Neoliberalisation enacted through development aid: the case of health vouchers in India

Neoliberalisation enacted through development aid: the case of health vouchers in India
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通过发展援助实施的新自由主义:印度医疗券的案例

DOI:
10.1080/09581596.2020.1770695
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发表时间:
2020
影响因子:
2.8
通讯作者:
Hunter B
Hunter B
中科院分区:
医学3区
文献类型:
--
作者:
Hunter B

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尽管对公共卫生领域的发展援助和新自由主义有着批判性的学术研究历史,但很少有人具体关注《千年宣言》之后卫生部门的援助承诺增加了两倍如何为推动新自由主义思想和做法创造了新的机会。在这里,我们考察了印度北方邦的一个外部资助的援助项目,该项目似乎包含了重要的公共卫生和获得护理的问题,但也可以被理解为一个更大的--破坏性的--意识形态项目的一部分。我们采用语境化和过程为导向的理解“新自由主义”,以检查其设计和制定。我们还展示了这些政策是如何受到政治家和公务员的不均衡抵制和推动的,他们被期望在不同级别的政府中引导这些政策的实施。在第一线,程序工作者和用户策略性地重新解释了“选择”的概念,以服务于他们的利益,而不是程序设计者预期的方式。就方案工作人员而言,这反映了方案制定的个性化业绩目标和现有的服务对象主义文化。我们的分析对不加批判地将卫生发展援助描述为资源的有益再分配提出了质疑。
Despite a history of critical scholarship on development aid and neoliberalism in public health, very little specific attention has been drawn to how a tripling in aid commitments in the health sector after the Millennium Declaration created new opportunities for the advancement of neoliberal ideas and practices. Here we examine an externally funded aid project in Uttar Pradesh, India that seemed to embrace important public health and access to care concerns but that can also be understood as part of a larger – and damaging – ideological project. We adopt a contextualising and process-oriented understanding of ‘neoliberalisation’ to examine its design and enactment. We also show how these policies were unevenly resisted and advanced by the politicians and civil servants who were expected to guide them through different levels of government on the way to implementation. On the frontline, programme workers and users tactically re-interpreted the notion of ‘choice’ to serve their interests in ways that were not anticipated by programme designers. In the case of the programme workers, these reflected the individualised performance targets set up by the programme and an existing culture of clientelism. Our analysis challenges uncritical portrayals of development assistance for health as a beneficent reallocation of resources.
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