Environmental Engineering Reference
In-Depth Information
Internal Brain Drain
the global migration of health practitioners from low-income countries to the richer
countries, often referred to as brain drain, is a major issue for developing countries.
However, there is also the problem of internal brain drain, with health practitioners
drawn to projects within the country that offer compensation significantly higher
than the local standard. these positions are often with international agencies, and
global health initiatives function in an advisory capacity for the implementation of a
project. thus health practitioners, typically the best left in the country, will migrate
out of the public health system to participate in the vertical programmes addressing
infectious disease, leaving the quality of the basic health services to deteriorate
further. of course, the global health projects and other vertical programmes must be
properly staffed, but a continual drain on primary healthcare resources in developing
countries left unaddressed is a serious concern.
Short- and Medium-Term Goals
although global health initiatives can provide a sustained effort for resolving
a particular problem, they are not a long-term solution to the healthcare needs of
developing countries. recent studies have looked at whether short-term vertical
programmes can complement basic health services where health infrastructure
is poor. Arguably, they do generate some lasting benefits; however, global health
initiatives perceive and assess the healthcare services of a country in terms of the
capacity to deliver the specific programme and not the overall strategies to address
all public health concerns over an extended period (Forsberg 2001, 29). reaching
set targets for infectious disease rates are of fundamental interest to global health
initiatives. this does not necessarily lead to the provision of services and activities
to increase the overall health of the population. If this is the case, and these projects
come in with significant resources, the wider healthcare systems may potentially
be tilted and unbalanced toward the goals of the global health initiative and not the
longer term needs of the country. the short- or medium-term modes of operation are
understandable. but how the global health initiative integrates best with ensuring a
longer-term whole-health sector strategy must be considered.
Unbalanced Capacity Building
the intention of global health initiatives is to bring together a global effort to resolve
a global problem. However, most of the problem is in the global economic South
and most of the driving force behind these initiatives is based in the global economic
North. This imbalance means that the benefits and even the priority setting may at
times fall closer to those administering the programmes rather than to the recipients.
when vertical programmes are put into place in a country, external health experts
and administrative staff are often brought in, instead of depending on local resources
that may not have the required expertise—but could form a base of lasting capacity
to address other health concerns (Forsberg 2001, 25).
Furthermore, the types of solutions and projects deemed acceptable for the
disbursement of a global health initiative's funds may have a northern bias and
