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Accepted Paper:
Hayley MacGregor (Institute of Development Studies)
Paper short abstract:
Involvement in global guidance on homecare for COVID-19 provides the basis for reflection on the ways in which the idea of ‘best practice’ advice can function to uphold ideals for public health action, deflecting attention from inconvenient truths about contexts where implementation has to occur.
Paper long abstract:
Early in the COVID-19 pandemic, the WHO issued guidance on disease management, focused on key priority areas. As a member of a social science expert group, I was involved in revising the guidelines on homecare for people with COVID-19. The original document, based on MERS coronavirus outbreaks, assumed capacity for testing and recommended hospital isolation of all positive cases. Homecare was sanctioned if this scenario proved impossible, and then only for mild disease. The availability of high-grade protective equipment, water and waste disposal was assumed. Advocating for adaptations to this text involved arguing for the salience of qualitative research that pointed to the likelihood that COVID-19 was being experienced in contexts where testing was unavailable, where access to healthcare was limited and where informal providers and/or kin would be caring for potentially very ill people in single-roomed houses, with limited resources. A related experience involving wider consultation with humanitarian practitioners on the provision of pragmatic advice for homecare in such circumstances surfaced discomfit in some quarters with formal guidance that might be seen to advocate for less-than-ideal practice, and even the view that such an endeavour was unethical and tantamount to accepting inferior standards of care for people in low-income settings. I will reflect on this process and the ways in which the idea of standardised ‘best practice’ advice can function to uphold ideal scenarios for public health action, thus deflecting attention from inconvenient truths about the inevitable messiness of real-life, resource-constrained contexts where measures have to be implemented.
Maintaining ignorance in global health and medical humanitarianism II
Session 1 Friday 21 January, 2022, -