Management of expatriate medical assistance in Mozambique
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BioMed Central
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Management of expatriate medical assistance in Mozambique Ferruccio Vio* Address: HIV/AIDS Care & Treatment Team, Health Alliance International, Rua Emília Dausse 17, Maputo, Mozambique Email: Ferruccio Vio* - [email protected] * Corresponding author
Published: 02 December 2006 Human Resources for Health 2006, 4:26
doi:10.1186/1478-4491-4-26
Received: 28 January 2005 Accepted: 02 December 2006
This article is available from: http://www.human-resources-health.com/content/4/1/26 © 2006 Vio; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract 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.
Background Shortly after independence (1975), the mass repatriation of the Portuguese cadres working in the Health System left the MOH with the urgent need of finding specialized medical doctors (MD) for its referral hospitals. In 1972 there were 289 MDs in the country [1]. In 1976, only about 60 MDs had remained [2]. The solution was found thanks to the assistance of the socialist countries, which promptly provided a contingent of mainly Russian and Cuban doctors. The political and economic collapse of the socialist block after 1990 caused a new crisis, threatening to leave hospitals without specialized MDs. After a rather chaotic period, the situation improved in 1996, through the activation of a pool funded by Switzerland, the Netherlands and Norway, which granted salaries for senior specialists, mainly from the former USSR republics, and kept the best of them in place. Under what was called the "pooling agreement", the MOH identified the need for personnel and took care of selection, supervision and assessment, while UNDP administered the contracting
and payment of salaries. Meanwhile, national specialists were slowly increasing in number, but they continued to be insufficient to satisfy the public system needs. Moreover, virtually all of them were working in Maputo. As a way t
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