Social The life of things Arjun Appadurai
-Economic exchange creates value, connection is politics (dictates the framework). Value
becomes embedded into commodities, but are not intrinsic of the commodities themselves (i.e.
supply demand)
-Commodities develop their own social lives and histories, these paths can be diverted for any
number of reasons
-e.g. ?
Clinton Foundation Bill Clinton, Ira Magaziner
- to identify markets that aren't supplying enough socially beneficial goods or services to meet
the potential demand, and then lead them to a new equilibrium
Green light committee
-WHO advisory board
-Helps country create MDR-TB programs, in return gets access to cheaper second line drugs
Brain drain
-When Laurie Garret discusses the challenges of the brain drain, smart people emigrate or get
hired and moved by better funded programs
-also aid tends to be stovepiped towards certain stuff over 60,000 ngos for AIDs now
Mental health
-Kleinman World Mental Health Report
- indirect links between structural violence and mental health
- the poverty, hunger, and malnutrition cycle
- Horwitz et. Al The Loss of Sadness
- Between 1987 and 1997 depression treatment increased by 300%
- any sadness is abnormal and must be treated by a professional.
-Pathologization of sadness Context is just as important as symptoms
4 Pillars Zanmi Lamaste (Partners in health)
HIV prevention and treatment (quality care like HAART) in context of PHC
TB detection and treatment
Women's health, family planning
Detection and treatment of STDs
Accompagnateurs
Visited patiends 1x or 2x a day to conduct DOT - Paid flat yearly salary of USD 743
Ajan Sante - Provided health education within community
Ajan Fanm - Focused on women's health issues
Matrons - Traditional birth attendants, not regularly paid by ZL
CCM Country Coordinating Mechanism
-2002 Haiti granted 66.9 million over 5 years to scale up HIV/AIDS prevention, required a
country coordinating mechanism
Voluntary Counseling and Testing (VCT)
-Hinche 50,000 people Saint Therese Hospital developed by PIH
-Voluntary Counseling and Testing (previously vastly underutilized) at Sainte Therese
-Although counseling and testing free, most had already paid for a clinical visit
-Clinicians were highly trained, but "didn't have the tools to start work"
-Got stuff through the International Dispensary Association Foundation (IDA) to secure generic
essential medicines and supplies
Contested History
-Peter Uvin
-Something about Rwandas history, Tutsi ruling class, last minute swap by Belgians, inverted
revolutions, development didnt help
PIH and HIV Care in Rwanda
-Paul Kagame president, led RPF
Pedro Suarez and National TB Program
-MINSA is Peruvian ministry of health, responsible for 87% of all primary care services
-by 1990 TB program was bankrupt, disorganized, and tx only available in treatment centers
-1990 Pedro Suarez appointed director. Rolled out standardized TB tx with help from PAHO and
introduced esquimo unico regime and the patient tracking and TB records around system
-Turned care, access tripled and tx achieved 80% success rates nationwide, with esquimo
uno they hit 91.5%
-However struggled against problem of MDR-TB, 70% of retreatment failed
-Despite WHO ideology shifts, refused to integrate, no examples
Useful Writing Connection
-Berger and Luckman institutionalization habitualizes and externalizes the institution so it
comes to exist objectively as fact
-Weber bureaucracy rigidifies systems and gains a force unto itself, iron cage of rationality
-Resisted ability to innovate and change systems to meet this challenge
MDR-TB in Peru
-Socios end Salud began work in Peru
-Discovered an MDR-TB epidemic in Carabayllo
-Despite WHO refusal to address, began to treat MDR TB with 2nd line drugs using DOTS
-Eventually shifted opinion to create DOTS Plus
AMPATH
-you should read this case
-partnership between Indiana University and Moi University (IU-MU)
-provided care for 65,000 in 2008, covers a catchment area of 1.8million, largest ART provider in
the country
-addresses challenge of AIDS, by 2000 health system was buckling
-focuses on systems and wrap-around services
-innovated Home Counseling and Testing (HCT), 95% of all eligible accepted it, covers 91% of
those at risk for HIV in Korsirai division of north rift valley province
Michael Porter
-Value-based care systems
-GHDP
-Evaluate implementation and evaluation
Health System Strengthening
-To identify and exploit positive synergies between health systems and GHIs need to look at this
renewed primary health care.
-WHO Positive Synergies GHI with PHC
-Global fund investments aim to HSS
- diagonal
Seguro Popular
-Frenks national health insurance. 250 interventions
Care cycle
-This encompasses all the costs, operations, and interventions associated with a given treatment,
such as ART for HIV. This gives the healthcare provider a better idea of how the specific actions
and interventions interact with the local community, the patient's life, etc. The holistic approach
to delivery allows practitioners to build health infrastructures, as well as deal with immediate
problems such as adherence
Participatory action research
Family of research methodologies that pursue action (or change) and research (or understanding)
at the same time
Anti-heroic
-Actions, which critique and resist the moral status quo by perturbing and disturbing our local
world
Many Farms McDermott
-1956 well-constructed comprehensive PHC system set up in the Navajo community Many
Farms-Rough Rock
-Did not change socio-economic conditions but brought full technology
-Only saw decent reductions in TB and otitis, none in dangeours pneumonia-diarrhea complex.
-Despite high expectations, overall little impact
James Grant (by Peter Adamson)
-Unicef 1980-1955
-GOBI Selective primary health care, top down intervention
-Quadrupled vaccination coverage 20 to 80%, raised ORTS to 2/3, measurable bottom line,
political will, achieved during global recessions
Cases to read
-Rwanda HIV care
-MDR TB Peru
-AMPATH
-Values to Value
-Cleveringa lecture