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Global health's durable dreams: ethnography, ‘community health workers’ and health without health infrastructure

Published online by Cambridge University Press:  11 March 2020

Ramah McKay
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Abstract

Tracing the persistence of community health workers (CHWs) as a key category in both global health policy and anthropological representation, this article asks how enduring scholarly investments in CHWs can reveal changing political stakes for both health work and ethnographic research. Amid renewed calls for a focus on health systems and universal health coverage, the article suggests that the durability of attention to CHWs is instructive. It simultaneously points to the imbrication of health with political and social relations and clinical and technological infrastructures as well as to how ethnographic investments in health systems can sometimes obscure the ambivalent politics of health. Drawing on fieldwork with CHWs, NGO staff and public health officials, and on public health literature on CHWs, it argues for greater attention to the political ambivalence of health labour. It suggests that the experiences of health workers themselves can serve as analytical examples in this regard, pointing to analyses that begin not with normative notions of health systems or the conceptual boundaries of global health ‘projects’ but with a focus on the contested relations through which health labour is realized over time. Such attention can also indicate possibilities for health beyond dreams of projects, clinics or health systems.

Résumé

Résumé

À travers la persistance des agents de santé communautaires en tant que catégorie clé, tant en matière de politique de santé mondiale que de représentation anthropologique, cet article examine en quoi l'attention durable portée aux agents de santé communautaires peut révéler une évolution des enjeux politiques pour le travail de santé et la recherche ethnographique. Face aux appels renouvelés à porter l'attention sur les systèmes de santé et la couverture de santé universelle, l'article suggère que l'héritage des agents de santé communautaires est instructif; il révèle simultanément l'imbrication de la santé avec les relations politiques et sociales ainsi que les infrastructures cliniques et technologiques, et la manière dont l'investissement ethnographique dans le travail de santé et les systèmes de santé peut à la fois illuminer et masquer l'ambivalence de la politique de santé. S'appuyant sur des travaux menés sur le terrain auprès d'agents de santé communautaires, de membres d'ONG et de responsables de la santé publique, et sur la littérature de santé publique consacrée aux agents de santé communautaires, il plaide pour une attention accrue sur l'ambivalence politique du travail de santé. Il suggère que les expériences des agents de santé eux-mêmes peuvent servir d'exemples analytiques à cet égard, en se référant à des analyses qui commencent non pas par des notions normatives de systèmes de santé ou les limites conceptuelles des « projets » de santé mondiale, mais par une focalisation sur les relations contestées au travers desquelles le travail de santé est réalisé au fil du temps. Une telle attention peut aussi indiquer des possibilités pour la santé au-delà de rêves de projets, de cliniques ou de systèmes de santé.

Type
Dreaming histories
Information
Africa , Volume 90 , Special Issue 1: Beyond realism: Africa's medical dreams , January 2020 , pp. 95 - 111
Copyright
Copyright © International African Institute 2020

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