Journal of Health Management current issue

Editorial

Kumar, M., Burman, E. — 2009-09-18

We welcome readers to the second special issue (11.2) of the Journal of Health Management in 2009. We hope the readers find the articles and various reviews enriching and provocative, both in terms of the range of ideas and critical approaches addressed. The key theme of this double issue concerns the political limits of mega-development projects such as the Millennium Development Goals (MDGs). The primary focus of the articles collected here is to provide an insightful, constructive and in-depth critique of the United Nations (UN) MDGs along with critical deliberations on their short- and long-term implications not only for health management but also for a wide range of issues around development and social change.

Disability and the Millennium Development Goals: A Missing Link

Ghai, A. — 2009-09-18

The objective of this article is to locate disability issues within the discourse of the Millennium Development Goals (MDGs). The idea is to question the failure of the goals addressing disability. MDGs cannot work as a universal remedy. It is critical to foreground the meaning of disability and underscore the reasons for the disabled people's absence from the agenda of the MDGs. Further, I discuss the ways in which state policy has addressed ‘disability’ in a globalising context. Finally, I outline the paradox of identity politics and its nuances based upon an understanding of the issues and related questions from my own experiences as a disabled Indian woman, having to contend with the existential realities of a visible physical disability. The plea is to expand the democratic space to ensure that the rights and needs of disabled people within the MDGs discourse are given due consideration.

Bottlenecks and Benevolence: How the World Bank is Helping Communities to 'Cope' with HIV/AIDS

Harman, S. — 2009-09-18

This article looks at how Goal 6 of the United Nations (UN) Millennium Development Goals (MDGs) impacts on the well-being of the people affected by Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS). The focus is on a specific aspect : how the aid emphasised by Goal 6 is channelled towards community groups responding to the HIV/AIDS crisis. It does so by exploring the institutional mechanisms used by one of the key international organisations involved in the realisation of the MDGs—the World Bank and its Multi-Country HIV/AIDS Programme (MAP) in Kenya, Tanzania and Uganda. The article explores the role of local government, rivalry between different forms of civil society organisations, the problems associated with effective delivery and community feedback, donor responses to these problems and how these factors impact upon the immediate and long-term realisation of Goal 6, and the position of communities within it. Key to which are themes of conditionality and divisions between implementation and decision-making. The article is based upon extensive qualitative research into MAP in East Africa.

Frustrated Potential, False Promise or Complicated Possibilities? Empowerment and Participation Amongst Female Health Volunteers in South Africa

Campbell, C., Gibbs, A., Nair, Y., Maimane, S. — 2009-09-18

We present a longitudinal case study of lay women's participation in a project seeking to facilitate home-based care of people dying of AIDS in a rural community in South Africa, drawing on four sets of interviews conducted with volunteers over a five-year period. We link participation in the project to three dimensions of women's agency: their knowledge and skills, their confidence; and their personal experiences of efficacy. We show that whilst the experience of participation enhanced each of these dimensions of volunteers’ agency at various stages of the project, the empowerment that did take place appeared to be limited to women's project-related roles, rather than generalising to other areas of their lives beyond the project. The project had limited impact on women's ability to negotiate condom use with husbands, to assert themselves in relation to male project leaders and to become more involved in wider community decision-making and leadership. We discuss three possible interpretations of our findings: (i) that greater empowerment might have occurred had the project run for a longer time period; (ii) that whilst such projects play a vital role in providing services, the more general ‘empowerment via participation’ agenda is a false promise in highly marginalised communities; or (iii) that whilst generalised positive impacts of such projects on volunteers are hard to track, such projects do open up glimpses of increased agency for many women. These might have positive but unpredictable results in ways that defy formulation in linear conceptualisations of social transformation and development, understood in terms of clearly observable and measurable inputs and outputs.

Is it Possible to Eradicate Poverty without Attending to Mental Health? Listening to Migrant Workers in Chile through their Idioms of Distress

C., L. N. — 2009-09-18

Departing from the existing critique of the Millennium Development Goals (MDGs), regarding the absence of mental health dimensions in the formulation of its poverty related goal, this article explores the interrelation between poverty and mental health by examining experiences of emotional distress of Peruvian migrant workers in Chile. Through an analysis of the idioms that Peruvian migrants use to communicate their distress, this article proposes an understanding of Peruvian migrant's emotional suffering that attends to the broader unequal relations that migrant workers are subjected to in the host society. The analysis enables an understanding of their experiences of social exclusion and personal uprootedness, making visible the agency that the migrants display in giving meanings and coping with their emotional distress, most often outside the medical system. This article argues for the need to develop alternative and culturally sensitive approaches to mental health, in order to support the everyday struggles of the poor.

