Global Health Business: The Production and Performativity of Statistics in Sierra Leone and Germany

Abstract

The global push for health statistics and electronic digital health information systems is about more than tracking health incidence and prevalence. It is also experienced on the ground as means to develop and maintain particular norms of health business, knowledge, and decision- and profit-making that are not innocent. Statistics make possible audit and accountability logics that undergird the management of health at a distance and that are increasingly necessary to the business of health. Health statistics are inextricable from their social milieus, yet as business artifacts they operate as if they are freely formed, objectively originated, and accurate. This article explicates health statistics as cultural forms and shows how they have been produced and performed in two very different countries: Sierra Leone and Germany. In both familiar and surprising ways, this article shows how statistics and their pursuit organize and discipline human behavior, constitute subject positions, and reify existing relations of power.

Alternative accounting in maternal and infant global health

“…Getting 'good numbers' -by which we mean numbers of a certain scale -can be nearly impossible and require significant resource commitments. Thus, critics of the RCT model (Deaton, 2010;Lambert, 2006;Timmermans & Berg, 2003;Weisz, 2005) shed light on how, as the demand for RCT forms of evidence proliferates, problems of not only manpower but also reliability also emerge (Biruk, 2012;Craig, 2012;Erikson, 2012;Wendland, in press). Still, many NGOs are now faced with the prospect of being seen as lacking an evidence base for what they do even while they are doing what most would consider exceptional and effective global health work under difficult circumstances.…”

“…We also note that RCTs are useful for large institutions working across many different regions because they provide a rubric for systematic comparison. However, we note that statistical neutrality and standardisation for comparison can create a kind of blindness about what is actually possible in diverse regions, what sorts of health care delivery compromises might be involved in getting good numbers, and the downsides to doing all health care as 'research' (Adams, 2013;Crane, 2013;Erikson, 2012).…”

“…This has changed the scope and meaning of doing health development, altering how time is spent in small NGOs from the boardroom to the rural clinic (Becker et al, 2013;Biehl & Petryna, 2013;Erikson, 2012), and yet how evidence-based health care gets done through small NGOs in complex and uneven ways is not yet well documented.…”

“…This shift to Global Health has also entailed an increased commitment to using evidence-based metricsfrom Disability-Adjusted Life Years (DALYs) to randomised controlled trials (RCTs) -for designing interventions and measuring outcomes (Duflo, 2010). The transition towards metrics, NGOs and humanitarian platforms places new demands on global health workers (Adams, 2013;Biruk, 2012;Crane, 2013;Erikson, 2012;Lorway & Khan, 2014), calling for new forms of accountability (Chang et al, 2010;Gates, 2013) and challenging coordination among nations which routinely receive global health aid, even while encouraging building capacity for effective small-scale health interventions.…”

NGOs, partnerships, and public-private discontent in Nepal’s health care sector

“…Performance-based frameworks are typically built around output-based indicators (such as counting the number of patients on antiretroviral therapy, or the number of such drugs dispensed), as opposed to summary or quality measures that might describe the workings of a system of longitudinal care or set of interventions (such as the percentage of people living with HIV enrolled in a community health follow-up program whose CD4 count has increased from baseline). Critical medical anthropologists have made important interventions here, unsettling the taken-for-granted assumptions about what it means 'to do global health through metrics' (Adams 2016;Erikson 2012;Rottenberg et al 2015;Wendland 2016b). …”