Paper short abstract:

Analyzing the “on the ground” manifestations of global health policies in an ART clinic in rural Malawi, the paper challenges notions of normalization of ART in resource-limited settings, and points to the discrepancies between rhetoric and reality as experienced by healthcare providers.

Paper long abstract:

Recent decades had seen unprecedented changes in global health policy and a massive rollout of new health services in resource limited settings. One such example is the push towards the provision of antiretroviral therapy in many areas of sub-Saharan Africa. In Malawi, a national policy shift towards universal access, operating under circumstances of scarce resources, brought new sets of healthcare delivery challenges to bear on both patients and healthcare professionals. Drawing from ethnographic fieldwork in an antiretroviral clinic in rural Malawi, and expanding the scope of anthropological inquiry into the impact of new global health policies to include ART providers, this paper discusses the difficulties stemming from the provision of what is known to be sub-standard care, necessitated by substandard resources, that confront healthcare providers with complex practical and ethical dilemmas on a daily basis. By challenging common notions of normalization of ART in resource-limited settings, this paper broadens the discussion on new global health policies to address their "on the ground" manifestations, and the discrepancies between rhetoric and reality as experienced by healthcare providers.