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- Convenors:
-
Helle Samuelsen
(University of Copenhagen)
Lise Rosendal Østergaard (Danish Immigration Service)
- Location:
- FUL-101
- Start time:
- 11 September, 2015 at
Time zone: Europe/London
- Session slots:
- 2
Short Abstract:
This panel will examine the multiple ways that the public of public health care engages with state-sponsored facilities and programs in low income societies and explore the tensions between global public health programs and people's embodied encounters with public health services.
Long Abstract:
This panel invites papers that reflect critically on the differentiated forms of public health in low income societies and the multiple ways that the public of public health care engages with state-sponsored facilities and programs. Contributors are invited to reflect on the role of public health in a political landscape of widening global and national inequalities and of relative poverty. How do citizens in low income societies view the responsibility of the state in providing for access to biomedical health services? Over the past years low income countries have been subject to multiple global public health interventions in the forms of programs targeting specific diseases from HIV, TB, malaria and many others which all rely on biomedicine and which all seek to intervene on the health of the collective. Each program comes with specific expectations to the people defined as legible to these interventions, establishing new forms of moral responsibilities, patientships and citizenships. This happens in a situation where we in many low income countries see faltering state-sponsored services, increasing privatization of health care provision and growing influence of non-state actors on national priority setting of which diseases to target and which population groups to reach out to. What are the tensions between global (and national) public health programs and people's embodied encounters with public health services? And how do the public in low income societies navigate changing health care landscapes and negotiate care within the public health care sector?
Accepted papers:
Session 1Julie Hastings (Brunel University London)
Paper short abstract:
This paper examines why a global health intervention in Tanzania to teat neglected tropical diseases was so vehemently rejected. While officials blamed locals for spreading ‘rumours’, ethnographic research reveals how global inequalities shaped local fears of covert eugenic plots.
Paper long abstract:
In 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases - schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents rushed to schools to prevent their children taking the drugs when they heard reports of children dying after receiving treatment, and fighting ensued. News of these apparent fatalities spread throughout the region, including to the village where I was conducting my doctoral fieldwork.
This paper discusses why this biomedical intervention was so vehemently rejected. By examining local understandings of this public health intervention in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro there was widespread suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by "ignorant" people. However, from an anthropological perspective, these 'rumours' reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world under the guise of global health.
Lise Rosendal Østergaard (Danish Immigration Service)
Paper short abstract:
This paper takes the perspective of ‘front line health workers’ to discuss how global public health priorities are implemented in public health facilities under extreme material limitations. How can public health care workers make sense of their work in a context of material limitations?
Paper long abstract:
This paper takes the perspective of so-called 'front line health workers' to discuss how global public health public priorities are implemented in health facilities with little of the medical equipment and pharmaceutical products which are required to perform biomedicine. How do public health care workers make sense of their in a context of material limitations? With a point of departure in the dynamic interplay between foreign donor agencies involved in health system strengthening and complex local realities, this papers explores the way nurses and midwives in rural Burkina Faso engage in public health. The term 'friction' (Tsing 2005) is used to unfold the way these health workers grapple with different agendas formulated by external donors and national authorities. Priorities such as 'maternal and child health' or 'universal health coverage' must be implemented by local actors, in this case nurses and midwifes. These health workers experience frictions when they have to juggle different accountabilities. These accountabilities are towards their supervisors and the local health communities, and are intertwined with their own more mundane concerns over livelihoods, exposure to risk and health hazards at the workplace, and social obligations. In the paper I argue that three different repertoires are available to rural health workers in Burkina Faso, each repertoire coming with a different objective of public health care.
Emilomo Ogbe (International Center for Reproductive Health, University of Ghent) Els Duysburgh Sue Mann (Institute for Women's Health, University College London)
Paper short abstract:
This paper presents findings from a comparative policy analysis done in 4 SSA countries to develop a programme theory for designing and implementing context specific interventions targeted at improving postpartum care, for the Missed Opportunities in Maternal and Infant care (MOMI) project.
Paper long abstract:
Introduction: Reducing postpartum (PP) maternal and infant mortality has been recognised internationally and in different national health policies as a priority. However, the translation of these policies into sustainable health programmes has been slow. In many countries in SSA, provision of PPC remains poor, with high maternal morbidity rates reported in the PP period. The Missed Opportunities in Maternal and Infant health (MOMI) project is a FP7 EU funded project focused on improving PPC for mothers and infants in four SSA countries in the year after childbirth.
Methods: A comparative policy analysis was done at the four MOMI study counties prior to the interventions design. The objective of this analysis was to understand and compare the place of PPC within the national epidemiological, and political contexts of the countries, and the gaps between the findings and international policies on maternal and child health.
Findings: Maternal, newborn and child health (MNCH) were recognised as key priority areas in the national health plans of all the four SSA countries. However, PPC was not prioritised in these health policies or within the MNCH programmes. Where policy guidelines did exist, they were not translated into effective interventions.
Conclusion: Provision of PPC in many SSA countries is poor, despite the existence of national guidelines on MNCH, elucidating the fact that international/national guidelines & health policies do not always translate into well implemented, sustainable health programmes. There is a need for more research, to understand factors that influence translation of health policies into effective interventions.
