Reported effects of Nongovernmental Organizations (NGOs) in health and education service provision: The role of NGO–Government relations and other factors

Abstract Motivation Non‐government organizations (NGOs) in low‐ and middle‐income countries (L&MICs) often deliver services that high‐income states might themselves provide, such as education and health care. But such service provision usually requires NGOs to engage with the state. Whether NGO–government relations affect NGO service provision to beneficiaries is not well studied. Purpose We assess how NGO–government relations affect reported outcomes of NGO service provision. We look at evidence from 1980 to 2014, a time when NGOs grew in number and activity. We consider five types of relatively constructive relations between NGOs and states, along a spectrum from high to low engagement: collaboration, contracting, consultation, advocacy, and substitution. Methods and approach We review 109 articles from academic journals about NGOs working in education and health in LMICs published between 1980 and 2014. These articles describe the activities of both international and domestic NGOs working at both national and subnational levels. We coded articles for content to allow detection of associations. Findings First, authors overwhelmingly report favourable outcomes from NGO service provision, regardless of the nature of the NGO–government relationship. Second, collaborative, advocacy, and substitutive relations are most often associated with favourable outcomes. This is especially so in democratic states. Third, subnational NGO service provision is more frequently associated with favourable outcomes. Fourth, NGO service provision in low‐income and African countries is disproportionately associated with reports of unfavourable or null outcomes. Policy implications Governments and development agencies should prioritize collaboration and engagement at the subnational level, create space for NGO advocacy, and redouble efforts to understand what drives favourable outcomes in low‐income countries.