Since the turn of the millennium, conceptual and practice-oriented shifts in global health have increasingly given emphasis to health indicator production over research and interventions that emerge out of local social practices, environments and concerns. In this special issue of Anthropology in Action, we ask whether such globalised contexts allow for, recognise and sufficiently value the research contributions of our discipline. We question how global health research, ostensibly inter- or multi-disciplinary, generates knowledge. We query ‘not-knowing’ practices that inform and shape global health evidence as influenced by funders’ and collaborators’ expectations. The articles published here provide analyses of historical and ethnographic field experiences that show how sidelining anthropological contributions results in poorer research outcomes for the public. Citing experiences in Latin America, Angola, Senegal, Nigeria and the domain of global health evaluation, the authors consider anthropology’s roles in global health.
Anthropological Knowledge and Practice in Global Health
Rodney Reynolds and Isabelle L. Lange
Ethnographic Insights from Senegal
Diane Duclos, Sylvain L. Faye, Tidiane Ndoye and Loveday Penn-Kekana
The notion of performance has become dominant in health programming, whether being embodied through pay-for-performance schemes or through other incentive-based interventions. In this article, we seek to unpack the idea of performance and performing in a dialogical fashion between field-based evaluation findings and methodological considerations. We draw on episodes where methodological reflections on performing ethnography in the field of global health intersect with findings from the everyday practices of working under performance-based contracts in the Senegalese supply chain for family planning. While process evaluations can be used to understand contextual factors influencing the implementation of an intervention, we as anthropologists in and of contemporary global health have an imperative to explore and challenge categories of knowledge and practice. Making room for new spaces of possibilities to emerge means locating anthropology within qualitative global health research.
Sara Van Belle
In this article, I set out to capture the dynamics of two streams within the field of global health research: realist research and medical anthropology. I critically discuss the development of methodology and practice in realist health research in low- and middle-income countries against the background of anthropological practice in global health to make claims on why realist enquiry has taken a high flight. I argue that in order to provide a contribution to today’s complex global issues, we need to adopt a pragmatic stance and move past disciplinary silos: both methodologies have the potential to be well-suited to an analysis of deep layers of context and of key social mechanisms.
On Being In-Between in a Global Health Intervention
Within multi-disciplinary global health interventions, anthropologists find themselves navigating complex relationships of power. In this article, I offer a critical reflection on this negotiated terrain, drawing on my experience as an embedded ethnographer in a four-year adolescent sexual and reproductive health research intervention in Latin America. I critique the notion that the transformative potential of ethnographic work in global health remains unfulfilled. I then go on to argue that an anthropological practice grounded in iterative, inter-subjective and self-reflexive work has the potential to create ‘disturbances’ in the status quo of day-to-day global health practice, which can in turn destabilise some of the problematic hubristic assumptions of health reforms.
A Century of Anti–Human African Trypanosomiasis Campaigns in Angola
Jorge Varanda and Josenando Théophile
This analysis of over a century of public health campaigns against human African trypanosomiasis (sleeping sickness) in Angola aims to unravel the role of (utopian) dreams in global health. Attention to the emergence and use of concepts such as neglected tropical diseases (NTDs) and ideas about elimination or eradication highlights how these concepts and utopian dreams are instrumental for the advancement of particular agendas in an ever-shifting field of global health. The article shows how specific representations of the elimination and eradication of diseases, framed over a century ago, continue to push Western views and politics of care onto others. This analysis generates insight into how global health and its politics of power functioned in Angola during colonialism and post-independence.
Kearsley A. Stewart
Interest in short-term international placements in global health training for U.S.-based medical students is growing; the trend is mirrored for global health undergraduate students. Best practices in field-based global health training can increase success for medical students, but we lack a critical framework for the undergraduate global health field experience. In what ways does an undergraduate field experience in global health resemble a medical student's first international health elective? Is it more similar to a study-abroad programme or a service-learning experience with a focus on personal development, civic responsibility and community engagement? This article suggests that an undergraduate global health field experience contains features of both the international medical elective and a traditional service-learning programme. I analyse a case study of a short-term U.S.-based undergraduate global health project and explore the intersections of research, professional training and service learning.
This article presents an account of a Qashqa'i health worker's upbringing, education and training, noting in particular his transition from life in a traditional nomadic family through completion of a formal education. The health worker, Jamal, describes certain problems of modernity and the personal conflict he faces as someone who loves his culture but also wants to see improvements in the health status of his people. Written by a Qashqa'i author, who brings his own sensitivity and cultural knowledge to the text, the article makes some recommendations about the training and integration of rural health workers in Iran.
Ana B. Amaya and Philippe De Lombaerde
This introduction to the special section explores the nexus between global health governance and international health diplomacy. In these dynamic governance spaces, particular attention is paid to the multi-level and multi-actor character of global health governance and how health diplomacy functions in such a complex context. It is pointed out that the regional level plays both vertical (i.e., as an intermediary between the global and national levels) and horizontal (i.e., interregional) roles. The contributions to the special section develop the conceptual understanding of those interactions and analyze a number of concrete cases, including the African Union, ASEAN, the European Union, SADC, and UNASUR.
EU cooperation with ASEAN and the African Union
This last decade, regional organizations progressively became unavoidable actors of regional health governance and have been supported by some global health actors to strengthen such a role. Among these actors, the European Union (EU) is the only regional organization that implements health initiatives in cooperation with its regional counterparts. This article focuses on such “health interregionalism” toward Southeast Asia and Africa and in the field of communicable diseases, with the main objective of assessing its nature and identifying its main functions. It concludes that although appreciated and needed, the EU’s health interregionalism should better reflect the EU’s experience in regional health governance in order to represent a unique instrument of development aid and an added value for regional organizations