1,720,975 research outputs found
The datafication of health policy and health data ecosystems in Senegal
Get PDFThe demands of global health actors weigh on the health systems of countries that receive global health funding, particularly on digital data infrastructures for health, which are formed to carry out two, often opposing, processes. More important for donors are the data they can use to justify their health investments to their stakeholders, while recipient countries seek data to shape domestic health policies. These conflicting objectives result in fragmented and incomplete information systems in countries that rely on global health funds for data infrastructural support. In this article, Senegal’s universal health coverage policy is used as an example – alongside global discourse – to show how Senegal’s data health ecosystem is established and maintained
Statistical capacity development and the production of epistemic infrastructures
Get PDFDesignating statistical capacity development as a target for measurement in the Sustainable Development Goals (SDGs) created a dilemma for statistical decision-makers in the United Nations system, as some saw the inclusion of statistical capacity in SDG17 as a “conflict of interest,” making their work both a goal of the SDGs and a means to achieve them. In 2022, there are five indicators for measuring both the statistical capacity of individual countries and the support provided to strengthen it, including one indicator for measuring a country’s ability to monitor the SDGs themselves. In this article, I argue that the epistemic infrastructuring of statistical capacity into the SDG framework is a privileged case. By parsing the interconnections between the data, actors, networks, and processes that constitute statistical capacity on national and global levels, we can understand how central these materialities and processes are in constituting the larger policy agenda of the SDGs as well as debates over the problems that statistical capacity is meant to solve. Like all indicators in the SDG framework, statistical capacity indicators are performative – defined and delineated by the global statistics community that also helps define and delineate the SDG framework’s development problems. Unlike other indicators, however, statistical capacity indicators have the added weight of also producing the conditions of possibility for the “SDG framework itself.” In this way, debates over what constitutes statistical capacity and its strengthening are also debates about ownership of policy agendas and where tensions between the local and global erupt
Metrics
Get PDFNumbers, enumeration, and the quantification of contemporary life seem to govern our existence more and more. Particularly since the dawn of the twenty-first century, the importance of quantification for governance has grown, and anthropologists have increasingly turned their attention to the ramifications of metrics, or numeric representation that translates assumed realities into numbers (Rottenburg & Merry 2015: 2). They study whether and how the production, synthesis, analysis, and use of metrics is tied to the rise and decentralization of audit and accountability in contemporary capitalism. This entry will first provide a theoretical framework for the anthropology of metrics, drawing on science and technology studies and the history of science. Then, it will discuss how anthropologists have analysed the social impact of enumerative practices. Looking at the practices and infrastructures that produce metrics and that metrics in turn produce, this entry will highlight the importance of colonial legacies for shaping what is ‘knowable’ in the realms of global governance, economics, and health. Finally, the entry will point to tensions at the heart of contemporary critiques of metrics: in our ‘post-truth’ world, these critiques cannot reject the usefulness of truthfully describing and estimating human phenomena. However, these critiques foreground the idea that metrics are always just one form of evidence among many
After Ebola in Sierra Leone: the politics of neglect and the social life of projectified post-epidemic recovery
Get PDFThis thesis provides a medical anthropological account of the Sierra Leonean
post-Ebola recovery initiative, how it was implemented by a District Health
Management Team (DHMT), and how the social life it produced was resisted
and manipulated at the district and community levels. To make sense of the
recovery priorities, this thesis unpacks the broader structures that underpin
global health programming in an attempt to strengthen ‘weak’ health systems.
The case of the post-Ebola recovery in Sierra Leone is an exemplary case of
how intrinsic the politics of neglect are within global health governance. It will
become clear that the politics of neglect were also evident during the post-Ebola recovery period. This thesis draws on fourteen months of research, which
was divided into two distinct phases: district level and community level. At the
district level, I spent eight months in Bo town with the district health
management team; at the community level, I spent five months in a hard-to-reach chiefdom in Bo North.
In this thesis, I unpack the post-Ebola health system recovery efforts by
exploring how the projectification of the different recovery programmes
produced a social life with wide reaching, often unintended, consequences. The
recovery initiatives’ emphasis on global health security ignored a more holistic
approach to health system strengthening; the focus on global health norms in
terms of strict project timelines led to months of drug stock-outs throughout
the country; and the focus on human resources for health so as to increase a
mixed skilled health workforce led to the temporary weakening of the health
system as thousands of volunteer community nurses were withdrawn from
their health facilities, which in turn led to gross understaffing, especially in rural
health facilities. Finally, the focus on institutional deliveries led to the
criminalisation of the traditional birth attendants, which in turn contributed to
the almost temporal collapse of the rural primary health system. Thus, the
projectification of the recovery priorities, much like any other development
programme, had the politics of neglect at its core as social and relational
aspects were disregarded in favour of narrow, disease specific aspects. This
thesis, then, attends to new health system strengthening rhetoric, which was
stressed to a large extent in the aftermath of the Ebola outbreak. This rhetoric
was nothing more than a reformulation of the old vertical and disease-focused
global health paradigm
Data Performativity, Performing Health Work: Malaria and Labor in Senegal
Get PDFIn this article, I investigate the ramifications of health data production in the health fight against malaria in and around Dakar, Senegal. Malaria health development funding at the community level is contingent on performativity; the Global Fund’s “performance-based funding,” for example, requires that local actors produce certain forms of evidence and that intermediaries synthesize this evidence into citable data. Analyzing the practices of diagnosis and approximation in health clinics and in global malaria documents, I argue that data production in Senegal is conditioned by and reifies preconceived notions of malaria as a problem addressable by the enumeration of technological fixes
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Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health
Get PDFThrough the lens of malaria control and eradication efforts, this dissertation considers the political nature of demarcating global health problems and the pursuit of evidence to support such framings. By attending to past international campaigns to eliminate malaria and shifts in the goals of international health as a whole, I investigate what is new about what some have called the “silver revolver” approach to global health governance: the deployment of simple, technologically-innovative tools to attack a disease from multiple angles through the support of public-private partnerships. Based on fieldwork with health workers, biologists, public health officials, and recipients of care in and around Dakar, Senegal and with designers and funders of malaria interventions in California, Switzerland, and Italy, my dissertation shows what counts as knowledge and who frames possible futures in global health research, design, implementation, and evaluation. I argue that talking about malaria means getting close to malaria or speaking from the proximity of malaria, as the ecologies that malaria produces and that produce malaria vary greatly on the parasite’s and its hosts’ historical, political, and socio-economic contexts. Speaking of malaria on a global scale – in a project of global control or global eradication – means creating and maintaining conceptual proximities through the discourse of a single, unified “malaria” (Kelly and Beisel 2012). Examining the central role of the informal in malaria treatment, practices of approximation in malaria diagnosis, and the space for political resistance in health data collection in Senegal, I argue that attention to conflicts over malarial knowledge and practices is in fact crucial to dreams of malaria eradication, as well as to a “more democratic and equitable” global health (Geissler 2011)
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