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- Convenors:
-
Ursula Read
(University of Essex)
Matthew Maycock (University of Glasgow)
Daniel Wight (MRC/CSO Social and Public Health Sciences Unit)
- Location:
- FUL-103
- Start time:
- 9 September, 2015 at
Time zone: Europe/London
- Session slots:
- 1
Short Abstract:
There is growing recognition in global health of the dynamic interaction between interventions and context leading to calls for the inclusion of social science in the evaluation of health interventions. This panel considers the challenges for anthropological theory and method in entering this field.
Long Abstract:
Once dismissed as a confounder, context has gained increasing attention in the evaluation of global health interventions through recognition of 'complexity' and the dynamic interaction between intervention and context. This is particularly pertinent in global health where 'local contexts' have been traditionally conceived as problematic cultural differences in behaviour and beliefs. From an ecological perspective, however, context includes not only individual and community characteristics but global political, economic and historical influences. This recognition of intervention outcomes as context dependent has led to calls for the contribution of social science, including anthropology, to discover 'what works, for whom, why and in what circumstances'. However there are challenges in accounting for the broader context and in aligning anthropology's critical interpretive approach with the programmatic objectives of health interventions. Though ethnography is increasingly valued to appraise implementation on the ground, anthropology extends beyond this to a historical and comparative consideration of evaluation itself as cultural process.
This panel will discuss challenges and opportunities presented by this ethnographic turn in evaluating health interventions, including critical appraisals from anthropologists in the field. We will consider questions such as: What are the challenges of conducting ethnography within the constraints of research budgets and timelines? How can anthropology as critical practice be operationalised? How do insights from anthropological inquiry intersect with other approaches to evaluation? How can anthropology span differences of scale contained in a broader notion of context? How might ethnographic approaches to evaluation within low-income settings inform those in high-income settings, and vice-versa?
Accepted papers:
Session 1Elsabe du Plessis (University of Manitoba)
Paper short abstract:
In a global health program, local knowledge systems inform how village-level enumerators participate in monitoring activities. Exploring the collisions between local knowledges and universalistic project imperatives raises crucial implications for understanding intervention 'success'.
Paper long abstract:
Contemporary global health projects are increasingly expected to conduct 'evidence-based' activities. As such, monitoring and evaluation procedures tend to rely on the collection of quantitative data guided by predefined, fixed indicators of 'success'. This approach often neglects the messier and more complex realities of the implementation process that shape intervention outcomes. Drawing upon eight months of fieldwork in a Muskoka Initiative-funded maternal newborn and child health project, I demonstrate how ethnographic methodologies, when used alongside more conventional project monitoring and tracking systems, can reveal the complex and integral role that 'local knowledges' play in the everyday workings of interventions. Expanding on Geertz's concept of 'local knowledge', I argue that local knowledges enacted during the Muskoka project are traceable to a history of intervention projects in the region. As people participate in a multitude of development and research projects over extended periods of time, universalistic knowledge unfolds in locales to become grounded epistemologies. As new projects are introduced, individuals draw on these grounded knowledges to make sense of project goals; it guides their participation in project activities, including monitoring and evaluation procedures. In particular, by analysing the jottings that village-level enumerators mark down on survey instruments—displaying highly relevant understandings that do not fit pre-determined survey response options—I show how this knowledge unsettles the expertise of the scientists who designed the survey and also questions the assumed the authority of the supervisors who reinforce universalistic scientific logics.
Svetlana McGill (Queen Margaret University)
Paper short abstract:
The specificity of NGO delivery systems funded by Global Fund, is discussed, as they were juxtaposed to the state-owned HIV healthcare in Ukraine.
