The workshop “Continuity of Care in Health” took place on April 3rd, 2025, at Hotel La Ensenada in Necoclí, a coastal town in the Gulf of Urabá, Colombia. Although Necoclí has been a major transit hub for migrants in recent years, local migratory peak has passed. At the same time, commitment to and funding for a humanitarian presence in Latin America and globally have shrunk. Necoclí is therefore witnessing a shift in its health landscape. Most of the International humanitarian organizations that previously supported migrant populations and local health services are no longer present. The organizations which primarily focused on migrant care worked in collaboration with local health providers to address the broader challenges posed by the increased demand and strained resources.
With the departure of these international humanitarian actors, mainly due to USAID cuts or interventions in other crises, local health systems are left to pick up the pieces and continue providing care to both permanent residents and any remaining or transient migrants. However, this transition is not without its difficulties. While local medical professionals were involved in delivering health services during the humanitarian response, the infrastructure and resources required to sustain these services independently are now under significant strain. The departure of international support has left gaps in coordination, health data management, and the material side of continuity of care, as many of the temporary systems put in place during the peak of migration are no longer viable.
The workshop was organized with the support of the Secretariat of Health and the Mesa de Salúd of Necoclí. It thus brought together health sector stakeholders to reflect on the current state of continuity of care in Necoclí, exploring how local providers can sustain and improve services as international humanitarian organizations are leaving. A key focus was the role of technology in bridging the gaps created by the exit of international humanitarians, particularly in terms of improving coordination among local health providers, enhancing health data management, and enabling more consistent care for both local populations and smaller groups of migrants. Discussions centred on how innovative technologies could support a more integrated health system in a context marked by limited resources and evolving needs.
Exploring Futures in Necoclí:
Reflections from a Foresight Exercise
The first part of the workshop was dedicated to a foresight exercise that explored possible trajectories for the continuity of care in the Necoclí region. Together, we asked: under what circumstances might the health sector need to operate in the future(s)? Drawing inspiration from horizon scanning tools, this process encouraged participants to reflect in a situated way, allowing us to consider the social, technological, environmental, and economic forces shaping the continuity of care in the region of Necoclí.
The exercise surfaced ongoing trends that included the persistent unpredictability surrounding international aid and a growing reliance on short-term, unstable contracts for healthcare professionals. Participants noted the ongoing shortage of specialized medical staff, a challenge compounded by the rising number of migrants returning to the region, which could place significant pressure on an already overstretched system.
Amid these trends, uncertainties emerged as another critical dimension of the discussion. Participants questioned whether advanced technologies could be effectively deployed in rural areas where health service coverage remains insufficient. The development and adoption of new biotechnologies were highlighted as both a source of hope and a matter of concern, given their uncertain relevance in Necoclí. The conversation also brought attention to tipping points — those pivotal moments or decisions likely to cause profound changes. Among these were the risks posed by large-scale natural disasters and the potential impacts of new diseases, including pandemics, on the healthcare infrastructure.
This exercise not only shed light on the region’s health sector but also prompted critical reflection within our team about how to approach future-oriented discussions with diverse stakeholders. Conversations about the future often reflect a particular culture of anticipation — one shaped by Western paradigms and assumptions. This raises an important question: how can we adapt our tools and language to engage meaningfully across different cultural and situational understandings of the future?
While decision-makers and policymakers are accustomed to considering medium- and long-term uncertainties, the capacity for future-oriented thinking can be significantly constrained for populations facing recurring violence or socioeconomic precarity. Projecting into the future can be an awkward exercise if the language and process to speak about it are not appropriate. This disparity in the ability to engage in foresight underscores that anticipation is not universal but rather deeply situated, shaped by the power relations and structural conditions that define different lived realities. As we continue to co-design interventions, we aim to remain attentive to these dynamics, recognizing that the capacity for future-oriented thinking is unevenly distributed and that we need to build processes that are equitable and meaningful.
A User-Centered Design Exercise
The second half of the workshop was focused on using user-centered design exercises to think more deeply about the needs of the various “users” in the healthcare space in Necoclí. Participants broke into groups to identify the stakeholders in the healthcare space in Necoclí (e.g. different patient profiles, doctors, nurses, etc). After doing some stakeholder mapping, participants voted and chose to focus the exercise on three profiles: a doctor, a pregnant woman living in a rural area, and a Haitian migrant with diabetes. These three profiles were used to think about their journey in the healthcare system and where there are challenges that could potentially be addressed through technology.
The exercise provided a few key insights into some specific challenges in the healthcare system. First, with the influx of migrants, particularly those returning to and staying in Necoclí, language is a challenge in serving the needs of migrants who don’t speak Spanish. Additionally, since Colombia in general has a large population of displaced people and in particular since Necoclí has seen large numbers of migrants coming and going over the last few years, having good medical records is difficult and inhibits medical professionals from properly providing care to patients. On the flip side, providing a good system is extremely challenging considering the context of migrants being concerned about sharing their identity and data privacy. Finally, because the hospital in Necoclí serves a large area, reaching rural patients is challenging due to the long travel required for patients in these areas, the resistance to medical care in some communities, the shortage of medical staff/medication for mobile health and more. The second half of the workshop initiated a deeper discussion about concrete challenges that might be addressed by technological interventions.
Towards a Tool for the Planning, Use, and Afterlife of Humanitarian Technologies
The local workshop facilitator opened the concluding session by asking those present if the results of the workshop reflected their interests and priorities. The participants confirmed their interest in exploring futures, reflecting on users and especially in continuing collective work. The discussion quickly turned towards the specific “humanitarian technologies” introduced by the EssentialTech’s work. One doctor expressed interest in the cervical cancer app, saying, “I would love to have that app. Is it possible to get it somewhere?” Another participant from the Alcaldía (the mayor’s office), continued along the same lines, and pointed out that she would be greatly interested in technologies that could ensure smoother communications with the international humanitarians. There was an enthusiasm in the room about the kinds of technologies EssentialTech is involved in developing and a curiosity to learn more about them as well as to know if these technologies might somehow be accessible to the local healthcare system.
Building on this central workshop conclusion, the team working on the continuity of care discussed the potential of developing a tool that provided the kind of information and insights that the participants were so eager about. More ambitiously, the tool might afford an active role for locals who offer humanitarian support. If they gave input on the choices of what kind of humanitarian technologies are brought, how they are used and which technologies are left when the international organizations leave, humanitarian technologies would be more sustainable. They would likely be used more extensively, and therefore possibly easier to fund and maintain. Such a tool would draw attention to the wide range of excellent, existing, humanitarian technologies rather than introduce yet another invention that would be tested, patented, and then disappear. It would be a tool making existing humanitarian technologies contribute to sustainable local care. In that sense, the tool could confront some of the persistent tensions in humanitarian action — the disconnect between emergency operations and long-term care. Such a re-tooling tool re-purposing existing humanitarian technologies seemed particularly timely, given the withdrawal of international organizations from Necoclí and other regions globally.
The Necoclí workshop concluded by highlighting the interest in and potentials of a tool connecting local and international humanitarians to the planning, use, and afterlives of humanitarian technologies.
