Management of expatriate medical assistance in Mozambique

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance. Different scenarios, partnerships and contract schemes that have evolved since independence are briefly described, as well as self-reliance option possibility and implications. Lessons learned about donor initiatives aimed at contracting specialists from other developing countries are singled out. The issue of obtaining expertise and knowledge in the global market as cheap as possible is stressed, and realistic figures of cost planning are highlighted, as determined by the overall health system necessities and budget limitations

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.

BACKGROUND: Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS: This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS: All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS: Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users

Why do people become health workers? Analysis from life histories in 4 post-conflict and post-crisis countries

Sophie Witter - orcid: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188While there is a growing body of literature on how to attract and retain health workers once they are trained, there is much less published on what motivates people to train as health professions in the first place in low- and middle-income countries and what difference this makes to later retention. In this article, we examine patterns in expressed motivation to join the profession across different cadres, based on 103 life history interviews conducted in northern Uganda, Sierra Leone, Cambodia, and Zimbabwe. A rich mix of reported motivations for joining the profession was revealed, including strong influence of personal calling,- exhortations of family and friends, early experiences, and chance factors. Desire for social status and high respect for health professionals were also significant. Economic factors are also important- not just perceptions of future salaries and job security but also more immediate ones, such as low cost or free training. These allowed low-income participants to access the health professions, to which they had shown considerably loyalty. The lessons learned from these cohorts, which had remained in service through periods of conflict and crisis, can influence recruitment and training policies in similar contexts to ensure a resilient health workforce.sch_iih33pub5152pub

International aid in the Occupied Palestinian Territories (OPT)

The unique nature of humanitarian aid to the OPT can be summed up by the position of Israel (an occupying power and \u2018un-obliging landlord\u2019) and by the attitude of the international community towards this position. The main dilemma is powerfully described by Israeli author and ex Deputy Mayor of Jerusalem, Meron Benvenisti: \u201cThe Palestinians managed to survive thanks to the international aid, but [...], the beneficiary of the international community\u2019s rallying to the rescue was their Israeli enemy. Moreover, the contributing states\u2019 humanitarian enlistment became a safety net, enabling Israel to impose a deluxe occupation in the West Bank \u2013 total military domination with no responsibility for running the life of the occupied population, and no price tag attached. Had Israel been required to fulfill its commitment as an occupying power [author\u2019s note: in accordance with the Geneva Conventions], it would have had to pay NIS 5-6 billion a year just to maintain basic services for a population of more than three million people. But it created an international precedent \u2013 an occupation fully financed by the international community. The harsher the Israeli measures with closures, blockades and safety fences, the larger the international aid \u201cto prevent a humanitarian crisis\u201d, and Israel is not held accountable\u201d. Furthermore despite the economic benefits it gains from the humanitarian aid that is supposed to go to the Palestinian people, Israel interferes in the flow of this aid by blocking access to it and thus reducing its effectiveness. \u201cBut while piling on barriers that block aid from Palestinians and Palestinians from aid, Israel is fervent in its support of humanitarian aid in face of the international community\u201d. The behaviour of the international community towards the Israeli government demonstrates that the flow of international aid to the OPT is directed towards alleviating the crisis of the Palestinian people rather than towards promoting a permanent solution. Although the main responsibility for the serious situation in the West Bank is down to the Israeli occupation, as reported by agencies that could hardly be described as hostile to Israel, the attitude of donors appears ambiguous, when not openly hypocritical. Israel\u2019s repeated violations of both international humanitarian and human rights legislation have met with insufficient responses, generally limited to vague condemnations and resolutions by the UN that have had practically no effect on Israeli policy. At the time this article was going to print (May 2008), the situation in the OPT, and in the Gaza Strip especially, was practically out of control and showed no signs of a tangible solution. How did we reach this point? One possible interpretation of recent events and of the factors that condition them can be found in the \u201cEnd of Mission Report\u201d (May 2006) by the UN\u2019s Middle-East envoy, Alvaro de Soto20, which provides a devastating description of the failure of international diplomacy and of how interventions, including humanitarian aid, are carried out in this part of the world. The painful and, we hope, overly pessimistic opinions expressed in this article aim to highlight the desperate need for more research and analysis on humanitarian aid. As a report by the International Red Cross states: \u201cThere is also a need for a strong \u201cinstitutional memory\u201d and a culture of serious research in the humanitarian field. This is both because some of the dilemmas and opportunities that are faced are historically new, and because some of them are timeless. Ignorance is no excuse for repeating old mistakes or making new ones\u201d

The unhealthy aid provided for the health of Palestinians

Aid to Palestinians looks like an inappropriate political tool, provided to limit the damage created by a political problem that donor countries dare not address.3 By perpetuating the structural flaws of the health sector, aid has become an essential condition for its survival. Despite this reality, the trend is more of the same, exemplified by the ambiguous maintenance of a development discourse,4 alongside massive emergency funds, by a shift towards direct assistance to the Palestinian Authority, and by inattention to Gaza. While it is evident that aid without freedom of movement is largely squandered, donors seem to be refraining from pressuring Israel to protect the peace process, thus underestimating the effect of the Israeli occupation on aid effectiveness. Aid is not only ineffective but might also be harmful. The International Court of Justice6 has ruled that states are under obligation not to render aid that might maintain the situation created by the occupying power, to ensure Israel’s respect for international humanitarian law, and not to substitute for the responsibility of the occupying power. For example, financing highly localised health facilities to mitigate the delays created by Israeli closures7 effectively normalises an unacceptable situation. In view of the fact that 45% of aid goes to Israel and the remaining 55% is divided between waste on occupation measures and actual project benefits,8 aid subsidises the Israeli expansion in the occupied Palestinian territory. Normalisation is also made easier by sanitised language (eg, dropping the word occupation so that occupied Palestinian territory becomes Palestinian territory). Generous and un- conditional assistance to the health sector has led to punishing levels of donor dependency: 42% of the health expenditure is financed by donors. What can be done? In view of the broader political environment, avoiding mere technical solutions, which might be “missing the forest for the trees”, is paramount. Both technical and political aspects should be tackled