Austerity and the “sector-wide approach” to health: The Mozambique experience

Pfeiffer, James; Gimbel, Sarah; Chilundo, Baltazar; Gloyd, Stephen; Chapman, Rachel R.; Sherr, Kenneth

doi:10.1016/j.socscimed.2017.05.008

Cited by 19 publications

(26 citation statements)

References 21 publications

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“…As a condition for receiving loans, the IMF and World Bank required governments to cut public spending, which in effect meant outsourcing many public services to the for-profit and non-profit private sector. Much aid was provided off-budget and was project based -meaning it was outside the Ministry of Health's budget and planning, as opposed to involving on-budget long-term strengthening of health systems (Pfeiffer et al 2017;Sridhar 2010) and education systems (Riddell and Niño-Zarazúa 2016). Many international donors perceived NGOs as having a comparative advantage over cumbersome states because of their assumed reliability, efficiency, and transparency (Edwards and Hulme 1996).…”

Section: From Representing the Grassroots To Service Provisionmentioning

confidence: 99%

“…Although global health initiatives improved disease-specific health services, critics argue they also contributed to overall weakening of public services (Birn 2009). As Pfeiffer et al (2017) show for Mozambique, the persistence of several donorsthe Global Fund, U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and GAVIin funding vertical or off-budget initiatives has weakened the SWAp in favour of NGO implementation and continues to undermine the health-system. Furthermore, Structural Adjustment Programmes have been replaced by Poverty Reduction Strategies, which continue to limit government spending on public services and the ability of the state to coordinate donors and NGOs, and will hinder the achievement of the third Sustainable Development Goalthat of attaining Universal Health Coverage (Pfeiffer et al 2017).…”

Section: From Service Provision To Ngos' Role In Policy Developmentmentioning

confidence: 99%

“…As Pfeiffer et al (2017) show for Mozambique, the persistence of several donorsthe Global Fund, U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and GAVIin funding vertical or off-budget initiatives has weakened the SWAp in favour of NGO implementation and continues to undermine the health-system. Furthermore, Structural Adjustment Programmes have been replaced by Poverty Reduction Strategies, which continue to limit government spending on public services and the ability of the state to coordinate donors and NGOs, and will hinder the achievement of the third Sustainable Development Goalthat of attaining Universal Health Coverage (Pfeiffer et al 2017). Furthermore, Bierschenk (2014a) argues that with this changing role of NGOs in the direction of policy advocacy, local implementers of donor-funded NGO projects have increasingly become 'norm entrepreneurs', aiming to modify the conduct of beneficiaries according to 'global norms'with regard, for example, to women's rights or education (Fichtner 2012;Merry 2006).…”

Section: From Service Provision To Ngos' Role In Policy Developmentmentioning

confidence: 99%

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Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector

Pot

2018

Forum for Development Studies

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International non-governmental organisations (INGOs) play an increasingly prominent and multifaceted role in the field of global healthas policy advocates, recipients of donor funds, and implementers of donor-funded programmes. Many such NGOs and their local affiliates have become highly professionalized and oriented towards the priorities of global-level actors, with potential negative consequences for their ability to represent the grassroots and to challenge structures of power and inequality. In this thesis, I examine the dynamics around INGO project implementation in Malawi, within the broader context of overlapping development initiatives, shifting priorities, conditions of scarcity and donor dependence, and poor health outcomes. I draw on ethnographic research conducted in rural Malawi between May 2015 and August 2016, which focused on the implementation of a Save the Children project that aimed to improve maternal health by reducing teenage pregnancies, primarily by keeping girls in school and increasing their use of reproductive health services, notably contraceptives. My ethnographic gaze is on the individuals who serve as intermediaries between donors, northern (I)NGOs and local recipients, who I conceptualise as brokers. They include INGO district staff, primary school teachers, health workers, village heads, and community representatives. Through a focus on their practices, I examine how they translate global norms and aims into programmatic practice. The thesis brings together three peerreviewed articles. The first (in Forum for Development Studies) discusses how primary school teachers deal with, and implement, various overlapping NGO initiatives targeting girls, and the implications for public sector institutions. The second article (in Medical Anthropology) examines how INGOs' programmatic focus on behaviour change interventions inadvertently results in staff blaming culture for teenage pregnancies and school dropout, reinforcing ethnic stereotypes originating in historical inequalities and previous health development initiatives which targeted harmful cultural practices. The third article (in Reproductive Health Matters) analyses the responses of village heads, midwives and women to the reintroduction of userfees for maternal health services resulting from donors' suspension of budget support, shifting national priorities, and unstable service delivery contracts. Overall, I argue that examining the practices of the brokers who implement and reshape health development initiatives can shed light on policy-to-practice gaps and how unintended consequences occur. My ethnographic research thus helps to explain why initiatives might not be sustainable despite the intention of donors and INGOs to strengthen existing public and community structures. 1 This research is led by Professor Sidsel Roalkvam, Co-Investigator Katerini Storeng, and senior researchers at the University of Malawi-Professor Blessings Chinsinga, Peter Mvula and Joseph Chunga. Fieldwork in Malawi has been carried out by three Universit...

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Section: From Representing the Grassroots To Service Provisionmentioning

confidence: 99%

Section: From Service Provision To Ngos' Role In Policy Developmentmentioning

confidence: 99%

Section: From Service Provision To Ngos' Role In Policy Developmentmentioning

confidence: 99%

See 1 more Smart Citation

Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector

Pot

2018

Forum for Development Studies

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“…Narrowly targeted global health funding in the early 2000s went disproportionately to projects focusing on services for HIV/AIDS, malaria, and reproductive and child health, neglecting the wider needs of health systems at a time when austerity was undermining government efforts to strengthen those systems (Pfeiffer et al . 2017). However, from 2003 to 2010, Kiunga staff managed to draw a small but not insignificant amount of outside attention to other institutional needs.…”

Section: Introductionmentioning

confidence: 99%

“…Homegrown PPPs are thus a means by which health-sector staff actively pursue uncertain becoming (Biehl and Locke 2017) beyond the restrictive frames of national budgets, donor-sponsored initiatives (Pfeiffer et al . 2017) or global PPPs (Storeng and Béhague 2016).…”

Section: Introductionmentioning

confidence: 99%

‘Like a real hospital’: imagining hospital futures through homegrown public–private partnerships in Tanzania

Sullivan¹

2020

Africa

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This article traces a shift in how hospital workers at a Tanzanian public hospital thought about their workplace. In 2010, for the first time, staff began collectively imagining what they called ‘a real hospital’. This collective dreaming of institutional possibilities emerged due to two transformations: a shift in Tanzanian government policies enabling government institutions to initiate their own ‘public–private partnerships’ (PPPs) with non-state ‘partners’ such as NGOs, private businesses, investors, missionary organizations and others; and the hospital's early successes in attracting (a few) partners. Unlike familiar global PPPs such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Tanzania's PPP policy allowed health facilities to initiate their own partnerships in order to improve public services. Drawing on longitudinal ethnographic research in one government hospital, this article traces successful, failed and fraught partnership initiatives through which public-sector health workers tried to improve hospital infrastructure and capacity. In tracing institutional aspirations and local workers’ efforts to achieve them through homegrown PPPs, this article highlights the contingency and malleability of public and private spheres operating within public health service provision in Tanzania, as well as the opportunities available to health workers and the constraints involved in attempting to improve hospital care.

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Sustainable Development Goal Integration, Interdependence, and Implementation: the Environment–Economic–Health Nexus and Universal Health Coverage

Cerf

2019

Global Challenges

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The sustainable development goals (SDGs) are interdependent and integrated. The SDGs aim to impact all levels of society, reach across all sectors, embrace equity, inclusion, and universality, and operate in an ecosystem. SDG 3 strives to improve health outcomes by reducing mortality, ending epidemics, preventing diseases, and implementing universal health coverage (UHC) for accessible, affordable, quality, and equitable healthcare. The available infrastructure (environment) should be supportive and sustained by a stable, growing economy (economy) to ensure the timely and reliable delivery of quality healthcare (health). A general framework is presented for the implementation of the SDGs with a focus on SDG 3 and one of its targets, UHC. The robustly aligned environment–economic–health nexus is a key determinant for the successful implementation of UHC (and the SDGs). SDG implementation presents multiple convoluted challenges at national, regional, continental, and global levels but will ultimately yield rewards. To advance UHC, a global effort is required where timely information is shared and nations partner to achieve this important global health target. Especially in low‐ and middle‐income countries (LMICs), the learning and sharing of experiences and knowledge are essential throughout the course of implementation. This will ensure that no nation is left behind.

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Austerity and the “sector-wide approach” to health: The Mozambique experience

Cited by 19 publications

References 21 publications

Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector

Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector

‘Like a real hospital’: imagining hospital futures through homegrown public–private partnerships in Tanzania

Sustainable Development Goal Integration, Interdependence, and Implementation: the Environment–Economic–Health Nexus and Universal Health Coverage

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