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Paper short abstract:

I explore the contradictory demands of ‘participation’ and ‘bureaucratization’ in Pakistan’s HIV/AIDS response. Community care workers were deemed essential and co-opted when rolling-out global health projects, yet as the projects scaled up, they were replaced by formally educated employees.

Paper long abstract:

In this paper, I explore the contradictory demands of ‘participation’ and ‘bureaucratization’ in Pakistan’s HIV/AIDS response where local models of relatedness, personhood, and informal networks, and the particular social and emotional skills of grassroot community care workers were deemed essential in the beginning and co-opted under the rubric of ‘participation’ while rolling-out projects for community healthcare. However, as the global health projects funded by the GFATM were scaled-up, the affect, the relations of trust, and the confidence built by these local workers during their work in their communities did not translate into templates for reporting-up project impact. Therefore, these technologically less equipped community workers were either forced to extend their roles into report-writing, template-filling and indicator-measuring or were driven out of HIV sector altogether. This, I ague, is a form of bureaucratic violence that exploits grassroot resources and undermines community care for its own data determinism. This paper draws attention to moving beyond the metrics-driven data determinism of global health policies and making space for other forms of assessing and evaluating projects of health and care within and beyond crises.

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A presentation of preliminary findings from PhD research examining how transformations of the GP system during and post COVID-19, are negotiated by marginalised populations. With a focus on the 'work' of engaging with the healthcare system, and 'responsibilisation' of patients for their healthcare.

Paper long abstract:

In response to the COVID-19 crisis, there’s been a shift in the way healthcare services are accessed in the UK with most non-acute healthcare service delivery made remote. The digitalisation of healthcare services is part of a longer narrative, accelerated by the pandemic. This is against a background of austerity and strong, persistent inequities in health outcomes and healthcare access in the UK. Whilst there are hopes that digital healthcare will remove barriers to accessing healthcare, it’s also possible that this form of service delivery will both create new types of inequities as well as replicate and re-embed existing ones. I will present the preliminary findings from my PhD research examining how transformations of the GP system during and post-crisis, are negotiated by marginalised populations.

I am taking an ethnographic approach involving observation and interviews, conducted across a range of field sites in London. These include a foodbank, an advice centre for refugees and asylum seekers, and a charity offering digital support. The analysis explores the ‘responsibilisation’ of individuals to self-manage their healthcare, the ‘work’ which individuals must do to engage with and navigate the healthcare system, and finally ‘candidacy’ for healthcare and how this is negotiated by patients and providers. I discuss the risk of the ‘uncommoning’ of GP services as individuals turn to private healthcare alternatives. I also consider how patient ‘work’ is constructed by changes to the healthcare system and how this is transformed and negotiated by individuals through strategies developed to increase their capacity for action.

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We analyze the implementation of health policies for young indigenous people and international migrants in sexual/reproductive health. In practice, these policies serve to domesticate the “otherness” into biomedical hegemony, exacerbating structural vulnerabilities.

Paper long abstract:

In Chile, during the 90´s, the Special Program for Health and Indigenous Peoples was implemented for the recognition of health systems of these communities. In 2018, given the increase in migratory flows that entered the country, the Health Policy for International Migrants in Chile was created. Both initiatives have aimed to generate intercultural health strategies that respond to the health needs of specific populations. In this paper, we analyze the implementation of these policies in the field of sexual and reproductive health of young indigenous and migrant people (18 to 24 years of age). Findings are drawn from a qualitative study carried out during 2021, in which in-depth interviews were carried out with 16 young migrants coming from different countries of Latin America, 16 young Mapuche people, 8 key-informants and 16 primary health professionals. The results show that although these policies were implemented to recognize and attend cultural differences in health, in practice they serve to domesticate the “otherness” into biomedical hegemony. Moreover, stereotypes related to specific ethnicities and bodies are hyperbolized -e.g. Afro-descendants as hyper-sexualized or Andean young women as “made” to be mothers-, exacerbating structural vulnerabilities. This deepens the historical distance between the official health system and vulnerated populations such as indigenous and migrant peoples, reinforcing exclusions instead of building bridges. The paper closes with recommendations for the inclusion of a comprehensive intercultural approach to health.

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This paper scrutinizes policy failures regarding migration and examines their double-edged impacts: First, it investigates inadequacies of health policies and refugees' (in)access to health care system in Eskişehir, Turkey. Second, it discusses emerging solutions to compensate for policy failures.

Paper long abstract:

This paper scrutinizes policy failures regarding migration and examines their double-edged impacts in Eskişehir, Turkey. The discussion shows structural and political reasons underlying policy failures in the migration domain and their consequences for state institutions, civil society organizations, and individuals at the local level. The lack and ambiguity of health policies and regulations for implementing laws entail a state of despair not only for refugees but also for state institutions and humanitarian organizations. The state of despair, however, opens up avenues for institutions and individuals to utilize loopholes in laws and policies. At the same time, it allows developing a network of services among various actors that benefit from each other’s expertise. The paper calls these networks of exchange “spontaneous reciprocity”. Reciprocal services based on spontaneity become a norm at the local level in the absence of clearly defined, rights-based legislation and institutionalized policies that follow the principle of equity. Bypassing formal institutionalized context, these haphazard reciprocal activities modify state and non-state actors’ areas of duties while underpinning reconfigurations in health services.

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We analyse how government, and public health stakeholders, as well as civil society organisations, conceptualise vulnerability in times of COVID-19 in Austria, Germany and Belgium. We focus on changes and contradictions as well as how vulnerability is embedded in discourses on solidarity.

Paper long abstract:

Many countries around the globe have experienced unseen mobility and social contact restrictions to stop the spread of COVID-19. It was the job of governments and health officials to explain to their citizens and residents why they had to stay home and physically distance themselves from family and friends. In the beginning, buzzwords such as 'for the common good', 'solidarity with vulnerable groups' were often used to motivate people to stay at home and stick to the rules. However, over the two-year course of this pandemic, the strategies of virus containment and the associated pandemic restrictions have evolved, and the ideas around who is vulnerable have shifted. In this presentation, we analyse how government and public health stakeholders as well as civil society organisation (CSO) representatives talk about and conceptualise vulnerability in times of COVID-19. The analysis will focus on changes and contradictions of who is considered vulnerable as well as how concepts such as solidarity and 'the common good' were instrumentalised to motivate people to protect vulnerable groups in Austria, Germany and Belgium. We will draw on qualitative expert interviews conducted with government and public health stakeholders as well as CSO representatives as in the three countries. The data we are building on was collected for the EU-funded COVID-19 research project COVINFORM (grant agreement ID: 101016247). The project analyses COVID-19 responses on the level of government, public health, community, and information and communication with a focus on the impacts on vulnerable individuals and groups in 15 countries.