Les politiques de développement et les politiques de la santé : Les contradictions de la prévention du sida au Népal

Cet article prend le programme de prévention du sida au Népal comme étude de cas pour réfléchir sur l’intersection entre les programmes internationaux de bien-être social et les politiques locales du développement. Il s’agit d’examiner comment un modèle progressiste mettant l’accent sur les conditions sociales qui favorisent l’infection au VIH s’est transformé dans la pratique, à la faveur de son application par des organisations non gouvernementales à travers la rationalité courante de l’appareil népalais de développement. Loin de remettre en question les rapports de pouvoir qui perpétuent les modèles de mauvaise santé, la réponse au sida issue des pratiques des ONG a davantage stigmatisé les groupes marginaux, spécialement les populations des castes inférieures et les travailleuses du sexe appartenant à une minorité ethnique, en les ciblant comme des gens qui « ont besoin » des interventions de prévention du sida. Pour comprendre comment et pourquoi cela a pu se produire, il faut examiner les pratiques de développement des ONG au sein du contexte politique dans lequel elles agissent. Les analyses des réponses sociales au sida dans des pays du Sud doivent tenir compte des façons dont les politiques locales de développement s’immiscent même dans les stratégies les plus progressistes de prévention du sida.This article takes an AIDS prevention program in Nepal as a case study for reflection on the intersection between international social welfare agendas and local politics of development. It examines how a progressive model emphasizing social conditions that foster HIV infection was transformed, in practice, as it was implemented by non-governmental organizations through the familiar rationalities of the Nepali development apparatus. Far from challenging the power relations that perpetuate patterns of ill-health, the response to AIDS that emerged from NGO practices further stigmatized marginal groups, especially low-caste and ethnic minority sex workers, by targeting them as people who “need” AIDS prevention interventions. To understand how and why this occurred, it is necessary to look at the development practices of NGOs within the political context in which they operate. Analyses of social responses to AIDS in countries of the South must take into account the ways local politics of development infuse even the most progressive AIDS prevention strategies

Acronyms and effacement: Traditional medical practitioners (TMP) in international health development

International development draws on a globalized vision of 'traditional medicine' when constructing country-specific programs that use local practitioners to further health objectives. This paper looks at the tension between this mobile notion of 'the traditional' and the local social ground. Categories such as traditional birth attendant (TBA) and traditional medical practitioner (TMP) emerge from a process of translation that links local realities to development in specific ways. Examination of training programs for two kinds of 'indigenous practitioners' in Nepal--birth attendants and shamans--shows that various Nepalese specialists are constructed as TBAs and TMPs in a discursive process that emphasizes some differences while eliding others. The acronyms TBA and TMP encapsulate numerous acts of translation through which diverse local practices are subsumed into an overarching development framework. The many layers of this process include: how 'traditional healers' are understood in international health policy; how, in national planning, these conceptions are made to fit with existing Nepalese healers; and how research on 'local ideas and practices' becomes authoritative knowledge about 'traditions', which then, in turn, form a basis for the planning and implementation of training programs. The conceptual categories evident in development discourse on 'traditional healers' take concrete, practical form in the design and implementation of training programs. At the same time development attempts to create programs tailored to local conditions, it generates frameworks that efface or exclude much of what local people think, believe and do. Although training programs for TBAs and TMPs have been advocated as a way to 'bridge the gap' between the realities of local peoples lives and development institutions' visions, it is important to realize that, at another level, development discourse produces the very problems it aims to solve. The case study of training programs for TMPs and TBAs in Nepal shows how the universalizing principles inherent in development discourse systematically dismantle and decontextualize different socio-cultural realities in the course of taking them into account. Development institutions are thus positioned as authoritative mediators of all local worlds. Translation is a social act that, through the management of the circulation of discourses, reinforces the particular global-local power relations of international development. Relations of power, as well as states of health, are at stake in health development encounters. This paper questions whether health development can achieve its humanitarian goals within the existing conceptual framework.traditional medical practitioners health development policy development discourse Nepal

Sexual and reproductive health rights and justice – tracking the relationship

1. (No abstract for Intro) 2. In this paper we draw attention to the difficulty of accessing reproductive rights in the absence of effective state and legal guarantees for gender equity and citizenship, and argue that if reproductive rights are to be meaningful interventions on the ground, they must be reframed in terms of reproductive justice. Drawing on multi-sited ethnographic fieldwork conducted in Rajasthan, Northwest India, we track two dynamic legal aid interventions on reproductive health rights in India, concerned with domestic violence and maternal mortality respectively, that have sought to fill this existing gap between ineffective state policies and the rhetoric on reproductive rights. Through an analysis of these interventions, we propose that requirements of reproductive justice cannot be met through discrete or private, albeit creative legal initiatives, pursued by individuals or civil society organisations but must involve comprehensive policies as well as strategies and alliances between state, non-state, transnational organisations and progressive political groups