Paper short abstract:

This paper explores the role of NGOs in implementing primary health care (PHC) in Guinea-Bissau and whether their assistance is sustainable. It argues that a fragile state like Guinea-Bissau is dependent on assistance from NGOs to revitalize PHC; but it is necessary to consider sustainability.

Paper long abstract:

In recent years there has been increased interest in revitalizing the Alma Ata Declaration to achieve the Millennium Development Goals. This interest is evident in Guinea-Bissau where the health policy has been under the influence of Alma Ata since the beginning. In Oio region the first community health units (CHUs) were opened in 1982 offering villagers primary health care (PHC) with a focus on mothers and children. The implementation of PHC was organized by government institutions and in the regions the regional health boards were responsible for implementation together with NGOs. In Oio the last NGO left the region in 1998 and after that government institutions had no resources to sustain PHC on their own. Consequently, only a few CHUs were functional a decade later. Today, with the revitalization process donors show an increased interest in allocating resources to NGOs instead of government institutions because of political instability. These NGOs are then expected to collaborate with government institutions.

This paper explores the importance of NGOs in the implementation of PHC in Guinea-Bissau and it discusses whether their assistance can be sustainable. The data is based on 20 months of anthropological fieldwork in Guinea-Bissau between 2009 and 2012. Interviews were taken with representatives of international organizations and NGOs, responsible people at the Ministry of Health, health staff and villagers. The paper argues that a fragile state like Guinea-Bissau is dependent on receiving assistance from NGOs to revitalize PHC. However, it is important to consider sustainability and to learn from past experiences.