnership with organizations already registered should be required to join the registry.

• Most comprehensively, countries could require registration of aid projects from any NGO seeking official status (for tax purposes, for example) for work in a developing country.

Care will have to be taken to ensure that registration requirements do not overburden smaller NGOs.

The Paris Declaration on Aid Effectiveness warns that excessive fragmentation of aid at the global, country, or sector level impairs the effectiveness of aid provided.⁸ The proposed database of aid projects—with mandatory registration—has the potential to improve the quality and broaden the scope of aid provided to those in need.

When it comes to international aid, the left hand has to know what the right hand is doing.

Dr Kelsall is Editor of Canadian Family Physician, Mr Hennings is an Assistant Professor of Business

Administration at Tyndale University College in Toronto, Ont.

Competing interests

Dr Kelsall has consulted for Health Partners International of Canada and International Health Partners (UK). Mr Hennings has been an employee of and consulted for Health Partners International of Canada and International Health Partners (UK).

references

1. United Nations Development Program. Human development report 2002. New York, NY: Oxford University Press; 2002.

2. United Nations. Agenda 21: Earth Summit—The United Nations programme of action from Rio. New York, NY: United Nations Publications; 1993. Available from: www.un.org/esa/sustdev/documents/agenda21/english/

agenda21chapter27.htm. Accessed 2007 October 3.

3. Enayet Kabir AKM. How NGOs serve the disadvantaged: some pertinent questions. Independent (Bangladesh) 2000 April 2. Available from:

www.globalpolicy.org/ngos/disadv.htm. Accessed 2007 October 3.

4. Salamon LM, Sokolowski SW, List R. Global civil society: an overview.

Baltimore, MD: The Johns Hopkins University (Centre for Civil Society Studies;

Institute for Policy Studies); 2003.

5. Faroohar R. Where the money is? Newsweek 2005 September 5.

6. World Health Organization Regional Office for Africa. Tripartite Collaboration:

an analysis of NGO country studies in the African region. Harare, Zimbabwe:

World Health Organization Regional Office for Africa; 2000.

7. World Health Organization. Millennium Development Goals. Geneva, Switz:

World Health Organization; 2000. Available from: www.who.int/mdg/goals/

en/index.html. Accessed 2007 October 3.

8. Paris declaration on aid effectiveness. Paris, Fr: Organisation for Economic Co-operation and Development; 2005. Available from: www.oecd.org/

dataoecd/11/41/34428351.pdf. Accessed 2007 October 8.

9. De Angelis D, Drazen JM, Frizelle FA, Haug C, Hoey J, Horton R, et al. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. Ann Intern Med 2004;141:477-8.

10. Kelsall D. Stand and declare. Opportunity and challenge of clinical trial registration. Can Fam Physician 2006:52:1189-90 (Eng), 1194-6 (Fr).

11. Godlee F. An international standard for disclosure of clinical trial information. BMJ 2006;332:1107-8.

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