The global pandemic of Covid-19 reveals the importance of robust health systems, and how epidemics can fundamentally affect and change health systems. Together with partners in Kenya (KEMRI and Maseno University) and UK (Cambridge University), our project studies the effects of Covid-19 on key dimensions of the Kenyan health system from the perspectives of those working within or using them: maternal health, community health workers, chronic disease management, immunisation and vaccination, and disease reporting and surveillance. These are all critical to Universal Health Coverage (UHC), which the Kenyan government was about to roll out when the Covid-19 pandemic began.
We are interested in immediate and long-term effects of the pandemic, in terms of the constraints and damage it causes, and the adaptations and innovations it triggers. Specifically, we will explore how Covid-19 and anti-epidemic measures reconfigure relations of trust and mutual commitment between health systems, professionals, patients and communities. To this end, we use an ethnographic approach, engaging, over time, with actors in the field - including health professionals and planners, patients, families and the wider community. This ethnographic work will also collaboratively work with specialists in public health, medicine and epidemiology.
Conducting all sub- projects in one country will facilitate day-today cooperation between the researchers during fieldwork, and enable critical comparisons across different health systems levels, institutions and actors, and attention to interactions between institutions, as well as to co-morbidities. In addition to contributing to the critical anthropology of global health, we will contribute to global policy conversations on the health systems effects of Covid-19 and on major policy goals such as Universal Health Coverage, generating lessons transferable across low and middle-income countries.
The project addresses the response of African health systems (HSs) to the Covid-19 pandemic, focusing on Kenya as case study. Covid-19 reaches Kenya at a critical juncture in its HS evolution. Recent decades brought considerable achievements and experimentation with new HS solutions. These include comprehensive HIV/AIDS care, a coordinated Community Health System, a maternal health financing programme reducing maternal mortality, improvements in chronic disease management, innovative digital health solutions increasing access to health care, and novel reporting and surveillance systems. Universal Health Coverage (UHC), piloted in 2019, was to be scaled-up nationwide in April 2020.
Our project asks what happens to these HS achievements, innovations and experiments under the impact of Covid-19, i.e. the epidemic itself and anti-epidemic counter-measures. We are interested in the damages to health, life and livelihoods and challenges to the HS, as well as in the productive effects triggered by Covid-19, such as adaptations and innovation of technologies, infrastructures, procedures and collaborations. Similar to HIV/AIDS, the new epidemic is a change-agent, which will shape the Kenyan HS for the foreseeable future, and beyond the limits of infectious disease control.
We will use an in-depth, holistic and integrated approach, employing collaborative multi-sited ethnography in rural and urban sites in western Kenya. Eight researchers from Norway, Kenya and UK trained in anthropology, epidemiology and public health will work across five different HS domains – maternal and community health, chronic disease, data and surveillance and Universal Health Coverage – to document effects of Covid-19, chart adaptations and innovations, and explore how Covid-19 is shaping relations between HS and communities. We aim to inform HS strengthening policies and contribute to global policy conversations on how Covid-19 impacts routes towards the Sustainable Development Goals in Africa.