Storeng Katerini T, Béhague Dominique P
Centre for Development and the Environment, University of Oslo, Oslo, Norway London School of Hygiene & Tropical Medicine, London, UK
The Center for Medicine, Health and Society, Vanderbilt University, USA Department of Social Science, Health and Medicine, Kings College London, London, UK London School of Hygiene & Tropical Medicine, London, UK.
Health Policy Plan. 2016 Oct;31(8):992-1000. doi: 10.1093/heapol/czw023. Epub 2016 Apr 22.
A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for 'MNCH', encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative's evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and 'sellable' interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance.
十年前，孕产妇、新生儿和儿童健康伙伴关系（PMNCH）成立，旨在应对全球卫生行动日益碎片化的问题，这些行动已演变成互不协调、针对特定问题的努力。受全球主要的公私卫生伙伴关系启发，PMNCH将此前相互竞争的安全孕产和儿童生存倡导联盟聚集在一起，并吸引了主要捐助者、基金会和专业机构的支持。如今，其创始人强调了它在为“孕产妇、新生儿和儿童健康”争取优先地位、鼓励综合卫生系统思维以及展示全球卫生工作中合作的价值方面所取得的成就。针对这种关于PMNCH成功的主流论述，本文表明，支持伙伴关系和整合的言辞往往掩盖了持续存在的结构驱动因素和政治动态，这些因素使全球卫生领域倾向于垂直目标。本文利用人种志研究，考察了安全孕产倡议向PMNCH的演变，这是对塑造当前全球卫生领域的竞争力量的一种回应。尽管取得了许多成功，但PMNCH一直在努力解决孕产妇和儿童健康倡导联盟之间历史悠久、根深蒂固的方案和意识形态分歧。对于安全孕产倡议来说，在竞争极其激烈的政策领域开展工作的代价是，部分放弃了实现更广泛社会变革的抱负，转而支持更狭隘但可行且“有卖点”的干预措施。一种普遍的看法是，即使在该伙伴关系内部，孕产妇健康仍从属于儿童健康，这引发了安全孕产阵营的自我保护反应。然而，具有讽刺意味的是，这种反应可能会加剧全球卫生治理、融资和政策解决方案的碎片化，而该伙伴关系原本旨在挑战这种碎片化。本文通过强调只有对全球卫生治理进行更激进的概念化，整合才有可能实现，从而为关于全球卫生倡议的新兴批判性人种志文献做出了贡献。
