Changes once again...

After thinking through the papers I've read on communities, resilience, and systems, I've decided, once again, to change my paper topic.  I think it would be a valuable exercise to identify real health problems of a country or region and use the ideas of community, resilience, and systems to guide research about possible solutions.  I thought it would be best to switch focus from sub-Saharan Africa to Nicaragua, because my prior knowledge and experience there can better guide the research.

Here are my new objectives for the paper:

• Identify key health problems in Nicaragua
• Child mortality, maternal mortality, malnutrition, etc.
• Focus on Atlantic region- consistently shows poorer health based on indicators
• Explore the underlying causes
• ethnic divide between Atlantic coast and Central/Pacific
• Less densely populated
• Political history
• Infrastructure
• loss of indigenous health knowledge
• Examine innovative ways health problems have been addressed
• community based approach
• Food security
• Millennium development villages
• lentils for immunizations in India
• Community health workers
• Suggest possible policy solutions for the health issues in Nicaragua

The research will be guided by the ideas of resilience, community, and systems, so the literature review and background readings will serve the same purpose as in my last proposal.

It may seem late to change my topic now, but I already feel like I have a better grasp on this.  I originally picked an area of the world I'm not as familiar with, but decided my paper could go more in depth if I focus on an area I'm more familiar with.  I'm working on updated my abstract/literature review to reflect this change and have some background research done on Nicaragua's health status.

Missing Health Knowledge

Here is an updated abstract and outline for my paper.  I've switched focus a bit to focus more on health knowledge- collective knowledge- rather than just health professionals.

Abstract:

Health knowledge is a key element in ensuring that communities are resilient- meaning they have the ability to bounce back from a shock or perturbation.  Lack of health knowledge, both indigenous and western, in sub-Saharan Africa severely undermines the ability of African communities to respond to everyday health care needs, as well as during crisis.  This paper will examine health systems in sub-Saharan Africa to understand the underlying causes of the missing health, its cost, and explore innovative solutions to this issue.

Research Questions: 

How have health systems in sub-Saharan Africa evolved?  How can the issue of missing health knowledge be addressed?

Outline:

Introduction

·         Sustainable development needs to build resilience

·         Focus on health as important for ensuring resilience

·         Health knowledge as important factor

·         Lack of health knowledge and expertise undermines a community’s/nation’s ability to react to everyday health needs of a community as well as health needs during a crisis

Health Systems

·         History

·         How have health systems evolved?

Missing Health Knowledge

·         Indigenous vs. western

·         WHO recommendations for doctor-patient ratio

o   Loss of $ for developing countries

o   Lack of health care professionals

§  Poor health

§  Low resilience to health shocks at a household, community, and national level

§  Lack of health knowledge

·         What can be done?

o   Case studies of innovative interventions

o   Required in-country service

o   Local health training- community health workers, especially in rural areas

Resilience in EU Aid Programs

The EU has released a proposal, “EU Approach to Resilience: Learning from FoodSecurity Crises,” to integrate resilience more deeply in their development and humanitarian aid programs.  The proposal included four principles to guide EU in embedding resilience in their programs: align EU support with recipient country priorities, support the development of national resilience strategies, boost the flexibility of EU aid programs, and elevate resilience in the list of aid priorities in countries facing recurrent crises.  Although it is important to prioritize resilience in countries facing recurrent crises it is important to evaluate the national resilience strategies and recipient country priorities before jumping on board assuming they build resilience.

The proposal stresses that “building resilience is a long-term effort that needs to be firmly embedded in national policies and planning” and that sustainable development needs to focus on the root causes of crises rather than the results of crises.  This makes Food Security, Climate Change Adaptation, and Disaster Risk Reduction priority programs for strengthening resilience. 

The proposal defines resilience as “the ability of an individual, a household, a community, a country or a region to withstand, to adapt, and to quickly recover from stresses and shocks.”  The EU is building on their experience in addressing crises in the Horn of Africa and the Sahel.  The EU also stresses the need to incorporate women in building resilience in households and communities affected by crises.

Resilience and Brain Drain in Sub-Saharan Africa

This is my working abstract/outline for my research paper...

Abstract: There has been a recent emphasis in the development aid community towards building resilience, meaning increasing a community’s ability to bounce back from external shocks.  Health knowledge is a key element in ensuring resilience at a household, community, and national level.  The human capital flight (brain drain) of health care professionals in sub-Saharan Africa severely undermines the ability of African communities to respond to everyday health care needs, as well as during crisis, at a local and national level.  This paper will examine the underlying causes of brain drain, its cost (social and economic) to Africans, and what can be done at a local, national, and international level to discourage brain drain and to mitigate the negative effects of brain drain.

Research Questions:  How does the human capital flight (brain drain) of health care professionals in Africa affect the ability of Africans to respond to health problems at a local and national level? What steps can national and international actors take to mitigate the brain drain problem?

Outline:

Introduction

·         Sustainable development needs to build resilience

·         Focus on health as important for ensuring resilience

·         Health knowledge as important factor

·         Lack of health knowledge and expertise undermines a community’s/nation’s ability to react to everyday health needs of a community as well as health needs during a crisis

Brain Drain in Africa

·         Why does it happen?

o   Health care professionals seeking better wages, working conditions

o   Demand in developing countries

o   Training needed abroad

·         Why is this a problem?

o   WHO recommendations for doctor-patient ratio

o   Loss of $ for developing countries

o   Lack of health care professionals

§  Poor health

§  Low resilience to health shocks at a household, community, and national level

§  Lack of health knowledge

·         What can be done?

o   Increase wages/working conditions

o   Required in-country service

o   More & improved in-country training

o   Temporary visas

o   Training exchange

o   Local health training- community health workers, especially in rural areas