The role of NGOs in mainstreaming services for podoconiosis into healthcare facilities: the case of two NGOs in Ethiopia

Non-Governmental Organizations (NGOs) have played an important role in supporting progress towards the goals of the WHO Neglected Tropical Disease (NTD) Roadmap 2021-30. Several NGOs have shifted from directly delivering NTD services to mainstreaming them to existing health systems. There is little information about the NGOs themselves – their organisational environments and their influence in mainstreaming NTD services and associated challenges. We studied two NGOs that have jointly implemented an intervention to mainstream services for the NTD podoconiosis to local healthcare facilities in rural Ethiopia. We conducted a focused ethnography at the NGOs’ precincts, analysed documents and conducted key informant interviews with staff of the NGOs and a representative of the Ethiopian Ministry of Health. The implementation design and the NGOs’ organizational environment were vital in implementing the intervention. The project activities were difficult to sustain within the local healthcare facilities. The NGOs relied too much on individual-level quantifiable short-term outcomes which overshadowed efforts to evaluate their success in institutionalizing activities. The intervention is challenged by lack of funding for NGOs and the limited capacity of local healthcare facilities to continue providing health services. Our study revealed that the implementation design and the organizational environments of the NGOs were crucial for implementing the project activities. However, activities were short-lived due to limited resources, overreliance on short term indicators and weak institutionalization within government structures. The challenges underscore the tension between mainstreaming interventions and the realities of the settings in which interventions are put into practice.