Paper long abstract:
Ethnographic enquiry is increasingly used in Global Health studies to better understand the complex transnational processes of combating the HIV epidemic, in which individuals, organisations, policies, and values constantly interact. In line with the critique of 'top-down' development model implying that international development initiatives often import value systems and principles into local contexts, the PhD study, recently completed by the author, analysed how the service delivery model by NGOs promoted by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), manifested itself on the ground in Ukraine. A critical ethnographic enquiry including 50 participant interviews in three oblasts in Ukraine, and in capital Kyiv, investigated the conduct and practice of international and national nongovernmental organizations (NGOs) as Principal Recipients of GF grants in Ukraine from 2003-2012. The study aimed to understand how NGO-based HIV prevention services were implemented within a post-Soviet 'Semashko' health care context. The paper presents some of the findings that emerged from the analysis and discusses the specificity of NGO delivery systems, juxtaposed to the state-owned HIV healthcare system in Ukraine. Instead of an anticipated outcome of robust and effective delivery of HIV services by NGOs, deeply embedded in GF rhetoric and promoted in its delivery models, the NGO-run programmes were reported as not to have been integrated with the state health care system, and were run in a 'standalone', isolationist manner, which compromised referral into the HIV continuum of treatment and care.
Benjamin Epstein (University College London)
Paper short abstract:
This paper will present an outline of my research surrounding the expansion of post-emergency clinical mental health services in Tohoku, Northern Japan, after the unparalleled catastrophic events of March 2011. It will ask: how are experiences rendered commensurable in disaster mental health practice?
Paper long abstract:
Psychological humanitarian aid highlights the belief that experiences in one place are commensurate with experiences in another through the production and reproduction of legitimate scientific authority, making previously unknown disorders visible and quantifiable in ways commensurate with global scientific discourse.
Understanding the effects of disasters on mental health is highly complex and notoriously difficult to study, as disasters are at once collective and individual experiences. The work of local and international psychiatrists, psychology students, researchers, and humanitarian actors does not by itself prove the success and applicability of any treatments. Simply inserting diagnostic criteria into new terrains - diagnostic procedures that rely on questionnaires and surveys developed in other countries - serves to produce a common language intelligible across domains without necessarily taking into account the existing social or cultural situation. Differences are rendered equivalent. These practices appear to suggest that after an event, not only is everybody equally susceptible to mental illness, but that the experiences would be more or less uniform and predictable. Furthermore, the experience of local researchers and clinicians is often considered a challenge to authoritative or more experienced international humanitarian coordinators.
Thus, the need to produce universal, standardised assessments of health and wellbeing is driven both by international institutions and the individuals who put the most relevant and up-to-date diagnostic criteria to use. The question I want to raise, then, is how can the experiences of survivors be made comparable in ways that retain their cultural specificity?
Ursula Read (University of Essex)
Paper short abstract:
Recognition of the intersection of health interventions and cultural context seldom account for increasing global diversity. This paper draws on two case examples to consider how anthropology might contribute to the evaluation of health interventions in settings of cultural complexity.
Paper long abstract:
The focus on the interaction of interventions with context has brought renewed attention to culture as 'a fundamental set of defining qualities of community life out of which interventions flow' (Trickett et al 2011). However the 'location of culture' has been a central problematic of anthropological theory with recognition of culture as complex, plural and dynamic. Social scientists have also interrogated the notion of 'communities' as socially or spatially predefined groups into which interventions can be introduced. In high-income contexts notions of 'culture' and 'community' are commonly deployed in the development of interventions targeting ethnic minority groups with little critical interrogation of how these are constituted. More recently researchers in health have highlighted the need to consider the intersection of multiple variables beyond culture and ethnicity, including age, gender, socio-economic status and migration history, with structural factors (Viruell-Fuentes et al 2012). However such diversity has less often been recognised in low-income countries where community settings for health interventions are generally conceived as bound together by cultural 'tradition'. By contrast such settings are also likely to be sites of 'cultural complexity' (Hannerz 1992) as a consequence of long histories of migration, trade, colonialism and cultural exchange, as well as intensifying processes of globalisation. This paper will draw on examples from two contrasting locations of ethnic and religious diversity - Kintampo, Ghana and London, UK - to explore how anthropological perspectives might contribute to the evaluation of health interventions in taking account of such complexity.