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 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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Knowing death

This article was written by Khyati Tripathi, a Commonwealth split-site PhD scholar from the Department of Psychology, University of Delhi, India and pursing a year of her PhD in the Department of Psychosocial Studies at Birkbeck under the supervision of Professor Stephen Frosh. Khyati has been selected for Cumberland Lodge’s Emerging International Leaders Programme on Freedom of Religion or Belief.
coffinThrough my PhD project, I am trying to understand how varied social constructions of dead bodies lead to different conceptualizations of death in a culture with a special focus on mortuary techniques (embalmment per se). Death is more than just a biological fact; it is also a social phenomenon. A dead body is the carrier of the social meanings that a culture attaches to death. Each culture has a different lens to look at the bodies whether it be male bodies, female bodies or dead bodies. Through my research I want to know how these cultural lenses differ by drawing a cross-cultural comparison between Delhi (India) and London (UK).

As a curious researcher, I have always been intrigued by the untouched complexes of human existence and death is one of them. This interest is closely tied with my experience of losing a friend in an accident when I was 14 and since then I have been on an ongoing quest to ‘know death’. I have been working in the area of death and related themes for eight years now and this journey started with my first project in  the final year of my undergraduate degree, which focused on the impact of physical health on death anxiety, where I worked with terminally ill (cancer patients), chronically ill and healthy individuals. A second research project that soon followed studied death personification i.e. how would people perceive death as a human or a person? A third analyzed the death rituals of  three religions- Hinduism, Islam and Christianity and a fourth was an ethnographic study to explore experiences of Hindu death priests of north India.

I have had many different experiences working on these projects. I remember sitting in the waiting area of the hospital where I had to meet cancer patients for my first project and not wanting to go inside thinking ‘I cannot do this’. I had presumed that none of the patients would want to talk to me about death and I would out rightly be rejected and dismissed. Gathering strength, I went inside the ward where I could see at least 15 beds. I took a right and approached the corner most one. There sat a 73-year-old man reading a newspaper. I greeted him and explained to him the purpose and objectives of my study. He replied saying, “of course, ask me whatever you want” while signing the informed consent. My interaction with him lasted almost six hours. My first ever participant made me realize that as a researcher you need to have no notions and assumptions about your field. There were quite a few  patients who wanted to talk about death with me because they did not want to talk about it with their family members. I can’t say that I was never rejected, I was – a lot and I accepted all rejections with respect. I knew that I was working in a sensitive research area and needed to be receptive.

I am asked a lot if working in this area makes me ‘depressed’. I would say no, it doesn’t but it does make me ask questions about our existence as humans. It gets overwhelming a lot of times and I distance myself when I feel saturated. My parents have been my pillars of strength. They supported me in each and every endeavor of mine and have given me the emotional care, support and motivation that I needed to continue.

I believe that life is a mystery that unfolds gradually but death is a bigger mystery because it is uncertain and this uncertainty and unpredictability about death make people anxious. Through my research, I want to study different aspects of death (ritual-based, culture-based, etc.) and contribute to the field of ‘Death Education’ in India and elsewhere.

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Reframing human-predator relations

This post was contributed by Dr Simon Pooley from Birkbeck’s Department of Geography, Environment and Development Studies. His paper ‘An interdisciplinary review of current and future approaches to improving human–predator relations‘ (Pooley et al. 2017) was published in the journal Conservation Biology on 13 February 2017.

wolvesFaced with shrinking habitats and increasing competition for natural resources, large charismatic predators are under severe threat in many developing countries. In contrast, in developing countries where protection is effective, predators like crocodilians and wolves are increasing. In both cases, the impacts on predators and humans bring the challenges of coexisting with wildlife sharply into focus. This year we have already had controversy over wolf culls in Scandinavia, wolves killed in Tuscany, mountain lions and black bears have been slated for culls in Colorado, USA, and there have been crocodile attacks in Australia, Indonesia Malaysia, South Africa and Zambia (among other incidents).

Currently, the dominant approach to managing human-predator relations focuses on negative impacts and frames the issue as ‘human-wildlife conflict’. This misses the complexity of the relationships in question, omits key influencing factors, and has limited effectiveness in delivering mitigation of conflicts where they occur.

