Penn Bioethics Seminar | Morgan Hoke, MPH, PhD
12:00pm - 1:00pm • BRB 0253 Seminar Room
2019-04-23 12:00:00 2019-04-23 13:00:00 America/New_York Penn Bioethics Seminar | Morgan Hoke, MPH, PhD Global health goals, local constraints: An ethnographic examination of maternal and child healthcare in a rural clinic in Southern Peru A recent publication in Lancet Global Health highlights Peru’s success in addressing millennial development goals of lower infant and maternal mortality. Between 2000 and 2013, Peru boasted a 4.2%/year reduction in maternal mortality and a 6.2%/year reduction in infant mortality (Huicho et al., 2016). Improved provision of prenatal care, culturally sensitive provision of reproductive care, expanded health insurance, and social aid programs specifically a conditional cash transfer program known as JUNTOS, have been credited as the source of these successes. Despite improving statistics, health outcomes and the quality of care within a decentralized and highly neoliberal Peruvian public healthcare system are highly variable and unequal between care locations and providers. In this paper, we use clinic-based ethnography including surveys, clinic observations, and interviews with providers and healthcare recipients to assess the logics and practice of care, infrastructural constraints, and experience of women seeking reproductive care at a network of clinics and rural health outposts in the Southern Peruvian Andes. We argue that the combination of inadequate funding and precarious labor conditions for health staff – both highly dependent on meeting productivity goals - coupled with substantial local autonomy, creates the conditions leading to the provision of inadequate and insensitive care. The use of the local health center as a mechanism of surveillance to determine whether JUNTOS beneficiaries are meeting the eligibility requirements creates a lever through which staff can coerce patients to conform to conditions that aid staff and the clinic in meeting their goals for employment and funding (reducing their own precarity) but may ultimately reduce quality of care for patients. Bio: https://www.sas.upenn.edu/anthropology/people/morgan-hoke BRB 0253 Seminar Room Penn Medical EthicsGlobal health goals, local constraints: An ethnographic examination of maternal and child healthcare in a rural clinic in Southern Peru
A recent publication in Lancet Global Health highlights Peru’s success in addressing millennial development goals of lower infant and maternal mortality. Between 2000 and 2013, Peru boasted a 4.2%/year reduction in maternal mortality and a 6.2%/year reduction in infant mortality (Huicho et al., 2016). Improved provision of prenatal care, culturally sensitive provision of reproductive care, expanded health insurance, and social aid programs specifically a conditional cash transfer program known as JUNTOS, have been credited as the source of these successes. Despite improving statistics, health outcomes and the quality of care within a decentralized and highly neoliberal Peruvian public healthcare system are highly variable and unequal between care locations and providers. In this paper, we use clinic-based ethnography including surveys, clinic observations, and interviews with providers and healthcare recipients to assess the logics and practice of care, infrastructural constraints, and experience of women seeking reproductive care at a network of clinics and rural health outposts in the Southern Peruvian Andes. We argue that the combination of inadequate funding and precarious labor conditions for health staff – both highly dependent on meeting productivity goals - coupled with substantial local autonomy, creates the conditions leading to the provision of inadequate and insensitive care. The use of the local health center as a mechanism of surveillance to determine whether JUNTOS beneficiaries are meeting the eligibility requirements creates a lever through which staff can coerce patients to conform to conditions that aid staff and the clinic in meeting their goals for employment and funding (reducing their own precarity) but may ultimately reduce quality of care for patients.
Bio:
https://www.sas.upenn.edu/anthropology/people/morgan-hoke