Understanding resilience, self-reliance and increasing country voice

A clash of ideologies in global health

Bibliographic Data

ID21881704
AuthorsYusra Ribhi Shawar (0000-0002-9539-0341, Johns Hopkins University, corresponding author), Richard Neill (0000-0002-1110-5479, Johns Hopkins University), Michael Kunnuji (0000-0001-5108-5639, University of Lagos), Malvikha Manoj (0000-0002-2309-4746, Johns Hopkins University), Joseph Shiffman (0000-0002-1693-4671, Johns Hopkins University)
Year2023
Volume8
Issue1
Pagese010895
Publication date2023-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010895
PMID36634980
OpenAlexW4315785119
LanguageEN
Citations received6
References cited82

BACKGROUND: 'Resilience', 'self-reliance' and 'increasing country voice' are widely used terms in global health. However, the terms are understood in diverse ways by various global health actors. We analyse how these terms are understood and why differences in understanding exist. METHODS: Drawing on scholarship concerning ideology, framing and power, we employ a case study of a USAID-sponsored suite of awards called MOMENTUM. Applying a meta-ethnographic approach, we triangulate data from peer-reviewed and grey literature, as well as 27 key informant interviews with actors at the forefront of shaping these discourses and those associated with MOMENTUM, working in development agencies, implementing organisations, low-income and middle-income country governments, and academia. RESULTS: The lack of common understanding of these three terms is in part a result of differences in two perspectives in global health-reformist and transformational-which are animated by fundamentally different ideologies. Reformists, reflecting neoliberal and liberal democratic ideologies, largely take a technocratic approach to understanding health problems and advance incremental solutions, working within existing global and local health systems to effect change. Transformationalists, reflecting threads of neo-Marxist ideology, see the problems as inherently political and seek to overhaul national and global systems and power relations. These ideologies shape differences in how actors define the problem, its solutions and attribute responsibility, resulting in nuanced differences among global health actors in their understanding of resilience, self-reliance and increasing country voice. CONCLUSIONS: Differences in how these terms are employed and framed are not just linguistic; the language that is used is reflective of underlying ideological differences among global health actors, with implications for the way programmes are designed and implemented, the knowledge that is produced and engagement with stakeholders. Laying these distinct ideologies bare may be crucial for managing actor differences and advancing more productive discussions and actions towards achieving global health equity

Global health · Health care · Ideology · Political economy · Political science · Politics · Public health · Public relations · Scholarship · Sociology · Technocracy · Global Health and Surgery · Global Maternal and Child Health · Law · Medicine · Viral Infections and Outbreaks Research