Statement held by Thomas Gebauer, Executive Director medico international, on Third People's Health Assembly (PHA3) - Cape Town - July 8th, 2012
Why talking about NGOs? Why challenging civil society organisations that many of us see in the light of change and not as a problem? I hope that at the end of my presentation I will have convinced you of both the need to have a critical look at NGOs and that it is high time to reconsider civil society.
Since the 80th a steadily growing number of NGOs has entered the political stage; local initiatives, independent associations, non-for profit charities, international human rights organisations, multinational eco-activists etc. – an estimated number of 50.000 – 100.000 worldwide. They all claim to act selflessly; promoting the interest of others, if not those of the whole mankind.
NGOs have its roots in different settings and times. Some emerged from the labour movement in the 19th century. Others have their origin in religious communities and churches. Most of today’s NGOs, however, arise as a reaction to the enormous political transformations that come about in the context of the neoliberal globalisation.
I don’t have the time to go into the details. But there are two points I would like to raise. You know that an important element of the neoliberal strategy was (and still is) to tell people that “there is no alternative”, that politics are determined by economics constraints and state entities charged with social affairs can be dismantled and replaced by market forces. “There is no such a thing as society” stated Margret Thatcher in the 80th, promoting the idea that there is no need for politics that aim at shaping social life. Pierre Bourdieu, the French sociologist, spoke of a “policy of de-politicisation” that belongs to the essence of neo-liberalism. It has been this policy that led to the privatisation of state entities und fostered the private initiative – also that of NGOs.
The second reason for the growing importance of NGOs is the economic globalisation, better: the global unleashing of capitalism. As the deregulation of the economy advanced the room for political governance decreased. Multinationals began to defy the control of national governments that at the same time increasingly failed to find an answer to emerging new problems such as the climate change, the shadow economy, the financial system, the illicit arms trade etc. In contrast to the economic globalisation at the political level no “world state” was formed. This gap was partly filled by NGOs. They stepped into the vacuum of missing international regulation and began to strive for a more rational way to govern the world.
With some noticeable success: NGOs played a crucial role in the implementation of the International Criminal Court, the improvement of access to antiretroviral medicine, the prohibition of landmines etc.
The prefix: non-governmental does not imply that NGOs oppose state-based policy. On the contrary: NGOs usually seek the cooperation with states and are quite often doing the job that governments are supposed to do.
They assist in identifying emerging problems and take care of the agenda-setting. They mobilise the knowledge for possible solutions and arrange proper planning. They serve as early warning systems and are in charge with charity and social welfare services that states aren’t able or willing to provide any longer.
As NGOs advanced governments could abandon their obligations. Seen from that perspective NGOs cannot be perceived as a gain of democracy only; they have also to be understood as an expression of lacking democracy. The privatization of states goes along with NGOs becoming “state entities” – with an important difference. NGOs are not formally obliged to meet the need of people or respond to their entitlements, as little as an individual can make a claim addressing NGOs.
And the problem goes even deeper. By alleviating the humanitarian effects of existing inequalities, some NGOs, the aid organisations, – at the end of the day – are stabilizing the unequal status quo and so even justifying the political systems.
Thus NGOs are both: they are part of the solution and – at the same time – part of the problem. This thesis may irritate; obviously it requires further explanation.
You may all agree that NGOs belong to what we call civil society. The uncertainty comes when we try to define civil society.
There a quite a few concepts to explain “civil society” I prefer that of Antonio Gramsci who didn’t conceptualise civil society as completely separate from the political sphere of the state. On the contrary: the political sphere (the administration, the regulatory and legal apparatus of states) is closely linked with the civil society (the political parties, the media, trade unions, grass-root organisations, the corporate sector, the NGOs, the World Social Forum as well as the industry driven Davos International Forum on Economy.
According to Gramsci both the political society and the civil society together form the “extended state”.
It would be absolutely misleading to perceive civil society just as being comprised of the good. In fact, civil society isn’t about particular actors, it is rather a place. It is the place of societies where opinion-making happens, where political decisions are prepared, where - as Gramsci put it - the struggle for “cultural hegemony” takes place.
In the past three decades the “cultural hegemony” was occupied by the neo-liberals. Media, universities, politicians, even quite a few of those who suffered the negative consequences of neo-liberalism have been convinced that public institutions based on the concept of common goods and solidarity aren’t effective and have to be replaced by private initiative, by business and entrepreneurship.
Today there is a little tendency in the opposite direction. With a view to the multiple crisis that has affected today’s world people begun to realise that neo-liberalism isn’t a saving idea but a highly destructive one.
The public dispute that occurs in societies in the course of defining the guiding political frame perfectly describes the struggle for cultural hegemony.
Gaining cultural hegemony is the precondition for change. The success stories that I already mentioned: the HIV movement, the landmine campaign e.g. have won their cases because they managed to change the public opinion. The HIV movement started with a few activists, involving affected communities. Later students joined the struggle; journalists began to cover the issue, and then a growing public awareness pressed on politicians to tackle the issue in parliaments etc.
