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Global health's durable dreams: ethnography, ‘community health workers’ and health without health infrastructure

Published online by Cambridge University Press:  11 March 2020

Ramah McKay
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Abstract

Tracing the persistence of community health workers (CHWs) as a key category in both global health policy and anthropological representation, this article asks how enduring scholarly investments in CHWs can reveal changing political stakes for both health work and ethnographic research. Amid renewed calls for a focus on health systems and universal health coverage, the article suggests that the durability of attention to CHWs is instructive. It simultaneously points to the imbrication of health with political and social relations and clinical and technological infrastructures as well as to how ethnographic investments in health systems can sometimes obscure the ambivalent politics of health. Drawing on fieldwork with CHWs, NGO staff and public health officials, and on public health literature on CHWs, it argues for greater attention to the political ambivalence of health labour. It suggests that the experiences of health workers themselves can serve as analytical examples in this regard, pointing to analyses that begin not with normative notions of health systems or the conceptual boundaries of global health ‘projects’ but with a focus on the contested relations through which health labour is realized over time. Such attention can also indicate possibilities for health beyond dreams of projects, clinics or health systems.

Résumé

Résumé

À travers la persistance des agents de santé communautaires en tant que catégorie clé, tant en matière de politique de santé mondiale que de représentation anthropologique, cet article examine en quoi l'attention durable portée aux agents de santé communautaires peut révéler une évolution des enjeux politiques pour le travail de santé et la recherche ethnographique. Face aux appels renouvelés à porter l'attention sur les systèmes de santé et la couverture de santé universelle, l'article suggère que l'héritage des agents de santé communautaires est instructif; il révèle simultanément l'imbrication de la santé avec les relations politiques et sociales ainsi que les infrastructures cliniques et technologiques, et la manière dont l'investissement ethnographique dans le travail de santé et les systèmes de santé peut à la fois illuminer et masquer l'ambivalence de la politique de santé. S'appuyant sur des travaux menés sur le terrain auprès d'agents de santé communautaires, de membres d'ONG et de responsables de la santé publique, et sur la littérature de santé publique consacrée aux agents de santé communautaires, il plaide pour une attention accrue sur l'ambivalence politique du travail de santé. Il suggère que les expériences des agents de santé eux-mêmes peuvent servir d'exemples analytiques à cet égard, en se référant à des analyses qui commencent non pas par des notions normatives de systèmes de santé ou les limites conceptuelles des « projets » de santé mondiale, mais par une focalisation sur les relations contestées au travers desquelles le travail de santé est réalisé au fil du temps. Une telle attention peut aussi indiquer des possibilités pour la santé au-delà de rêves de projets, de cliniques ou de systèmes de santé.

Type
Dreaming histories
Information
Africa , Volume 90 , Special Issue 1: Beyond realism: Africa's medical dreams , January 2020 , pp. 95 - 111
Copyright
Copyright © International African Institute 2020

