Global Health Partnerships: How Local and International Organizations Work Together in the Age of Localization

Mann Global Health
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“Localization” in the global health assistance space has a number of definitions, but most focus on increasing agency for local actors in development efforts and changing attitudes on how to prioritize development assistance. A primary way that donors are operationalizing localization is by adjusting their procurement procedures and directly channeling more money to the people and organizations that are from places that will benefit from their investments. 

Much analysis is focused on the development impact of localization. What is less clear is how traditional partnerships and power dynamics between local and international organizations are affected by localization, especially when international non-governmental organizations (INGOs) and local actors undertake less familiar leadership roles in implementation and business development efforts. Also less examined are the kinds of business development changes that will be required for localization of global health assistance to succeed. This piece explores these topics. 

The data collection for this study involved interviews with staff from 22 INGOs, local NGOs, and donors. The interviews were selected based on connections to the authors and on recommendations from other interviewees. They took place during the summer of 2022 and highlighted challenges and opportunities around how local NGOs and INGOs – as well as their donors – work together now, and how they may need to rethink partnerships and business development to advance localization. Some key findings: 

Local actors say they are frustrated at the progress of localization 

Interviewees were broadly critical of the years of inattention and underinvestment by donors, which has created a system where many local NGOs are not yet ready to lead major donor programs and can rarely compete with INGOs in business development. Multiple local NGOs said they have been starved of overhead rates that would fund capacity growth (vs. 60 years of ample donor overhead support to INGOs), and are now woefully understaffed in business development and other core functions that would make them competitive. They also said that most of the current donor processes for competing awards are structured in ways that continue to favor INGOs, and still effectively block local NGOs from taking leadership roles at the proposal stage. In turn, some local NGOs – worried they are not yet ready to win without support – partner with INGOs to create workarounds on locally restricted procurements that can maintain INGO dominance and decision-making in partnerships, and reinforce inequities. 

INGOs say they want localization to work, even as they struggle to remain viable, relevant, and funded 

Multiple INGO staff talked about how they believed in the global development goal of “working ourselves out of a job.” They also acknowledged the disconnect and challenges reconciling their philosophical agreement with the tenets of localization, and the financial imperative to remain viable as a business. Multiple 

interviewees spoke about the fact that they are still trying to find the intersection between localization, business development success, and organizational mission and continuity, and that this creates uncertainty about how their roles may change over the long term. Despite this uncertainty, most local NGO, INGO, and donor interviewees said they believe INGOs are still relevant and will remain so, even as their roles continue to evolve. 

Given decades of asymmetrical donor support to INGOs, and the paucity of such support to local NGOs, there remains a sizable difference in certain capacities between the two groups – not just in business development, but also in finance and administration, compliance, risk mitigation, and monitoring and evaluation (M&E), among other areas. Acknowledging this capacity gap, donors, INGOs, and local NGOs agree on a need for INGOs to support local partners in improving their capacities. Multiple interviewees noted the importance of INGO contributions in the promotion of learning across countries and regions, and in taking on mission-driven work that can be politically or legally challenging in some countries (e.g., working with LGBTQ+ youth or intravenous drug users). 

For now, INGOs still receive the majority of donor funding and lead most of the largest donor-funded projects. During what is likely to be a period of transition, both INGOs and local organizations acknowledge potential growing pains as they partner to reach public health outcomes. Bilateral governments are also still the largest donors within global health, though that gap is closing with large foundations and the private sector increasing their share of development assistance. As such, while we acknowledge the ever-increasing importance of private sector and foundation funding to the broader story of localization, we focused this examination on partnerships between INGOs and local organizations within the government donor space. What follows are additional details on these findings, as well as recommendations to bilateral donors, INGOs, and local NGOs on how to take actions that will drive the goals of localization. Quotes from interviewees are included in each section. Additional quotes from interviewees that shed further light and nuance on these topics can be found in the Annex. 

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