Flexible sustainabilities: continuity and change in an MNCH project in Eastern Kenya

Abstract

In current global health parlance, sustainability is a key concern of funders and implementers alike, tied to growing concerns with accountability and, relatedly, the demand for precise measurement. Concerns over sustainability relate to vertical programming, fragmented care and short funding cycles. Communities who participate in successive programs may become disillusioned by the continual turnover and shifting priorities. In this thesis, I analyze the central role of program discourses, evidence production regimes and knowledge practices in the everyday life of a global health project to illuminate power imbalances that emerge within international partnership formations. Furthermore, within the context of a multi-partner maternal, newborn and child health (MNCH) project in Kenya, I illustrate how local communities engage with global health projects to ensure sustainability on their own terms. Methods: I conducted a 13-month ethnographic study of a MNCH and nutrition project in Taita Taveta County, eastern Kenya, following a project ethnography. Data collection took place between July 2014 and August 2016. Because the social dynamics of the project unfolded in multiple locales, I conducted my ethnographic fieldwork in Winnipeg, Canada, and in Nairobi and Taita Taveta, Kenya. In addition to participant observation, I undertook primary and secondary archival research to gain a deeper understanding of the history of development in Taita Taveta. I also conducted key informant interviews with university scientists and analyzed secondary qualitative data from the MNCH project. Data analysis occurred through an iterative process that triangulated the findings from the various sources. Results and Conclusions. Evidence is a central preoccupation in global health practice, with respect to 1) how scientists and program implementers attempt to meet funders’ demand for standardized, quantitative metrics and 2) how local people and communities position themselves to benefit from global health projects. Prolonged engagement with development projects cultivate “local intervention knowledges” that inform how people think about and engage with projects. I demonstrate how people in Taita Taveta strategically engage with discourses around sustainability, actively participating in the formation of the discourse while contesting and remaking the principles and activities of programs to better meet local exigencies. This I refer to as flexible sustainabilities.