Public-Private Partnerships viewed through a gender lens

In a new paper, published in the Journal of International and Comparative Social Policy, Dr Jasmine Gideon argues that despite their current popularity, Public-Private Partnerships need to be reviewed through a gender lens in order to establish whether they are really enabling the health sector to address wider social determinants of health and to ensure the longer-term success of any pro-women healthcare interventions.

Credit: Russell Watkins/Department for International Development.

Credit: Russell Watkins/Department for International Development.

Good health and sustainable development are widely acknowledged to be inextricably linked, and the promotion of health and well-being is an essential element in the Sustainable Development Goals (SDGs).  Within SDG3, ‘Ensure healthy lives and promote wellbeing for all at all ages’, governments have pledged to ensure universal access to sexual and reproductive health (SRH) care services by 2030.

One of the approaches often cited as necessary to provide universal access is through Public-Private Partnerships (PPPs) in health. The term PPP has been used in a variety of different contexts, but in the case of delivery of SRH services, PPPs have been used to fund and implement social franchising and health care voucher programmes in the Global South. They typically tie the recipient to a specified good or service package, such as medical consultations during pregnancy, provided by specified service providers who are often private practitioners or private sector facilities.  The approaches have grown in popularity since 2000 because:

  • they have been promoted by a range of aid donors including DFID and USAID
  • they are relatively easy to administer and to measure and monitor,
  • they are considered to be a way of encouraging poor households to use services e.g. family planning that they would not otherwise access.

However, there is criticism about the lack of evidence to sustain the claims made about the effectiveness of PPPs in improving access to health care services, and a recent paper by Benjamin M. Hunter, Susan F. Murray and I has argued that such PPPs may do little to address gender inequalities in health. We highlight the need to apply a ‘gender lens’ to the debate around the effectiveness of PPPs in SRH. We propose three key questions that should be asked of all PPP programmes to determine whether issues of gender inequality have been considered:

  1. What are the assumptions underpinning agendas in SRH-PPP interventions?
  2. How are SRH-PPP programmes framed and judged?
  3. To what extent do the SRH-PPP interventions take into account, reinforce or confront the existing realities of gendered social and economic life?

Applying these questions to a case study of a voucher scheme in India, we found that the design of the voucher programme was based on an assumed relationship between use of formal healthcare and decreased mortality and fertility, and the assumed superior effectiveness of private healthcare ‘markets’. The programme was framed as ‘innovative’ yet programme documents indicate the emphasis was on demonstrating rather than testing vouchers as a healthcare delivery model, and claims of success were made based on changes in healthcare use that were not adjusted for government programmes running concurrently.

The scheme in India did little to confront gender norms and values that are deeply embedded within health systems as well as the households that interact with them. For example despite the claims in programme documents to give pregnant women a choice of facility where they wish to give birth, in reality the decision was made by a husband, mother-in-law, female community health worker or the worker’s male supervisor.

The case study also shows that while PPPs claim to address gender-based inequalities, they do so within a limited framework whose simplistic focus on the gaps in women’s health fails to consider the socially constructed relations between men and women. Such PPPs therefore become part of a wider trend of interventions that have contributed to the depoliticization of women’s health and instead maintain a simplistic focus on maternal health that ignores the gendered power relations.

We argue that despite their adoption as the buzzwords of the moment it is not clear that PPP arrangements move us closer towards the ability of the health sector to address the wider social determinants of health that are critical to ensuring the longer-term success of any pro-women healthcare intervention. Applying a gender lens to review the evidence is one way that we can move closer to this goal.

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The Seasons in Quincy UK release

On 23 June The Seasons in Quincy: Four Portraits of John Berger, a film produced by Birkbeck’s Derek Jarman lab, will be released in the UK and Ireland, screening in cinemas in London, Glasgow, Manchester and Bristol, among others. It will also be available online via Curzon Home Cinema, and a DVD will come out in August. Lily Ford, Deputy Director of the Derek Jarman Lab and producer of the film, explains the significance of the film’s cinematic release for research-based film-making.

siq_ukquad_master_medThe Seasons in Quincy is the first feature-length documentary to be produced by the Derek Jarman Lab, Birkbeck’s audiovisual hub, and was made by graduate students there (Lily Ford, Bartek Dziadosz and Walter Stabb) in collaboration with Tilda Swinton, Christopher Roth, Simon Fisher Turner and Colin MacCabe.

