Paper short abstract:

Based on qualitative data from 2009 to 2012 this paper explores the elaboration of a new community health policy in Guinea-Bissau and its effects based on theories of global governance. It argues for the importance of taking the local context into consideration when elaborating a new health policy.

Paper long abstract:

In recent years there has been an increased interest globally to revitalize the Alma Ata Declaration on primary health care (PHC) from 1978 to achieve the Millennium Development Goals. In Guinea-Bissau, a country where the health policy has been under the influence of Alma Ata, the revitalization process started in 2010. Initially the implementation of PHC went well, but due to a number of reasons it started to deteriorate around the year 2000. Consequently, a new policy was elaborated to revitalize community health care. The new policy emphasized professionalization of community health workers (CHWs) and preventive health care for mothers and children. Traditional birth attendants (TBAs), who had played an important role in the past, were however excluded.

This paper aims to explore the elaboration of the new community health policy in Guinea-Bissau and its effects based on theories of global governance. The data is based on 20 months of anthropological fieldwork between 2009 and 2012.

The Ministry of Health in Guinea-Bissau emphasized the importance of learning from past experience when elaborating the new community health policy, but this study shows that international health policy did influence certain aspects of the policy. During the initial implementation phase there was certain tension related to the selection of new CHWs and the consequent exclusion of older illiterate CHWs and TBAs. Workload of new CHWs was high and they needed appropriate motivation. This paper argues through empirical examples for the importance of taking local contexts into consideration when elaborating a new health policy.