Periodic Reporting for period 3 - UNIVERSAL HEALTH (Engaged Universals: Ethnographic explorations of ‘Universal Health Coverage’ and the public good in Africa)
Periodo di rendicontazione: 2021-09-01 al 2023-02-28
UNIVERSAL HEALTH is an anthropological project that follows policies, reforms and aspirations surrounding universal health coverage and universal health care, and the social and political collectives forming around struggles for public health, through ethnographic and historical research in four African countries (Kenya, Tanzania, Zambia and Ghana).
Defined by the WHO as ensuring that all people can use the health services they need without financial hardship, Universal Health Coverage (UHC) approaches public health as a matter of justice and obligation and figures prominently in the 2015 Sustainable Development Goals. In African countries, moves towards UHC appear to represent new ways of thinking about poverty and redistribution, the state and citizenship, healthcare and development, offering recognition that citizenship implies some basic entitlement to care and protection. Yet UHC serves very different social and political agendas and, in providing a limited set of services for the poor, it appears to offer only a minimalist biopolitics of care. Moreover, while moves towards UHC appear to reinsert questions of state responsibility into healthcare, historically African states have only partially pursued the public good. UHC reforms should be situated within the complex framework of governmentality in postcolonial Africa, where the state is not a predictable, monolithic power; where transnational agents are creating enclaves and exclusions; and where colonial and post-colonial legacies exist alongside new regimes of consumer choice and patient’s rights.
Approaching UHC not as a universal model but a contested field, UNIVERSAL HEALTH explores the frictions and contradictions surrounding questions of universality, solidarity, and responsibility as they take shape in different sites and engender debates about public health, state responsibility, citizenship, and the public good. The project has four research objectives: 1) To explore how moves towards UHC shape the role and responsibility of the state towards its citizens; 2) To explore how actors at national and local levels approach and negotiate the concept of health as a ‘public good’; 3) To explore how UHC reforms intersect with formal welfare, health-care and social protection policies and interventions; 4) To explore how UHC reforms intersect with informal networks of mutual support and obligation that people are embedded in or struggling with.
Defined by the WHO as ensuring that all people can use the health services they need without financial hardship, Universal Health Coverage (UHC) approaches public health as a matter of justice and obligation and figures prominently in the 2015 Sustainable Development Goals. In African countries, moves towards UHC appear to represent new ways of thinking about poverty and redistribution, the state and citizenship, healthcare and development, offering recognition that citizenship implies some basic entitlement to care and protection. Yet UHC serves very different social and political agendas and, in providing a limited set of services for the poor, it appears to offer only a minimalist biopolitics of care. Moreover, while moves towards UHC appear to reinsert questions of state responsibility into healthcare, historically African states have only partially pursued the public good. UHC reforms should be situated within the complex framework of governmentality in postcolonial Africa, where the state is not a predictable, monolithic power; where transnational agents are creating enclaves and exclusions; and where colonial and post-colonial legacies exist alongside new regimes of consumer choice and patient’s rights.
Approaching UHC not as a universal model but a contested field, UNIVERSAL HEALTH explores the frictions and contradictions surrounding questions of universality, solidarity, and responsibility as they take shape in different sites and engender debates about public health, state responsibility, citizenship, and the public good. The project has four research objectives: 1) To explore how moves towards UHC shape the role and responsibility of the state towards its citizens; 2) To explore how actors at national and local levels approach and negotiate the concept of health as a ‘public good’; 3) To explore how UHC reforms intersect with formal welfare, health-care and social protection policies and interventions; 4) To explore how UHC reforms intersect with informal networks of mutual support and obligation that people are embedded in or struggling with.
Three postdoctoral researchers (Muinde, Wintrup and Bannister) began their contracts in September 2018. Between October 2018 and March, 2019, the team worked on gaining ethics approvals and research permits from the relevant countries (Kenya, Zambia, Tanzania, Ghana and Norway). PhD student (Ameso, funded by a MarieCurie training grant) joined in September 2018. A fourth postdoctoral fellow (Neumark, funded by University of Oslo) began in June 2019. From 2018 to January 2019, Prince, Muinde and Ameso pursued ethical clearance in Kenya, and established research sites. The Kenya fieldwork took place mostly from January 2019-March 2020. Tanzania research (Neumark) took place from September 2019-February 2020. The Ghana research (Bannister) took place from June-August 2019, while the Zambia research (Wintrup) took place from June 2019 to February 2020. All further research plans were interrupted or cancelled by the pandemic.
