Sitting in an empty park in the suburbs of New Delhi, India, Rachana (a pseudonym) told me the real story about her work in the sex trade. While shocking, it wasn’t nearly as horrific as the story the organization she worked for urged her to tell when speaking to national media and foreign donors. I’ve learned since then that the prompting she received isn’t unheard of — a famous non-governmental organization (NGO) that helped women who were rescued from sex trafficking in Cambodia was caught in fabrications that resulted in its subsequent closing.
Rachana had been rescued several years earlier from a community in northeastern India in which women are commonly sold for sex by their families. When we spoke, she was a staff member at one of the NGOs fighting the flesh trade. In the story she told the funders of her NGO, most of whom were from America, she had been raped and violated by members of her community and her clients. But it wasn’t exactly true. Rachana was lucky, she told me, to have escaped before she had been subjected to that horror. Yet she had been told by the organization’s leaders to stick with the more compelling and shocking tale.
I met Rachana when I spent several months in the outskirts of New Delhi researching how women in cultural sex work (sex work performed by certain tribes that see it as their tradition) interacted with the health care systems in their cities and communities. But I also learned that some NGOs create false images of their success, especially on days when donors visit.
During such donor visits, which are often known weeks in advance, women from the community are urged to attend meetings or workshops in far higher numbers than on average days, when few, if any, would actually attend. Or staff members would make a point of showing up to work, while they might be far more lackadaisical on non-visit days. Some of the differences were unintentional, others purposeful, but patterns of negligence and laxity eventually made themselves known.
The global health sector is immensely challenging, and it’s not always easy to fully understand what is happening within an organization that is working with complex vulnerable populations. The most egregious concern is blatant corruption, which a recent Kaiser Family Foundation poll cited as the single largest impediment to success in global health efforts. We have seen some such examples in recent times — orphanages in Nepal that actually kidnapped children from their families and disappearing funds in Haiti’s earthquake relief efforts. Sadly, we simply do not have the data or the means to understand the extent of corruption in the global health and human rights sectors, or how we might identify it in various settings around the world.
Exaggerating stories or overselling the impact of an NGO to potential donors isn’t corruption. But it is disappointing at best, and dishonest at worst. The challenges of working in marginalized communities deserve attention and thoughtful improvement, not false appearances of success.
When it comes to global health NGOs, a critical piece in the accountability dialogue is missing. While traditional accountability measures focus almost entirely on fiscal responsibility, such as through organizations like Charity Navigator, we lack even a fuzzy picture of what is happening on the ground on an average day. Equally important, we are missing a critical voice — the recipients of NGO services, such as female sex workers, people displaced from earthquakes, or the parents of children who have been kidnapped and falsely orphaned. These are people who don’t have access to the internet and who are often limited by language and educational barriers.
One way to gather this essential information is by engaging the thousands of students who spend weeks or semesters abroad working in these communities. These students can be the eyes and ears into the daily affairs of global health NGOs. Furthermore, students are far more likely to engage with the recipients of NGO services and hear their perspectives, as I had with Rachana.
To help keep global health NGOs honest, several colleagues and I at the Harvard T.H. Chan School of Public Health are launching The Global Health Watch to bring ground-level accountability through the voices of student volunteers who are working or have worked abroad. While one story is an opinion, several can provide a more accurate picture of reality. Our group is developing modules to train student volunteers on the ethics of global health work and the fundamental principles of journalistic integrity.
Through untapped student potential, we hope to hear many voices that have for too long gone unheard.
Abraar Karan, MD, is a graduate student in the Harvard T.H. Chan School of Public Health.