Paper short abstract:

Ethnography in Malawi reveals complex local realities set aside in pursuit of trachoma elimination. A WHO strategy, ignoring context, draws on rationalities and moral justifications from development goal rhetoric, which prove counterproductive for tackling genuine everyday health concerns in Malawi

Paper long abstract:

The WHO's global elimination policy for trachoma, the leading infectious cause of global blindness, boasts some impressive impact since its outset in 1997. Under the umbrella of the neglected tropical diseases, grandiose global health rhetoric positions the public health strategy for trachoma, 'SAFE' - Surgery, Antibiotics, Facial cleanliness and Environmental improvement - as 'one of the more convincing ways to 'make poverty history', aligning itself the UN's sustainable development goals. However SAFE is implemented with little attention to the social, political, economic, and historical context in which it is delivered. In doing so, assumptions of universal disease experience, discrete, linear pathological processes, and rational human responses are made. In addition, the strategy's more holistic dimensions are often side-lined in pursuit of the alluring elimination targets, themselves negotiated and constructed with little evidence base. Ethnographic work in Malawi at national, regional and local levels with strategy implementers, policymakers, health care workers and a Yao village population, reveals complex local realities which are persistently set aside in pursuit of the elimination goals. Tools, technologies, and metaphors of the strategy do political work which is strategically ignored by the multi-million-pound global elimination assemblage, even when evidence suggests otherwise. Concerns regarding the sustainability of global funding, and national political will, drive a steadfast but false optimism, counterproductive for tackling genuine everyday health concerns in Malawi