Global Processes, Local Consequences: Gender Equity and Health Sector Reform in Peru

Ewig, Christina

doi:10.1093/sp/jxl002

Cited by 27 publications

(18 citation statements)

References 35 publications

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“…Several notable studies, although not focused on the role of the World Bank, include information about the World Bank's involvement in specific health policy change. Ewig () examines health sector reform and gender in Peru, and Lloyd‐Sherlock () discusses health sector reform in Argentina. Noy () provides an overview of the World Bank's changing approach to health.…”

Section: The World Bank and Health Sector Reformmentioning

confidence: 99%

The Washington Consensus and Social Policy: World Bank Projects and Health Sector Reform in Costa Rica

Noy¹

2015

Latin American Policy

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International financial institutions-namely the International Monetary Fund and the World Bank-have been central in diffusing neoliberal ideas. However, little is known about the World Bank's involvement in health policy reform in Latin American countries, and even less about governments' responses to these recommendations and directives. I use World Bank project and loan documents together with national policy documents to examine health sector reform in Costa Rica between 1980 and 2005. I trace World Bank involvement in and discourse surrounding Costa Rican health sector reform, including the ideal role of government in health, the shifting relationship between the Costa Rican social security system and the Ministry of Health, and the focus on primary care. Using the policy paradigm approach, I identify two paradigmatic goals apparent in World Bank and national documents: efficiency and equity. I find that, although the government and the World Bank are consistent in their approach to these goals, they do not emphasize them in the same way, and they describe them in the context of differing logics. I conclude by assessing the implications of this study for our understanding of the relationship between neoliberalism, international financial institutions, and health sector reform in Latin America.Las instituciones financieras internacionales, en particular el Fondo Monetario Internacional y el Banco Mundial, han sido centrales en la difusión de ideas y prácticas neoliberales, pero poco se conoce de la participación del Banco Mundial en las reformas de los sectores de salud en los países latinoamericanos y menos aún sobre la respuesta de los gobiernos a estas recomendaciones y directivas. Basada en documentos de los proyectos y los préstamos del Banco Mundial y en documentos de política nacional, esta investigación examina la reforma del sector de salud en Costa Rica. Se examina la participación del Banco Mundial en el discurso que rodea la reforma de salud costarricense, incluyendo las discusiones del papel ideal del gobierno en la salud, la relación cambiante entre la CCSS (seguridad social) y el Ministerio de Salud y un énfasis en la atención primaria. Al utilizar el enfoque del paradigma político, se identifican dos objetivos paradigmáticos aparentes del discurso del Banco Mundial y en los documentos nacionales, la eficiencia y la equidad. Mientras que el gobierno y el Banco Mundial son consistentes en su acercamiento a estos objetivos, las instituciones los enfatizan de manera distinta y los describen en el contexto de lógicas diferentes. Se concluye con una evaluación de la importancia de este estudio con respecto a un entendimiento de las consecuencias del neoliberalismo y las instituciones financieras internacionales para la reforma de los sectores de salud en América Latina.

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Section: The World Bank and Health Sector Reformmentioning

confidence: 99%

The Washington Consensus and Social Policy: World Bank Projects and Health Sector Reform in Costa Rica

Noy¹

2015

Latin American Policy

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“…This opened up the formal political sphere for feminists to develop advocacy strategies. After implementing austerity measures and subduing the Shining Path, the Fujimori government set out to rebuild the public health system, in part by implementing reforms (Burt 2004, Ewig 2006, Rousseau 2007. The government disregarded the Catholic Church by legalizing sterilization, establishing a national family planning program and offering contraceptives free of change: it was the first ever government in Peru to prioritize reproductive health policies and pass major laws to address gender inequalities (Coe 2004).…”

Section: Conditions Shaping the Development Of Feminist Advocacy In Lmentioning

confidence: 99%

Policy change as one piece of the picture: outcomes among reproductive rights advocates in Peru

Coe

2012

Journal of Gender Studies

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In the 1990s, feminist movements in Peru began to shift strategies from a focus on community training to an emphasis on policy advocacy. Since then, they have seen many of their demands translated into public policies favoring gender equity and reproductive rights. Some scholars argue that such policy changes have a limited impact on women's daily life in Latin America and it is necessary to conceptualize the outcomes of social movements more broadly to include their cultural and political effects as well as the links between these. Findings are presented from a study of two coalitions engaged in reproductive rights advocacy in Arequipa and Cusco, Peru. The approach for evaluating the materials included participant observation, focus group discussions and individual interviews with coalition members. The study found that coalition members perceive the effects of their advocacy on government policies in terms of five dimensions: coalition-government interactions, issue visibility and recognition, policy enactments, policy implementation, and policy position. I conclude that a broader definition of social movement outcomes is needed to evaluate efficacy and models for future action and that this should take into account the complexities of social and political change, particularly concerning reproductive rights and gender equity.

