Global Health Initiatives and aid effectiveness: insights from a Ugandan case study
Oliveira Cruz, V.
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Oliveira Cruz, V. & McPake, B. (2011) Global Health Initiatives and aid effectiveness: insights from a Ugandan case study, Globalization and Health, vol. 7, , ,
Background The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government. Methods The study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study. Results The Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms. Conclusion Notwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such effortsIt is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were livingoutside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995.As the global labour market strengthens, it is increasingly highly skilled professionals who aremigrating. Medical practitioners and nurses represent a small proportion of highly skilled workerswho migrate, but the loss of health human resources for developing countries can mean that thecapacity of the health system to deliver health care equitably is compromised. However, data tosupport claims on both the extent and the impact of migration in developing countries is patchyand often anecdotal, based on limited databases with highly inconsistent categories of educationand skills.The aim of this paper is to examine some key issues related to the international migration of healthworkers in order to better understand its impact and to find entry points to developing policyoptions with which migration can be managed.The paper is divided into six sections. In the first, the different types of migration are reviewed.Some global trends are depicted in the second section. Scarcity of data on health worker migrationis one major challenge and this is addressed in section three, which reviews and discusses differentdata sources. The consequences of health worker migration and the financial flows associated withit are presented in section four and five, respectively. To illustrate the main issues addressed in theprevious sections, a case study based mainly on the United Kingdom is presented in section six.This section includes a discussion on policies and ends by addressing the policy options from abroader perspective.