Evidence-based policy practice has become pervasive and counterproductive in the global HIV response.
Choolwe Muzyamba (University of Amsterdam)
Paper short abstract:
local knowledge in Africa is being delegitimized in preference for ‘scientific’ knowledge which in most cases is premised on overrated, yet very simplistic 'what-works-formulas". We rely on two studies to demonstrate that Evidence-based policy practice has become counterproductive in the global HIV response.
Paper long abstract:
The assumption that "because it worked there, then it must work here" is to a large extent responsible for the exacerbation of the HIV scourge in Sub-Saharan Africa. We show this in two separate studies from Zambia. 1) In the 1st study, we demonstrate that the application of the Human Rights approach as a one-size-fits all concept in Zambia is at odds with local realities and in some instance responsible for the rise in risky sexual behavior 2) In a 2nd study we showed that the act of outlawing Traditional Birth Attendants (TBAs) in Zambia purely on the advice of 'scientific evidence' obliterated the only option available to HIV+ pregnant women in poor rural areas, thereby worsening the situation. Conclusion These two studies render the question of "what works" obsolete and irrelevant. Like other scholars have observed recently, the question should no longer be about "what works?" but rather "what are we committed to making work in the given context?". The later question accepts the fact that reality is complex and cannot be summarized in a "cook-book" to be used by many. It is reflective, decentralized, and less authoritative. It allows for use of local practical wisdom; and at the same time, prioritizes processes that give room to local responsiveness, and careful judgement of what might work and how, given the context (rather than following mechanical solutions anchored on 'evidence').
Local Knowledge: development opportunities coming from the countryside? Methodological and political strategies and challenges in the health area