scholarly journals Disentangling the efficiency drivers in country-level global health programs: An empirical study

2016 ◽  
Vol 45 (1) ◽  
pp. 30-43 ◽  
Author(s):  
Gemma Berenguer ◽  
Ananth V. Iyer ◽  
Prashant Yadav
Author(s):  
Hani Kim ◽  
Uros Novakovic

The function of ideology is to naturalize and maintain unequal relations of power. Making visible how ideology operates is necessary for solving health inequities grounded in inequities of resources and power. However, discerning ideology is difficult because it operates implicitly. It is not necessarily explicit in one’s stated aims or beliefs. Philosopher Slavoj Žižek conceptualizes ideology as a belief in overarching unity or harmony that obfuscates immanent tension within a system. Drawing from Žižek’s conceptualization of ideology, we identify what may be considered as ‘symptoms’ of ideological practice: (1) the recurrent nature of a problem, and (2) the implicit externalization of the cause. Our aim is to illustrate a method to identify ideological operation in health programs on the basis of its symptoms, using three case studies of persistent global health problems: inequitable access to vaccines, antimicrobial resistance, and health inequities across racialized communities. Our proposed approach for identifying ideology allows one to identify ideological practices that could not be identified by particular ideological contents. It also safeguards us from an illusory search for an emancipatory content. Critiquing ideology in general reveals possibilities that are otherwise kept invisible and unimaginable, and may help us solve recalcitrant problems such as health inequities.


PLoS Medicine ◽  
2017 ◽  
Vol 14 (10) ◽  
pp. e1002397 ◽  
Author(s):  
Alyssa Bilinski ◽  
Peter Neumann ◽  
Joshua Cohen ◽  
Teja Thorat ◽  
Katherine McDaniel ◽  
...  

Author(s):  
Jeff McMahan

Many people believe that death is one of the worst things that can happen to us. At the same time, the incident of death cannot be experienced. This raises philosophical questions about how and to whom death is bad. Is death negative primarily for the survivors, or does death also affect the decedent? And when is the worst time to die? Is it late in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must provide answers to these questions. In this volume, leading philosophers, medical doctors, and health economists discuss different views on how to evaluate deaths and the relevance of such evaluations to health policy. These include state-of-the-art theories about the harm of death and its connections to population-level bioethics. The standard view in global health is that newborn deaths count as the worst deaths, while stillbirths are neglected. This raises a question about why birth is so significant. Several of the book’s authors challenge this standard view. This is the first volume to connect philosophical discussions on the harm of death with discussions on population health. The results from the book will change the way we evaluate deaths in global health. If we do change how deaths are evaluated, this will have consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we think about inequality in health.


2020 ◽  
Author(s):  
Irene Akua Agyepong ◽  
Fredline A.O. M’Cormack-Hale ◽  
Hannah Brown-Amoakoh ◽  
Abigail N.C. Derkyi-Kwarteng ◽  
Theresa Ethel Darkwa ◽  
...  

Abstract Background: Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. This study is part of a series of country case studies to inform the Lancet Commission on synergies between UHC, HS and HP.Results: National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions: There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.


A critical ethnography of global health must attend to the granular ways in which interventions (multiple and fragmentary and tied to neoliberal principles and strategies) become part and parcel of public health landscapes and social relations in resource-poor settings. The chapter by Susan Reynolds Whyte, Michael Whyte, Lotte Meinert, and Jenipher Twebaze focuses on the micropolitics of HIV/AIDS care in Uganda—the ways in which social networks are produced, expanded, and cultivated in efforts to access health programs and the associated benefits they confer—and how the roles of the state and ideas of political belonging are being transformed by global health initiatives....


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