Lightening the global burden of disease? The contribution of international NGOs to population health since 1990

International non-governmental organizations (INGOs) play a major role in global health governance and in relation to health policy and services around the world. However, their contribution to the improvement of population health remains controversial. Case studies have shown how INGOs helped reduce disease burdens, specifically in low- and middle-income countries. But other research suggests that their involvement in health policy development and service delivery is sometimes futile or even counterproductive. INGOs are frequently criticized for undermining the quality and coverage of public health systems, distorting health policies and programmes in low-income countries by promoting the priorities of their donors rather than the needs of the intended beneficiaries, advancing their managers’ narrow interests and providing channels for corruption. While researchers have highlighted instances of positive impact, no impact, or even negative impact generated by individual or coalitions of INGOs, we still know little about the big picture: have health INGOs as a whole improved human health? More specifically, in which disease categories can we detect a reduction of the burden resulting from INGO activities? What contextual factors moderate (amplify or reduce) the health impact of INGOs? The paper provides quantitative estimates of the contribution of health-focused INGOs to the improvement of population health globally since 1990 using a longitudinal research design. The primary outcome indicator is Disability-Adjusted Life Years (DALYs) lost because of the 369 diseases and injuries included in the Global Burden of Disease (GBD) study. The estimates are provided at the disaggregated level for INGOs specialized in 22 disease categories and at the aggregate level for the whole population of several thousand health INGOs.