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- Convenors:
-
Isabelle Lange
(London School of Hygiene and Tropical Medicine)
Rodney Reynolds (University College, London)
- Location:
- JUB-117
- Start time:
- 9 September, 2015 at
Time zone: Europe/London
- Session slots:
- 1
Short Abstract:
This panel invites research, methodological and speculative papers that explore how qualitative research across the domain of global health becomes anthropology and leads to nuanced understandings of how communities and people emerge from, stand-out against and help shape statistical imaginaries.
Long Abstract:
As a field, 'Global Health' integrates several overlapping, but different social imaginaries. Each of these principally emerges from a specific discipline and draws on that discipline's methods and language. By bringing social and medical sciences together, global health uses research to try and shape policy and practice in diverse social, cultural, economic and health settings. The ways in which research from these fields functions in collaboration with political and administrative processes serve to nudge the putative liberal subjects of modern states towards certain behaviors and away from others. The achievement or deficit of these efforts and their effects is most often articulated via quantitative results. Talal Asad argues that qualitative experiences and research in such a world may be strategically positioned to test how thoroughly the values associated with the imaginaries of quantitative methodologies and statistics have been embodied by local populations and inform their social practices. Recognition within global health that knowing why people do things matters as much as knowing what they do has created the opportunity for qualitative research to contribute to global health. While qualitative research experience may inform anthropology, it is not congruent with it. So, where is anthropology located within global health's evidence base and how is it to be found? This panel invites research, methodological and speculative papers that explore how qualitative research across the domain of global health becomes anthropology and leads to more nuanced understandings of how communities and people emerge from, stand-out against and help shape statistical imaginaries.
Accepted papers:
Session 1Paper short abstract:
This paper is a critical reflection on the competing imaginaries of ‘scientific’ knowledge in a multi-country, multi-partner sexual health research intervention. What were the tensions between the project’s hard science disciplines and the practices of an ethnographer, and what were the options for strategic positioning in such circumstances?
Paper long abstract:
Between 2010 and 2014 I worked as the on-the-ground ‘qualitative researcher’ for an adolescent sexual and reproductive health (ASRH) intervention in Latin America. Funded by the European Commission, the project drew together teams of obstetrician-gynaecologists, epidemiologists, community health nurses, psychologists, public health educators, statisticians and… two anthropologists. Having already produced an account of the qualitative results in academic publications and EC work package reports, this paper is a more personal reflection of how my position as the embedded anthropologist was variously interpreted and given meaning by consortium colleagues and project participants. Through an analysis of field notes, meeting minutes, participatory ethnographic research and public presentations of Proyecto CERCA’s work, I will explore competing imaginaries of ‘scientific’ knowledge – what were participants understandings of how ‘scientific’ knowledge is produced? What was the relationship between the project’s hard science disciplines and the practices of an ethnographer? I ask: what are the options for strategic positioning in such circumstances? When trained to understand research as process, and the processes of research as constituting new socialities, how does the anthropologist meaningfully participate in an outcome-focussed endeavour?
Paper short abstract:
It is recognised that the success of a health intervention depends on its local translation into practices. Drawing on results from the evaluation of an Informed Push Model for Family Planning in Senegal, this paper explores how anthropological approaches contribute to complex evaluations.
Paper long abstract:
It is today acknowledged that the success of Health programs depend on their local translation into practices, norms and policies. In this context, qualitative research gained visibility within impact evaluation designs. However is there room for Anthropology within qualitative evaluations in the field of Global Health? To what extent can Anthropology help integrating local communities implementing an intervention in evaluation processes? How can we in turn inform anthropological theories from health evaluation practices? The Maternal healthcare markets Evaluation Team (MET) at the LSHTM has been contracted by MSD for Mothers to evaluate the effect of a Family Planning distribution model using performance-based contracting on stock availability and Modern Contraceptive Prevalence Rate in Senegal. MSD for Mothers and the Gates Foundation are providing funding to IntraHealth International to implement the IPM across Senegal. Private Operators have been introduced in the supply chain for Family Planning (FP) to deliver FP stocks and measure inventory. Payments to operators are based on their performance, with incremental penalties if stock-outs rise above 2%. In this framework, contractors may be reluctant to expose the challenges they are facing to researchers by fear of being "sanctioned". Beyond qualitative interviews, it is argued that ethnographic material can inform impact evaluations on lived experiences of individuals and communities contributing to implement Global health programs. By situating knowledge within the IPM supply chain and its inherent logistical structure, an anthropological approach triggers a socio-political understanding of how logisticians make sense of the statistics defining (and emerging from) their performance.
Paper short abstract:
Drawing on the fieldwork in Angola on anti-sleeping-sickness campaigns and implementation of verbal autopsy, this paper highlights the importance of qualitative experiences and research to unpack the quantitative imaginary dominating global health archipelagos.
Paper long abstract:
Drawing on the fieldwork in Angola carried out between 2008-2012 on the campaigns against sleeping-sickness and implementation of verbal autopsy tool, this presentation attempts to highlight the role and importance of qualitative experiences and research to unpack the quantitative imaginary dominating global health archipelagos.
Actions against Human African trypanosomiasis in Angola started over century ago but the modus operandi of such programs changed little. The colonial programs with its statistics, images and publications still play a key role on the new idea of elimination. However, a more careful attention to such colonial representations, based on oral history and fieldwork carried out amidst post-independence programs hint at a more nuanced reality. The path to elimination may not be so smooth and easy.
Using qualitative large toolkit of qualitative methodologies it is possible to unpack persuasive fictions of present-day global health agenda, that of elimination of a disease or the statistical establishment of mortality causes amidst a peri-urban community.
This paper intends to bring to the fore how qualitative data on the complex social realities, cultural cosmovisions, economic and political contexts and glocal health settings are central to map the hurdles any conceptualization of global health program faces in its implementation, be it for elimination or to use a specific evaluation instrument such as that of verbal autopsy, to assert the main diseases most affecting a community.
Paper short abstract:
As a social anthropologist and a practitioner in theory-driven inquiry and evaluation, the author compares practitioners' use and positioning of theory-driven inquiry approaches on the one hand, and methods used in social anthropology on the other, in the current landscape of global health research.
Paper long abstract:
There is currently a renewed attention (and re-discovery) of social sciences theory in global health research, spurred by, amongst others, theory-driven inquiry approaches. Theory driven inquiry (TDI)approaches, with Realist Evaluation (Pawson & Tilley, 1997) as one of the main strands, are increasingly being applied in the evaluation of health programmes and in research on health policy and systems in low-and middle income countries. Its power of attraction for global health practitioners, the majority of which are primarily operating in a world defined by quantitative approaches, appears to stem from its explanatory potential. TDI makes use of social science theory to unearth causal mechanisms, which are believed to trigger social action in a given context.
Moreover, grounded in a realist epistemology and ontology, theory driven inquiry is considered as a helpful bridge between constructivism and positivism, and between statistical approaches and qualitative research, as it purports to be method-neutral. Being a social anthropologist and practitioner of theory-driven inquiry, the author critically examines the promise and pitfalls of the use of theory-driven inquiry for global health research, and its potential for opening up social anthropological methods to a wider audience of global health researchers and evaluators.