Brigit Obrist: Towards a Relational Understanding of Participation in Social Health Protection

Health, Technology and Welfare in Africa

We live in an age of participation. In the field of global development, the biggest players have invested massively in participatory approaches; and they now propagate participation as a crucial principle to reach the Sustainable Development Goals 2015-2030. One of the priority goals on the SDG agenda is Universal Health Coverage, defined as providing all people with access to essential health services - without financial hardship. In order to reach this goal, the International Labor Office, the World Bank and the World Health Organization push social health protection as a key strategy. Social health protection measures include different health financing protection mechanisms, from tax-based financing, statutory social health insurance to private health insurance, community-based health insurance, and various fee exemptions for health services. Politicians, policy makers and implementers call on the public to participate in these measures. My task as a scholar is of course not to promote participation in social health protection but to critically examine it as a social process. Many scholars of diverse disciplinary backgrounds - including anthropologists - have discussed participation controversially, pointing for instance to the ambivalences, dilemma and paradoxes of participation. I try to push our analytical understanding a step further by introducing a relational or figuration-inspired perspective. In this view, we can examine, for instance, how actors produce social health protection through participation in specific networks. We can further study how and why actors create, regulate, prescribe and obstruct participation of other actors in separate as well as interconnected social protection networks. My discussion of these and related questions is grounded in empirical examples brought forth by ethnographic field research in Tanzania. Contemporary Tanzania presents a particularly interesting case for studying participation in social health protection in this more analytical sense because of the country’s long and deep normative engagement with participatory development and the current government’s aspiration to transform Tanzania into a middle-income country with Universal Health Coverage.

Speaker: Prof. Brigit Obrist, University of Basel

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