Helle Samuelsen (University of Copenhagen)
Paper short abstract:
In this paper, I explore the pragmatic use – and non-use of primary health care facilities by citizens in rural Burkina Faso and discuss why the relationship between the state and its citizens appears so fragile.
Paper long abstract:
The security situation in the West African region is subject to international concern as it appears increasingly fragile. In Burkina Faso, the situation has been fairly stable over the last two decades, but the conflicts in neighbouring countries also shake the political stability in Burkina. In the project "Fragile Futures: Rural lives in times of conflict", we explore the critical relationship between civil society and state from a village perspective. The relationship to the government health services is the most prominent and critical relationship the rural population has to public institutions. In this paper, I explore the pragmatic use - and non-use - of the primary health care facilities by rural citizens. By careful reading of reports from the health facilities, I also look at the use and non-use of specific diagnoses and discuss how villagers' understand the relationship between the state and its citizens and why this link appears so fragile.
Bronwen Gillespie (University of Sussex)
Paper short abstract:
A discussion of the nutrition awareness work carried out by the state in the rural Peruvian Andes will help shed light on how social relations are intrinsic to the way that public health work is implemented and understood by those targeted by the health service.
Paper long abstract:
In the Peruvian Highlands, the public health system is working to reach all children and pregnant women, as part of its move towards universal coverage. This paper is concerned with a specific priority as defined by the state for the rural Andes - that of chronic childhood malnutrition. With a focus on nutrition programs and services operating in a rural district of the Peruvian Highlands, I will describe how the encounters between mothers and healthcare workers are subject to particular prejudices and agendas on both sides, shaped by the historical nature of state presence in the zone. I argue that a perspective that explores the state not only as structure and policy, but as actual social relations between real people, can shed light on how public health challenges are conceptualized. The paper will look at the way that both state workers and mothers targeted by nutrition programs negotiate their way through the expectations raised by public health programs, and will raise questions regarding the negative associations surrounding public (versus private) healthcare, on both sides. Local actors can be seen to transform and interpret the state public health agenda in ways which inadvertently undermine the initial policy intention. I will ask whether decision makers or policy actors can find spaces in which to address this process.
Jens Seeberg (Aarhus University)
Paper short abstract:
This paper discusses the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics contributes to a transition from a treatable TB epidemic to a increasingly untreatable XDR-TB epidemic.
Paper long abstract:
New public health funding mechanisms with global reach have dramatically changed the funding mechanisms of global public health, and they have changed what is to be funded, involving a shift from prevention to medical treatment. At the same time, access to treatment - especially ARV for HIV infection - had been successfully defined as a human rights issue. In 1993, WHO declared that TB presented a global health emergency and it became the focus of a separate vertical public health program, known as DOTS (directly observed treatment - short-course). Initially funded by the World Bank, bilateral donors and governments in high prevalence countries, and subsequently by the Global Fund, DOTS was a very ambitious public health programme in terms of its requirements for infrastructure, supervision, monitoring, delivery and diagnosis. It aimed for 70% case-detection and 85% treatment success rates; these cut-off points were expected to reduce prevalence by half within a decade in omplementing countries. Despite subsequent revisions of the strategy, the impact on TB prevalence in a high-prevalence country like India was marginal, whereas the country has seen the development of a new epidemic of multi-drug resistant TB (MDRTB). This situation leaves global health policy with a difficult the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics over a few decades will contribute to a transition from a treatable TB epidemic to a increasingly untreatable extensively drug-resistant TB (XDRTB) epidemic.
Aysecan Terzioglu (Sabanci University)
Paper short abstract:
This talk investigates the global and local organizations' perspectives and activities to overcome the health problems of Syrian immigrants in Istanbul, Turkey. It explores how they address the challenges and discriminations that these immigrants experience in their social and medical interactions.
Paper long abstract:
There are currently around 2.5 million Syrian Immigrants in Turkey, which generate a major health problem. Escaping from the war, many of them suffer from war wounds, PTSD, infectious diseases, which particularly affect the children, who are in need of urgent health care. One-third of them live in the camps, which many of them consider "open-air prisons", and the others prefer to live in the major cities, such as Istanbul, where they have social networks and employment opportunities. Although the living and health conditions of Syrian immigrants vary considerably depending on their socio-economic background, the lay people and medical staff often generalize and label them as a source of a new and major global health problem, since they started to "spread previously eradicated infectious diseases, such as TB and Polio, in Turkey". Based on two year-fieldwork, consisted of interviews with Syrian Immigrants and Global and local organizations' medical and social workers who treat them, this talk investigates the global and local organizations' perspectives and activities to overcome the health problems of Syrian immigrants in Istanbul, Turkey. It explores how they address the challenges and discriminations that these immigrants experience in their social and medical interactions. The talk develops a critical approach on the policies of Global, national and local organization in dealing with the Syrian immigrants' health problems, relating them to the conceptual transition of health care, from a basic human right to an individual responsibility where people should do their best to maintain their health.