The Role of NGOs in the U.S. Global Health Response

Kellie Moss and Jennifer Kates
Published: Jul 21, 2015

Non-governmental organizations (NGOs) are key implementers of U.S. global health programs, yet in the past, little has been known about the scope of their role. To help shed light on this issue, two recent Kaiser Family Foundation reports assessed NGO engagement in U.S. global health efforts, looking first at U.S.-based NGOs¹ and then at those based outside the U.S.² that received U.S. government funding from the U.S. Agency for International Development (USAID) (the largest U.S. global health implementing agency as measured by funding). While these individual analyses provided new windows into the respective roles of NGOs in and outside of the U.S. – showing, for example, that U.S.-based NGOs were headquartered in 25 states and the District of Columbia³ – this data note pulls them together with updated data to paint a more comprehensive picture.⁴ This analysis found that NGOs received a significant share of U.S. government (USG) global health funding disbursed by USAID in FY 2014. While the majority of these NGOs were based outside the U.S., most funding went to those based in the U.S. Specifically, the analysis found that:

Of the more than $6.71 billion disbursed by USAID in FY 2014 for global health activities, 41% ($2.74 billion) was provided to more than 300 NGOs. See Figure 1.

Figure 1: Share of USG Global Health Funding Directed to NGOs, FY 2014

More than half (59%, 179) of these NGOs were based outside the U.S.; the rest (41%, 125) were U.S.-based. On the other hand, most funding went to U.S.-based NGOs, which accounted for almost $9 of every $10 (88%); the remaining 12% went to NGOs based outside the U.S. See Figure 1 and Table 1.
Funding overall was concentrated among a small group of NGOs – 20 NGOs received 80% ($2.2 billion) of funding going to NGOs; of these, 17 were U.S. based. See Table 2.
Most NGOs, however, received much smaller amounts of funding, including 198 NGOs that received $1 million or less.
NGOs carried out U.S. global health activities in all major program areas – HIV; tuberculosis (TB); malaria; family planning and reproductive health (FP/RH); maternal and child health (MCH); nutrition; other public health threats (which includes neglected tropical diseases or NTDs); pandemic influenza and other emerging threats (PIOET); and water supply and sanitation.
Most though (210 NGOs) received funding in just a single program area; less than a third (94) received funding in two or more areas.
HIV had the greatest number of NGOs (164) and accounted for the most funding ($1.65 billion), followed by MCH; see Figure 2.

Figure 2: Number of NGOs and USG Global Health Funding by Program Area, FY 2014

HIV was the only program area with more non-U.S.-based than U.S.-based NGOs, while TB was the only program area that provided more funding to non-U.S.-based than U.S.-based NGOs. See Tables 1 and 3.
Overall, NGO efforts were carried out in close to 80 countries, though most NGOs received funding for activities in a single country.⁵ Both U.S.-based NGOs and those based outside the U.S. were most likely to be working in Africa, where most funding was directed. See Table 1.
In more than a third of the countries reached, 10 or more NGOs received U.S. support.⁶

While this analysis provides new information on the role of NGOs in U.S. global health activities, it also raises several questions and issues for U.S. global health policy, including the following:

Although the U.S. government has signaled its intention to work more directly with in-country partners, strengthen local capacity, and support country ownership, this analysis shows that most U.S. global health funding for NGOs was directed to those based in the U.S.⁷ Will this distribution shift going forward? Does it need to? And what effects might such a shift have on the impact of U.S. global health efforts?
Similarly, while this analysis shows that most NGO recipients were not based in the U.S., it is unclear how many of these NGOs are actually local organizations,⁸ versus international NGOs akin to their U.S.-based counterparts. What is the mix of local and international NGOs among recipients, and will this mix, as well as the respective roles of these NGOs, change in coming years?
In some sense, this analysis captures just the first couple of steps of the U.S. global health funding process – the funding provided by USAID to NGOs. What happens to the funding then? Does the recipient NGO carry out global health efforts directly, or does it contract further with other entities, including other NGOs?
Finally, how has the U.S. leveraged its support for NGOs to strengthen civil society in some countries and to develop technical networks of NGOs working in certain areas of global health or networks of NGOs working in global health more generally?

