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Paper short abstract:

We explore the expanding 'datafication' of health, specifically community health, as enacted by state and non-state actors. We push back against North/South, colonizer/colonized binarisms in favour of a nuanced picture of how new 'data relations' benefit elites politically as well as economically.

Paper long abstract:

International political economy often points to foreign actors’ practices of value extraction in the South, which enrich capitalist elites in the North. Recent literature on ‘data colonialism’ adds weight to this corpus. In this article, we point to less obvious forms of data capitalism and extraction on the part of domestic elites in east Africa, prompting a more expansive understanding of accumulation than profit alone. Drawing on Couldry and Mejias’ notion of ‘data relations’, we examine community health as an unlikely frontier of the datafication of everyday life in Burundi and Kenya, staffed by unsalaried Community Health Workers. While community health is a space inhabited by either state-based (Burundi) or a blend of state and non-profit actors (Kenya), we observe similar, intensifying logics of extraction and commodification. However, we go beyond commercial valuations to explore how data relations engender political capital, as well as enact new forms of social surveillance and control. Given the contentious politics of data extraction within communities, the datafication of healthcare requires forceful, at times oppressive interventions at different levels of the state, which works against community health’s founding ethos. While development authoritarianism is more apparent in Burundi, we explore resonant dynamics in Kenya, whereby state and non-state actors meld managerialism regarding cost effectiveness and performance incentives with authoritarian repertoires of duty, sacrifice and labour. We thus conclude community health to be a particularly insidious site of data relations, subsidized by cheap labour, and is one ripe for future exploitation by a range of vested interests.