Journal of Health Management

We welcome readers to the first special issue (11.1) of the Journal of Health Management. We hope the readers find the articles and various reviews enriching and provocative, both in terms of the range of ideas and critical approaches addressed. The key theme of this double issue concerns the political limits of mega-development projects such as the Millennium Development Goals (MDGs). The primary focus of the articles collected here is to provide an insightful, constructive and in-depth critique of the United Nations (UN) MDGs along with critical deliberations on their short- and long-term implications not only for health management but also for a wide range of issues around development and social change.

The Millennium Development Goals are framed within the post-war discourses of development that also gave us Basic Human Needs and Human Security. The Goals set out a consideration of the failures of earlier strategies along with an agenda for the accelerated reduction of poverty and its accompanying human insecurities. Though the more critical aspects of the MDG discourse were sorely needed, they also left space for the repetition of earlier top–down development strategies, and, more generally, for a (re)vision and wider implementation of globalised intervention by developed countries into the less-developed. In this discourse developed countries identify needs on the part of the less-developed and then supply these needs. The ‘need’ discourse focussed on here represents inferior public health that requires services, goods and equipment to be provided by developed countries; what it ignores are negative health consequences that can arise from development schemes themselves.

The Erased are a group of individuals who were taken off the register of permanent residents in the aftermath of Slovenia's independence in 1991. With this they faced total social exclusion. This article discusses how Erasure came to be and its consequences. The plight of those Erased who are without legal status even today is discussed with regard to issues concerning health and access to health services from which they are excluded through a combination of nationalist and neo-liberal policies. As such, they not only form a section of society that can be completely overlooked by the implementation strategies of the Millennium Development Goals (MDGs), but can also be seen as indicative of some of the conditions that may also effect other vulnerable individuals and groups such as those emerging from various conflicts, precarious workers, migrants and ethnic minorities.

In this article we reflect upon the relationship between the Millennium Development Goals (MDGs) formulated by the United Nations (2000) and the migration phenomena that is characteristic of the present globalised society. First, we argue that the Millennium Goals have not sufficiently considered migration processes as a structural phenomenon. Development goals must take in account this emergent phenomenon in post-industrial societies in order to achieve human rights and social equity and to promote the well-being of all people in their origin and host societies.

Second, by interpreting the results of an ethnographic study carried out in social services aimed at migrant women in the city of Barcelona, while focusing on the 3rd Millennium Goal: gender equity and the empowerment of women, we reflect on the limits and possibilities of these intervention practices in advancing towards the goal in host societies. We conclude that changes in public policy and social services are necessary in order to advance towards the achievement of the gender equity goal and empowerment of women, a transformation that aims at the achievement of citizenship for all people in this global society.

Gender mainstreaming has itself become something of a mainstream practice in much development work. As the theory and practice of mainstreaming has developed so too have a range of debates over what exactly gender mainstreaming can contribute to development. This article reflects on a gender mainstreaming intervention in the East African region to explore the role that gender mainstreaming can play in achieving the Millennium Development Goals. In this article we discuss how gender mainstreaming has, at times, functioned as a retreat from women's equality and is used to render feminist perspectives more palatable to those who resist them. Far from being a simple critique of gender mainstreaming this reflects the broader tensions and debates that are shaping what gender has come to mean in different contexts. This brings difficult tensions over who develops a gender mainstreaming agenda and who claims to have expertise on gender. We explore how much is at stake in claims to represent the ‘beneficiary’ groups and the ways that donor relationships with NGOs function in this regard. Gender mainstreaming has clearly offered a mechanism for legitimating attention to gender inequality that is sufficiently flexible to account for local contexts. However, this flexibility also means that gender mainstreaming can be co-opted for conservative means and the struggles over ownership of gender mainstreaming can just as easily hamper the achievement of gender equality as envisaged in the MDGs.