Table 1: Number of NGOs and USG Global Health Funding, FY 2014⁹
*Region*	*# of NGOs*			*Region*	*Funding (in $ millions)*
*Region*	Overall	U.S.	Foreign	*Region*	Overall	U.S.	Foreign
Total	304	125	179	Total	2,741	2,404	337
By Region				By Region
Africa	200	78	122	Africa	1,519	1,260	259
Asia*	72	35	37	Asia*	301	245	56
Europe & Eurasia	19	16	3	Europe & Eurasia	11	10	<1
Latin America & the Caribbean	35	25	10	Latin America & the Caribbean	67	62	4
Middle East	12	9	3	Middle East	33	32	1
“Worldwide”	78	66	12	“Worldwide”	810	794	16
By Program Area				By Program Area
HIV	164	62	102	HIV	1,646	1,453	193
MCH	92	62	30	MCH	273	256	17
FP/RH	70	42	28	FP/RH	261	219	43
TB	43	24	19	TB	134	64	69
Malaria	37	26	11	Malaria	130	129	2
Nutrition	46	35	11	Nutrition	127	122	5
Other Public Health Threats^	14	14	0	Other Public Health Threats^	89	89	0
Water Supply and Sanitation	76	40	36	Water Supply and Sanitation	72	64	8
PIOET	11	9	2	PIOET	8	8	<1
NOTES: Reflects NGOs that received funding disbursed by USAID for USG global health efforts and funding disbursed by USAID to NGOs for activities in specific regions and “worldwide”, which is a “benefitting location” designated by USAID in the data. Regions align to USAID Bureaus of the same names, reflecting countries addressed by and regional programs overseen by these bureaus (except * indicates includes Afghanistan and Pakistan, which has a separate USAID office). Additional NGOs operating “worldwide” efforts may also operate in specific regions. ^ indicates includes NTDs. # of NGOs by region/program area will not sum to equal overall # of NGOS, as some NGOs work in more than one region/program area. Funding subtotals may not sum to equal overall funding due to rounding.

Table 2: Top 20 NGOs by USG Global Health Funding, FY 2014 (in millions)¹⁰
Partnership for Supply Chain Management ~	523.7	IntraHealth International	56.2
FHI Development 360	346.0	World Vision	51.9
Management Sciences for Health (MSH)	224.9	Save the Children	45.2
Jhpiego	206.8	Right to Care	37.9
Population Services International (PSI)	161.5	PACT	33.3
Research Triangle Institute (RTI International)	102.4	EngenderHealth	31.7
Program for Appropriate Technology in Health (PATH)	72.8	CARE	31.5
JSI Research & Training Institute	67.8	Elizabeth Glaser Pediatric AIDS Foundation	29.9
Pathfinder International	62.2	Marie Stopes International (MSI)	28.7
KNCV Tuberculosis Foundation	59.7	International AIDS Vaccine Initiative (IAVI)	28.3
NOTES: Non-U.S.-based (foreign) NGOs are highlighted in bold. Other NGOs are U.S.-based. ~ indicates NGO is a separate legal entity established by JSI Research & Training Institute and MSH to implement specific work. Reflects NGOs that received funding disbursed by USAID for USG global health efforts.

