Paper short abstract:

In 2017, the Global Fund Board revised its Eligibility Policy, which sets out criteria for which countries are eligible for financing. This paper considers the role of civil society in high-level policy negotiations over such contested indicators as Gross National Income per capita (GNIpc).

Paper long abstract:

In 2017, the Board of the Global Fund to Fight AIDS, TB and Malaria revised its Eligibility Policy, which sets out the criteria for which countries are eligible for financing. This chapter considers the impact of decisions made using those indicators, and explores debates over use of Gross National Income per capita (GNIpc) to determine aid eligibility. It also shows the role of civil society and community representatives in these high-level policy debates. At a moment of flatlining global health financing, the Global Fund is not the only donor wrestling with these problems of prioritisation; in many countries the Fund is the last remaining external HIV donor to transition out. When some middle-income countries with concentrated epidemics among key populations saw multiple donors divest, programs for stigmatised key populations were at risk. In revising the Fund's Eligibility Policy, the high-stakes contest was focused on a brief document of just a few pages, in which changing a single indicator could have sweeping consequences for countries such as Russia, where the Fund supported civil society advocacy for key populations. This study shows how three civil society delegations worked together to advance a shared position on the policy.

Paper short abstract:

It analyzes the incorporation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) in the Brazilian socio-political context. Specifically, it describes through ethnography, the "assessment of disability" based on the conceptual changes brought about by the CRPD.

Paper long abstract:

In 2006, United Nations (UN) promulgated the Convention on the Rights of Persons with Disabilities (CRPD). It is one of the most progressive declarations of human rights, as it has radically changed the way as disability was viewed by international organizations. One of the transformations was the adoption of a definition of disability that expands the way it was historically used, that is, it change from only on individual and bodily definitions and starts to adopt a social perspective. Brazil ratified the CRPD in 2009 and, since then, it has been adopting strategies to adjust public policies in accordance with international regulations. The central points in the discussion about policies for people with disabilities in the Brazilian context is to define who is the person with disabilities for access to services and benefits, such as income transfer policies and assistive technologies. However, disputes over the definition of disability and the best ways to evaluate (questionnaire to be used, more qualified professionals to carry out the evaluation) have caused impasses and instabilities regarding access to public policies and rights advocated in CRPD. Based on an ethnography of a small village and with the participation of the author in national research on the implementation of disability assessment, this communication will analyze: professional and epistemological disputes regarding the concept of disability in the elaboration of public policies; ways in which organizations of people with disabilities have problematized the issue; consequences of the form of assessment in the daily lives of subjects with disabilities.

Paper short abstract:

The prioritisation of global human antibiotic reduction obscures their inseparability from past national policy. We take the case of Thailand and its metrics. We demonstrate how Thailand's research played a role in the WHO's GAP as "global assemblage", which extends to local health centres.

Paper long abstract:

We argue that the prioritisation of global human antibiotic reduction imperatives, obscures their inseparability from past national and sub-national policy, research and programmes. We take the case of Thailand and its development of metrics to monitor and evaluate the reduction of human antibiotic use as a means to explore. We demonstrate how Thailand's research and policy on antibiotic use and rational drug programmes have played an important role in the development of the WHO's GAP as "global assemblage", which now extends to health centres in Thailand, where health workers responsibilised for the reduction of national antibiotic use. Analysing practices of diagnosis, prescription and data entry, guidelines and policy documents as well as a graphical user interface for monitoring staff's performance together with interviews of key policy actors, we argue that antibiotic use targets disrupt, but do not always change, health workers' prescription practices in ways intended. In fact, health workers and patients create ways to continue caring while also creating data that meets the designated prescriptions targets. This follows what we call a form of 'conscientious practice', a means by which health workers attempt to maintain their professional legitimacy, sustain patient care and the semblances of functioning the "global assemblage" of human antibiotic reduction. Given the concern for AMR, we call on those in global health and national policy to consider the limitations of targeting health worker prescriptions. Furthermore, we call for more discussions of the relations between categories of global, national and local and the potential consequences for care.

Paper short abstract:

In this paper, I examine a strategic shift in global health towards governing emergencies (of multiple kinds), analyze the resulting implications, and argue that global health's boundaries are being contested and renegotiated.

