Abstract
This paper offers a reflection on the effects of global health policy decisions on the visions of appropriate care in sub-Saharan Africa. Two waves of policy decisions changed the experiences and landscapes of ART for patients and providers in sub-Saharan Africa. The first wave came in the early 2000s with the introduction of the 3 by 5 initiative, the Global Fund, and PEPFAR.
The public health approach characterizing this wave focused on algorithms built for limited resources and created populations of countable patients with “one size fits all” solutions. The second wave of policy decisions came in late 2015 with the WHO’s “treatment for all” recommendations. For the first time in the history of HIV, these recommendations addressed an assumed unified standard of care without distinguishing between people living in rich and poor countries. And while the standard of care was never truly unified, this wave of policies transformed African patients into members of a global community. Although much has been written about the impact of these policies on the specific practices of providing ART in sub-Saharan Africa, this paper explores the effects of the expansion of ART on the visions of what constitutes appropriate care for both patients and providers. Based on studies of ART programs in Malawi and Zimbabwe, the paper focuses on the effects of the policies on the collective imaginaries of appropriate care and its deserving subjects in the context of pandemics, the rise of NCDs and the effects of climate change.
Bio
Anat Rosenthal is a Medical Anthropologist and a Senior Lecturer at the Department of Health Policy and Management in the School of Public Health at Ben-Gurion University of the Negev.
Her research focuses on global health policy and healthcare delivery in resource-limited environments. Rosenthal completed her PhD in Anthropology at the Hebrew University of Jerusalem (2009) and was a Fulbright Fellow at the Department of Global Health and Social Medicine at Harvard Medical School (2009-2010). She was also a Lady Davis Fellow at the Hebrew University of Jerusalem (2011-2012), and an MHERC Fellow at the Institute for Health and Social Policy and Centre de recherche en éthique (CRÉ) at McGill University (2012-2015). She has conducted fieldwork in Israel, Malawi and Zimbabwe on the social and cultural effects of AIDS, healthcare delivery in resource-limited settings, the impact of climate changes on health services, national and international health policy, and undocumented migration. Rosenthal’s book on the rollout of HIV care in Malawi titled Health on Delivery: The Rollout of Antiretroviral Therapy in Malawi was published by Routledge in 2017.