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The power-trust cycle in global health: Trust as belonging in relations of dependency

Published online by Cambridge University Press:  08 July 2021

Emma-Louise Anderson Open the ORCID record for Emma-Louise Anderson [Opens in a new window] ,
Laura Considine  and
Amy S. Patterson Open the ORCID record for Amy S. Patterson [Opens in a new window]
Emma-Louise Anderson*
Affiliation:
School of Politics and International Studies (POLIS), University of Leeds, Leeds, United Kingdom
Laura Considine
Affiliation:
School of Politics and International Studies (POLIS), University of Leeds, Leeds, United Kingdom
Amy S. Patterson
Affiliation:
Department of Politics, University of the South, Tennessee, United States
*
*Corresponding author. Email: [email protected]
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Abstract

Trust between actors is vital to delivering positive health outcomes, while relationships of power determine health agendas, whose voices are heard and who benefits from global health initiatives. However, the relationship between trust and power has been neglected in the literatures on both international politics and global health. We examine this relationship through a study of relations between faith based organisations (FBO) and donors in Malawi and Zambia, drawing on 66 key informant interviews with actors central to delivering health care. From these two cases we develop an understanding of ‘trust as belonging’, which we define as the exercise of discretion accompanied by the expression of shared identities. Trust as belonging interacts with power in what we term the ‘power-trust cycle’, in which various forms of power undergird trust, and trust augments these forms of power. The power-trust cycle has a critical bearing on global health outcomes, affecting the space within which both local and international actors jockey to influence the ideologies that underpin global health, and the distribution of crucial resources. We illustrate how the power-trust cycle can work in both positive and negative ways to affect possible cooperation, with significant implications for collective responses to global health challenges.

Keywords

Global HealthHealth DiplomacyPowerTrustDependencyAfricaMalawiZambia
Type
Research Article
Information
Review of International Studies , Volume 47 , Issue 4 , October 2021 , pp. 422 - 442
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the British International Studies Association

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102 In 2015, 97 per cent of CHAM's operating budget came from donors. CHAM, ‘Annual Report’ (2015), p. 547.

103 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

104 CHAM, ‘Strategic Plan 2015–2019’ (2015), p. 6, available at: {http://www.cham.org.mw/uploads/7/3/0/8/73088105/cham_strategic_plan_7-2-15__1___1_.pdf}; Authors’ interview with CHAM official.

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113 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

114 Authors’ interview with CHAZ official, Lusaka, 16 August 2007.

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119 Patrick Kyalo and Doris Mwarey, ‘Looking Back and Encouraged to Press on for the Health Workforce in Africa’ (13 April 2015), available at: {https://imaworldhealth.org/looking-back-and-encouraged-to-press-on-for-the-health-workforce-in-africa}.

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124 CHAZ, ‘2013 Annual Report’.

125 Amy Patterson, ‘Christianity and democracy’, in Gabrielle Lynch and Peter VonDoepp (eds), The Routledge Handbook of Democratization in Africa (London, UK: Routledge, 2019), pp. 275–87.

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136 Ibid., pp. 91, 96.

137 Ibid., p. v.

138 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

139 CHAZ, ‘2018 Annual Report’, pp. 7, 9.

140 CHAZ, ‘2017 Annual Report’, pp. 9, 17.

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153 Authors' interviews with: US PEPFAR program official, Lusaka, 13 August 2007; international FBO official, Lusaka, 17 March 2011.

154 ‘A discussion with Karen Sichinga’, interview available online.

155 Authors’ interview with World Vision official, Lusaka, 15 August 2007; authors’ observation, donor meeting, Lusaka, 11 February 2011.

156 David Lewis and David Mosse, Development Brokers and Translators (West Hartford, CT: Kumarian, 2006).

157 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

158 Authors’ interviews with: CHAZ official, Lusaka, 16 August 2007, 13 April 2009; World Vision official, Lusaka, 15 August 2007. See also Patterson, African Church and the AIDS Crisis.

159 Authors’ interview with CHAZ physician, Lusaka, 8 April 2009.

160 Authors’ informal discussions with CHAZ-facility clients, Lusaka, February 2011.

161 Lewis and Mosse, Development Brokers and Translators.

162 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

163 Authors’ interview with CHAZ official, Lusaka, 13 April 2009.

164 Authors’ interview with Reformed Church official, Lusaka, 31 March 2011.

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167 Makoka, ‘Strengthening PPPs and Interfaith Partnerships for UHC’.

168 Authors’ interviews with: programme managers – major international donor, Lilongwe, 6 June, 4, 9, 10 July 2014; health advisor – major international donor, Lilongwe, 7 July 2014. Anderson, ‘Shadow diplomacy’.

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171 Authors’ interview with CHAZ board member, Lusaka, 13 June 2014.

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173 CHAZ, ‘2018 Annual Report’, p. 9.

174 Ibid.

175 Authors’ interview with CHAZ official, Lusaka, 16 August 2007.

176 Authors’ interview with CHAM official, Lilongwe, 3 July 2014; CHAM, ‘Strategic Plan 2015–2019’.

177 The only civil society organisations to receive grants were FBO World Vision International and NGO ActionAid International Global Fund, ‘Partner Investments’, dataset (2019), available at: {https://data.theglobalfund.org/partners/MWI}.

178 Authors’ interview with CHAM official, Lilongwe, 3 July 2014.

179 Head, Naomi, ‘Costly encounters of the empathic kind’, International Theory, 8:1 (2016), pp. 171–99CrossRefGoogle Scholar; Wheeler, ‘To put oneself into the other fellow's place’.

180 See Pfeiffer, ‘International NGOs and primary health care’.

181 Pfeiffer, ‘International NGOs and primary health care’, p. 736.

182 Andrews, Pritchett, and Woolcock, Building State Capability, p. 288.

183 Keating, Vincent and Thrandardottir, Erla, ‘NGOs, trust, and the accountability agenda’, The British Journal of Politics and International Relations, 19:1 (2017), pp. 134–51CrossRefGoogle Scholar.