10/11/10 Meeting Notes

Tasks from here:

Susanna and Sarah: continue analysis specifically on own field notes and relevant from past years, email dave

Jean: continue Ecuador policy research and include PSRP for Ecuador, and send data discussed

John: continue high level development themes research

All: next meeting be prepared to start drafting…

Status Updates:

Susanna: relevant stuff pulled from data about health transition and blending of medical modalities, slight resistance, distrust 

Sarah: Tena interview very important for setting up structure of paper. Lots of info! Esteban and Arturo stuff too.

Jean: reading policy papers from Ecuador to tease out role of state and/versus NGOs in providing healthcare.

John: in progress

Thoughts, theory and history to consider as we move forward…

·      Policy reacting to people losing confidence in the state to restore health, so how do they do that…

o   Espousing decentralization

o   Promoting local knowledge and empowerment

§  Our data and literature support this…TENA: assessment is community based but organized under state

o   National government: broad plan…implemented locally

o   BUT contradiction…decentralization forces change at local level…(WB)

o   Local communities aggregate needs to inform national policy

·      What does participation look like…forced to engage with international funding agencies but tension with local wants/needs

·      Countries relying on int’l aid

o   Gov’t makes plan

o   Revisions/sugg. Revisions by WB

o   Think grant writing

o   It you want $$$…do A B C

o   Poverty reduction strategy papers (PRSP) produced by countries. Revised by WB.

·      TENA: 2007: doctor, nurse, dentist in every community.

o   Govt cant do it all. Must happen at local level

·      NGOs being “pushed out”

o   Not grouped with civil society

o   Not explicit policy

o   But excluded from conversation

·      NGOs attempted to correct SAPs

·      We as a state are taking back

o   Some critique:

§  90s stabilized econ

§  lost confidence in state

·      NGOs fail in provding a comprehensive health plan

o   Disarticulated according to niche of NGOs

o   Tension with nationalist health care

·      PRSP no funding from anyone. DFID, IMF, USAID,  template?

o   Positive outcome is development

o   “Iron cage of democracy”

Sarah and Susanna (10/8) Data Tasks

DATA ANALYSIS TASKS

Pull out data about CH in Mondana. Community narrative combined with woman in Tena.

NGO, GOVT and Community Health and Health System…

CODE with Thesis in Mind

Arturo (BOTH)

Esteban (Sarah)

Douglas (own field notes of D encounters)

Partera (Susanna)

Tena (Sarah)

Partero Wife—Francesca (Susanna)

Paragraph Summary of Each

Female Group and Solo: Paragraph Summary (Sarah)

Male Group and Solo: Paragraph Summary (Susanna)

Community Men and Women Merged: Paragraph Summary

Old Reports

2007-2008: Pull out salient possibilities (SS)

2006-2007: Pull out salient possibilities (SN)

[save for later...if time]

9/24 Meeting Notes

AAA Presentation and Paper for Publication

Session Date & Time:  11/18/2010, 10:15:00AM - 12:00:00PM

Schedule of Meetings

[2^nd and 4^th Friday @ 1 PM]

10/8

10/22

11/12

Note: We might want to consider meeting on November 4^th as well, depending on how the work is going.

Tasks:

ALL: Stay current on research memos…possibly post on blog…

John:

1. High Level, broad literature review/synthesis of the state involvement in healthcare

Jean:

1. Ecuador health policy research
2. Gather four years of field school data for coding by SS and SN
3. De-identify all field school data

Susanna and Sarah:

1. Code Interviews
2. Code field notes
3. Read Teetering on the Rim 

Central Argument

Reaction to neoliberalism and development paradigm of last 20 years and structural adjustment of 80s and 90s, gutted the power of the state and the handing over to NGOs

NGOs, privatization and growth of civil society

PSRP programs and processes push back, socialist governments,

Co-opting techniques and strategies of NGOs and public health to fit health care models to the local context

Not going back to Alma Ata exactly but incorporating what we have learned from the past twenty years of including indigenous practices

                Health care for everyone, social justice, push back

                Same level of care even in rural areas

                Ropes and parteras in the delivery rooms, bringing local healers into the planning process

Thesis: Data from this study through several years to examine how the state is taking back right and responsibility for health care through reengagement with the primary health care model

Through 30 years of work with PHC since Alma Ata and NGO experience and how they have absorbed those lessons in their efforts to reengage with PHC

New Codes

• Actors
• The state
• Local healers
• NGOs
• Government paid health care providers (Tena and Yachana)
• Local populace
• Reengagement of PHC
• Incorporation of best practices
• Blending of tradition and modern medicine
• Health equity
• Yachana
• Health Transition (from old code book)
• C ommunity Context (economics, agriculture, oil exploitation, migration, urbanization)
• Local history of health care

Abstract submitted for AAAs

The Reemergence of Primary Health Care: Evaluating the Impacts of Medical Pluralism in Rural Ecuador

The Alma Ata Declaration of 1978 emphasized Primary Health Care (PHC) as the optimal approach to decrease global health inequities. Following decades of neoliberal reform and growing participation of non-governmental organizations [NGOs] in health care delivery, PHC is reemerging in Latin America as national governments reassert control over health care. Today, PHC programs seek a balance between traditional and biomedical practices to enhance health and extend access to all citizens. The health transition, marked by rapid changes in family size, fertility and patterns of mortality and morbidity, provides a theoretical foundation for a rapid assessment of health care in Mondaña, Ecuador in December 2009-January 2010 conducted by a team of faculty and student researchers through the annual field school of the University of Colorado Denver.  Mondaña is a valuable case study because of its close articulation with the Yachana Foundation, an NGO promoting sustainable development through eco-tourism, educational programs and health initiatives. This paper discusses the current state of maternal health care in Mondaña, for example, how traditional and biomedical modalities interact. It also is a focal point to assess changes in health-seeking behavior created by construction of a government-funded, Yachana-supported maternity hospital. The new hospital incorporates Traditional Birth Attendants into their biomedical model of care as a response to Kichwa women’s current preference to birth at home. We will examine rapidly changing health care approaches in which local people are actively working with governments and NGOs to construct a system that reflects their needs and cultural realities.