Table 3: NGOs by Program Area and Type, FY 2014¹¹
HIV
U.S.-Based NGOs		Foreign NGOs
Academy for Educational Development Africare AIDS Vaccine Advocacy Coalition American Council on Education Amref Health Africa in the USA Ananda Marga Universal Relief Team Axios Foundation CARE Caris Foundation International Catholic Relief Services Center for Human Services ChildFund International USA Citizens Network for Foreign Affairs Education Development Center Elizabeth Glaser Pediatric AIDS Foundation EngenderHealth Feed the Children FHI Development 360 FXB USA (Association Francois-Xavier Bagnoud USA) Global AIDS Interfaith Alliance Global Communities Gorongosa Restoration Project (Gregory C. Carr Foundation) Health Through Walls Heartland Alliance for Human Needs & Human Rights HOPE worldwide International AIDS Vaccine Initiative (IAVI) International Partnership for Microbicides International Relief and Development International Youth Foundation Internews Network IntraHealth International James R. Jordan Foundation Jhpiego JSI Research & Training Institute Management Sciences for Health mothers2mothers NetHope Opportunity International PACT Partners In Health Partnership for Supply Chain Management PATH Pathfinder International Plan International USA Population Council Population Services International Project Concern Project HOPE Public Health Institute RTI International Save the Children Search for Common Ground Sesame Workshop South Africa Partners Synergos Institute	TechnoServe Touch Foundation U.S. Pharmacopeial Convention WomanCare Global World Education World Learning World Vision	ADEMAS ADPP Angola Africa Health Placements African Enterprise African Palliative Care Association AgriAIDS SA Agribusiness in Sustainable Natural African Plant AIDS Foundation East-West AIDS Support Organization, The (TASO) Akphivath Neary Khmer Organization All-Ukrainian Network of People Living with HIV/AIDS Anova Health Institute ARCAD-SIDA Associacao Espaco de Prevencao e Atencao Humanizada (EPAH) Associacao Nacional des Enfermeiros de Moçambique (ANEMO) Association of Private Health Facilities in Tanzania Aurum Institute, The Banja La Mtsogolo British Council Caribbean HIV/AIDS Alliance Caritas Rwanda Catholic AIDS Action Center for Community Health Research and Development Centre for Promotion of Quality of Life Centre International de Developpement et de Recherche CHAMP Child Welfare Bloemfontein & Childline Free State Childline Mpumalanga Children in Distress Network Church Alliance for Orphans Dasra Dignitas International Equity Group Foundation Ethiopian Society of Sociologists, Social Workers, and Anthropologists Expanded Church Response Fondazione AVSI Fundacao para o Desenvolvimento da Comunidade Future Families GECHAAN Ghana – West Africa Project to Combat AIDS and STI GHESKIO Centers Health Insurance Fund HIVSA Hope for Children Hospice Africa Uganda Hospice Palliative Care Association of South Africa IKP Knowledge Park Indonesian International Education Foundation International Centre for Reproductive Health International HIV/AIDS Alliance Inter-Religious Council of Uganda Jembi Health Systems	Johns Hopkins Health and Education in South Africa Joint Medical Store KAYEC Trust Kenya Community Development Foundation KHANA Kheth’Impilo AIDS Free Living Khmer’s Women Cooperation for Development KNCV Tuberculosis Foundation Lifeline/Childline Namibia Lifeskills Promoters Lilongwe Medical Relief Fund Trust Luapula Foundation Marie Stopes International Maritime Life Precious Foundation N’weti – Health Communication National Association of Child Care Workers National Council of People Living with HIV and AIDS (NACOPHA) National Network of Positive Women Ethiopians NawaLife Trust – Namibian Centre for Communication Programmes Nepal CRS Company Network on Ethics/Human Rights, Law, HIV/AIDS – Prevention, Support & Care Networking HIV/AIDS Community of South Africa Nyumbani Organization for Public Health Interventions and Development Partners in Hope PASADA PharmAccess Foundation Population and Community Development Association Profamilia Pro-Health International Reencontro Reformed Church of East Africa Regional Centre for Quality of Healthcare Reproductive Health Uganda REPSSI Right to Care Society for Family Health Namibia Society for Family Health Nigeria Society for Family Health Rwanda Solutions for Innovative Policies, Programs, and Technologies Soutoura Association Thembalethu Development Tovwirane HIV/AIDS Organisation Uganda Health Marketing Group University Research South Africa Vodafone Foundation Witkoppen Health and Welfare Centre Women and Law in Southern Africa – Zambia Women in Law and Development in Africa (WILDAF) Zambia Centre for Communication Programmes
Maternal and Child Health (MCH)		Family Planning and Reproductive Health (FP/RH)
U.S.-Based NGOs	Foreign NGOs	U.S.-Based NGOs	Foreign NGOs
