Politics and practices of global health: Critical ethnographies of health systems

Over the past decade, growing recognition that weak health systems threaten global health progress has galvanised renewed global and national commitment to strengthening health systems (Hafner & Shiffman, 2012). Global health leaders from the World Health Organization to the GAVI Alliance, national governments and donors today endorse the goal of health system strengthening (HSS), though there is little, if any consensus on what this entails. Mirroring the business-oriented and technical bias of dominant global health actors (Birn, 2006), HSS is often approached as a technical challenge, focused on efforts to strengthen implementation and management structures within health service delivery, with little attention to the politics and social relations that shape health systems. This special issue aims to demonstrate the potential of ethnographic enquiry to reinvigorate a political – rather than technical – debate about ‘health systems’. With the emergence of a new global health subfield of health policy and systems research (HPSR), there have been important calls for a social scientific perspective that challenges the biomedical and technocratic understanding of health system policies and practices (Gilson et al., 2011). This budding field of research, however, has a long way to go before it establishes methodological rigour and liberates itself from the threat of ‘disciplinary capture’ by dominant health research traditions driven by utilitarian or instrumental views of health systems and policies (Bennet, 2007; Sheikh et al., 2011). As it develops, HPSR will hopefully engage productively with the conceptual and theoretical roots of disciplines that have traditionally had a strong analytical focus on the social and political aspects of health systems, including social medicine and medical anthropology (Holmes, Greene, & Stonington, 2014). The articles in this special issue argue that medical anthropology – and the core ethnographic method – is particularly well-placed to bring forth a social and political, rather than purely techno-managerial perspective in the study of the politics and practices of diverse health systems. From the 1970s onwards, medical anthropologists have demonstrated how medical systems can be best examined within larger historical, economic and political contexts (Janzen, 1978; Kleinman, 1978). Since the 1990s, anthropological research within a critical interpretative tradition has extended the study of medical systems to offer