InternationalNGOsandprimaryhealthcareinMozambique.pdfVIP

Social Science Medicine 56 (2003) 725–738 International NGOs and primary healt hcare in Mozambique: the need for a new model of collaboration James Pfeiffer* Department of Anthropology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106 7125, USA Abstract In keeping wit hthe neo-liberal emphasis on privatization, international aid has been increasingly channeled throug non-governmental organizations (NGOs) and their expatriate technical experts to support primary healt hcare (PHC) in the developing world. Relationships between international aid workers and their local counterparts have thus become critical aspects of PHC and its effectiveness. However, these important social dynamics of PHC remain understudied by social scientists. Based on three years of participant-observation in Mozambique, this paper presents an ethnographic case study of these relationships in one central province. The Mozambique experience reveals that the deluge of NGOs and their expatriate workers over the last decade has fragmented the local healt hsystem, undermined local control of healt hprograms, and contributed to growing local social inequality. Since national healt hsystem salaries plummeted over the same period as a result of structural adjustment, healt hworkers became vulnerable to financial favors offered by NGOs seeking to promote their projects in turf struggles wit hother agencies. It is argued that new aid management strategies, while necessary, will not be sufficient to remedy the fragmentation of the healt hsector. A new model for collaboration between expatriate aid workers and their local counterparts in the developing world is urgently needed that centers o