Blurring ‘social justice’ with ‘market justice’ in recent experiments with healthcare and social protection in the Global South

Abstract

More than three decades after structural adjustment programmes were imposed on governments across the Global South, and amid growing recognition that development has largely failed to address poverty, experiments with expanding forms of welfare and social protection have gathered pace, focusing not only on workers and their families in formal-sector employment but also, in rhetoric at least, on 'all citizens'. Cash transfer programmes, basic income grants, social pensions, and universal health coverage (UHC), have all gained currency in the 21st century. Reconfiguring relations between labour and welfare, these offer 'new visions of social security in a world of precarious work' (Kar, 2017: 12) and a recognition of the state's responsibility (Ferguson, 2015) for those facing a 'wageless life', even while they draw them into financial infrastructures of global capitalism (Nilsen, 2021).A large body of research focuses on cash transfer programmes and their ambitions to alleviate poverty, with heated arguments about their potential to generate new forms of citizenship or merely cement existing inequalities (e.g. Ferguson, 2015;Leisering, 2019;Nilsen, 2021). An arena of social policy generating similar disagreement concerns the expansion of 'universal' social protection in the field of health care. Universal Health Coverage (UHC), defined as 'ensuring that all people can receive the quality health services they need without being exposed to financial hardship' (WHO, 2010), has moved up the policy agenda as arguments for a more comprehensive approach -to invest in public health systems and ensure that the poor are included -have gained currency. Below, I discuss how UHC, like other attempts to introduce a 'thin' form of more universal welfare, remains squarely located within neoliberal social policy. I discuss the policy's focus on expanding health insurance coverage to previously un-insured populations, particularly those who have no formal employment, drawing upon research conducted in Kenya and Tanzania.