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      Training New Doctors in Mozambique. A Sustainable International Aid Health Program

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          Abstract

          The collaborative project between the University of Las Palmas de Gran Canaria and the public University of Mozambique, UniZambeze, aims to strengthen the institutional and training capacities of its Faculty of Medicine located in Tete to provide new medical graduates. The essence of the program, training doctors, has the objective of improving the healthcare system and making it sustainable for the integration of new graduates into the staff of the faculty. In this work, we determine the cost of education for a new doctor and we evaluate the social benefit of the program in terms of the human capital. The program has led to the training of 199 new doctors in the 11 years of operation and is leading the way for 100 more in the next four years. The incorporation of some of them into the faculty’s staff will generate new doctor graduates in the near future with a cost below 6000 EUR each in normal circumstances. These results can help to determine how much traditional international aid healthcare programs can save when investing in the education of new doctors. This program is an alternative policy for the international aid financing budgets of donor countries. Supporting teachers and native doctors in the future with private and public patronage programs can raise the efficiency per EUR spent.

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              Costs and cost-effectiveness of community health workers: evidence from a literature review

              Objective This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems. Methods From a larger systematic review on effectiveness and factors influencing performance of close-to-community providers, complemented by a supplementary search in PubMed, we did an exploratory review of a subset of papers (32 published primary studies and 4 reviews from the period January 2003–July 2015) about the costs and cost-effectiveness of CHWs. Studies were assessed using a data extraction matrix including methodological approach and findings. Results Existing evidence suggests that, compared with standard care, using CHWs in health programmes can be a cost-effective intervention in LMICs, particularly for tuberculosis, but also – although evidence is weaker – in other areas such as reproductive, maternal, newborn and child health (RMNCH) and malaria. Conclusion Notwithstanding important caveats about the heterogeneity of the studies and their methodological limitations, findings reinforce the hypothesis that CHWs may represent, in some settings, a cost-effective approach for the delivery of essential health services. The less conclusive evidence about the cost-effectiveness of CHWs in other areas may reflect that these areas have been evaluated less (and less rigorously) than others, rather than an actual difference in cost-effectiveness in the various service delivery areas or interventions. Methodologically, areas for further development include how to properly assess costs from a societal perspective rather than just through the lens of the cost to government and accounting for non-tangible costs and non-health benefits commonly associated with CHWs.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                02 February 2021
                February 2021
                : 18
                : 3
                : 1355
                Affiliations
                [1 ]Department of Business History and Social Sciences, University of South-Eastern Norway, 3199 Borre, Norway
                [2 ]Department of Applied Economic Analysis, University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; coraima.clavijo101@ 123456alu.ulpgc.es
                [3 ]Department of Quantitative Methods in Economy and Management, University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain; patricia.barber@ 123456ulpgc.es
                [4 ]Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; luismateo.lopez@ 123456ulpgc.es
                Author notes
                Author information
                https://orcid.org/0000-0002-8100-3806
                https://orcid.org/0000-0001-8904-8358
                Article
                ijerph-18-01355
                10.3390/ijerph18031355
                7908321
                33540896
                298b357b-25b2-49bc-8926-61d8c399ac23
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 01 December 2020
                : 27 January 2021
                Categories
                Article

                Public health
                economic evaluation,human capital,cost-effectiveness,healthcare,higher education,jel codes d61, i15, i230, i250, and o12

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