As you know the political sphere of states is by no way committed to public interests only, but much more to those actors that dominate civil society. The current efforts of governments to resolve the financial crisis describe that. States act in favour of private interests, the banking system. They do it even better than the banks themselves. With good reason states - as they are - can be describes as the ideal personification of national capital.
On the other hand, also civil society actors such as NGOs can be engaged in both: public und private interests. Even if they aim at a radical change NGOs cannot act separate from the prevailing political and economic system. They have to deal with economic constraints, staff members need to be paid, funds must be raised, etc. Some accept extensive funding from state donors and get into dependency, others are directly organised e.g. by pharmaceutical companies, just calling for more pills and other technical solution organised by commercial companies.
To keep their public profile NGOs tend to search for activities that could make it easier to approach the media. A spectacular natural disaster is much easier to cover than structural problems, such as the international migration. Because of own economic constrains NGOs aren’t free to publicly raise any issue.
Thus, it isn’t that simple to divide between private and public, when private stands for bad and public equals good. That is the reason why I prefer a more political distinction.
Instead of classifying actors by just referring to private and public I draw the line between those that are committed to social justice, institutionally based on common goods, in other words: that are committed to “social/public property” and those that first and foremost seek for their own profit, for “private property”. “Public property”, by the way, doesn’t necessarily require the presence of state institution, it can be perfectly organised e.g. through co-operatives.
If you take a look at the WHO it becomes obvious that both tendencies can even affect one and the same organisation. As a public agency the WHO internally struggles with competing conceptualisations of health. Some still consider health in the context of human rights and health equity, others only through the lens of bio-security, consumerism and business.
One of the main problems of NGOs is that they are not beyond being instrumentalized. Their engagement in social change can be interfered by opposed objectives. Instead of supporting people to overcome misery and dependence NGOs may unintentionally even assist those who are responsible for the precarious state of the world.
The risk of being exploited by others is higher, if NGOs do not realize the political frame that is set by the economic and political power.
There is plenty of evidence that NGOs can be instrumentalized for security policy; commercial interests; and to overcome the lack of political legitimacy.
It has been the former US-Minister of Foreign Affairs Colin Powell who – at the beginning of the war in Iraq – openly defined humanitarian NGOs as “force multipliers and an important part of the troops”.
Yes, it should not be surprising that NGOs - active in times of war - also influence the course of conflicts - for better or for worse. It is well known that humanitarian aid provided by charity organisation to civilians is also an important economic and political resource used by all warring parties. Aid can contribute to improve the image of military forces and to expand their reach of action. Also the denunciation of human rights violations can contribute to shift the balance of power that exists between parties of conflict.
All over the globe military personnel have learned that lesson. Since a few years they seek for a systematic involvement of NGOs in civil-military cooperation. Field manuals of the US-army explicitly classify aid as a non-lethal weapon system.
Most of the NGOs still reject the idea to get involved in military strategies, but there are already some that are proud to be allowed to cooperate with the army, and particularly US-NGOs are forced to play a role in joint strategies it they accept public funding.
However, even those that oppose civil-military-cooperation can be unintentionally instrumentalised. By drawing the public attention to a refugee emergency relief organisations may contribute to increase the public acceptance of military interventions.
These dilemmas cannot be resolved by reducing the reality of wars just to a humanitarian problem. Insisting on a neutral position as many NGOs do seems to be rather an illusion. Security policy does not strive for social justice. Its main objective is to effectively keep the status quo. For this purpose the European Union has defined a “Common Foreign and Security Policy” that explicitly combines military and police action with economic cooperation, development aid and even human rights policy. The later isn’t seen as an own value any longer but only as an instrument to “averting a danger”.
If NGOs do not reject the attempts of being involved in security strategies they run the risk of becoming a hostage to a security policy that only aims at stabilizing existing privileges and misery. At the end of the day, NGOs contribute to a kind of permanent “crisis management” that is replaced the idea of “social justice” by controlling the social gaps that day by day become deeper.
The instrumentalisation of NGOs does not always occur in such a direct manner. NGOs can be also co-opted indirectly.
If ecologist groups spend own resources – let’s say – on developing an energy saving automobile, the industry must not be scared. The industry may save own development expenses and can be ensured that the concept of mobility based on private cars isn’t challenged.
If health initiatives concentrate their activities on just calling for drugs and other technical solution instead of focusing on social and political change for heath, NGOs can make a most welcome contribution to the interests of pharmaceutical companies. As much as drugs are needed, the pure promotion of bio-medical solution can also open up new opportunities for profit.
Knowledge is a prerequisite for the realization of economic and political interests. With their expertise NGOs can assist to stabilize the prevailing economic model, but they can also oppose it.
A special look has to be taken at those civil society actors that are called „philanthrocapitalists”. I am referring to e.g. the Bill and Melinda Gates Foundation that is the most important private funder of health activities all over the world by now. However, philanthrocapitalists do not provide money only they also influence global health strategies. Business people like Gates are used to handle problems in terms of investment and return; they calculate input and output. Their philosophy is that any problem - also social problems – can be resolved by an efficient linkage of market forces, science and techniques. The participation of affected groups, on the other hand, does not seem to be really necessary.
