Title: The Local Bases of Global Health: Historical and contemporary perspectives on primary healthcare in South Asia
Funder: Wellcome Trust

Abstract: Based on years of experience of working on the history of international health programmes, this research project will examine an important theme in global health: the development, advocacy and impact of primary health care, as international, national and local phenomena. At the global level, the theme will be studied from the perspectives of the WHO Headquarters in the WHO -- rather than treating this body as a monolith, an effort will be made to look at the complexity of attitudes within different WHO departments. On this basis, multiple attitudes towards -- and attitudes about -- the spread of PHC frameworks with be outlined and analysed. At the international level, the development and advocacy of PHC will be studied at the level of WHO Regional Offices. Particular attention will be paid two the two ROs involved in the South Asian sub-continent: the South East Asia Regional Office (based in New Delhi, India) and the Eastern Mediterranean Regional Office (based initially in Alexandria and now in Cairo, Egypt). The aim will be to see how WHO Regional Directors and RO departmental managers responded to PHC ideas proposed from the WHO HQ -- importantly, this project will also look at practice, specifically the ways in which models proposed by the WHO HQ were adapted at the RO level. We will look at the shape of the adaptations, their effects on health projects and the reasoning provided -- publicly and privately -- for the re-shaping of PHC policy. The project will then examine attitudes and policy implementation at national level, selecting India, Pakistan, Nepal, Sri Lanka and Bhutan for detailed study. A careful analysis of discussions and debates within federal governments will be carried out, and negotiations between government officials and the WHO HQ and WHO ROs will be outlined and studied. A significant part of this section will be to assess the shape and impact of policy adaptations adopted by national governments, and the rationale provided for these actions. Finally, the research project will look at local policy implementation, and local civilian and bureaucratic responses -- using case studies of 2 or 3 districts in each nation being examined in this project, we will seek to explain how a diversity of local factors impacted on the implementation of the global PHC movement. This study has tremendous relevance for the new global programme for PHC, as it is being advocated by the WHO at the moment -- as part of this study, we will examine contemporary PHC models and associated policies at the WHO HQ, WHO ROs, nations and localities, seeking to understand variations in policy and practice. This, we believe, can allow us to provide an independent and important policy recommendations to departments within the WHO HQ and WHO ROs involved in advocating the reinvigoration of the PHC movement with the active participation of national governments. This research work will also be tied up with an active and ambitious programme of Global Health Histories activities with the Department of Knowledge Management and Sharing at the WHO HQ. This will involve the continuation of annual seminars that involved historians/social scientists and senior policy managers, who are invited to speak on important themes in global health. At the same time, this activity will be tied up more closely with health policy design, advocacy and management -- this will be done by linking the annual seminars with WHO departments charged with preparing World Health Reports and other important consultative documents; by co-ordinating the seminars to fit specific themes, we will ensure that the information provided by speakers will act as background material for all these important WHO publications. In addition, other important WHO activities will be unveiled. This will take the following forms: 1). The organization of 2 Witness Seminars annually on important themes of global health 2). The organization of smaller annual seminar series in collaboration with the WHO ROs. 3). The organization of annual workshops for senior UN personnel and national diplomats based in Geneva -- dealing with medical history, medical ethics and health diplomacy, these will be carried out in association with KMS/WHO. 4). Active outreach activities relating to all the above activities, through the web (through You Tube etc.) and publications (pamphlets, postcards etc.). 5). The initiation of an internship scheme within the WHO HQ for UK-based postgraduate students -- the goal will be to help students of medical history and humanities to get valuable experience within the UN system, thereby preparing them careers in global health. The project will result in two major books, one looking at historical aspects of PHC and the other looking at contemporary trends. In addition, a number of public outreach oriented publications will be produced, alongside several website-based resources. All the aforementioned activities will be made possible through a major medical history and humanities programme grant application, which will be submitted through the University of York later this year -- Sanjoy Bhattacharya will be the PI, and the application will involved political scientists, sociologists, philosophers and economists based within the University of York as co-applicants. Work on the application is almost complete, and senior WHO officials and several departments within the WHO HQ have been lined up as collaborators. At the same time, it is recognized within the WHO HQ that the information made available through this project will be both critical and independent -- WHO colleagues involved in these activities accept that this independence will increase the value of this study and enable it to inform contemporary policy more effectively


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE