Can International Nongovernmental Organizations Boost Government Services? The Case of Health

Do international nongovernmental organizations (INGOs) lessen the need for states to provide their own services? In the case of health, many assume that INGOs limit health spending by governments. Against the conventional wisdom, we argue that these organizations create increased demand for governmental health spending through three mechanisms: (1) indirectly affecting the policy-making climate (“climatic conditioning†), (2) aiding domestic NGO and health activists in their efforts, and (3) directly pressuring governments for increased health spending themselves. Given these mechanisms, health INGOs, although typically supplying health services of their own within a country, should augment pressure for public service provision by the state and, it follows, lead to increased state health spending. We test our argument using a new data set on health INGOs, together with a well-established model of health spending, and find ample support for our arguments. Increases in health INGOs' activities do lead to increased governmental health spending, mainly by indirectly affecting the policy-making climate and, most especially, advancing the effective efforts of domestic activists.