Gates enjoys himself in the role of an action man who does not need to spend much time for deliberation but goes ahead. That is what I call the “can-do-attitude”. Recently Gates announced to concentrate his efforts on the development and the allocation of vaccines: we can safe 10 million lives. No doubt, vaccination programs are important, but they cannot overcome the scandalous health inequalities.
Those who praise the “can-do-attitude” of business people oversee that e.g. Gates generates his revenues out of investment. A big deal of the 25 bio $ that Gates could invest in health during the last ten years he made as a shareholder of notoriously known pharmaceutical, chemical and food producing companies.
In the meanwhile also many other NGOs have been affected by the just described “can-do attitude”. Like Gates they prefer a pragmatic approach; they do not ask for the root-causes of hunger, e.g. but limit their activities on providing food-aid.
Of course it is an ethical must to help starving people, but if NGOs ignore the circumstances that have caused hunger they are perfectly contributing to the neo-liberal ideology that “there is no alternative”, that hunger cannot be abolished but only alleviated, that losers are inevitable.
The impact of such a apolitical approach is usually measured by the quantity of delivered aid and the number of people reached. It is an action that aims at avoided the death, without improving the life (“we can save 10 Mio lives”, as Gates said).
Precisely the can-do attitude of NGOs helps the political system to overcome its lacking legitimacy. A world that seems to be divided in people providing aid and others receiving aid appears much more acceptable than a world that is divided in privileged and socially excluded people.
But to be just: the pragmatism that is guiding many NGOs today isn’t a problem of NGOs only. The wrong idea that social change can be measured by business assessments and economic comparison calculations is widely spread. The McKenseys have not stopped before the doors of NGOs. Unfortunately also NGOs are mixing up effectiveness with efficiency today.
Only recently a group of NGOs published a call for universal health coverage. The call also strives for efficiency which brings in business thinking. Following that call it is to be feared that at the end of the day coverage will be measured just by the percentage of people covered. Such statistical figures however don’t tell you anything about the quality of health coverage.
We all agree that health isn’t a commodity; but in our own strategies many of us have already accepted a business perspective. Also NGOs get more and more used to speak of stakeholders, controlling mechanisms, impact analysis, managerial business etc. - despite the fact that social change cannot be planned on a drawing board.
It is no surprise that business-influenced NGOs are less hesitant to cooperate with the corporate sector. When medico together with the DGH coalition opposed the idea of establishing a World Health Forum at the WHO bringing together main actors, such as the industry, international institutions like the World Bank and some NGOs, we got in conflict with NGOs that explicitly call for such a forum. Obviously these NGOs didn’t realize that it would contribute to legitimate the influence of the business sector on global health policy.
Also the NGO movement has reached a crossroads. In order to avoid further instrumentalisation NGOs have to fundamentally revise the role that they play within global health policy. There are five principles that can assure the re-politicisation of NGOs. :
NGOs have to develop a critical understanding of their own nature. NGOs stand for growing democratic participation but at the same time they are also an expression of an increasing lack in accountability of public institutions. Some NGOs claim to represent those who have no voice. Yes, NGOs can do advocacy, they can raise the issue of the poor, and it is great if they struggle alongside with the excluded, but NGOs do not formally represent they excluded, the poor. NGOs are not formally obliged to meet the need of people.
NGO have to realize that they do not act separate from the prevailing political and economic power relations. Only by taking a political stand NGOs can assure that their activities aren’t misused. The concept of Universal Coverage goes beyond technical improvements; if it is taken seriously it is a highly political matter that clashes with the interest of those who are still making a lot of profit out of the existing health inequalities. Thus, NGOs have to understand that Human Rights are not given by governments, they do not embody a quasi sacred affair, that can be brought to an imaginary world court, but must be taken in possession by the people themselves, and it is up to societies (not states) to establish the institutional frame that guarantees equal access.
NGOs should seek for a maximum of independence. Change will only come about if NGOs stop to follow those who demand realism. We have to go beyond pragmatism. Looking to all what is happening in the world in the name of realism, realism has turned out to be stupid long since.
And there is a window of opportunity for change. The TINA-principle doesn’t convince people any longer. Change is possible if there is the “desire for change”, actively expressed by an engaged public, by social movements, community organisations, and NGOs – forming a countervailing power that gain cultural hegemony.
Only by establishing this countervailing power the involvement of NGOs in governance structures makes sense. Only it there is strong public that make governments a hard time there will be the “diplomatic space” that allows NGOs to influence policy.
NGOs should never forget their roots. It is not just the professional expertise that has made NGOs to an accepted actor; but it is the public that has empowered NGOs and is still backing them up. Only if NGOs continue to be aware of being rooted in movements that oppose the prevailing political system they can really make a difference.
Since change requires joint strategies and joint actions NGOs should actively seek for networking – even at the costs of getting less visible. Political effectiveness has nothing to do with the frequency a particular NGO logo is shown. Those NGOs that pit success against their own visibility are already trapped by the market,