Unpacking ‘women’s health’ in the context of PPPs: A return to instrumentalism in development policy and practice?

Abstract

There has been a significant increase in funding for health programmes in development over the last two decades, partly due to the formation of public–private partnerships. This article examines the impact of public–private partnerships from the perspective of women’s health, asks whether the current culture of funding has led to an increased instrumentalism in women’s health programming and what effects this has on how women’s health is addressed at the level of practice. The article is based on research carried out with UK-based non-governmental organisations (NGOs), and its conclusions raise further challenges for improving women’s health policies and programmes in development.

Challenging Gendered Inequalities in Global Health: Dilemmas for NGOs

“…This in turn impacts on the types of projects that NGOs are able to promote and engage with, which often serves to reinforce more limited understandings of women's health and fails to give voice to the women they claim to be supporting (Gideon and Porter, 2015). Research conducted with UK-based NGOs working on women's health programmes has highlighted how the dominant discourse emerging from corporate sector actors is reducing the understanding of women's health to more instrumentalized notions of maternal and reproductive health.…”

“…A study of UK-based NGOs working in the health sector found that these shared ideas appear to privilege the market-led needs of distributing products or services, rather than utilizing the knowledge and experience of NGOs derived from working with those at 'the grassroots'. However, they did not want to use this power to fundamentally challenge their new funding partners to address more deeply embedded inequalities in health (Gideon and Porter, 2015). Some (large, international) NGOs do have significant power, based on the value of their 'brand', and for respondents in these NGOs this power makes the relationship with some private sector partners more equal, or at least more nuanced in the way power is balanced.…”

“…This can be seen as an illustration of the knowledge technologies that are reinforced by the dominance of the market-led system of funding and partnership at the 'top' of the Aid Chain (Wallace et al, 2006). Although some respondents in NGOs felt these gave more credibility to women's health programmes, others feared that an over-reliance on such methods reinforced the shift towards a more technical understanding of women's reproductive health, rather than addressing questions of power and inequality which reinforce gendered vulnerabilities to poor health (Gideon and Porter, 2015). However, they did not want to use this power to fundamentally challenge their new funding partners to address more deeply embedded inequalities in health (Gideon and Porter, 2015).…”

“…PPPs in the health sector tend to be relatively institutionalized initiatives, established to address global health problems, in which public and for-profit private sector organizations have a voice in collective decision making. Moreover, critics have also argued that when NGOs become embroiled in relationships within PPPs their ability to address other forms of inequality -particularly gender and racealso comes into question (Gideon and Porter, 2015;Murray, 2016). As O'Laughlin (this issue) notes, NGOs are frequently engaged in PPPs, either as a direct partner or in a service delivery role -something which is discussed in more depth later in this article.…”

How serious are global health leaders about gender equality?

“…These multiple actors and their vertical orientations have led to pressing gender equity concerns and a shift away from a focus on the economic, political, social, and commercial determinants of health. 78 This shift should prompt closer attention to the unintended gendered effects of global health programmes.…”