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International NGOs and primary health care in Mozambique: the need for a new model of collaboration


  • Pfeiffer, James


In keeping with the neo-liberal emphasis on privatization, international aid has been increasingly channeled through non-governmental organizations (NGOs) and their expatriate technical experts to support primary health care (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 health system, undermined local control of health programs, and contributed to growing local social inequality. Since national health system salaries plummeted over the same period as a result of structural adjustment, health workers became vulnerable to financial favors offered by NGOs seeking to promote their projects in turf struggles with other agencies. It is argued that new aid management strategies, while necessary, will not be sufficient to remedy the fragmentation of the health sector. A new model for collaboration between expatriate aid workers and their local counterparts in the developing world is urgently needed that centers on the building of long-term equitable professional relationships in a sustainable adequately funded public sector. The case study presented here illustrates how the NGO model undermines the establishment of these relationships that are so vital to successful development assistance.

Suggested Citation

  • Pfeiffer, James, 2003. "International NGOs and primary health care in Mozambique: the need for a new model of collaboration," Social Science & Medicine, Elsevier, vol. 56(4), pages 725-738, February.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:4:p:725-738

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    Cited by:

    1. World Bank, 2006. "Timor-Leste Health Sector Review : Appendices," World Bank Other Operational Studies 14898, The World Bank.
    2. Silvia Amaral & Tomaz Dentinho, 2005. "The development of the Huambo Province in Angola - The application of a spatial interaction model to simulate the movement from autarky to external integration," ERSA conference papers ersa05p252, European Regional Science Association.
    3. World Bank, 2006. "Timor-Leste Health Sector Review : Meeting Challenges and Improving Health Outcomes," World Bank Other Operational Studies 14897, The World Bank.
    4. Bridget O'Laughlin & Bridget O'Laughlin, 2016. "Forum 2016," Development and Change, International Institute of Social Studies, vol. 47(4), pages 686-711, July.
    5. Hoey, Lesli, 2017. "Reclaiming the Authority to Plan: How the Legacy of Structural Adjustment Affected Bolivia’s Effort to Recentralize Nutrition Planning," World Development, Elsevier, vol. 91(C), pages 100-112.
    6. Iram A. Khan, 2010. "Public sector institutions, politics and outsourcing: Reforming the provision of primary healthcare in Punjab, Pakistan," Journal of International Development, John Wiley & Sons, Ltd., vol. 22(4), pages 424-440.
    7. Ridde, Valéry, 2008. ""The problem of the worst-off is dealt with after all other issues": The equity and health policy implementation gap in Burkina Faso," Social Science & Medicine, Elsevier, vol. 66(6), pages 1368-1378, March.
    8. Bertone, Maria Paola & Witter, Sophie, 2015. "An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone," Social Science & Medicine, Elsevier, vol. 141(C), pages 56-63.
    9. Maes, Kenneth & Kalofonos, Ippolytos, 2013. "Becoming and remaining community health workers: Perspectives from Ethiopia and Mozambique," Social Science & Medicine, Elsevier, vol. 87(C), pages 52-59.
    10. Lettieri, Emanuele & Bartoli, Laura & Masella, Cristina, 2013. "Coordinating intra-sector services in healthcare: Requirements and elements that managers should take into account," European Management Journal, Elsevier, vol. 31(6), pages 591-601.
    11. Jennings, Michael, 2015. "The precariousness of the franchise state: Voluntary sector health services and international NGOs in Tanzania, 1960s – mid-1980s," Social Science & Medicine, Elsevier, vol. 141(C), pages 1-8.
    12. Doyle, Cathal & Patel, Preeti, 2008. "Civil society organisations and global health initiatives: Problems of legitimacy," Social Science & Medicine, Elsevier, vol. 66(9), pages 1928-1938, May.
    13. repec:eee:socmed:v:187:y:2017:i:c:p:287-295 is not listed on IDEAS
    14. World Bank, 2005. "Health Service Delivery and Utilization in Timor-Leste : A Qualitative Study," World Bank Other Operational Studies 12461, The World Bank.
    15. Druetz, Thomas & Kadio, Kadidiatou & Haddad, Slim & Kouanda, Seni & Ridde, Valéry, 2015. "Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso," Social Science & Medicine, Elsevier, vol. 124(C), pages 232-240.
    16. repec:eee:socmed:v:187:y:2017:i:c:p:208-216 is not listed on IDEAS
    17. Sundewall, Jesper & Jönsson, Kristina & Cheelo, Caesar & Tomson, Göran, 2010. "Stakeholder perceptions of aid coordination implementation in the Zambian health sector," Health Policy, Elsevier, vol. 95(2-3), pages 122-128, May.
    18. World Bank, 2005. "Health Service Delivery and Utilization in Timor-Leste : A Qualitative Study," World Bank Other Operational Studies 8257, The World Bank.
    19. repec:eee:socmed:v:187:y:2017:i:c:p:296-305 is not listed on IDEAS


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