Humanitarian agencies in North Korea operate within a complex sociopolitical environment historically characterized by a baseline of mistrust. As a result of operating within such a heated environment, health sector collaborations between such agencies and the North Korean government have followed unpredictable courses.

The factors that have contributed to successful programmatic collaborations, as perceived by United States non-governmental organizations (NGOs) and North Korean officials were investigated.

A qualitative, multi-case, comparative, research design using semistructured interviews was used. Expert North Korean informants were interviewed to generate a list of factors contributing to programmatic success, defined as fulfilling mutually established objectives through collaboration. The North Korean informants were asked to identify US NGOs that fulfill these criteria (“mission-compatible NGOs”). Representatives from all of the missioncompatible NGOs were interviewed. All informants provided their perspectives on the factors that contributed to successful programmatic collaborations. The interviews were recorded, transcribed, and analyzed for thematic content.

North Korean informants identified six mission-compatible US NGOs. The North Korean and US NGO informants provided a number of factors that contributed to successful programs.These factors were grouped into the following themes: (1) responsiveness to North Korean requests; (2) resident status; (3) program monitoring; (4) sincerity (apolitical objectives); (5) information gathering; and (6) interagency collaboration.

Some US NGOs have devised innovative measures to work within a unique set of parameters in North Korea. Both US NGOs and North Korean authorities have made significant concessions to maintain their programmatic partnerships. In this manner, seasoned collaborators have employed creative strategies and a form of health diplomacy to facilitate programmatic success in North Korea by building trust within a complex sociopolitical space.