Austerity across Africa has been operationalized through World Bank and IMF structural adjustment programs since the 1980s, later rebranded euphemistically as poverty reduction strategies in the late 1990s. Austerity’s constraints on public spending led donors to a “civil society” focus in which NGOs would fill gaps in basic social services created by public sector contraction. One consequence was large-scale redirection of growing foreign aid flows away from public services to international NGOs. Austerity in Africa coincides with the emergence of what some anthropologists call “audit cultures” among donors. Extraordinary data collection infrastructures are demanded from recipient organizations in the name of transparency. However, the Mozambique experience described here reveals that these intensive audit cultures serve to obscure the destructive effects of NGO proliferation on public health systems.
Audit cultures and the weakening of public sector health systems
A year ago, assessing the health-care situation, Enza Caruso and Nerina
Dirindin wrote: “The year 2007 can only be described as a positive one
for health in terms of planning, given the great number of programs
launched, commissions and councils put in place, and protocols of
agreement signed by the Ministry of Health. Finance within the health
sector was also notable for complying with the health pact and the rigorous
control of public accounts backed up by deficit reduction plans,
which regions under financial warning had to observe scrupulously or
be put under compulsory administration.” The year 2008, however,
began and then continued with a shocking series of health-care mismanagement
cases, including the controversy over the appointment
procedure for general managers and chief medical officers of health-care
providers, the question of controlling health expenses, and the possible
compulsory administration of regions that are unable to meet deficit
Autonomy or bureaucratization?
Eliana Elisabeth Diehl and Esther Jean Langdon
Brazil’s Unified Health System ( Sistema Único de Saúde [SUS]) was created in 1990, establishing the principles of universal access, equity, integrality and social participation. SUS is based on decentralization, municipal administration of health
Research Findings and Questions on a Modern Public Health Perspective
Ota de Leonardis
This article aims at contributing to the discussion on the features of public health systems consistent with the broader definition of health – broader than the strictly bio-medical one – which is currently accepted in the related literature. The questions it raises are on how social capital influences well-being, and on whether and how it can be recognized and cultivated as a basic resource for health, and integrated into the health systems. In the first part, research literature on the ways health conditions are correlated with both poverty and social capital is briefly discussed. In the second part, several cases on health prevention and rehabilitation programs are analysed in some detail, as they appear to improve the health conditions of a community by investing in its 'social capital'. The main insights are on how to combine social protection with individual agency.
This article discusses the medically pluralistic character of malaria prevention and treatment-based health-seeking behaviour among the inhabitants of a predominantly Jola village in the Gambia, West Africa. Through the presentation of ethnographic data obtained between 2003 and 2004, the paper demonstrates that traditional health services - represented by traditional medical practitioners and medicinal plant usage - among the Jola appear as much, if not more accessible, available, affordable and acceptable than the biomedical services - represented by biomedical practitioners and antimalarial medication usage - provided by the Gambian government health system. This accessibility, availability, affordability and acceptability occur to the extent that many of the villagers suggest that traditional health services become incorporated into the Gambian government health system. The need to integrate traditional and biomedical services becomes especially relevant given the existence of traditional services within the context of biomedical hegemony and limited Jola accessibility, availability and affordability of biomedical services.
Health, Justice and the Persistence of the Sacred
James R. Cochrane
The essay refers to a concern for social justice in the origins of public health, borne in part by religious commitments, and to more recent expressions of a similar concern in debates about health equity. Equity, moreover, is affected by discursive power relations (dominant/hegemonic versus local/suppressed), which are discussed in relation to current research in the African Religious Health Assets Programme on the interaction of particular 'healthworlds' (a conceptual innovation) that shape the choices and behaviour of health-seekers. Two background theoretical positions guide the argument: Amartya Sen's claim that development is linked to freedom (including religious freedom); and, building on Sen's and Martha Nussbaum's human capabilities theory, an asset-based community approach to the building or reconstruction of public health systems. On this basis, it is argued that health systems and health interventions are just to the extent that they mediate between the necessary leadership or polity from 'above' (techné) and the experience and wisdom (métis) of those who are 'below', taking into account the asymmetries of power that this equation represents. Because difference and diversity are so often expressed in what we might reasonably call 'religious' terms, I specifically emphasize the continuing persistence of religion and, hence, the importance of accounting for its pertinence in social theory generally, and in relation to discourses of health and justice in the African context specifically. Acknowledging the ambiguities of religion, I nevertheless argue that an appreciative alignment between public health systems and religious or faith-based initiatives in health promotion, prevention and care is crucial to sustainable and just health systems in Africa.
The constitution, the law of the land of the modern state, is fertile ground for the Eurocentric imagination of the Canadian polity as a result of the resiliency of Victorian-era sentiments. The ethno-racial hierarchy contained within this political imagery merges well with the public health mandate process of 'othering'. Othering situates the causes of disease and illness in foreign bodies rather than in the social structures of industrial capitalism. Chief among its morbid symptoms, othering produces a sense of alienation in those subjected to it. Sri Lankan Tamils are one of the newer migrant populations who have been subjected to, and have resisted this intrinsically violent othering process. This article examines the Canadian constitution as it relates to ethno-racial classification, and then explores how this scheme is reproduced in common experiences of the public health system and its effects on the health and well-being of Canadian Tamils.
Publications, Exhibitions and Conferences
Sara Farhan, Paul Fox and Fakhri Haghani
associate of international disease control networks, and an active member of WHO (1957) . Yet, recently, Iraq’s health systems proved to be ineffective in the face of a cholera outbreak ( WHO 2015) . Moreover, attacks on medical experts, especially surgeons
Training Health Workers for Community-Based Roles in Ghana
health systems, in which discourses of capacity building and the social aspects of poverty are being integrated with an ethos of basic, low-cost service provision informed by the economic strategies of the previous decades. Both the recipients and primary
The Case of Expert Clients in Swaziland
clinics, and heavily dependent on external funding to expand ART. Donors fund staff salaries, equipment and provide expertise and mentorship. I positioned myself within the pre-ART treatment phase to analyse health system threats and barriers to treatment