Coordinators: Fred Eboko (CEPED, Université Paris Descartes, IRD) and Carine Baxerres, (MERIT, Université Paris Descartes, IRD, Centre Norbert Elias)
The last issue of Politique africaine to deal with the subject of health was published in December 1987.1 The goal of the present issue is to address what has occurred in the intervening thirty years and to highlight significant changes the public health sector has undergone in recent years.
Throughout Africa and, in a broader sense, across the “South,” the 2000s ushered in a new era of so-called “global health.” Several characteristics attend this trend: a considerable increase in resources allocated to health matters, the emergence of new actors (philanthropic foundations), new types of interventions (public-private partnerships), and the definition of new priorities and targets in the context of health policies. “Global health can be understood as the outcome of the permanent and reciprocal influence between international relations and health problems.”2 Much celebrated but too little defined or questioned, this new trend constitutes both an extension of and a rupture with the era of “international health.” Associated with the post-1945 world order and the creation of the World Health Organization (WHO), the latter was conceived of as the treatment of health-related issues at the supranational or multilateral level. The break with this model encountered in recent years is not only a matter of where (or with whom) the initial decision-making process rests. What is at stake here is a global manner of addressing health matters: an approach that transcends borders, individual governments, continents and regions, creating linkages between human beings and other living creatures, so as to position given health problems as issues of concern (at least theoretically) to the entire planet, in the name of particular security imperatives and/or humanitarian values. The quest to account for these developments has resulted in an explosion of publications on “global health” in the social sciences.3
This issue of the journal seeks to train upon the “global health” turn such as it manifests in Africa the gaze of social scientists whose primary focus is matters political. The questions raised by the emergent dynamics outlined above are particularly trenchant as regards the continent. This is so because Africa faces strikingly acute health problems and because transnational actors are particularly present there. Findings as to Africa’s marginalization from a health standpoint are common, with reference made, among others, to: lack of HIV-AIDS treatment in the early 2000s; multiple, highly problematic health indicators; and underserved health systems in West African countries impacted by the Ebola epidemic of 2014-2015. Our goal here and, we hope, our contribution to the extant literature, will be to bring together new findings born of research undertaken in Africa at the time of the “global health” turn that are inspired neither by the ethos nor by the praxis of said turn. In other words, we seek takes able to reflect in political terms upon the global health debate. Our intent is by no means to belittle progress made in certain health-related areas (HIV-AIDS, malaria); rather, we seek to analyze reconfigurations at work in the health sector in Africa by:
- Offering an institutional, political and historical account of these phenomena that is more than a simple chronicle of progress made or of actions undertaken by the most visible transnational actors in the field—one that focuses on the (changing) role of governments and of African actors in the context at hand;
- Treating claims of rupture and of progress, predictions of success or even promises of salvation for what they are: performative political discourses that play a key role in the construction of a manner of hegemony—a humanitarian, security-focused and speculative construct whose underpinnings need to be questioned, as do its blind spots;
- Engaging in a critical and carefully calibrated analysis of health programs and strategies, paying particular attention to so-called “simple solution policies,” which, in the context of “global health” initiatives, look to a basic and highly problematic triad—“miraculous technological solution” / “cultural obstacles” / “patients and populations requiring education”—while failing entirely to consider deep-seated inequities, structural violence and the specific historical trajectories of given states or political systems;
- Taking seriously the historicity of relations between power, illness and extraversion in Africa—an approach that requires of us that we consider the “global health” era in light of past experiences, conflicts, interpretations and accusations, all of which are intimately linked to the manner in which Africa’s place in the world order is/has been posited and problematized.
