Aside

Some Nuggets From the Amber: Keshavjee’s ‘Blind Spot’

Just finished Salmaan‘s Blind Spot: How Neoliberalism Infiltrated Global Health. Below, a few tidbits of his weaving of the local and personal with the global, ideological, and ideal. everything below represents a direct quote and the page numbers are marked in parentheses.

This book is intended to add to the conversation about how to more effectively bring the fruits of technology and innovation to those for whom it is a matter of life and death; how social, political, and economic forces have shaped practices in global health; and how ideological blind spots are traps along the path of achieving some of our most humane and important societal goals (xxxii).

In truth, I was confused. I was in my mid-twenties and had been convinced by seasoned development experts that this approach [a revolving drug fund in badakhshan, tajikistan] was an integral part of the transition from “humanitarian assistance” to “long term development.” Of course, as a graduate student somewhat versed in development theory, I knew that something was not right about planning a strategy with people from France and Switzerland, whose medicines were paid for by health insurance, to convince the Canadians, whose medicines were paid for by health insurance, that the Bangladeshis, whose entire life-world had collapsed, who had no access to pooled-risk insurance schemes, and who were now living in poverty, should finance medicines from their destitute communities; that they should “participate in their own health” by joining committees that defined what doctors could prescribe for them; and that their system of curative care – with hospitals, clinics, and experts trained over 70 years of soviet rule – should move towards a more “preventative” medical system in the midst of epidemic disease and hunger. But I participated in moving the strategy forward because i saw it as a means of protecting the most vulnerable (82).

The rise of NGOs as recipients of aid dollars closely followed the ascendancy of neoliberal thinking in washington and london. in their studies of the ngo sector, David Hulme and Michael Edwards described the 1980s and 1990s as a period dominated by a “new policy agenda,” which placed a premium on the untested belief that the private sector was a better mechanism for delivering services and that NGOs are more efficient than the government, especially in providing services to poor people… NGOs became a powerful global political force explicitly identified as a meeting place for economic and political aid (106).

As Ahmed and I were to see, these assumptions did not stop with the revolving drug fund. Instead, it appeared to us that the idea that privatization was the only logical path forward – an assumption made without critical assessment of the potential consequences – was manifesting itself in other ways. It was as if the aspirations of Hayek and his colleagues at the Mont Pèlerin Society were being realized in real time: ideology was operating as common sense. as to other important outcomes – reduced mortality or morbidity, or ensuring justice and dignity – they fell into what I refer to as realms of neoliberal programmatic blindness: areas of programs that are eclipsed by ideological aims (114).

I have come to the conclusion that the way out of the amber is both complex and simple. At its most complex, it will require the re-calibration of our goals as a society and the type of world we wish to create… at its most simple, this will require re-calibrating our focus in global health and development from “sustainability” and “local ownership” to an approach that puts equity and patient outcomes first… a re-calibration of focus towards equity of access and equity of outcome will allow NGOs to again take up the mantle as a vanguard of a moral order that finds poverty and structural violence unacceptable (142).

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