Resisting Eradication: The Cultures of Global Health and LocalHealth Systems in the Polio Eradication Initiative in Pakistan 公开
Closser, Svea Hupy (2008)
Abstract
The Polio Eradication Initiative is the largest public health project in history. It is currently experiencing difficulties; the global polio case count has been holding steady since 2003. This dissertation is a multi-sited ethnography of this major global health project. It focuses on Pakistan, one of the last four countries in the world with endemic polio, and draws on fieldwork in Atlanta, Geneva, Islamabad, and two districts in Pakistan where eradication activities are being carried out. This dissertation explores (1) the historical and cultural underpinnings of eradication as a public health strategy; (2) the culture of optimism that characterizes global health institutions; and (3) the reach, limits, and complex negotiation of the power of United Nations and bilateral agencies over the Pakistani health system, as well as the techniques of resistance that government workers from the district to the capital use against UN demands.
The need to frame projects in a way that impresses donors and a faith in the power of technological solutions to health problems contribute to a culture of optimism in the World Health Organization. The problems experienced by the Polio Eradication Initiative grow out of this culture of optimism, which fosters the unrealistic expectation that polio eradication will be a priority in every district in every nation of the world simultaneously. The ideals of "participation" and "collaboration" that drive current global health policy are a part of this culture and hide the exercise of power by UN agencies behind the rhetoric of "partnership." Officials at places like the World Health Organization in Geneva have no direct control over the implementation of immunization activities, and are unable to make polio the priority in a nation beset with other, more politically pressing problems. Polio vaccination campaigns are carried out in Pakistan by highly political district health offices and very poorly paid workers. Government workers use a variety of strategies that resist the mandates of the Polio Eradication Initiative, including foot-dragging, false compliance, and the use of networks of patron-clientism. This dissertation presents suggestions for future eradication programs to circumvent some of the problems the Polio Eradication Initiative faces.
Table of Contents
Chapter One: Introduction...........................................................................1
Chapter Two: Polio Eradication in Policy.......................................................34
Chapter Three: Polio Eradication in Practice....................................................68
Chapter Four: Kaifabad...........................................................................117
Chapter Five: Islamabad..........................................................................153
Chapter Six: Geneva..............................................................................186
Chapter Seven: Conclusion.......................................................................214
Works Cited........................................................................................242
Appendix A: Organizational Charts.............................................................258
Appendix B: Mobile Populations and Polio Campaigns in Kaifabad .......................261
Appendix C: Polio Eradication Initiative Expenditures and Case Count...................276
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