Population Research Discovery Seminars
The Residua of Health Programs in Sub-Saharan Africa
Rachel Robinson, American University School of International Service
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All health programs have residua: the side-effects that ripple outwards during implementation or that are left behind after the program is finished. These residua may then influence other health programs, either enabling or hindering them. For example, the monitoring system put in place to combat polio in Nigeria is credited with limiting the Ebola outbreak to just 19 cases, and there are now multiple examples of how community health worker programs developed to combat HIV/AIDS are aiding the response to COVID-19. Drawing from examples of health programs implemented in sub-Saharan Africa—family planning, HIV/AIDS, polio, and Ebola—the paper uses theories of path dependence, policy feedback, and social capital to develop a framework of health program residua and draws two main conclusions. First, when designing or revising health programs, donors and other implementing organizations should take into consideration the residua of previous health programs, which may either serve as resources or obstacles. Second, donors and governments should invest in structural interventions that address the social determinants of health, rather than vertical programs that narrowly focus on one disease, in order to increase the odds of positive residua.
Rachel Robinson is a sociologist and demographer whose research focuses on global health interventions in sub-Saharan Africa, including family planning, HIV/AIDS, and sexuality education. Her book, Intimate Interventions: Preventing Pregnancy and Preventing HIV in Sub-Saharan Africa (Cambridge University Press 2017), investigates the relationship between family planning and HIV/AIDS interventions across the continent with a focus on Senegal, Nigeria, and Malawi. Journals that have published her research include Demography, Journal of the International AIDS Society, Population Studies, and Population Research and Policy Review. She has conducted field research in Namibia, Malawi, Nigeria, and Senegal, and current projects relate to politicized homophobia in sub-Saharan Africa and the extent of social science knowledge on NGOs. Her research has been funded by the MacArthur Foundation, the Council of American Overseas Research Centers, and the National Science Foundation. Dr. Robinson teaches courses on statistics, global health, NGOs, population studies, and development.