ACDI/VOCA American Association for the Advancement of Science Adventist Development and Relief Agency Africa-America Institute Africare Aga Khan Foundation American Council on Education American Refugee Committee Amref Health Africa in the USA CARE Catholic Relief Services Center for Human Services ChildFund International USA Citizens Network for Foreign Affairs Concern Worldwide US Counterpart International Curamericas Global D-REV Elizabeth Glaser Pediatric AIDS Foundation EngenderHealth FHI Development 360 Future Generations Global Environment and Technology Foundation Grameen Foundation USA Health Alliance International Health Partners Health Right International Health Through Walls Helen Keller International International Aid International Relief and Development International Rescue Committee Internews Network IntraHealth International James R. Jordan Foundation Jhpiego JSI Research & Training Institute Management Sciences for Health Medical Care Development Medical Teams International Mercy Corps National Collegiate Inventors and Innovators Alliance New Venture Fund Partners for Development Partnership for Child Health Care Partnership for Supply Chain Management PATH Pathfinder International Plan International USA Population Council Population Reference Bureau Population Services International Public Health Institute RTI International Save the Children Sesame Workshop Touch Foundation U.S. Pharmacopeial Convention World Learning World Relief World Renew World Vision	ADEMAS Ariel Glaser Pediatric AIDS Healthcare Initiative Asociacion Benefica PRISMA Asociacion Los Andes Cajamarca (ALAC) Association de Soutien au Developpement des Activites de Population Caritas Rwanda Christian Health Association of Malawi CPTAFE Dasra Federacion Red Nicasalud Federation of Indian Chambers of Commerce and Industry Health Insurance Fund Indonesian International Education Foundation Institut Pasteur Integrated Midwives’ Association of the Philippines International Union Against Tuberculosis and Lung Disease Joint Medical Store KHANA KNCV Tuberculosis Foundation Lifeline Nepal Marie Stopes International Nepal CRS Company Population Foundation of India Regional Centre for Quality of Health Care Reproductive Health Association of Cambodia Social Marketing Company Society for Family Health Nigeria Society for Family Health Rwanda Women’s League of Creative Initiative Zuellig Family Foundation	American Association for the Advancement of Science American Council on Education Amref Health Africa in the USA Aspen Institute, The CARE Center for Human Services ChildFund International USA Conservation International Foundation Counterpart International Education Development Center EngenderHealth FHI Development 360 Helen Keller International Innovations for Poverty Action International Center for Research on Women International Medical Corps International Partnership for Microbicides International Rescue Committee Internews Network IntraHealth International Jhpiego JSI Research & Training Institute Management Sciences for Health Mercy Corps Partnership for Child Health Care Partnership for Supply Chain Management PATH Pathfinder International Plan International USA Population Council Population Reference Bureau Population Services International Public Health Institute RAND Corporation RTI International Save the Children Touch Foundation Volunteers for Economic Growth Alliance WomanCare Global World Education World Learning World Vision	ADEMAS Ariel Glaser Pediatric AIDS Healthcare Initiative Ashonplafa Caritas Rwanda Confederation of Ethiopian Trade Unions Dasra Federation of Indian Chambers of Commerce and Industry Health Insurance Fund Ifakara Health Institute Integrated Midwives’ Association of the Philippines International Planned Parenthood Foundation Kazakhstan Association on Sexual and Reproductive Health KHANA Malawi Adventist Health Services Marie Stopes International N’weti – Health Communication Nepal CRS Company Organization for Development in Action Population Services Zimbawe Regional Centre for Quality of Healthcare Reproductive and Child Health Alliance (RACHA) Reproductive Health Association of Cambodia Rohi Weddu Pastoral Women Development Organization Social Marketing Company Society for Family Health Nigeria Society for Family Health Rwanda T-MARC Tanzania Zuellig Family Foundation
Tuberculosis (TB)		Malaria
U.S.-Based NGOs	Foreign NGOs	U.S.-Based NGOs	Foreign NGOs
American Association for the Advancement of Science Africa-America Institute CARE Center for Human Services Elizabeth Glaser Pediatric AIDS Foundation FHI Development 360 Global Alliance for TB Drug Development International Relief and Development IntraHealth International Jhpiego JSI Research & Training Institute Management Sciences for Health Partnership for Supply Chain Management PATH Pathfinder International Plan International USA Population Services International Project HOPE Public Health Institute U.S. Pharmacopeial Convention Volunteers for Economic Growth Alliance World Learning World Relief World Vision	Anova Health Institute Centre for Health Solutions – Kenya GHESKIO Centers Hospice Palliative Care Association of South Africa Indonesian International Education Foundation International Union Against Tuberculosis and Lung Disease Jaringan Kesejahteraan/Kesehatan Masyarakat KHANA KNCV Tuberculosis Foundation Lembaga Kesehatan Nahdlatul Ulama (LKNU) NawaLife Trust – Namibian Centre for Communication Programmes Operation ASHA Penabulu Alliance Philippine Business for Social Progress Regional Centre for Quality of Healthcare Reproductive Health Association of Cambodia Roman Catholic Diocese of Timika Social Marketing Company Trust for Democratic Education and Accountability	American Association for the Advancement of Science Adventist Development and Relief Agency American Council on Education Catholic Relief Services Center for Human Services ChildFund International USA Concern Worldwide US Episcopal Relief & Development FHI Development 360 IntraHealth International Jhpiego JSI Research & Training Institute Lutheran World Relief Management Sciences for Health Medical Care Development Mennonite Economic Development Associates PATH Pathfinder International Plan International USA Population Services International Public Health Institute RTI International Save the Children U.S. Pharmacopeial Convention World Learning World Vision	Community Health and Development Action Equip Liberia Health, Development and Anti-Malaria Association Innovative Vector Control Consortium Institut Pasteur Kenan Institute Asia Malaria Consortium Medicines for Malaria Venture Mentor Initiative, The Society for Family Health Nigeria Society for Family Health Rwanda
