NGOs-state relations in health care services: a case study of Lagos, Nigeria

Provision of adequate health care has been challenging for government and private (profit and non-profit) providers. Despite this, relations between the government as primary provider and the non-governmental organisations (NGOs) as co-providers at the grassroots affect the latter's ability for effective health care delivery. This study analyses NGOs-state relations using Najam's Four Cs: confrontation, co-optation, cooperation and complementarity in health care. Eleven in-depth interviews with executive directors (EDs) of NGOs (7) and government officials (4) show a continuum form of relations, from confrontation, co-optation through cooperation and complementarity, shaped by the strategic institutional interests of actors. However, government tends to contrive confrontation or isolated existence through =institutional engagement' of NGOs in satisfying donor agencies insistence on their participation in public health. Co-optation is the prominent form of relation as the government control the public space, which significantly affects NGOs' capability for effective health service delivery.