With this in mind I convened a team of experienced, open-minded experts from the natural and social sciences and the humanities, to discuss the problem of human-predator relations. We were hosted by Professor David Macdonald at WildCRU headquarters in rural Oxfordshire. Following a stimulating day of interdisciplinary dialogue, we forged the resulting profusion of ideas, perspectives and experiences into a position paper (Pooley et al. 2016).

In our paper, we review the limitations of current approaches to mitigating conflicts over predators, observing that scientifically sound recommendations have often foundered for unforeseen reasons. These include locals feeling left out of the process, the high costs in terms of time and labour of effective livestock protection methods, resistance to what locals see as infringements on their freedom of behaviour, and disagreements over what causes predator attacks (e.g. supernatural explanations versus scientific ones).

We identify fruitful perspectives on how to reframe, research and successfully intervene in conflict scenarios. Importantly, conservationists need to rethink ‘conflict’ as a framework for dealing with problematic human-predator encounters. Framing an encounter as a ‘conflict’ can polarise and redefine it. For example, when conservationists intervene to resolve conflicts the problem (and the animal) becomes identified with them. It also leads them to ignore successful examples of coexistence. Other themes include the need to understand the historical, social and political context of such encounters, and to properly engage with their (often neglected) cultural dimensions.

It is challenging to unravel the multiple dimensions of conflicts over predator management. Local experiences with and representations of predators coincide with representations circulated in the global media, which inspire and inform international conservation NGOs and their local implementation efforts. Both dimensions impact on local management practices (and resistance to these). The response to the killing of Cecil the Lion in Zimbabwe was a good example of the disjunctions that exist between local and international attitudes to charismatic predators. To some Africans it seemed Americans care more for lions than local Africans.

Another challenge is to think more rigorously about human-predator coexistence and co-adaptation. New ways of thinking about human-animal relationships being developed by social science and humanities researchers can inform this process. Humans and animals should be studied in relation to one another: it is vital to transcend disciplinary divides over who studies what and how. Stimulating approaches here include studies of human-animal geographies, and multispecies ethnography. Further useful ideas include the notion of cosmopolitan nature (it is local and global), and reflexivity about how species’ charisma influences conservation decision-making. Political ecology and peace studies can contribute to improving conflict mitigation efforts. Environmental histories of human-predator relations, and human-human conflicts over conservation, provide essential context for framing interventions.

Another challenge concerns how to reconcile scientific and cultural ways of thinking about animals. Anthropology and psychology have much to teach us about studying the perceptions, beliefs, attitudes and behaviour of humans around dangerous animals. Our understanding of attitudes towards animals is developing fast, but the factors that guide attitudes and ultimately behaviour are less well understood. Moreover, we need to consider human positions in relation to the conservation management practices we put in place.

We seek robust, effective management of destructive and damaging conflicts. However, it is seldom possible to deliver the ‘win-wins’ increasingly demanded by funders. Indeed, aiming for win-wins focusses projects on dispute resolution and technical approaches to preventing or mitigating harmful impacts. It ignores deep, ongoing underlying drivers of conflict, and differences in power and vulnerability among the key role-players.

To adequately tackle this complexity requires a more inclusive approach, open to new ideas, perspectives and approaches for understanding the drivers of what we have unhelpfully characterised as human-wildlife conflicts. It is a challenge to co-produce knowledge about such problematic relationships, without generating a paralyzing relativism. We need to achieve agreement on what constitutes good evidence, and collaborate on developing processes and methods to mitigate conflicts. We should monitor and evaluate and share the outcomes of our efforts.

In sum, conservationists need to transcend the paradigm of conflict in human-predator relations. Conservation is one (to us vital) perspective among others on such relations, and it is necessary to draw on a wider range of concepts, frameworks and approaches to understand the full range of interests and factors influencing these relationships over time and in particular contexts (local and international).

Over the last 20 years conservation biology has evolved into conservation science, recognising that we live in a human-dominated world (Kareiva & Marvier 2012). Perhaps the field needs to evolve once again, to reflect the need for collaboration across the natural and social sciences and humanities, together with those managing and living alongside predators.

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