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“…Women in both urban and rural areas have taken part in all manner of development programmes, training courses, activism, and projects, from building roads and schools (Laurie 1999), and implementing immunization programmes (Ewig 2006), to the setting up of soup kitchens during times of economic crisis (Blondet and Montero 1995), and the administering of the ''glass of milk scheme'' (Barrig 1994), to name but a few examples from Peru.…”

Section: Women and Voluntary Work In Latin Americamentioning

confidence: 99%

“…Similarly, Tanski (1994) asserts that ''between August and December 1990, there was an 86.3% decrease in healthcare expenditures for the poorest families'' (Tanski 1994(Tanski , p. 1628. 3 Such cutbacks leave hospitals and clinics under-funded and understaffed (Kabeer 1994); user fees were introduced by the Fujimori government in 1991, in an apparent attempt to improve healthcare financing (Ewig 2002(Ewig , 2006. Overall, this situation impacts negatively on the healthcare that poor families are able to access, but also forces poor women to take on the burden of looking after the health of their family and community (Smyke 1991), as they are either unable to pay for services or the services provided are inadequate.…”

Section: Healthcare Privatization and Voluntarismmentioning

confidence: 99%

“…Although spending on healthcare has slowly increased since the crises of the early 1990s, Ewig (2002) observes that there has been little emphasis on improving the quality of healthcare provision. Poorer patients in particular report poor treatment by medical staff, routine overcharging, and poor availability of medicines (DFID and World Bank 2003;Ewig 2006).…”

Section: Healthcare Privatization and Voluntarismmentioning

confidence: 99%

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“We have a lot of goodwill, but we still need to eat…”: Valuing Women’s Long Term Voluntarism in Community Development in Lima

Jenkins

2009

Voluntas

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This paper focuses on recognizing the contribution made to development by grassroots women working on a voluntary basis in long term development projects. Using the example of healthcare, the paper problematizes the widespread move towards an increased reliance on voluntary and third sector provision. Drawing on literature around women's community activism, the research considers the extent to which women carrying out health promotion work in Peru have taken on this role as more than ''just voluntary work,'' highlighting their long term commitment during more than a decade of health promotion activities. The paper develops debates around the professionalization of voluntary work, particularly considering the issue of economic remuneration for health promoters, and emphasizing the gendered nature of their voluntarism; concluding by questioning the sustainability of poor women's long term, and largely unpaid, involvement as the linchpins of community development projects.Résumé Cet article met l'accent sur la reconnaissance de la contribution bénévole apportée au développement par des femmes issues du peuple sur des projets de développement à long terme. En prenant pour exemple les soins médicaux, l'article met en perspective le mouvement à large échelle vers une plus grande dépendance vis-à-vis du volontariat et de la prestation du troisième secteur. En considérant les écrits ayant pour objet l'activisme communautaire des femmes, la recherche considère à quel point les femmes prenant en charge la promotion de la santé au Pérou ont pris ce rôle plus au sérieux qu'un «simple travail bénévole», ce qui met en valeur leur engagement à long terme, durant plus d'une décennie d'activités liées à la santé et à son développement. Cet article a pour objet les débats liés à la professionnalisation du travail bénévole, particulièrement en considérant le problème de la rémunération des promoteurs de la santé, tout en mettant l'accent sur la nature sexuée de leur volontariat, en concluant sur la question de la viabilité de ces femmes pauvres à long terme et le plus souvent non payées, pilier des projets de dével-oppement de la communauté.Zusammenfassung Dieses Artikel konzentriert sich darauf, den Entwicklungsbeitrag, den einfache Frauen an der Basis durch ehrenamtliche Arbeit in langfristigen Entwicklungsprojekten leisten, zu würdigen. Anhand des Beispiels medizinische Versorgung problematisiert der Artikel den weitverbreitenden Schritt, sich stärker auf freiwillige Helfer und den dritten Sektor zu verlassen. Gestützt auf Literatur über das Engagement von Frauen für die Kommune, prüft die Forschungsarbeit, in wie weit Frauen, die gesundheitsfördernde Arbeiten in Peru ausführen, diese Rolle als mehr als''nur freiwillige Arbeit'' übernommen haben und heben deren langfristiges Engagement von mehr als einem Jahrzehnt gesundheitsfördernder Aktivitäten hervor. Der Artikel fördert die Auseinandersetzung um die Professionalisierung von ehrenamtlicher Arbeit, insbesondere unter Berücksichtigung des Problems von wirtschaftlicher Vergütun...

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Global Processes, Local Consequences: Gender Equity and Health Sector Reform in Peru

Cited by 27 publications

References 35 publications

The Washington Consensus and Social Policy: World Bank Projects and Health Sector Reform in Costa Rica

The Washington Consensus and Social Policy: World Bank Projects and Health Sector Reform in Costa Rica

Policy change as one piece of the picture: outcomes among reproductive rights advocates in Peru

“We have a lot of goodwill, but we still need to eat…”: Valuing Women’s Long Term Voluntarism in Community Development in Lima

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