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Engaged Universals: Ethnographic explorations of ‘Universal Health Coverage’ and the public good in Africa

Periodic Reporting for period 1 - UNIVERSAL HEALTH (Engaged Universals: Ethnographic explorations of ‘Universal Health Coverage’ and the public good in Africa)

Reporting period: 2018-09-01 to 2020-02-29

"What is the problem/issue being addressed?
Defined by the WHO as ensuring that all people can use the health services they need without financial hardship, UHC is a powerful concept that approaches public health as a matter of justice and obligation and is included in the SDGs. UHC is particularly important in Africa, where structural-adjustment policies undermined state capacity, promoted privatization and pushed the burden of payment for health services onto the poor. While UHC reinserts questions of state responsibility and the public good into health-care, historically, African states have only partially pursued the public good, while in practice UHC is surrounding by conflicting interests. UHC is thus not a universal model but a contested field, making it an intriguing site for anthropological research.

Overall objectives
The project follows policies and reforms relating to ""Universal Health Coverage"" in four African countries. 1) How do moves towards UHC engage with the role and responsibility of the state towards its citizens? 2) How do actors at national and local levels approach and negotiate the concept of health as a ‘public good’? 3) How do UHC reforms intersect with formal welfare, health-care and social protection policies and interventions? 4) How do UHC reforms intersect with informal networks of mutual support (including kinship, neighborhood and religious networks) that people are embedded in, striving for, or struggling with?

Importance of this research for society?
Moves towards Universal Health Coverage in Africa appear to represent a new approach and new ways of thinking about poverty and redistribution, the state and citizenship, health and development. Yet UHC is also contradictory, serving very different social and political agendas. In providing a minimal set of services for the poor, it can be seen as offering a miminalist biopolitics not of care but of ‘bare life’. These contradictions suggest that what is defined (as contested) as ‘universal’ in Universal Health Coverage needs to be studied, alongside associated debates surrounding redistribution, inequality, and solidarity. Following UHC leads us to explore and document the social and political collectives forming around struggles for public health in Africa (and beyond)."
"1. Recruitment of project team
2. The project website and twitter account have been established, and collaborations established with other project groups.
3. Collection and archiving of policy documents and newspaper reports is ongoing.
3. Regular reading groups and project progress meetings have been held.
4. Ethics review and research permissions have been secured.
5). Research trips by the PI and project team members have been interrupted due to Covid-19.
6) Project workshops and conferences: (for full list, see https://www.med.uio.no/helsam/english/research/projects/universal-health-coverage-africa/news-and-blog/news/events-attended-and-organised-by-the-project-2018-.html
• Kick-off project workshop 31 October 2018, with project team and external advisors and academics, at Professorbolig, University of Oslo.
• International project workshop, “Curious Utopias: large and small blueprints for human societies”, University of Oslo, 6-7 September, 2019. (with project advisors among 14 paper givers) https://www.med.uio.no/helsam/english/research/projects/universal-health-coverage-africa/events/curious-utopias
• The project team invited and hosted international advisors and scholars to present papers at organized seminars in Oslo.
• Presentations at international conferences (detailed on the website): in September 2018, November 2018; invited seminars and paper presentations at the Universities of Bergen, Oslo, CERMES 3, Paris, Bern, Edinburgh, UCL (London), Bayreuth, Nairobi, LSHTM, Manchester, Cambridge, USIU Nairobi, British Institute of East Africa Nairobi.
• Thematic stream and 4 panels on “Addressing Inequality: New forms of welfare and social protection in Africa”, organized by Ruth Prince at the African Studies Association of the UK (ASAUK) Conference, Birmingham, September 11-14, 2018.
• Conference, “The Political Origins of Health inequities and Universal Coverage”, Oslo, November 2018. Invited paper: Ruth Prince, “Universal Health Coverage and the Public Good: Critical Perspectives from Kenya”.
• Project-organized conference panels at the ECAS (European Assoc. for African Studies) Conference, Edinburgh, June 2019, on:
a) “Remembering Alma Ata? Revisiting 'health for all' amid aspirations for universal health coverage in Africa” (co-organized by David Bannister)
b) “Welfare, redistribution and new forms of the ""public good” (co-organized by Ruth Prince)
• Upcoming panels organized by the project at international conferences have been cancelled due to the Covid-19 pandemic.
• Invited presentations at university seminars and workshops elsewhere have been postponed, due to the Covid-19 pandemic.

Publications and outputs:
1. Prince (2017). Universal Health Coverage in the Global South: New models of healthcare and their implications for citizenship, solidarity and the public good. Michael 14(2): 153- 172 .

Project team’s posts on Somatosphere (www.somatosphere.net):
1. Prince, Ruth J. 2020 Utopian aspirations in a dystopian world: “Health for all” and the Universal Health Coverage agenda – an Introduction (April 20th, 2020)
http://somatosphere.net/2020/universal-health-coverage.html/
2. Prince, Ruth J. 2020. A Politics of numbers? Digital registration in Kenya’s experiments with universal health coverage
http://somatosphere.net/2020/digital-registration-kenya-universal-health-coverage.html/
3. Neumark, Tom. 2020. The hype and hope of data for healthcare in Africa
http://somatosphere.net/2020/data-healthcare-africa.html/
4. Muinde, Victoria Jacinta. 2020. Health Insurance for the poor: insights from the Kenyan coast
http://somatosphere.net/2020/health-insurance-poor-kenya.html/
5. Bannister, David. 2020. Futures and the past in Ghana’s Universal Health Coverage infrastructure
http://somatosphere.net/2020/universal-health-coverage-ghana.html/
6. Wintrup, James. 2020. Achieving Universal Health Coverage in Zambia: state accountability and universality in a new community health worker programme
http://somatosphere.net/2020/universal-health-coverage-zambia.html/"
"Planned activities:
1. September 2020. Project members will organize a thematic stream on ‘New moral economies of care and welfare in Africa. A return to the universal?’, for the 2020 UK African Studies Association Conference, 8-10 September in Cardiff (cancelled due to the Covid-19 pandemic)-
2. September 2020, project members will organize a panel on ""Universal Health Coverage, health insurance and the market: Universality, solidarity and care?"" For the conference on “Mobilising Methods in Medical Anthropology”, to be held at LSHTM, London, UK, September 2020 ( cancelled due to the Covid-19 pandemic).
3. James Wintrup and Thomas Neumark have a panel on ""Curiousity and the role of Critique"" at the Assoc. of Social Anthropologists of the UK 2020 conference (postponed to 2021).
4. ""Curious Utopias: Dreaming Big Again in the 21st Century"": A collection of papers from our workshop held in September 2020, are being prepared for a Special issue (to be submitted September 2020).
5. Plan to develop a second special issue on ""Universal Health Coverage and the Public Good"" for publication."