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Title After Ebola in Sierra Leone: the politics of neglect and the social life of projectified post-epidemic recovery
Full text https://hdl.handle.net/1842/38503; http://dx.doi.org/10.7488/era/1767
Date 2021
Author(s) Hubmann, Michaela
Contributor(s) Smith, James; Tichenor, Marlee; Economic and Social Research Council (ESRC)
Abstract This thesis provides a medical anthropological account of the Sierra Leonean post-Ebola recovery initiative, how it was implemented by a District Health Management Team (DHMT), and how the social life it produced was resisted and manipulated at the district and community levels. To make sense of the recovery priorities, this thesis unpacks the broader structures that underpin global health programming in an attempt to strengthen 'weak' health systems. The case of the post-Ebola recovery in Sierra Leone is an exemplary case of how intrinsic the politics of neglect are within global health governance. It will become clear that the politics of neglect were also evident during the post-Ebola recovery period. This thesis draws on fourteen months of research, which was divided into two distinct phases: district level and community level. At the district level, I spent eight months in Bo town with the district health management team; at the community level, I spent five months in a hard-to-reach chiefdom in Bo North. In this thesis, I unpack the post-Ebola health system recovery efforts by exploring how the projectification of the different recovery programmes produced a social life with wide reaching, often unintended, consequences. The recovery initiatives' emphasis on global health security ignored a more holistic approach to health system strengthening; the focus on global health norms in terms of strict project timelines led to months of drug stock-outs throughout the country; and the focus on human resources for health so as to increase a mixed skilled health workforce led to the temporary weakening of the health system as thousands of volunteer community nurses were withdrawn from their health facilities, which in turn led to gross understaffing, especially in rural health facilities. Finally, the focus on institutional deliveries led to the criminalisation of the traditional birth attendants, which in turn contributed to the almost temporal collapse of the rural primary health system. Thus, the projectification of the recovery priorities, much like any other development programme, had the politics of neglect at its core as social and relational aspects were disregarded in favour of narrow, disease specific aspects. This thesis, then, attends to new health system strengthening rhetoric, which was stressed to a large extent in the aftermath of the Ebola outbreak. This rhetoric was nothing more than a reformulation of the old vertical and disease-focused global health paradigm.
Subject(s) Sierra Leone; post-Ebola; health system strengthening; Projectification; social life
Language en
Publisher The University of Edinburgh
Type of publication Thesis or Dissertation; Doctoral; PhD Doctor of Philosophy
Format application/pdf
Repository Edinburgh - University of Edinburgh
Added to C-A: 2023-05-08;09:21:49