As the foregoing suggests, in this issue we wish to query processes whereby health-centered policies are conceived, constructed and pursued in Africa today. What are the characteristics and the configurations of actors that determine the emergence of a given policy, the decision to prioritize it, and the transnational, international and national circulation of actors, institutions, experts and stakeholders associated with said policy? We are interested in a dynamic understanding of actor interaction and multilevel governance deployment in Africa and in the ways in which these differ from one pathology or health issue to another. Health-centered policies on the continent have undergone and continue to undergo (re)configurations in response to the evolution of international objectives, therapeutic innovations and/or an absence of knowledge concerning a given disease, institutional shifts highlighted by the creation of financing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the growth of powerful foundations, the best known of which is the Bill and Melinda Gates Foundation. Regarding the latter, one, single statistic is telling: its operating budget for 2016-2017 (5 billion dollars)4 was superior to that of the WHO (4400 million dollars).5
We seek analyses of these various states of affairs by way of contributions each of which is centered on an individual question addressed by the “global health” agendum. The subject may be a given pathology or health question, or a particular health-focused or technical mechanism. Given its planetary impact, the extent to which its treatment highlights strident inequalities between “North” and “South,” and the sheer breadth of civil society mobilizations it has prompted,6 AIDS, “global health”’s poster child, would make for a fascinating case study centering on a specific national context. Malaria, which has done Africa particular violence over an extended period of time and, since, the mid-1950s has been a subject of increasing concern, would make an excellent subject too, as would the latest pathology to galvanize international attention: Ebola. The emergency responses that the latter has prompted, responses often characterized by a lack of international coordination, would be important to study, notably as an example of “global health”’s capacity for (financial) mobilization, on the one hand, and, often, on the other hand, its incapacity to set afoot effective on-the-ground strategies.7 Still other, more “classical” health questions (maternal and child health, nutrition) or ones of more recent vintage (arterial hypertension, diabetes) could also be considered. Technical and health-centered mechanisms could also be addressed as means of thinking critically about the “global health” juggernaut. Local approaches to universal health coverage (UHC), for example, would offer a useful entry point to question, in broader terms, the role of the state in configuring globalized public action in Africa today. It would be meaningful as well to consider the deployment of results based financing (RBF) and the setbacks it has encountered in the face of development projects gone wrong (perverse effects, misappropriation of funds, dysfunction, etc.).8
We seek proposals for original studies, based on an empirical social science approach, that highlight difficulties inherent in and challenges posed by the battle against given diseases and by the setting afoot of individual health-related mechanisms/policies in Africa today. We are particularly interested as well in analyses that consider how the “global health” system functions (vertical structure of programming, sheer mass of funds raised, use first and foremost of “magic bullets” and related technological solutions, lack of interest in reinforcing national health systems, etc.)9 and, in so doing, highlight tensions between local realities and global injunctions.
- 10 September: Send article proposals (1 page maximum) to coordinators listed above;
- 20 September: Coordinators let submitters know if their proposals have been accepted;
- 25 November: Articles sent by coordinators to editorial board
- March 2019: Publication
- Didier Fassin ed., Politiques de santé, Politique africaine 28 (1987). [↩]
- Celia lmeida, Fred Eboko and Jean-Paul Moatti, ““Global Health” : What are We Talking About ?” in C. Almeida, F. Eboko and J-P Moatti eds., “Does Global Health Exist? Health, Science and Politics in the Global South,” Face A Face. Regards sur la santé, 12 (2013): 1-6, http://faceaface.revues.org/936 [↩]
- See, notably, to cite but a few examples, Laëtitia Atlani-Duault and Laurent Vidal, “La santé globale, nouveau laboratoire de l’aide internationale ?” in L. Atlani-Duault and L. Vidal eds., “Le moment de la santé globale. Formes figures et agendas d’un miroir l’aide internationale,” Revue Tiers Monde 215 (2013): 7- 16 ; Celia Almeida, Fred Eboko, Jean-Paul Moatti, 2013, art. cit.; Paul Farmer, Arthur Kleinman, Matthew Basilico eds., Reimagining Global Health, California Series in Public Anthropology, « Global health: evolution of the definition, use and misuse of the term », Face à Face. Regards sur la santé, 12 (2013), http://faceaface.revues.org/745 ; João G. Biehl and Adriana Petryna, When People Come First: Critical Studies in Global Health, Princeton: Princeton University Press, 2013. [↩]
- See Léa Lejeune, “La Fondation Bill & Melinda Gates, une puissante machine humanitaire, » Challenges 26 (2015), https://www.challenges.fr/challenges-soir/la-fondation-bill-melinda-gates-une-puissante- machine-humanitaire_77808. [↩]
- See WHO/OMS, Programme 2016-2017, Geneva: WHO/OMS 2015, http://www.who.int/about/finances- accountability/budget/PB201617_fr.pdf. [↩]
- Fred Eboko, Frédéric Bourdier and Christophe Broqua eds., Les Suds face au sida. Quand la société civile se mobilise, Marseilles: IRD Editions, 2011. [↩]
- See Anthropologie et Santé 11 (2015), https://anthropologiesante.revues.org/1884. [↩]
- Jean-Pierre Olivier de Sardan, Anthropologie et développement. Essai en socio-anthropologie du changement social, Paris : Karthala, 1995. [↩]
- Marcus Cueto, « A Return to the Magic Bullet? », in J.G. Biehl & A. Petryna, Eds, When People Come First, STU-Student edition, Princeton University Press (Critical Studies in Global Health), 2013, p. 30‑53. [↩]