Pandemic Influenza and Other Emerging Threats (PIOET)		Other Public Health Threats, Including Neglected Tropical Diseases (NTDs)
U.S.-Based NGOs	Foreign NGOs	U.S.-Based NGOs	Foreign NGOs
American Association for the Advancement of Science Adventist Development and Relief Agency Citizens Network for Foreign Affairs FHI Development 360 International Medical Corps Management Sciences for Health Mercy Corps Public Health Institute U.S. Pharmacopeial Convention	Indonesian International Education Foundation Kenan Institute Asia	Armenian American Cultural Association Armenian EyeCare Project Carter Center, The Center for Human Services ChildFund International USA FHI Development 360 Innovations for Poverty Action International Virtual e-Hospital Foundation IntraHealth International JSI Research & Training Institute Management Sciences for Health Project C.U.R.E. RTI International Vishnevskaya-Rostropovich Foundation
Water Supply and Sanitation		Nutrition
U.S.-Based NGOs	Foreign NGOs	U.S.-Based NGOs	Foreign NGOs
A Glimmer of Hope Foundation ACDI/VOCA Adventist Development and Relief Agency American Council on Education American Near East Refugee Aid American Refugee Committee Amref Health Africa in the USA Catholic Relief Services Citizens Network for Foreign Affairs FHI Development 360 Global Communities Global Environment and Technology Foundation Green Empowerment Hispanic Association of Colleges and Universities Innovations for Poverty Action International City/County Management Association International Relief and Development International Rescue Committee Jhpiego JSI Research & Training Institute Lifewater International Management Sciences for Health Mercy Corps Mercy-USA for Aid and Development Millennium Water Alliance mWater National Cooperative Business Association CLUSA International Pacific Institute for Studies in Development, Environment and Security PACT Palms for Life Fund Pathfinder International PCI-Media Impact Plan International USA Population Services International Relief International RTI International Save the Children Winrock International World Concern World Vision	ACTED ADECA ADPP Angola African Water Association Areopagus Association Centrafricaine pour le Bien-Etre Familial Association for the Development and Protection of the Environment Aghbalou Caritas Senegal CCAP Nkhoma Synod Relief and Development Congress of Local Authorities from Moldova Cooperative Agricola de Cangombe DAPP Zambia Development Workshop Environment and Public Health Organization Federation of Indian Chambers of Commerce and Industry FIELD Indonesia Fundacion REDDOM Groupe d’Action pour le Developpement Communautaire Hararghe Catholic Secretariat Hospice Palliative Care Association of South Africa Humana People to People – Congo Indonesian International Education Foundation Institute of Natural Resources International Center for Biosaline Agriculture International Water Management Institute Kigezi Diocese Water and Sanitation Programme Laikipia Wildlife Forum Oromo Self-Help Organization PALM Foundation Population Foundation of India SEBAC Nepal St. Lucy Filippini Home Economic School Water & Sanitation for the Urban Poor Wildlife and Environment Society of South Africa Women Farmers Advancement Network Yayasan Cipta Cara Padu	American Association for the Advancement of Science ACDI/VOCA Africare Amref Health Africa in the USA CARE Catholic Relief Services Center for Human Services ChildFund International USA Citizens Network for Foreign Affairs Concern Worldwide US Curamericas Global FHI Development 360 Future Generations Global Communities Health Through Walls Helen Keller International International Relief and Development IntraHealth International Jhpiego JSI Research & Training Institute Management Sciences for Health Mercy Corps National Collegiate Inventors and Innovators Alliance National Cooperative Business Association CLUSA International Partners of the Americas Partnership for Supply Chain Management PATH Pathfinder International Plan International USA Public Health Institute RTI International Save the Children Winrock International World Relief World Vision	ADEMAS Asociacion Los Andes Cajamarca (ALAC) Association de Soutien au Developpement des Activites de Population (ASDAP) Caritas Rwanda Global Alliance for Improved Nutrition, The (GAIN) Nepal CRS Company Regional Centre for Quality of Health Care Relief Society of Tigray Reproductive Health Association of Cambodia Society for Family Health Nigeria Society for Family Health Rwanda
NOTES: Reflects NGOs that received funding disbursed by USAID for USG global health efforts by program area.

