The impact of vertical public health initiatives on gendered familial care work: public health and ethical issues

ABSTRACT

Rigorous evaluations of the effects of vertical public health enterprises on the health systems of low-income countries usefully identify the public health and ethical costs of those initiatives. They reveal that such narrowly focused public health ventures undermine the efforts of those countries to establish and maintain adequately resourced and well-developed national health systems, including comprehensive primary care programs. This paper argues that the scope of assessments of vertical public health ventures should be broadened to include gender as an additional axis of analysis. When members of socio-economically marginalized populations are sick with conditions that are not covered by fragmented and inadequate public health programs or disease-specific vertical public health schemes, their untreated illnesses add to the gendered familial caregiving responsibilities of the female members of their households. Those women and girls have to perform their ‘normal’ familial care work, work outside the home for pay, and take care of the unwell family members for whom the household cannot afford treatment. Given that women and girls from low-income households already shoulder a disproportionate amount of care work for their families, their health and life prospects are further affected by the amplification of their caregiving responsibilities. This paper argues that analyses of the impact of vertical public health initiatives should also track this gendered consequence of those enterprises because it is a crucial public health and ethical matter.

Acknowledgements

The author would like to thank the anonymous reviewers for their comments and Lindsay McLaren for editorial guidance.

Disclosure statement

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

Notes

1. While the term ‘females’ is used interchangeably with ‘women and girls’, no essentializing claims are intended.

2. Also see Litsios (2002) on the formulation of the Declaration.

3. That assertion elicited a strong response from some Northern actors. For instance, David Rockefeller (1975) was highly critical of the NIEO’s stance that (global South) countries should be able to regulate and supervise the actions of transnational corporations within their borders.

4. UNICEF had originally been a proponent of comprehensive primary healthcare. But, in the 1980s, it succumbed to the ‘logic’ of the SAPs. UNICEF’s GOBI and later GOBI-FFF are selective primary healthcare programs. For a detailed analysis of the failings of those initiatives, see Werner et al. (1997).

5. See Bruen (2018) for a history and detailed analysis of GAVI’s policies for when countries transition out of its program.

Additional information

Funding

This work was supported by the Career Enhancement Grant, Council for Research, University of Rhode Island [N/A].