Ngoasong, Michael Zisuh.
(2010)
The role of global health partnerships in shaping policy practices on access to medication in Cameroon: theory, models and policy practices.
PhD thesis, University of Nottingham.
Abstract
This thesis argues that health policy practices on access to medication in Cameroon have been shaped by global health partnerships (GHPs), with the result that the capacity of the state has been undermined and the national health system fragmented, with no resultant reduction in the incidence and burden of malaria and HIV I AIDS. GHPs have played an increasing part in relation to access to medication in a number of developing countries in Africa, defined in terms of potential and actual access to pharmaceuticals and healthcare services. GHPs are supposed to provide a better policy response to the practical problem of access to medication by combining the expertise of UN agencies, the pharmaceutical industry, international civil society organizations, national government and local groups to formulate and implement country-specific policies. Ostensibly, they are able to bridge the gap between medical technology and the public health needs of poor societies. Neither of these claims can be substantiated.
Theoretical approaches to models, embodied knowledge and social constructionism are used to provide a conceptual framework to study the role of GHPs on access to medication. GHPs are conceptualised as 'models' that occupy the intermediate position between theory and policy practices, within which are found three major narratives, based on public health, economistic and human rights approaches to the issue of access to medication. These narratives became embodied within GHPs, and are analysed to show how they shape different elements of policy practices. The operation of GHPs within a 'transcalar network', this 'social space' in which global-national-local linkages are formed and interactions take place is also examined.
Global and national (country-specific) perspectives on the emergence of the GHP as a facilitator of access to medication are identified, and the role of GHPs in determining national health policy and local delivery practices for achieving access to medication for the poor and most vulnerable population is investigated. Two programmes in Cameroon are used as case studies: 1) National Malaria Programme created on Roll Back Malaria partnership guidelines and 2) National HIV/AIDS Programme created on Accelerating Access Initiative and Equitable Access Initiative guidelines respectively.
The empirical evidence from this thesis supports a critical evaluation. GHPs emphasise specific medical intervention programmes, and are effective only in this narrow technical sense. Even though their efforts have not reduced the incidence and burden of malaria and HIV I AIDS, they have legitimised the direct intervention of international agencies, private corporations and civil society organizations at the local level. The GHPs' pursuit of 'quick results' has fragmented the national health system and undermined the role of the state. This thesis suggests that the key to reducing disease burden and improving public health is a strengthened national health system, one that the current GHP model does not offer. Developed to address the supposed failure of African states to ensure access to medication, GHPs have further marginalised the role of the Cameroon state, thereby reducing its capacity to protect and advance the health of its citizens.
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