Paper short abstract:

Historical ethnography in Guyana draws attention to strong continuities between reforms under cooperative socialism and structural adjustment, encouraging us to revisit our origin stories and tales of neoliberalism in health.

Paper long abstract:

Today's anthropological literature remembers structural adjustment projects of the 1980s as a key turning point in the decline of public health services and the rise of neoliberal health policies in much of the world. However, historical ethnography of health system reform in Guyana reveals a picture of continuity much more than change associated with structural adjustment. In this paper I argue that the origin stories we tell of neoliberal reforms risk constructing international financial institutions as villains so pure that they obscure our vision of what came before, and of the context within which reforms have come into being. Tales of user fees, frozen salaries, and private insurance instituted under loan projects sit uncomfortably with the story that emerges from ethnographic research with healthcare workers in Guyana and the documentary traces produced by health programs in the 1980s and 90s. In some cases this is because the "hollowing out" of the health system had begun much before structural adjustment, especially as Guyana was cut off from international funding under its cooperative socialist regime, in other cases it is because health professionals fought to keep "international best practices" from being instituted here. These stories highlight that financial institutions have not been all-powerful, and instead draw attention to the specific negotiations of Guyanese healthcare workers and the health system within which they worked.