1. East Africa

2. 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. Historical legacies Environment Local, social, cultural Political landscape Regional and International connections

4. Historical legacies Missionaries Colonialism Doctors 2 nd 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. 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)Yaws Mengo University ….Makerere University Mulago Medical School – clinical emphasis, est. 1927

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

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

8. 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

11. 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)

12. 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

14. 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… samplesample 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/

15. 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