Programme full

Friday 17 April 2015 11:00 - 12:30
PAPER SESSION 7
acceptance of public subsidy of commercial activity and the striking monotheism of 'public private partnerships' for
health (Kapilashrami), the envisaging of the superspeciality 'health cities' and their location, material form and
invested meaning (Murray); the development of a new domestic and international industry around assisted
reproduction and commercial surrogacy (Bisht); and the regulation challenges posed by an outsourced and
commercialised clinical trials industry (Sarojini).
Transforming India’s Health System: The Last 30 Years
Jeffery, R.
(University of Edinburgh)
This paper reviews changes and continuities in India’s health systems since 1980. The situation then could be
characterized by ‘medical dependency’ (a legacy of patterns of medical training and bureaucratic public sector medical
services, supported by patterns of international aid that reinforced inappropriate emphasis on tertiary care and vertical
programmes). In addition, doctors were losing battles for autonomy both within and outwith public employment, and
were unable to exclude unqualified people – so-called indigenous practitioners and semi-qualified and unqualified
‘Western doctors’ – from competitive medical practice. But because health services were not central to class interests,
there was some ‘relative autonomy’ for health policy, allowing some public health achievements – in creating network
of primary health care facilities, or in controlling some major diseases such as malaria, for example. In this paper I
argue that several recent changes, such as the rise of ‘corporate’ hospitals, increasing ‘pharmacuticalization’ and
commodification of health care, and a clinical trials ‘industry’, have been superimposed on the previous structures,
without drastically changing them. Using biographies of prominent medical personalities, analyses of patterns of
hospital ownership and size in Delhi, and material from recently-concluded research projects, I argue that talk of a
‘neo-liberal turn’ disguises continuities and fails to appreciate counter-vailing factors.
Examining the Rhetoric and Realities of Public Private Mix in HIV Management in India
Kapilashrami, A.
(Queen Margaret University)
This paper aims to deconstruct the monotheism of public private partnerships (PPP) for health, and the notion of
shared power within, and demonstrate the polytheism of practices enabled by it in the context of HIV management in
India. I draw on research undertaken between 2007-2010 examining the discourse and practice of PPPs in select
districts in five states in India.
Using a critical enquiry lens, I examine partnerships between corporate sector, civil society with the National AIDS
agency enabled by the Global Fund to fight AIDS TB and Malaria to reveal the contingencies and plurality of practices.
Through specific case studies of HIV interventions, I demonstrate the proliferation of multiple unaccountable entities
which emerge as sites where principles of partnership are subsumed by competition for resources, power and
individual and organisational gains. This raises an important question that the paper attempts to answer: How despite
the tensions and ruptures can growing salience of PPPs as a key mechanism in global and national health
governance be maintained? In response to this, I focus on the role of the development brokers and street level
bureaucrats who act at the interface of the global discourse and the local perspectives and create “order” by
negotiating dissent, building coherent representations and translating common meanings into individual and collective
objectives. I conclude with a discussion on the implications of the discursive practices for the management of HIV and
equity in health care.
Commercialization of Clinical Research in India
Sarojini, N., Ambhore, V.
(Sama Resource Group for Women and Health)
Commercial interests are one of the strongest forces in drug discovery and medical research. The commercialization
of clinical research, conflicts of interest in academia, researchers, CROs, and for-profit IRBs converge to give
pharmaceutical companies unprecedented control over how trials are designed, approved and conducted. In the
recent past, the number of trials by multinational pharmaceutical companies in developing countries has increased
due to the low cost and availability of patients who are seeking treatment because of inadequate public health system.
The drugs tested in such countries are not necessarily marketed in those countries. If they are marketed, their price
can be prohibitively high making it unaffordable and inaccessible. Moreover, when the drugs being tested are not
relevant to the public health need of the country, the trials only serve as a mechanism for testing the drugs only to be
used in developed world to gain profits.
BSA Annual Conference 2015 270
Glasgow Caledonian University