A new universalism? Universal health coverage and debates about rights, solidarity and inequality in Kenya
A new universalism? Universal health coverage and debates about rights, solidarity and inequality in Kenya
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DOI：
10.1016/j.socscimed.2022.115258
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发表时间：
2023-02-06
影响因子：
5.4
通讯作者：
Prince，Ruth Jane
中科院分区：
文献类型：
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作者：
Muinde，Jacinta Victoria S.;Prince，Ruth Jane
全民健康覆盖（UHC）作为可持续发展目标（SGD）认可的全球政策的兴起似乎标志着全球卫生的新方向，因为它引入了包容，团结和社会正义的进步语言，并倡导“每个人”都有权获得他们所需的医疗保健“没有经济困难”。自2018年以来，肯尼亚政府一直试图通过试验免费医疗服务和扩大医疗保险覆盖范围来扩大医疗保健的可及性。然而，这些进步的举措是在医疗保健、公民身份和国家责任的历史上形成的，在肯尼亚，这些历史一直被排斥、分化、庇护政治和阶级不平等的形式所主导，所有这些都不利于普及。在本文中，我们跟踪了最近增加医疗服务的尝试，特别关注权利和包容性的语言如何在“普通公民”以及负责实施改革的卫生工作者和政府官员中传播。尽管披着普遍主义、团结和包容的外衣，肯尼亚的全民健康覆盖改革却融入了已经支离破碎、举步维艰的医疗体系，强化了获得医疗服务的差异化、有限和不均衡，并再现了不平等和排斥。在这种情况下，承诺一种实质性公民身份的全民医疗保险改革与肯尼亚人获得医疗保健的经历存在矛盾。我们探讨了如何，在对医疗成本和国家忽视的声音的关注，承诺和期望周围的全民医疗保险改革塑造了人们对获得医疗保健的要求。虽然我们的线人对这些承诺持怀疑态度，但他们也充满希望。普遍性和包容性的语言使人们注意到根深蒂固的不平等和差异形式、团结的局限性以及承诺与现实之间的差距，但它也产生了期望和对新的可能性的感觉。
The rise of universal health coverage (UHC) as a global policy endorsed in the Sustainable Development Goals (SGDs) appears to signal new directions in global health as it introduces a progressive language of inclusion, solidarity and social justice and advocates the right of ‘everyone’ to access the healthcare they need ‘without financial hardship’. Since 2018 the Kenyan government has attempted to widen access to healthcare by experimenting with free health care services and expanding health insurance coverage. Such progressive moves are, however, layered onto histories of healthcare, citizenship and state responsibility that in Kenya have been dominated by forms of exclusion, differentiation, a politics of patronage, and class inequality, all of which work against universal access. In this paper, we follow recent attempts to increase access to healthcare, paying particular attention to how a language of rights and inclusion circulated among “ordinary citizens” as well as among the health workers and government officials tasked with implementing reforms. Despite being clothed in a language of universalism, solidarity and inclusion, Kenya's UHC reforms feed into an already fragmented and struggling healthcare system, reinforcing differentiated, limited and uneven access to healthcare services and reproducing inequity and exclusions. In this context, reforms for universal health coverage that promise a form of substantial citizenship are in tension with Kenyans' experiences of accessing healthcare. We explore how, amid vocal concerns about healthcare costs and state neglect, the promises and expectations surrounding universal health coverage reforms shaped the claims people made to accessing care. While our informants were cynical about these promises, they were also hopeful. The language of universality and inclusion drew people's attention to entrenched forms of inequality and difference, the limits of solidarity and the gaps between promises and realities, but it also generated expectations and a sense of new possibilities.