Through the globalisation of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), policies and prevention measures related to the epidemic have become increasingly influenced by the knowledge claims of international experts and organisations. This article critically analyses the mechanisms through which international expertise has come to influence the practice of rapid testing within the South African context. Through this analysis the article aims to illustrate the unintended consequences of the process of HIV/AID globalisation and internationalisation. While the article argues that knowledge claims about the pandemic are always produced through an interaction of local and international processes, it contends that these interactions are characterised by inequalities when the experiences of local people and contextual factors are not adequately fed into the process of policy development and implementation. The article concludes by arguing that more intercultural inquiry that prioritises cognitive justice is required if we are to develop more contextually appropriate and effective HIV/AIDS related policies and interventions.

The article examines health inequalities and the impact of changing healthcare provision in rural Indonesia. Traditional medicine is often the only source of medical care for a majority of the population in rural Indonesia. However, the pursuit of the Millennium Development Goals (MDGs) requires the provision and implementation of modern healthcare systems. Using case studies from four rural districts in Kaledupa, a remote island in southeast Sulawesi in Indonesia, the study shows that although modern healthcare facilities are present in the sampled island, they seem to be remote with limited access in comparison with the number of traditional practitioners. High costs, cultural beliefs, distrust and distance to modern healthcare facilities appear to be the most common reasons for people opting for traditional healthcare. However, social reconstruction in the perception and provision of care has also led to a gradual disappearance of the traditional healthcare provision. The study calls for policy intervention approaches that are geographically and culturally sensitive as the most pragmatic means towards the attainment of MDG targets for the health sector of Indonesia.

The 2008 UNAIDS Global Update estimated that there were 33 million people living with HIV and that, of these, 67 per cent of adults and 90 per cent of children live in sub-Saharan Africa. There were 2.7 million new infections during 2007 and 2.1 million AIDS deaths, 76 per cent in sub-Saharan Africa. The aims of Millennium Development Goal (MDG) 6 are to arrest the spread of HIV and to promote access to treatment. However, the vulnerability to HIV of people with disabilities, their need for HIV & AIDS information and the constraints they face in accessing treatment have largely been ignored by international development academics and practitioners when disabled people may account for 10 per cent of the world's population and 80 million Africans are estimated to be disabled. Why, then, are disabled people not mentioned anywhere in descriptions of or implementation strategies for MDG 6? This article will use the case study of the relationship of disabled people in Mozambique to HIV & AIDS to draw out the reasons for disabled people being ignored throughout HIV & AIDS policy and services and then provide recommendations to bring about disabled people's inclusion.

In this article I critically reflect on the hegemonic modernist framework of development by focusing on its reflection and application in the United Nations’ (UN) Millennium Development Goals (MDGs) and practices. Not only do I find it falling short of explaining, understanding or bringing about global development, but quite the opposite, since it feeds into and reproduces the status quo. While I plead for serious (re)definitions, and genuine global commitment towards the (re)solution, of the current micro/macro social problems, which are interdependent and need to be treated in connection and at once, I pick four urgent areas of transformation as sub-topics for the present discussion. They include the (meta)theoretical framework and discourse of development, historical and contextual analyses of diverse human socio-cultural conditions, political will and agency and psychology's contributions within a transdisciplinary participation paradigm. I also briefly hint at various issues from the ‘developing’ context of Turkish society in order to illustrate some of the arguments. It is hoped that the complexity of these issues and widespread inequity problems will no longer be ignored in favour of conventional policies and programmes that are based on the reductionist framework and that truly trans(/post)disciplinary and trans(/post)cultural dialogues will enable new connections, meanings and actions towards desired global transformations.

The present article analyses the association between the way in which public policy conceptualises poverty (in discourse and practice), the conception of poverty of people who live in extreme poverty conditions and the strategies they develop to affront it, in the light of their participation in the Puente Programme in Chile. The data emanate from research work carried out from a qualitative perspective using in-depth interviews with people considered to be living in extreme poverty and including a gendered analytic.

The ‘Puente Programme’ is part of Chilean public policy aimed to reduce levels of poverty and extreme poverty, in consonance with the Millennium Development Goal (MDG) One as stated by the UNDP.