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References

Abrahamsson, H. and Nilsson, A. (1995) Mozambique: the troubled transition, from socialist construction to free market capitalism. Chicago IL: University of Chicago Press.Google Scholar
Adalima, J. (2016) Changing Livelihoods in Micaúne, Central Mozambique: from coconut to land. Pretoria: University of Pretoria.Google Scholar
Adams, V. (2016) Metrics: what counts in global health. Durham NC: Duke University Press.CrossRefGoogle Scholar
Adams, V. and Biehl, J. (2016) ‘The work of evidence in critical global health’, MAT: Medicine Anthropology Theory 3 (2): 123–6.CrossRefGoogle Scholar
Appel, H., Anand, N. and Gupta, A. (2018) ‘Introduction: temporality, politics, and the promise of infrastructure’ in Anand, N., Gupta, A. and Appel, H. (eds), The Promise of Infrastructure. Durham NC: Duke University Press.Google Scholar
Araujo, M. (2009) ‘Promoting employment, income, and labour standards through foreign direct investment in post-war Mozambique. The cases of Dunavant and Mozal’. PhD thesis, University of East Anglia.Google Scholar
Asad, T. (1992) ‘From the history of colonial anthropology to the anthropology of Western hegemony’ in Stocking, G. (ed.), Colonial Situations: essays on the contextualization of ethnographic knowledge. Madison WI: University of Wisconsin Press.Google Scholar
Barker, C. (1985) ‘Bringing health care to the people’ in Saul, J. (ed.), A Difficult Road: the transition to socialism in Mozambique. New York NY: Monthly Review Press.Google Scholar
Benton, A. (2015) HIV Exceptionalism: development through disease in Sierra Leone. Minneapolis MN: University of Minnesota Press.Google Scholar
Biehl, J. and Petryna, A. (eds) (2013) When People Come First: critical studies in global health. Princeton NJ: Princeton University Press.Google Scholar
Biruk, C. (2018) Cooking Data: culture and politics in an African research world. Durham NC: Duke University Press.CrossRefGoogle Scholar
Biruk, C. and McKay, R. (2019) ‘Introduction: objects of critical global health studies’, Medicine Anthropology Theory 6 (2): 142–50.Google Scholar
Braga, C. (2017) ‘Producing and reproducing inequality: biopolitical exclusion, marginalized bodies, and AIDS care in central Mozambique’, Africa Development 42 (1): 221–43.Google Scholar
Buur, L. (2010) ‘Xiconhoca: Mozambique's ubiquitous post-independence traitor’ in Thiranagama, S. and Kelly, T. (eds), Traitors: ethnographies of suspicion, intimacy, and the ethics of state-building. Philadelphia PA: University of Pennsylvania Press.Google Scholar
Chichava, S. (2013) ‘“They can kill us but we won't go to the communal village”: peasants and the policy of “socialisation” of the countryside in Zambezia’, Kronos 39 (1): 112–30.Google Scholar
Cohen, L. (2012) ‘Making peasants Protestant and other projects: medical anthropology and its global condition’ in Inhorn, M. C. and Wentzell, E. A. (eds), Medical Anthropology at the Intersections: history, activisms, and futures. Durham NC: Duke University Press.Google Scholar
Comaroff, J. (2007) ‘Beyond bare life: AIDS, (bio)politics, and the neoliberal order’, Public Culture 19 (1): 197–219.CrossRefGoogle Scholar
Cueto, M. (2004) ‘The origins of primary health care and selective primary health care’, American Journal of Public Health 94 (11): 1864–74.CrossRefGoogle ScholarPubMed
Dewachi, O. (2017) Ungovernable Life: mandatory medicine and statecraft in Iraq. Stanford CA: Stanford University Press.Google Scholar
Farmer, P., Kim, J., Kleinman, A. and Basilico, M. (2013) Reimagining Global Health: an introduction. Berkeley CA: University of California Press.Google Scholar
Ferguson, J. (2005) ‘Anthropology and its evil twin: “development” in the constitution of a discipline’ in Edelman, M. and Haugerud, A. (eds), The Anthropology of Development and Globalization: from classical political economy to contemporary neoliberalism. Berkeley CA: University of California Press.Google Scholar
Geissler, P. W. (ed.) (2015) Para-states and Medical Science: making African global health. Durham NC: Duke University Press.CrossRefGoogle ScholarPubMed
Gonçalves, E. (2013) ‘Orientações superiores: time and bureaucratic authority in Mozambique’, African Affairs 112 (449): 602–22.CrossRefGoogle Scholar
Gonçalves, E. (2019) ‘African anthropological practice in the “era of aid”: towards a critique of disciplinary canons’ in Grinker, R. R., Lubkemann, S. C., Steiner, C. and Gonçalves, E. (eds), A Companion to the Anthropology of Africa. Malden MA: Wiley-Blackwell.Google Scholar
Gupta, P. and Rodary, E. (2017) ‘Opening up Mozambique: histories of the present’, African Studies 76 (2): 179–87.CrossRefGoogle Scholar
Haines, A., Sanders, D., Lehmann, U., Rowe, A. K., Lawn, J. E., Jan, S., Walker, D. G. and Bhutta, Z. (2007) ‘Achieving child survival goals: potential contribution of community health workers’, Lancet 369 (9579): 2121–31.CrossRefGoogle ScholarPubMed
Honwana, A. (2012) The Time of Youth: work, social change, and politics in Africa. Boulder CO and London: Kumarian Press.Google Scholar
Igreja, V. (2008) ‘Memories as weapons: the politics of peace and silence in post-civil war Mozambique’, Journal of Southern African Studies 34 (3): 539–56.CrossRefGoogle Scholar
Igreja, V. (2013) ‘Politics of memory, decentralization and recentralization in Mozambique’, Journal of Southern African Studies 39: 313–35.CrossRefGoogle Scholar
