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Public Private Entanglements: Global Health Assemblages and the Right to Healthcare in Nepal

David Citrin 

University of Washington

 

Abstract

In 1995, Dr. Hemang Dixit wrote in his book Nepal’s Quest for Health that, while “some health services are provided by NGOs, health care delivery is by and large a government affair.” This is no longer the case. Against the backdrop of Nepal’s complex healthcare sector, increasingly dominated by fee-for-service healthcare providers, Public-Private-Partnerships (PPPs) have become a popular model of collaboration between a growing range of actors. These include multinational institutions, non-governmental organizations (NGOs), public and private medical colleges, commercial entities, research laboratories, pharmaceutical companies, philanthropic donors, development agencies, and branches of government. The sometimes fuzzy definitional and operational boundaries between various kinds of partnerships—as well as their potential breadth in scope, form, and composition—make them appealing arrangements in the emergent field of “global health.” Yet these assemblages also raise important questions about the very nature of what is, or becomes, public or private. Further, what are the shifting boundaries of the concept of “partnership” when these collaborations are forged across such staggering inequalities? How should we measure the “impact” of such partnerships, and who gets to define these terms? Drawing on my experience working in a public-private-partnership in Nepal, and my longer-term research on the country’s shifting healthcare landscape over the past sixteen years, I offer an ethnographic discussion of the fragile and contested spaces of public private partnership in Nepal. I discuss the power dynamics, potential, and pitfalls of these partnerships, as well as the implications for strengthening Nepal’s national healthcare system.