Global norms and local brokers: An ethnography of an international NGO project to ‘reduce teenage pregnancies’ in rural Malawi
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AbstractInternational non-governmental organisations (INGOs) play an increasingly prominent and multifaceted role in the field of global health – as policy advocates, recipients of donor funds, and implementers of donor-funded programmes. This thesis examines how INGOs implement ‘global’ programmes in ‘local’ context. Based on 10 months of ethnographic fieldwork conducted in rural Malawi, it focuses on a donor-funded INGO project that aimed to improve maternal health by reducing teenage pregnancies through interventions designed to keep girls in school and increase their use of reproductive health services. The thesis examines the dynamics of project and policy implementation within a context characterised by many overlapping development initiatives, shifting donor priorities, a weak public sector, unsustainable donor-funding and short term projects. The analysis focuses on various local individuals who operate within fields of unequal power and ‘broker’ between donors, and local communities. They translate global norms and aims into programmatic practice, to fit the local context but also to derive benefits for themselves. The first article discusses how primary school teachers deal with, and implement, various overlapping NGO initiatives targeting girls, and the implications for public sector institutions. The second article examines how INGOs’ programmatic focus on behaviour change interventions inadvertently results in staff blaming culture for teenage pregnancies and school dropout, denying socio-economic and socio-political realities and the complexity of girls’ aspirations. The third article places the aim to reduce teenage pregnancies within the broader context of maternal health and the Malawian health system. It analyses how dynamic responses and accountability relationships can help explain problems with the implementation of policy and their inequitable effects when confronted with broader malfunctions of health systems. The thesis argues that examining brokers’ practices within fields of unequal power can shed light on why projects are unsustainable and how similar unintended effects repeatedly occur despite the intention of donors and INGOs to strengthen existing public and community structures. The intense professionalisation and donor dependence of INGOs working with the fields of global health and development may undermine their ability to challenge structures of power and reduce inequality.
List of papers
|Paper 1: Pot, H. (2019). Public Servants as Development Brokers: The Shaping of INGOs’ Reducing Teenage Pregnancy Projects in Malawi’s Primary Education Sector. Forum for Development Studies 46 (1), 23-44, DOI: 10.1080/08039410.2018.1427624 (published online 29 Jan 2018). The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1080/08039410.2018.1427624|
|Paper 2: Pot, H. (2019). INGO behaviour change projects: culturalism and teenage pregnancies in Malawi. Medical Anthropology [1-26]. DOI: 10.1080/01459740.2019.1570187. The accepted version is included in the thesis. The published version is available at https://doi.org/10.1080/01459740.2019.1570187|
|Paper 3: Pot, H., de Kok, B.C., Finyiza, G. (2018). When things fall apart: local responses to the reintroduction of user-fees for maternal health services in rural Malawi, Reproductive Health Matters, 26 (54), 126-136, DOI: 10.1080/09688080.2018.1535688. The article is included in the thesis. Also available at http://hdl.handle.net/10852/68306|