Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV in India
Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV in India
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DOI：
10.1093/heapol/czs102
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发表时间：
2013-09-01
影响因子：
3.2
通讯作者：
McPake, Barbara
中科院分区：
文献类型：
--
作者：
Kapilashrami, Anuj;McPake, Barbara
全球卫生倡议作为处理全球卫生优先事项的创新和有效的政策机制，已获得显著地位。最近的文献揭示了与治理有关的挑战及其对卫生系统的意外影响。对这些机制之间的关系、作为其基础的思想以及它们所产生的国家一级做法的关注要少得多。全球基金已经筹集了大量资金，并在协调控制艾滋病毒/艾滋病的各种努力方面发挥了主导作用。全球基金在受援国的影响力日益增强，这使它成为一个有用的案例，可以审查这种关系，并评估关于全球基金的主要公共话语在多大程度上脱离了其运作中隐藏的阻力和冲突。根据民族志实地考察和对多个利益相关者的70次采访的见解，本文旨在更好地了解和揭示公众和全球基金及其在印度活动的隐藏记录。我们认为，虽然它的公开成绩单放弃了它在国家一级的业务中的作用，关键的人种学研究的组织和治理的基金在印度揭示了一个对比的情况。它的组织原则促使议程相互冲突的不同行为者聚集在一起，以应对资金的可用性。出现了多个独立的项目，每个项目都利用控制权和资源，并充当权力的管道。我们研究艾滋病毒的管理是如何被打断的权力和利益的冲突，在一个由基金议定书所引发的竞争环境中，并讨论其全系统的影响。调查结果还强调，需要对全球健康机构的筹资和决策结构进行类似的人种学研究。
Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechanisms to tackle global health priorities. More recent literature reveals governance-related challenges and their unintended health system effects. Much less attention is received by the relationship between these mechanisms, the ideas that underpin them and the country-level practices they generate. The Global Fund has leveraged significant funding and taken a lead in harmonizing disparate efforts to control HIV/AIDS. Its growing influence in recipient countries makes it a useful case to examine this relationship and evaluate the extent to which the dominant public discourse on Global Fund departs from the hidden resistances and conflicts in its operation. Drawing on insights from ethnographic fieldwork and 70 interviews with multiple stakeholders, this article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India. We argue that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario. Its organizing principles prompt diverse actors with conflicting agendas to come together in response to the availability of funds. Multiple and discrete projects emerge, each leveraging control and resources and acting as conduits of power. We examine how management of HIV is punctuated with conflicts of power and interests in a competitive environment set off by the Fund protocol and discuss its system-wide effects. The findings also underscore the need for similar ethnographic research on the financing and policy-making architecture of GHIs.