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Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics
Author(s) -
Zhou Amy
Publication year - 2019
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.12841
Subject(s) - government (linguistics) , health care , rationing , nursing , economic growth , prenatal care , public relations , business , medicine , political science , environmental health , population , economics , philosophy , linguistics
This article examines how HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and interviews with providers ( N = 37). I argue that neoliberal ideology, which structures the global health field, produces a fragmented healthcare system on the ground. Findings show two kinds of healthcare practices within the same clinic: donor‐funded NGO s took on HIV services while government providers focused on prenatal care. NGO practices were defined by surveillance , where providers targeted pregnant HIV ‐positive women and intensively monitored their adherence to drug treatment. In contrast, state‐led practices were defined by rationing . Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. This paper builds on concepts of therapeutic citizenship and clientship by exploring how global health priorities produce different conditions, practices and outcomes of NGO and state‐led care.