Setting: A camp for internally displaced persons (IDPs) in the Horn of Africa

Scenario: Prior to unrolling a mass vaccination campaign, the expatriate staff of an international medical NGO conduct a survey of camp residents to assess the need for vaccination. The staff collaborate with representatives of the host country’s Ministry of Health to hire ten camp residents as community health workers (CHWs) who will conduct the survey. A contract is agreed upon by all parties that sees the CHWs paid a salary which is slightly more generous than local wages and roughly corresponds with the cost of living of the local economy. The survey is successfully completed.

Meanwhile, a number of other international aid agencies have set up operations in the camp and begin hiring local workers at several times the rate of local wages. Several concerns are voiced by individuals within the camp.  First, it is reported that most of these higher-paying jobs are going to members of several influential and well-connected families. It is also suggested that these higher wages are enhancing disparities, and pushing up the cost of living for all camp residents. Finally, the CHWs hired for the vaccination survey now complain they were unfairly remunerated for their work and insist on being compensated for the difference in salaries.

Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT  is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions.  The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.

Download PDF and Worksheet

Disclaimer: Case studies in the ENHA (Ethics Narratives in Humanitarian Aid) series are based on the reflections of humanitarian healthcare workers on ethical challenges experienced in the field. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.

While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many humanitarian healthcare workers. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.

How to cite: Humanitarian Healthcare Ethics. 2014. ENHA Case Study Series: Disparities in the Salaries of Local Staff. www.humanitarianhealthethics.net.

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