Politics, Practical Logic, and Primary Health Care in Rural Haiti

Abstract

During the 1980s, an ambitious project for health development restructured medical services throughout rural Haiti. The "Rural Health Delivery System" (RHDS) pursued several goals of primary health care, including dispensary-based maternal and child health services and the provision of low-cost drugs. Based on fieldwork in a single village, this article examines how local residents pushed the project in unpredictable and ironic directions. People did not regard dispensary services-which were planned and financed by international health agencies-as essentially foreign elements in the local health-care system. They rather engaged with the dispensary according to long-standing local strategies for prestige and economic advance. Despite the dramatically new shape of biomedicine introduced by the RHDS, the dispensary remained for most people a recognizable arena to gain access to state resources or to contest state control over their lives. The "success" of clinic services, and the "failure" of the project to distribute essential drugs arose more from people's practical routes to symbolic and material power than from the formal plans of health planners or state bureaucrats. This practice-based analysis provides another dimension to both the liberal and neo-Marxist critiques of international health development.

Institutional heterogeneity in globalization: Co-development of western-allopathic medicine and traditional-alternative medicine

“…Even if different medical practices exist on a single dimension, complementary or mutually renewing relationships are possible in a vertical or horizontal manner (Brodwin, 1997;Comaroff, 1980;Frank and Stollberg, 2004;Lock, 1984). In this vein, we expand two complementary models of cultural-institutional dynamics -i.e.…”

“…Colonization has been substantially accompanied by the introduction of WAM into non-western colonies (Comaroff and Comoroff, 1992). Attempts to transform medical practices in the global South continue to this day, whether or not they are prompted by intentions equivalent to historical colonization projects (Brodwin, 1997;Reznik et al, 2007). In industrialized societies, conversely, efforts to revive TAM invoke both indigenous traditions and others' contemporary experience, such as acupuncture and Asian medical traditions (Bodeker, 2007;Bodeker and Burford, 2007;Frank and Stollberg, 2004;Mahady, 2001).…”

“…For their part, however, most studies of medical transformation have been driven by ethnographic interest in the WAM-TAM relationships in a single society, without addressing the global medical scene that involves multiple local societies (Brodwin, 1997;Comaroff, 1980;Frank and Stollberg, 2004;Lock, 1984;Reznik et al, 2007;Young, 1976). These studies have neither made a systematic comparison of different cases nor attempted to discuss medical transformations at a global level.…”

Clinics, Communities, and Cost Recovery

“…As political economic analyses of primary health care in the 1970s and 1980s demonstrated, national governments can shape or distort primary health care implementation to suit a variety of domestic agendas. However, as Brodwin (1997) argued, the intentions of both international funders and 25. Given the widely recognized aversion to the acknowledgement of sexuality across generations, it is likely that low adult attendance made Katleho Clinic more attractive to teenagers seeking contraceptive services.…”

“…Despite the strong social justice content of PHC rhetoric, medical anthropologists reported that governments implemented these programs in ways that reflected and consolidated their own domestic agendas-whether these were directed toward political repression, economic liberalization, or revolutionary reform (see Morgan, 1989a and associated articles 2 ). Furthermore, the ultimate effects of PHC programs were shaped by local, as well as national, power relations and agendas (Brodwin, 1997).…”