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.