Indeed, such policies seem to have had the effect of generating a self-perception of lack of opportunities, low level of agency in the solutions of their problems and consequently, fewer possibilities of achievement of the ends that they have in mind among the users. Also, we conclude that the strategies used by the Puente Programme have neither strengthened community association, nor helped to regenerate community networks. Additionally, the interviewed people do not feel empowered or improved in their citizenship capacities. Instead, what results is a sense of dependency on institutions. Finally, we postulate that the Puente Programme has not contributed to the development of a community or in subjective welfare.

Water is essential to human life, health and development. Prepaid water metres are a popular yet controversial approach to extending water services to the poor. They operate on an upfront payment system which automatically disconnects water if households do not have enough money to replenish supplies. While prepaid water metres have been criticised on a number of levels, this article focuses on the equally problematic discourses used to promote them amongst the poor. By drawing on a case study of a poor South African community's struggle against prepaid water metres, this article highlights how prepaid metres were promoted using psycho-education campaigns under the guise of ‘participation’. It also documents community resistance to the campaigns ending in a court battle that ruled in favour of communities’ right to sufficient water.

In the context of the targets for primary health identified by the MDGs this article evaluates the link between decentralisation and positive outcomes for women and children. Using India as a case study, the article traces the changes in health attainments as a result of decentralisation reforms. The evidence presented, drawn from the experiences of two states, speaks to the relevance of such a link. Despite the heterogeneity of contexts and in implementation, in general democratic decentralisation has enhanced health outcomes for women in the selected village Panchayats. However, the article unearths significant differences in the impacts of decentralisation between the two states. The variations in outcomes between the two states are found to be linked to the architecture of decentralisation design as well as to ‘non-statutory’ provisions that can create a process of path-dependency towards achieving MDGs. The article also flags key methodological complexities inherent in the current MDG framework with respect to the actualization of the goals of equity and access to primary health.

There are several issues to be faced in developing mental health services in South Asia if they are to be culturally and socially appropriate to the needs of the communities in the region. The meanings of mental health relevant to culturally appropriate service development can be obtained by exploring local notions of well-being, systems of care available to people and current practices among those seeking help for mental health problems. Participatory research carried out in communities in Sri Lanka affected by prolonged armed conflict and by the 2004 tsunami clarified the nature of well-being as perceived by communities themselves. Subsequent development of mental health services for Sri Lanka can be based on community consultation, using methodologies and interventions that involve the participation of the communities and their local institutions, and adapting relevant western approaches to the Sri Lankan context.

This article aims to explore the psychosocial practices in one of the sites that respond to vulnerable women who suffer abuse in their couple relationships: the criminal justice system. A discursive theoretical–methodological perspective is used (Foucault 1969; Ibáñez and Iñiguez 1997; Wetherell and Potter 1993), based on the discourse analysis and their positions that can be found in the practices of professionals in the criminal justice system (judges, prosecutors, lawyers, police), as well as in some of the narratives of vulnerable women. These accounts have been gathered through participant observations in courtrooms and police stations where complaints are filed, and through in-depth interviews. The results show the influence and the effects of: (a) an ‘empiricist position’ characterised by objectivity and emotional distance, and (b) a ‘professional position’ characterised by the predominance of professional roles and pragmatic experiences over reflexive practice. Nevertheless, emerging resistant practices include elements that could be placed in a ‘feminist position’ and provide new insights for the treatment of vulnerable women.

This article examines the policy of using target-setting and measurement to deliver on the United Nations’ (UN) development goals. Using evidence from similar monitoring and management strategies in the United Kingdom (UK), we question the purpose of using process and outcome targets and suggest that this approach can be counter-productive. It can also lead to a situation where maintaining public relations and image is prioritised at the expense of making real impacts on key development issues. While the UN's aims are praiseworthy, we suggest that the somewhat simplistic methodology adopted is damaging to the very people that the UN is seeking to help.