The Seasons started out as a film-making exercise, and the open-endedness of the project as it evolved over several years allowed for a great degree of creative freedom and experiment. We were extremely lucky to have the goodwill of John Berger, and the close involvement of Tilda Swinton. We travelled to the Alps as a capsule crew, conducting our shoots as efficiently and unobtrusively as possible and without a script or fixed shotlist, then spent a long time editing each part of the film. It took two years to find the right edit for the first part of the film, ‘Ways of Listening’; we then used this to raise funds for three more chapters from the Silicon Valley Community Foundation and the Pannonia Foundation, via the University of Pittsburgh. The nature of the funding, and our home within Birkbeck, enabled the Lab to give the process the necessary time, and to involve other Birkbeck students in filming, editing and disseminating the finished film.

Over 2016 the film had a vigorous festivals run, and was distributed in the US and Canada, making us realise that there was a wider audience and some commercial potential for it. We were really delighted to get UK and Ireland distribution this year, both as recognition of the quality of the film, and to enable a broader public around the two countries to watch it on big and small screens. It is almost unprecedented for a British university to produce a feature film that is commercially viable; Birkbeck and the Derek Jarman Lab have done this.

John Berger’s humanist commitment, accessible erudition and generosity of spirit is already well known, and it gives all of us great pleasure to have preserved this in the film, now that he is no longer with us. He was of course no stranger to the camera, and we were able to draw on his broadcast past in The Seasons; in this respect the film consists of many more than four portraits. The essayistic approach we took, a hallmark of the Lab’s modus operandi, makes the film very different from a classic biographical documentary and allows space for quite unique forms of engagement with Berger’s work. The critical reception of the film, as well as the warm audience response, confirms that it is a necessary and rewarding approach.

It is this kind of filmmaking – collaborative, innovative and intellectually engaged – that a university-based organisation such as the Derek Jarman Lab can undertake. We continue to advocate for research-based filmmaking, reaching out to graduate students and faculty at Birkbeck and encouraging them to think with film. While digital video and online platforms have made the moving image a very accessible medium for research output, the success of The Seasons in Quincy shows there is also scope for more long-form and cinematic enterprises from within the academic environment.

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Making a market for acts of God

How is the damage of major global disasters paid for? And who by? Dr Rebecca Bednarek, Senior Lecturer in Management at Birkbeck, explores this in new book Making a Market for Acts of God, now available from Oxford University Press. 

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Catastrophic events appear to be increasing in both frequency and severity globally. The financial cost of their losses can be sudden and huge – but who pays the insurance bill for such massive events? Who paid for Hurricane Katrina, or 9/11, or the 2011 Tohuku earthquake?

It all comes from the ‘Reinsurance’ industry – a financial market that trades in the risk of major disasters. This means reinsurance is a crucial social and economic safety net that helps to mitigate some of the effects of disasters, both financially and in terms of allowing for a swifter rebuilding of people’s day-to-day lives following destruction or damage. Dr Rebecca Bednarek, Senior Lecturer in Management at Birkbeck uncovers the everyday realities of the reinsurance market in her book, Making a Market for Acts of God, co-authored with Professor Paula Jarzabiwski and Dr Paul Spee. They get to the bottom of how the risk of such disasters can be calculated and traded in a global market.

rebecca-bednarek_photoIn a recent interview for BBC Radio 4’s programme Thinking Allowed, Bednarek explains: ‘In the reinsurance industry, the increase and frequency of weather related events are put in the context of climate change. In addition, what is also happening is increased urbanisation; as cities get bigger, the losses and expenses of these events become more expensive, as more people are insured in localised settings.’ Further, increasingly, a natural disaster in one country could affect significant losses to supply chains in businesses around the world, and it is against this backdrop of increased globalisation that we must attach more significance to understanding the market of reinsurance.