Paper long abstract:

While the term 'emergency' certainly existed in the lexicon of global health prior to the 2014 West African Ebola epidemic, since then, it has become a cornerstone in the global health community's new strategy for saving lives and improving well-being. As increasing investments and recent reforms, initiatives, and projects by the World Health Organization, the European Commission, and European countries such as Germany indicate - the global governance of health emergencies is not merely a site where actors come together to prepare and respond to events, but a new organizing scheme, a way to rearrange, redefine, and prioritize problems and solutions.

Drawing on my on-going ethnographic research in a Europe-based global health community comprised of experts, practitioners, bureaucrats, academics, and activists, I analyze some of the implications fostered by this strategic shift towards governing emergencies. Focusing on policies and priorities set by the World Health Organization (and its new Health Emergencies Programme) and corresponding developments in the European Union, I argue this shift towards governing emergencies in global health entails the contestation and renegotiation of boundaries. Internally - in how different projects, from Universal Health Coverage to health systems strengthening and surveillance, are linked. And externally - in what counts as a global health concern and responsibility (e.g. diseases and floods), and what conducts are part of, and therefore directed by, global health (e.g. humanitarian aid and development).

Paper short abstract:

This paper analyzes the universalizing concept of universal health coverage both in global health discourse and in Senegal to investigate the ideas that travel with global health initiatives and to highlight the contradictions of health solidarities and health privatization at the heart of UHC.

Paper long abstract:

The central goals of this paper are to take up the universalizing concept of universal health coverage (UHC) - its place on the global health agenda and the current push for it in Senegal - as a place to think through the politics of global health, the ideas that travel with global health initiatives, and to piece together a narrative of the contradictions of health solidarity and the privatization of health that exist at the heart of the concept of UHC. "Universal health coverage," as a "social humanitarian," "health economics," and "public health" concept - as Abiiro and De Allegri (2015) have described it - contains hegemonic, as well as alternatives in and to, approaches to global health. Through the example of the mutuelle de santé - or community-based health insurance schemes - and the push for UHC in Senegal, I want to think through the kinds of systems of solidarity that are promoted - and opposed to - through the different assumptions that UHC carries with it. What does it mean that the US - through its bilateral funding agency the US Agency for International Development and its influence on the World Bank - has been a large supporter of community-based health insurance in Senegal, and how is the current roll out of Couverture Maladie Universelle a continuation of the decentralization of health and decentralization of responsibility for the wellbeing of the Senegalese people?

Paper short abstract:

This paper considers mutual health organisations as sites of contestation in early efforts to implement Universal Health Coverage in Senegal.

Paper long abstract:

Couverture Maladie Universelle (CMU), Senegal's version of Universal Health Coverage (UHC) was launched by President Macky Sall in 2013, the year after his government was elected to power. One of the key pillars of Senegal's vision for UHC rests on health mutuelles. Mutuelles are mutual health organisations that provide health insurance to its members and which are formed on the basis of an ethic of mutual aid, solidarity and collective pooling of health risks. In the context of CMU, mutual health insurance is grounded in the idea that it will work on the 'law of the big number' (loi de la grand nombre), whereby each person contributes a yearly enrolment fee which is matched by the government.

In this paper I draw on PhD fieldwork carried out in the capital, Dakar to consider health mutuelles as sites of contestation amid contemporary challenges posed to health financing. I examine the implications of funding gaps by highlighting strains experienced by mutuelles as well as pointing to the sources that money often ends up coming from, through for example existing modes of distribution like patronage, NGOs and informal associations. I situate the discussion in this paper in the context of a strong tradition of health mutuelles in francophone West Africa as well as within the broader picture of the global organisations which support the implementation of CMU in Senegal.

Paper short abstract:

Whereas advocacy was once the driving force for U.S. public support for HIV drug development and access, the nation's response to the global epidemic is now shaped by austerity.

Paper long abstract:

Whereas advocacy was once the driving force for U.S. public support for HIV drug development and access, the nation's response to the global epidemic is now shaped by austerity. Extending past scholarship about the role of advocates and governments in support of drug development and access around the world, in this article I identify key shifts in U.S. public sector support over the past 40 years. During the early years of the AIDS epidemic, the U.S. government and civil society expedited drug development for antiretroviral therapy (ART). After the turn of the century, a new wave of advocacy expanded access for ART, including to low- and middle-income countries through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). On the heels of these accomplishments, advocates and governments set an ambitious agenda to 'End AIDS' by 2030. However, progress toward this goal has been limited by a new era of austerity, as demonstrated by U.S. government spending on HIV.