Endnotes

Kaiser Family Foundation (KFF), NGO Engagement in U.S. Global Health Efforts: U.S.-Based NGOs Receiving USG Support Through USAID, Dec. 2014, https://www.kff.org/global-health-policy/report/ngo-engagement-in-u-s-global-health-efforts-u-s-based-ngos-receiving-usg-support-through-usaid/.

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KFF, Foreign NGO Engagement in U.S. Global Health Efforts: Foreign NGOs Receiving USG Support Through USAID, May 2015, https://www.kff.org/global-health-policy/report/foreign-ngo-engagement-in-u-s-global-health-efforts-foreign-ngos-receiving-usg-support-through-usaid/.

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KFF, NGO Engagement in U.S. Global Health Efforts: U.S.-Based NGOs Receiving USG Support Through USAID, Dec. 2014, https://www.kff.org/global-health-policy/report/ngo-engagement-in-u-s-global-health-efforts-u-s-based-ngos-receiving-usg-support-through-usaid/.

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KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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Specifically, 203 NGOs received country-specific funding in a single country, among 257 NGOs who received funding for global health activities in a specific country(s). These NGOs, and others, may have received non-country-specific funding as well or instead (e.g. regional funding and “worldwide” funding). KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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Of the 79 countries, 17 countries had 1 NGO that received funding, 33 countries had 2-9 NGOs, and 29 countries had 10 or more NGOs. Additional NGOs may have operated in these countries with USG regional and “worldwide” support. KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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USAID, Local Systems: A Framework for Supporting Sustained Development, April 2014, http://www.usaid.gov/policy/local-systems-framework; USAID, USAID Policy Framework 2011- 2015, 2011, http://www.usaid.gov/documents/1870/usaid-policy-framework-2011-2015; U.S. Government, U.S. Government Interagency Paper on Country Ownership, July 2012, http://www.ghi.gov/principles/docs/ownershipInteragencyPaper.pdf.

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USAID, Local Capacity Development: Suggested Approaches - An Additional Help Document for ADS 201, July 22, 2013, http://www.usaid.gov/sites/default/files/documents/1870/201saf.pdf.

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KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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KFF analysis of USAID FY 2014 transaction data, downloaded 4-1-15 from the U.S. Foreign Assistance Dashboard, www.ForeignAssistance.gov.

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