In the shadowlands of global health: Observations from health workers in Kenya

Prince, Ruth J.; Otieno, Phelgona

doi:10.1080/17441692.2014.941897

Cited by 19 publications

(23 citation statements)

References 44 publications

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“…). The findings show how neoliberal structuring of global health creates a bifurcated healthcare system on the ground, where priority conditions like HIV function separately from the rest of the health sector (Prince and Otieno , Sullivan ). In this case, NGO and state providers in the same clinic worked under very different conditions.…”

Section: Resultsmentioning

confidence: 94%

“…Whereas 'horizontal' approaches, where funding would support national healthcare systems, are deemed financially unsustainable and thus often left to the side (Ooms et al 2008). The findings show how neoliberal structuring of global health creates a bifurcated healthcare system on the ground, where priority conditions like HIV function separately from the rest of the health sector (Prince andOtieno 2014, Sullivan 2011). In this case, NGO and state providers in the same clinic worked under very different conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, rather than a package of care delivered through national healthcare systems, there are separate state and non‐state systems for providing health services to different populations (Meinert et al . , Pfeiffer , Prince and Otieno , Sullivan , Wendland ).…”

Section: From Therapeutic Citizenship To Clientship Of Global Healthmentioning

confidence: 99%

“…women, children and orphans), and they fund international NGOs to design and implement programmes (Swidler and Watkins 2017). Thus, rather than a package of care delivered through national healthcare systems, there are separate state and non-state systems for providing health services to different populations (Meinert et al 2009, Pfeiffer 2013, Prince and Otieno 2014, Sullivan 2011, Wendland 2012.…”

Section: From Therapeutic Citizenship To Clientship Of Global Healthmentioning

confidence: 99%

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Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics

Zhou

2019

Sociology Health & Illness

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This article examines how HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and interviews with providers (N = 37). I argue that neoliberal ideology, which structures the global health field, produces a fragmented healthcare system on the ground. Findings show two kinds of healthcare practices within the same clinic: donor‐funded NGOs took on HIV services while government providers focused on prenatal care. NGO practices were defined by surveillance, where providers targeted pregnant HIV‐positive women and intensively monitored their adherence to drug treatment. In contrast, state‐led practices were defined by rationing. Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. This paper builds on concepts of therapeutic citizenship and clientship by exploring how global health priorities produce different conditions, practices and outcomes of NGO and state‐led care.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: From Therapeutic Citizenship To Clientship Of Global Healthmentioning

confidence: 99%

Section: From Therapeutic Citizenship To Clientship Of Global Healthmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics

Zhou

2019

Sociology Health & Illness

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“…Furthermore, training workshops might lure health personnel away from their regular duties. However, few studies describe the experiences of public sector health workers in navigating under-resourced, fragmented landscapes created by 'vertical' or disease specific global initiatives and aid fragmentation and how this climate influences patient care (Livingston 2012;Mussa et al 2013;Prince and Otieno 2014). My thesis contributes to filling this gap in the literature.…”

Section: The Co-production Of Policymentioning

confidence: 99%

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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The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Marten

2022

Global Maternal and Child Health

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Strengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

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In the shadowlands of global health: Observations from health workers in Kenya

Cited by 19 publications

References 44 publications

Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics

Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics

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

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

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