Isaacman, A. (1996) Cotton Is the Mother of Poverty: peasants, work, and rural struggle in colonial Mozambique, 1938–1961. Portsmouth NH: Heinemann Press.Google Scholar
Israel, P. (2014) In Step with the Times: mapiko masquerades of Mozambique. Athens OH: Ohio University Press.Google Scholar
Janes, C. R. and Corbett, K. K. (2009) ‘Anthropology and global health’, Annual Review of Anthropology 38 (1): 167–83.CrossRefGoogle Scholar
Macamo, E. (2016) ‘Violence and political culture in Mozambique’, Social Dynamics 42: 85–105.CrossRefGoogle Scholar
Machava, B. (2011) ‘State discourse on internal security and the politics of punishment in post-independence Mozambique, 1975–1983’, Journal of Southern African Studies 37 (3): 593–609.CrossRefGoogle Scholar
Maes, K. (2015) ‘“Volunteers are not paid because they are priceless”: community health worker capacities and values in an AIDS treatment intervention in urban Ethiopia’, Medical Anthropology Quarterly 29 (1): 97–115.CrossRefGoogle Scholar
Maes, K. and Kalofonos, I. (2013) ‘Becoming and remaining community health workers: perspectives from Ethiopia and Mozambique’, Social Science and Medicine 87: 52–9.CrossRefGoogle ScholarPubMed
Maes, K., Closser, S. and Kalofonos, I. (2014) ‘Listening to community health workers: how ethnographic research can inform positive relationships among community health workers, health institutions, and communities’, American Journal of Public Health 104 (5): e5–9.CrossRefGoogle ScholarPubMed
McKay, R. (2012) ‘Afterlives: humanitarian histories and critical subjects in Mozambique’, Cultural Anthropology 27 (2): 286–309.CrossRefGoogle Scholar
McKay, R. (2018) Medicine in the Meantime: the work of care in Mozambique. Durham NC: Duke University Press.CrossRefGoogle Scholar
McKay, R. (2019) ‘Critical convergences: social science research as global health technology’, MAT (Medicine Anthropology Theory) 6 (2): 181–92.Google Scholar
Meneses, M. P. (2015) ‘Xiconhoca, o inimigo: narrativas de violência sobre a construção da nação em Moçambique’, Revista Crítica de Ciências Sociais 106: 9–52.CrossRefGoogle Scholar
Mkandawire, T. (2010) ‘Aid, accountability, and democracy in Africa’, Social Research 77 (4): 1149–82.Google Scholar
Mwambari, D. and A. Owor (2019) ‘The black market of knowledge production’, Governance in Conflict Network (blog), 20 March <https://www.gicnetwork.be/the-black-market-of-knowledge-production/>, accessed 15 October 2019.,+accessed+15+October+2019.>Google Scholar
Ntarangwi, M. (2019) ‘African participation in, and perspectives on, the politics of knowledge production in Africanist anthropology’ in Grinker, R. R., Lubkemann, S. C., Steiner, C. and Gonçalves, E. (eds), A Companion to the Anthropology of Africa. Malden MA: Wiley-Blackwell.Google Scholar
Olivier de Sardan, J.-P., Diarra, A. and Moha, M. (2017) ‘Traveling models and the challenge of pragmatic contexts and practical norms: the case of maternal health’, Health Research Policy and Systems 5 (S1): 60.CrossRefGoogle Scholar
Packard, R. (2016) A History of Global Health: interventions into the lives of other people. Baltimore MD: Johns Hopkins University Press.Google Scholar
Pfeiffer, J. (2013) ‘The struggle for a public sector: PEPFAR in Mozambique’ in Biehl, J. and Petryna, A. (eds), When People Come First: critical studies in global health. Princeton NJ: Princeton University Press.Google Scholar
Prince, R. J. (2013) ‘“Tarmacking” in the millennium city: spatial and temporal trajectories of empowerment and development in Kisumu, Kenya’, Africa 83 (4): 582–605.CrossRefGoogle ScholarPubMed
Prince, R. and Brown, H. (2016) Volunteer Economies: the politics and ethics of voluntary labor in Africa. Woodbridge: James Currey.Google Scholar
Prince, R. and Marsland, R. (eds) (2014) Making and Unmaking Public Health in Africa: ethnographic and historical perspectives. Athens OH: Ohio University Press.Google Scholar
República Popular de Moçambique (1977) Manual do Agente Polivalente Elementar. Direcção Nacional do Pessoal (Secção de Formação). Maputo: Ministry of Health.Google Scholar
Stevenson, L. (2014) Life Beside Itself: imagining care in the Canadian Arctic. Berkeley CA: University of California Press.Google Scholar
Stoler, A. (2016) Duress: imperial durabilities in our times. Durham NC: Duke University Press.CrossRefGoogle Scholar
Storeng, K. T. and Mishra, A. (2014) ‘Politics and practices of global health: critical ethnographies of health systems’, Global Public Health 9 (8): 858–64.CrossRefGoogle ScholarPubMed
Tousignant, N. (2018) Edges of Exposure: toxicology and the problem of capacity in postcolonial Senegal. Durham NC: Duke University Press.Google Scholar
Vail, L. and White, L. (1980) Capitalism and Colonialism in Mozambique: a study of Quelimane District. Minneapolis MN: University of Minnesota Press.Google Scholar
WHO (1978) Declaration of Alma-Ata: international conference on primary health care. Geneva: World Health Organization (WHO) <http://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdf?ua=1>, accessed 29 November 2018.,+accessed+29+November+2018.>Google Scholar
WHO (2018) Declaration of Astana: global conference on primary health care. Geneva: World Health Organization (WHO) <https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf>, accessed 29 November 2018.,+accessed+29+November+2018.>Google Scholar
Whyte, S. Reynolds (ed.) (2014) Second Chances: surviving AIDS in Uganda. Durham NC: Duke University Press.CrossRefGoogle Scholar