Listening to Oral Traditions in a Re-searching for Praxis in a Non-western Context

Eskell-Blokland, L. M. — 2009-09-18

The relevance and appropriateness of western oriented psychology in practice and research is a concern in developing and non-western contexts. It is difficult to address this problem from any alternative position other than the western academic frame if one is situated in a tertiary educational institution in South Africa. In acknowledgement, this article explores the academic context including some local voices from the field in a search for possible congruent research methodologies, which may echo knowledge systems of the traditions of the local context in South Africa and its broader context in the continent. Constraining factors to the development of an appropriate praxis have been suggested to include epistemological issues, western academic hegemony and the perceived elitism of psychology as a discipline. In particular, this article explores the adoption of a narrative literary stance for research in psychology. Literary theory and discussions of the narrative from Bakhtin's writings are drawn on in an attempt to bridge a perceived epistemological divide between local traditional knowledge systems and western academia. From this perspective the oral tradition of Africa is considered at the interface of local and western knowledge around healing /helping traditions.

Danger and Disease in Sex Education: The Saturation of 'Adolescence' with Colonialist Assumptions

Macleod, C. — 2009-09-18

The United Nations Development Programme's (UNDP) Millennium project argues for the importance of sexual and reproductive health in the achievement of all Millennium Development Goals (MDGs). Sex education programmes, aimed principally at the youth, are thus emphasised and are in line with the specific MDGs of reducing the incidence of HIV and improving maternal health. In this article, I analyse recent South African sex education and Life Orientation (a learning area containing sex education) manuals. Danger and disease feature as guiding metaphors for these manuals, with early reproduction and abortion being depicted as wholly deleterious and non-normative relationships leading to disease. I argue, first, that these renditions ignore well-designed comparative research that calls into question the easy assumption of negative consequences accompanying ‘teenage pregnancy’ and abortion, and, second, that the persistence of danger and disease in sex education programmes is premised on a discourse of ‘adolescence’. ‘Adolescence’ as a concept is already saturated with the colonialist foundation of phylogeny re-capitulating ontogeny. Individual development is interwoven with collective development with the threat of degeneration implied in both. This interweaving allows for the instrumentalist goal of sex education in which social changes are sought through changing individuals’ sexual attitudes and behaviour.

The Millennium Development Goalposts: Researching the Score on and off the Field

Bradbury, J., Clark, J. — 2009-09-18

The United Nations’ Millenium Development Goals (MDGs) work in pervasive and powerful ways in the international imagination, by naturalising a strategic set of goals, indicators and targets, and in doing so, either opening up, or precluding and prescribing particular possibilities for understanding the state of the world and people's experiences. Our departure point for exploring the need for alternative research routes is therefore an engagement with the conceptualisation of ‘development’, the hopeful product of the 2015 target. This conceptual critique is three-fold: 1. There is a slippage in the discourse of the MDGs between ‘poverty’, ‘health’ and ‘development’ and consequently, the relations between different goals are poorly theorised. 2. There is an absence (or extreme paucity) of structural analysis. 3. While people are surely the centre of the developmental goals, in their formulation there is a remarkable absence both of specific groups of people and any conceptualisation of personhood in a more universal human sense. An alternative framework for understanding development and the relations between structure and agency is explored by theorising the themes of gender, national identity and childhood/youth. We then suggest that narrative methodologies may offer a productive research trajectory.

Universal Primary Education for All Towards Millennium Development Goal 2: Bangladesh Perspective

Rahman, Md. O., Islam, M. T. — 2009-09-18

Bangladesh, in theory and law, advocates equity of access to largely uniform, mass-oriented and universal system of education. This objective remains unfulfilled owing to the lack of commitment of all concerned to reach the goal of Education for All. Although the aggregate performance indicators (e.g. gross enrollment rate) for the primary education sub-sector has been relatively satisfactory in 2000s compared to the situations in 1990s. Beset with numerous problems, the education system is at once discriminatory and inconsistent. The standard of education is on the decline. The absence of effective quality control mechanisms and non-standardisation of the core content of basic learning materials make the education scenario even less satisfactory. More then half of the population in Bangladesh is denied the right to education. In this backdrop, this article critically examines government commitments for universal primary education for all by 2015 and the present situation of primary education sub sector. This article focused on the problem, challenges and policy issues to achieve the second goal of MDGs.

This Benevolent Hand Gives You Soap: Reflections on Global Handwashing Day from an International Development Perspective

Plyushteva, A. — 2009-09-18

In October 2008, the first Global Handwashing Day was celebrated internationally. It was promoted as the highlight of a global effort to spread the practice of washing hands with soap, reducing the incidence of diarrhoeal disease and saving hundreds of thousands of lives. However, the objectives and strategies of the public-private partnership (PPP) behind this initiative, which includes the three biggest global producers of soap, have not received sufficient scrutiny. This article offers a critical reassessment of the Global Handwashing Day, its origins and its implications, and challenges the campaign's significance for its alleged beneficiaries and benefactors.

Book Review

2009-09-18