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Health Care Infrastructure

Health Care Infrastructure. East Africa. indigenous medicine ( review from Friday). Practitioners Divination (diagnose via material devices or inspiration) Spirit Mediums – exorcise or integrate spirits, or propitiate Rainmakers (or rain controllers) Herbalists Midwives Medicine

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Health Care Infrastructure

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  1. Health Care Infrastructure East Africa

  2. indigenous medicine (review from Friday) • Practitioners • Divination (diagnose via material devices or inspiration) • Spirit Mediums – exorcise or integrate spirits, or propitiate • Rainmakers (or rain controllers) • Herbalists • Midwives • Medicine • curative treatment • restore and protect • some things activate medicines, e.g. v. sorcery • Incorporated innovations • Swahili – mganga; Luganda - omusawo

  3. parameters for contemporary health systems • Historical legacies • Environment • Local, social, cultural • Political landscape • Regional and International connections

  4. Parameters for contemporary health systems • Historical legacies • Missionaries • Colonialism • Doctors 2nd largest group recruited into British Colonial Service after Admin Officers (Crozier, 2007) • Alternative to being Missionary; Empire; Adventure • New discipline of “Tropical Medicine” • Focus of work • Diseases • Prevention

  5. Parameters for contemporary health systems • Historical legacies • South Asian sub-assistants • Training of African Health Care providers (see Iliffe, 1998) • Missionary trained ‘semi’ - professionals • African Native Medical Corps (WWI) • “Tribal” dressers – rural areas • Disease campaigns • E.g. versus Yaws , (1920s – 1930s) • Mengo University ….Makerere University • Mulago Medical School – clinical emphasis, est. 1927

  6. factors • Human Resources – Work force • Not just doctors and nurses • Who staffs…? • Pharmacies • Labs • Training facilities • Administrative and finance • Record keeping • administration

  7. factors • Physical – facilities • Institutional mix • Cultural expectations • Legal Framework • Licensing, malpractice, insurance • Providers • Public • Private (…for profit) • Voluntary (…non-profit) • Type of approach

  8. approaches • Approaches • Allopathic/ conventional/ ‘modern’ /western • Complementary, Alternative and biosocial • ‘traditional’ / indigenous • Western alternatives – osteopathic, homeopathic, chiropractic, etc • Eastern alternatives – Chinese, Ayurvedic, etc • Influence of latest donor concern / trend / fad … e.g… • Decentralization and community decision making • Monitoring and Evaluation • Integration

  9. Some East African Institutions

  10. Issues from articles • Surgical work force • Attrition of work force • Cost of migration • Central control and standards (including safety) • Local knowledge of local needs • Role of local politics and patronage • Technocrats versus politicians • Complex mix of agencies involved in hiring (Tanzania)

  11. Issues from articles • Administrative theory • You stand where you sit… • Recruitment and socialization within organization • Organizational goals (health care philosophy) • Efficiency, effectiveness, equity • Accountability, Standards • Decentralization • Deconcentration • Delegation • Devolution • Privatization

  12. Influence of Politics…

  13. Health care systems – Big Business • USAID funded Health Systems 20/20 • Health Systems 20/20 (2006-2012), funded by the United States Agency for International Development, is the Bureau of Global Health’s principal project for health system strengthening. • http://www.healthsystems2020.org/ • Useful collection of resources… sample • CSIS Global Health Policy Center • The Global Health Policy Center is a leading policy research institution focused on building bipartisan awareness about global health and its importance to U.S. national security.Including the Forum on Advancing U.S. Leadership in Global Health • http://www.smartglobalhealth.org/

  14. Health care systems – Big Networks.. • Global Health Europe • promotes synergy between the policy spheres of public health, foreign policy, development, and research for health. Not-for-profit, non-partisan platform and think tank. • http://www.globalhealtheurope.org/ • Global Health Security Initiative (GHSI) • informal, international partnership among like-minded countries to strengthen health preparedness and response globally to threats of biological, chemical, radio-nuclear terrorism (CBRN) and pandemic influenza. • http://www.ghsi.ca

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