Early results from our research appeared in the series in Somatosphere in 2020, on “Health for all? Critical perspectives on Universal Health Coverage”, see http://somatosphere.net/2020/universal-health-coverage.html/. Our ambition of developing anthropological engagement beyond critique was the subject of an international conference titled “Curious utopias: large and small blueprints for human society” (University of Oslo, 6-7 September, 2019), several sessions of our joint reading groups, and an ASAUK panel on “Critiquing What We Like” (March 2021). The plan to hold a major conference on the theme of “Health for all?” was replaced by a series of webinars in May 2021. Project members have publicized research through online sites such as The Conversation, Africa-is-a-Country, and Somatosphere. We have also built up a project archive of media
Early results from our research appeared in the series in Somatosphere in 2020, on “Health for all? Critical perspectives on Universal Health Coverage”, see http://somatosphere.net/2020/universal-health-coverage.html/. Our ambition of developing anthropological engagement beyond critique was the subject of an international conference titled “Curious utopias: large and small blueprints for human society” (University of Oslo, 6-7 September, 2019), several sessions of our joint reading groups, and an ASAUK panel on “Critiquing What We Like” (March 2021). The plan to hold a major conference on the theme of “Health for all?” was replaced by a series of webinars in May 2021. Project members have publicized research through online sites such as The Conversation, Africa-is-a-Country, and Somatosphere. We have also built up a project archive of media
UNIVERSAL HEALTH is situated at the forefront of a critically engaged medical anthropology that focuses on the terrain of the biopolitical, addressing questions of inclusion and exclusion and exploring new configurations and mobilizations around care. The project offers a large-scale comparative anthropological study of a major global health policy that asks questions about how progressive policy might redefine relations between citizens and the state. It is now widely acknowledged that structural adjustment policies were hugely detrimental to healthcare access and poverty alleviation. As African countries seek to expand access to health care for their citizens, amidst dwindling international aid and resources, UHC – conceived of as expanding access to healthcare alongside social and financial protection – has become central to goals of health system strengthening. However, moves towards UHC are taking place amidst increasing socio-economic inequalities and the enclaving of middle-class aspirations within private health care. In this context, key questions arise. Who do public health systems serve? How should they be financed? What does state responsibility entail? Who is responsible for whose healthcare needs and costs?
Moves towards UHC in African countries offers a unique opportunity to explore the role of the state within public health as well as the meanings and entitlements of citizenship. It also offers an opportunity to study the meanings that values such as social solidarity, obligation and the public good have in these contexts. Such issues are particularly important given the recent history of public health on the continent. Here, development, welfare and global health have long been sites of experimentation and governmentality neither fits models of biopower nor confirms to neoliberal models found elsewhere. The project aspires to a critically engaged anthropology that addresses both the politics of the possible and the ways progressive policies may be limited by social, economic and political contexts. It aims to generate anthropological engagement with global health that moves beyond the stance of critique to take aspirations for improving health equity seriously.
Studying the frictions surrounding a global health policy that aims for inclusion and equity across different African countries and sites, the project also explores how histories of state formation and citizenship, as well as patterns of inequality and the politics of class shape aspirations for the public good and visions of health equity. In the next phase, the project will bring our anthropological and historical research into conversation with policy makers, global health experts and advisors, and government officials, seeking to improve equity in health systems.
Moves towards UHC in African countries offers a unique opportunity to explore the role of the state within public health as well as the meanings and entitlements of citizenship. It also offers an opportunity to study the meanings that values such as social solidarity, obligation and the public good have in these contexts. Such issues are particularly important given the recent history of public health on the continent. Here, development, welfare and global health have long been sites of experimentation and governmentality neither fits models of biopower nor confirms to neoliberal models found elsewhere. The project aspires to a critically engaged anthropology that addresses both the politics of the possible and the ways progressive policies may be limited by social, economic and political contexts. It aims to generate anthropological engagement with global health that moves beyond the stance of critique to take aspirations for improving health equity seriously.
Studying the frictions surrounding a global health policy that aims for inclusion and equity across different African countries and sites, the project also explores how histories of state formation and citizenship, as well as patterns of inequality and the politics of class shape aspirations for the public good and visions of health equity. In the next phase, the project will bring our anthropological and historical research into conversation with policy makers, global health experts and advisors, and government officials, seeking to improve equity in health systems.