Director Putting Reforms Ahead of Money From NGOs
With outdated equipment and a staff that still needs training, Mongkol Borei provincial hospital in Banteay Meanchey province badly needs the money and other help that NGOs can provide.
But hospital director Hou Serey Witchouk, who took over four months ago, is not ready to ask for outside assistance.
He doesn’t want a repeat of the past.
From 1989 to 1997, three successive NGOs provided assistance to Mongkol Borei hospital. When the last one pulled out during the factional fighting three years ago, the hospital could not survive.
NGOs involved with the project and Hou Serey Witchouk said the hospital staff, particularly the last director, was so corrupt the hospital could not go on after the NGOs left. Doctors charged patients for services that should have been free, and staff stole supplies.
“First I want to strengthen the hospital and let the NGOs see that we have changed,” Hou Serey Witchouk said. “We don’t want to ask them now when we have nothing to show.”
The goal of most NGOs and donors is to create a project that can eventually support itself, so when the outside agencies leave, their work survives them.
But as the Mongkol Borei hospital example shows, it is not easy to create something that can survive in the long term. Questions of funding and adequate training for local staff are just some of the challenges.
A study released by the Cambodian Development Resource Institute on technical assistance and capacity building shows that 58 percent of NGOs and donors have a partial or unconvincing plan for post-project sustainability. Twenty-six percent have no plan.
Steven Sharp, country representative of Pact Cambodia, an organization that provides money and other help to NGOs, said the major issue is providing adequate planning and lead time for an outside agency to pull out of a project.
“Also, the decision [to localize] is mostly made by foreigners,” he said. “Decisions are made without consulting the Cambodians who will be taking over.”
One NGO that seems to be getting it right is Veterinaires Sans Frontieres, which has established several Associations of Livestock Agents that are entirely self-supporting.
Jean-Marie Brun, country director of VSF, said when the group began training the livestock agents in 1992 and creating the associations in 1996, he realized that one of the key issues was convincing the trainees they had a personal stake in making the project succeed.
Because livestock agents are paid by clients for treating farm animals and providing medicine for them, it was easy to convince them they could make a profit if the associations succeeded.
“All the members individually provide a service, and they get their income from this,” Brun said. “The association helps with the drug supply and so it is seen as useful by the members. So the members have a direct interest in making it work.”
VSF now plays a limited role in the associations, acting as an adviser, but only when asked.
As Brun and the CDRI study points out, it is much easier to make a project sustainable when it is a private enterprise, such as a business selling goods or services.
Projects involved in the public sector, such as Mongkol Borei hospital, are difficult to sustain because of problems with corruption due to the low salary of civil servants and other issues.
A Cambodian employee of the humanitarian NGO World Vision, who asked not to be identified, said his organization plans to hand control over to the local staff in five to 10 years. Although the expatriate staff at World Vision have been training local staff on how to oversee the organization’s programs and project, the Cambodian employee said he is worried about obtaining enough funding so World Vision can survive when the foreigners leave.
“We are Cambodians and we don’t know how to communicate or how to make a proposal for financing,” he said. “The foreigners still fund World Vision and the Cambodians work only on the projects.”
Men Sam Nang, former assistant country director of the American Refugee Committee, which was the second NGO involved with the Mongkol Borei hospital, agreed and said funding is difficult to obtain for the local staff.
“Local staff can do project development and take care of programs, but they don’t know how to get money and donors don’t always want to give it to Cambodians,” said Men Sam Nang, who has been working with NGOs for the last 20 years.
Sometimes donors are right to not believe in the local staff, Men Sam Nang said. With corruption as a part of everyday life, a Cambodian who is put in charge of a project isn’t always honest. “There are internal issues,” he said. “If the person is honest and willing, then the project can succeed.”
That’s why Sharp says the strength of an organization can be more important than funding.
“The values of the organization need to be embraced by the local staff,” he said. “As foreigners, sometimes we take that for granted and it’s the kind of thing that’s hard to transfer over [to the local staff]. But if the organization is strong, it is more likely to obtain the funding.”
And making his staff competent and embrace the values of a public hospital is what Hou Serey Witchouk is trying to do. “Now we train the staff to have morals,” he said. “But it’s still very hard to make them understand that they have to stop the corruption they practiced before. However, we are still trying.”
