"Refiguring the Social?" Exploring moves towards Universal Health Coverage and associated debates about the public good in Kenya, Zambia, Ghana and Tanzania

LSE Presentation, 18 November 2020

Ruth Prince, Victoria Jacinta Muinde, David Bannister, Tom Neumark, Jamie Wintrup, University of Oslo & Edwin Ameso, University of Oslo/University of Århus

Across the globe, the Universal Health Coverage (UHC) agenda often appears to be about extending “the social”, that vague notion of a society that has historically underpinned welfare and distribution efforts. Reviving a language of fairness and social justice, solidarity and human rights, and recognizing the responsibility of the state for the health of its citizens, UHC takes up earlier aspirations of ‘health for all’, aiming to expand access to quality healthcare for all citizens.

In many African countries, recent attempts to introduce UHC take place on the terrain or debris of earlier, post-independence, dreams, visions and struggles surrounding health as a public good. The provision of healthcare as a public good was only ever partially achieved, even in so-called ‘developmental states’. Today, such an achievement seems perhaps even further out of reach as healthcare has become increasingly privatized and commodified, while inequality becomes ever more profound. At the same time, conceptions of public goods diverge widely as other moral economies and values jostle for space. Any healthcare or welfare reform does not enter a vacuum but is inserted into a complex space of power, contestation and negotiation.

Following James Ferguson’s arguments about new forms of welfare and the politics of (re)distribution in southern Africa, moves towards UHC may be approached as evidencing a shift towards a progressive politics of expanding welfare and state responsibility for healthcare on the  African continent. However, UHC can also easily be dismissed as, at best, a sticking plaster solution, and at worse, an agenda that participates in the reproduction of neoliberal forms of governance and market-orientated healthcare reform, offering minimal forms of financial protection and access to a limited range of healthcare services for the poor. Our research aims to move beyond the impasse between endorsement and critique to follow the aspirations, interpretations, translations and frictions surrounding moves towards expanding access to healthcare for ‘all’.

Based on our ethnographic and historical research in Kenya, Tanzania, Ghana and Zambia, we discuss tensions and frictions surrounding moves towards UHC, focusing on health insurance systems and community health worker programmes, experiments with free healthcare and with developing digital health technologies, alongside explorations of generational memory and popular notions of distributive justice, responsibility and obligation.

Join the Zoom Meeting https://lse.zoom.us/j/93734545013