Health Sector Reform in Honduras: Privatization as Institutional Bad Faith

ABSTRACT

I address the privatization of public health care services in Honduras by focusing on one family’s experiences using both private and public health services. I juxtapose their increasing use of private health care services, over public services, against sustained and consistent episodes of health sector reform culminating in protests against decrees that sought to further restructure the Ministry of Health during early 2019. By complementing the concept of “privatization by attrition” with “institutional bad faith,” I argue that the increased use of private health care may be understood as privatization by coercion.

KEYWORDS:

• Health reform
• Honduras
• institutional bad faith
• morbidity surveys
• privatization by attrition
• public health

Acknowledgements

UCONN IRB approved research (Protocol #H17-123). Thanks to Merrill Singer, César Abadía-Barrero, Heide Castañeda, Sarah Willen, two anonymous reviewers, and William Sax’s doctoral colloquium at Heidelberg Universität for invaluable comments and revisions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Weekly recurring interviews focused on the same four questions to ascertain illness episodes within the household and household-level responses.

2. For a different use of Gordon’s (1995) “institutional bad faith” by an anthropologist see Stevenson (2014).

3. Decreto No. 286-2009: Ley para el establecimiento de una Visión de País y la adopción de un Plan de Nación para Honduras. 2 February 2010. Periódico Oficial La Gaceta No. 32,129.

4. The decrees in question were ‘Law for Budgetary Restructuring and Transformation of the Secretary of State in the Office of Health’ and ‘Law for Budgetary Restructuring and Transformation of the Secretary of State in the Office of Education.’ The protests that followed the initial approval of the decrees in Congress ensured that these were never published in the official Legal Gazette (La Gaceta) and thus never became law.

5. The exchange rate at the time: 24.55 Honduran Lempiras (Lps.) = 1 US$.

6. A common malady reported for young children stemming from, according to Rosalinda, envious wayward glances.

7. Local illness associated with a variety of gastrointestinal symptoms (Baer et al. 1998), in Tegucigalpa it was treated with massages and laxatives.

8. Someone skilled at performing the massages used to cure empacho.

Additional information

Funding

Funding provided by the Inter-American Foundation Grassroots Development Fellowship and a Dissertation Writing Fellowship from the Department of Anthropology at UCONN.

Notes on contributors

José E. Hasemann Lara

Jose Enrique Hasemann Lara Ph.D. anthropology (UCONN, 2021), MA (anthropology) and MPH (USF, 2011).