East Africa

• 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

• Historical legacies• Environment• Local, social, cultural

• Political landscape• Regional and International connections

• 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

• 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

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

• Physical – facilities• Institutional mix• Cultural expectations• Legal Framework• Licensing, malpractice, insurance

• Providers• Public• Private (…for profit)• Voluntary (…non-profit)

• Type of approach

• 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

• 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)

• 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

• 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/

• 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