Do Aid Donors Plant the Grassroots？ Evidence from a Randomized Field Experiment in the US and Uganda

Recent literature dealing with nongovemmental organizations （NGOs） claims that NGOs have little incentive to base their decisions and strategies on local needs and instead are governed largely by their current and prospective donors （McGann ＆ Johnstone, 2006; Prakash ＆ Gugerty, 2010; Bollen et al., 2005）. To test this claim, I have created a quantitative experiment in the US and Uganda in which organizations were randomly assigned to a control group or one of four treatment groups based on the main stakeholders of the NGO market---donors, local government officials, project beneficiaries, and NGO peers. In each group, organizations were invited to take a survey and were told that the results of their survey would be published to one of these four stakeholder groups. Thus, differences in response rates between groups are attributed to differences in the degree of concern that NGOs felt about the opinions of a given stakeholder. I hypothesized that NGOs care more about the opinions of their donors than other stakeholder groups and found support for this hypothesis among NGOs in the US.

International non-governmental organizations’provision of communitybased tuberculosis care for hard-to-reach populations in Myanmar,2013-2014

Background:National tuberculosis(TB)programs increasingly engage with international non-governmental organizations(INGOs),especially to provide TB care in complex settings where community involvement might be required.In Myanmar,however,there is limited data on how such INGO community-based programs are organized and how effective they are.In this study,we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar,and assess their contribution to TB case detection.Methods:We conducted a descriptive study using program data from four INGOs and the National TB Program(NTP)in 2013-2014.For each INGO,we extracted information on its approach and key activities,the number of presumptive TB cases referred and undergoing TB testing,and the number of patients diagnosed with TB and their treatment outcomes.The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.Results:All four INGOs implemented community-based TB care in challenging contexts,targeting migrants,post-conflict areas,the urban poor,and other vulnerable populations.Two recruited community volunteers via existing community health volunteers or health structures,one via existing community leaderships,and one directly involved TB infected/affected individuals.Two INGOs compensated volunteers via performance-based financing,and two provided financial and in-kind initiatives.All relied on NTP laboratories for diagnosis and TB drugs,but provided direct observation treatment support and treatment follow-up.A total of 21995 presumptive TB cases were referred for TB diagnosis,with 7383(34%)new TB cases diagnosed and almost all(98%)successfully treated.The four INGOs contributed to the detection of,on average,36%(7383/20663)of the total new TB cases in their respective townships(range:15-52%).Conclusion:Community-based TB care supported by INGOs successfully achieved TB case detection in hard-toreach and vulnerable populations.This is vital to achieving the World Health Organization End TB Strategy targets.Strategies to ensure sustainability of the programs should be explored,including the need for longer-term commitment of INGOs.