The sheer scale of the claims means risk must be spread further in order to mitigate its effects – the attacks on the World Trade Centre in 2001 insured losses of $35.5 billion, for example, and for Hurricane Katrina in 2005 the payout was $46 billion. But as Bednarek says: ‘It’s not just the scale of this loss, it’s the fact that you couldn’t predict them. The reason reinsurers are able to themselves survive and to weather such large claims is because for each individual insurance deal, multiple reinsurers take a small part of this deal. No one reinsurer is exposed themselves to a single risk.’ The book also explains how long-term trust-based relationships between insurers and reinsurers are crucial to enabling and stabilising capital flows before and following these large-scale events. These relationships also enable reinsurers to build up deep contextual knowledge of specific risks; something which remains crucial in informing their judgement about risk even as they also use highly technical vendor models and actuarial techniques.

acts-of-god-book-cover

Bednarek and her co-authors shadowed underwriters from various different countries for over three years, gathering ethnographic observations from reinsurers in Bermuda, Lloyd’s of London, Continental Europe and South East Asia, studying their trading activities across many disaster situations.

There may be some developments in the reinsurance industry which could cause future problems, however. Bednarek says: ‘What we found was a whole milieu of long-standing social practices that had ensured that this industry had worked’ and provided capital to underpin large scale catastrophes for centuries. However towards the end of their period of engagement, the researchers began to observe ‘a period of rapid change; things like collatorised forms of finance, different kinds of deals that were changing the industry in certain ways. We wonder what these changes might do to some of these long existing practices that we identified as integral to this market and how it works.’

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The pleasure of raising multilingual children

This article and podcast were contributed by Professor Jean-Marc Dewaele from Birkbeck’s Department of Applied Linguistics and Communication. His new book is Raising Multilingual Children and is published by Multilingual Matters.

Parents everywhere in the world want the best for their children. It means looking after their physical and psychological health as well as their education. I remember reading books with my wife when she was pregnant with Livia about the best ways to raise children. We felt a little overwhelmed by the amount of information and the occasionally contradictory suggestions on how to be good parents. We were also struck by the strong opinions people had about early multilingualism. Many expressed doubts about it being beneficial for the child “before a first language” settled in: wasn’t there a risk of the child ending up with a “muddled” linguistic system, unable to distinguish between the languages? Others wondered whether growing up with multiple languages might lead to an absence of clear linguistic and cultural roots for the child.

Having read my former PhD supervisor, Hugo Baetens Beardsmore’s (1982) book, Bilingualism: Basic Principles, my wife and I decided that the potential benefits of early multilingualism outweighed the potential drawbacks, and when Livia was born in London in 1996, my wife used Dutch with her, I used French, with English spoken all around us. She picked up Urdu from her Pakistani child-minder, who spoke English and Urdu with the English-speaking children. We were a bit concerned that the introduction of a fourth first language might be too much for Livia, but this fear turned out to be unfounded and her languages developed at a normal pace – though Urdu faded away after the age of two and a half when she moved to an English nursery school. From the moment she started speaking, she was perfectly capable of separating her languages, and switching from one to another effortlessly depending on the linguistic repertoire of her interlocutor. She still sounds like a native speaker in her three languages and consistently got some of the highest marks for English during her primary and secondary education. The brain of a baby is like a sponge: sufficient and regular linguistic input will allow it to absorb the languages in its environment. There is no danger of the brain ‘overheating’ because of exposure to too many languages.

Livia’s case is the first story in the book Raising Multilingual Children that has just come out. It includes Livia’s own view on her multilingualism at the age of ten and sixteen. My co-authors Greg Poarch and Julia Festman tell the story of their trilingual children. Greg’s son, Loïc, speaks two minority languages (English and Dutch) at home and uses German outside of his home. Julia’s daughter and son, Aya and Noam, grew up as trilinguals from birth, with two minority languages (English and Hebrew) at home and German outside. The situation changed when Julia’s husband passed away and the input in Hebrew dried up. Now German is the majority language spoken inside and outside of their home and English is the language used at school. Greg, Julia and I decided to pool our family experiences with three languages to produce a book for the general public informed by the academic research. We adopted an issue-related approach and agreed that we would present tips based on examples from our daily lives to highlight things that worked, and strategies that backfired with our children. The book contains concrete and practical ideas to implement multilingualism in the household.

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