Constructing success in global health: the World Bank and the Onchocerciasis Control Programme in West Africa
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Date
27/07/2020Author
Winters, Janelle Kathleen
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Abstract
The Onchocerciasis Control Programme in West Africa (OCP), a United Nations-sponsored
initiative that targeted a neglected tropical disease (NTD) from 1974-2002, has been
depicted as a major global health success story since the late 1980s. The programme’s
fiscal agency (the World Bank) and executing agency (the World Health Organization)
have been vocal in their praise for the programme, which is often put forward as a model
disease control and development initiative. This dissertation uses the World Bank’s role in
the OCP as a case study for how success is defined and operationalised by global health
institutions. It explores three inter-related questions: in what ways and by what definition
has the OCP been seen as a success by the Bank and the global health community, what
complexities does the Bank’s success narrative overlook, and how does the OCP success
narrative relate to frameworks of success used by global health researchers and
policymakers?
Using global health governance and history methodologies – including a literature review
of ‘success’ and the OCP, an analysis of development assistance for health financial flows,
oral history interviews, and in-depth archival research at six sponsoring agency and donor
institutions – I identify four major components of the Bank’s ‘dominant’ success narrative.
These include clear objectives and metrics; sound extra-budgetary financial management;
strong partnership among sponsoring agencies, donors, and the private sector; and
community-based delivery mechanisms. I then describe the complexities of programme
operation (‘underlying narratives’) for each of these components.
Finally, I discuss the legacy of the OCP’s success, in terms of the Bank’s role in global
health governance. I engage with four major themes in global health governance to
explain the appeal of the OCP dominant narrative. First, the metrics used to justify the
OCP’s success are the product of significant assumptions, which themselves reflect the
Bank’s heavily politicised ideologies of human capital and efficiency. Second, the OCP
showcases the Bank and WHO’s growing reliance on globally-focused trust funds, which
allow these institutions to argue that they are ‘catalysing’ novel investments in global
health. Third, the rise of public-private partnerships (PPPs) in global health reflects this
controversial embrace of cost-effectiveness, catalytic aid, and private philanthropy.
Fourth, the Bank and other multilateral institutions’ emphasis on community-based
delivery mechanisms for the integrated control of NTDs embraces a ‘selective’ definition
of primary health care and health system strengthening. Ultimately, I argue that success
in global health is constructible. It is non-absolute, contestable, and inseparable from the
ideologies of influential institutions. I conclude with a discussion of mechanisms by which
success is constructed in global health, including visual politics and active marketing
techniques.