RT Journal Article
SR Electronic
T1 Understanding resilience, self-reliance and increasing country voice: a clash of ideologies in global health
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e010895
DO 10.1136/bmjgh-2022-010895
VO 8
IS 1
A1 Yusra Ribhi Shawar
A1 Rachel Neill
A1 Michael Kunnuji
A1 Malvikha Manoj
A1 Jeremy Shiffman
YR 2023
UL http://gh.bmj.com/content/8/1/e010895.abstract
AB Background ‘Resilience’, ‘self-reliance’ and ‘increasing country voice’ are widely used terms in global health. However, the terms are understood in diverse ways by various global health actors. We analyse how these terms are understood and why differences in understanding exist.Methods Drawing on scholarship concerning ideology, framing and power, we employ a case study of a USAID-sponsored suite of awards called MOMENTUM. Applying a meta-ethnographic approach, we triangulate data from peer-reviewed and grey literature, as well as 27 key informant interviews with actors at the forefront of shaping these discourses and those associated with MOMENTUM, working in development agencies, implementing organisations, low-income and middle-income country governments, and academia.Results The lack of common understanding of these three terms is in part a result of differences in two perspectives in global health—reformist and transformational—which are animated by fundamentally different ideologies. Reformists, reflecting neoliberal and liberal democratic ideologies, largely take a technocratic approach to understanding health problems and advance incremental solutions, working within existing global and local health systems to effect change. Transformationalists, reflecting threads of neo-Marxist ideology, see the problems as inherently political and seek to overhaul national and global systems and power relations. These ideologies shape differences in how actors define the problem, its solutions and attribute responsibility, resulting in nuanced differences among global health actors in their understanding of resilience, self-reliance and increasing country voice.Conclusions Differences in how these terms are employed and framed are not just linguistic; the language that is used is reflective of underlying ideological differences among global health actors, with implications for the way programmes are designed and implemented, the knowledge that is produced and engagement with stakeholders. Laying these distinct ideologies bare may be crucial for managing actor differences and advancing more productive discussions and actions towards achieving global health equity.Data are available on reasonable request.