Dependent Agency in the Global Health Regime : Local African Responses to Donor AIDS Efforts

This volume examines how local actors respond to Africa’s high dependence on donor health funds. It focuses on the large infusion of donor money to address HIV and AIDS into Malawi and Zambia and the subsequent slow-down in that funding after 2009. How do local people respond to this dynamic aid architecture and the myriad of opportunities and constraints that accompany it? This book conceptualizes dependent agency, and the condition in which local actors can simultaneously act and be dependent, and investigates conditions under which dependent agency occurs. Drawing upon empirical data from Malawi and Zambia collected between 2005 and 2014, the work interrogates the nuanced strategies of dependent agency: performances of compliance, extraversion, and resistance below the line. The findings elucidate the dynamic interactions between actors which often occur “off stage” but which undergird macro-level development processes. Dependent Agency in the Global Health Regime 3 Acknowledgments 6 Contents 9 Acronyms 10 1 Dependent Agency and the AIDS Enterprise: Global Programs, Local Actions 12 A Theory of African Agency 16 Conditions for and Strategies of Dependent Agents 20 The AIDS Enterprise 28 The Country Cases 32 The Research Design 37 Next Steps 41 Note 42 2 Unique Opportunities in a Dynamic Aid Architecture: The Conditions for Agency 43 The “Ramping Up” of AIDS Funding: Global Attention, Local Mobilization 45 Slowing Down or Leveling Off AIDS Funding: Financial Crisis and Corruption 55 Sustainable Solutions and Local Empowerment 59 Dependent Agency Revisited 61 3 Performing, Extraverting, and Resisting: The Strategies of Dependent Agents 63 Performances of Compliance 65 Echoing the Official Story 65 Learning and Normalizing the Required Performances 71 Perfecting the Performances of Compliance 74 Official Transcripts Cut Both Ways: Holding Powerful Actors to Account 77 Extraversion 79 Extraversion around PLHIV Testimonies 80 Using Donor Practices in Extraversion: The Theme of Exclusion 85 Extraversion for Training and by Training 88 Resistance Below the Line 91 Conclusion 94 Notes 95 4 Complex Power on the Margins: The Implications of Dependent Agency 96 Dependent Agency and Development 98 Reacting to the Strategies 99 Undermining Trust and Solidarity 103 Shaping the Broader Development Agenda 105 Dependent Agency and Local Democracy 109 Citizenship Responsibilities 109 Dependent Agency and Democratic Deepening 111 Lessons on Conceptual Complexity: Dependent Agency and International Politics 115 Note 120 Bibliography 121 List of Fieldwork Data 139 Interviews 139 Malawi 139 Zambia 140 Other 141 Focus Group Discussions 141 Malawi 141 Zambia 142 Participant Observations 142 Malawi 142 Zambia 142 Index 144 This volume examines how local actors respond to Africa's high dependence on donor health funds. It conceptualizes dependent agency, a condition in which local people can both influence and be dependent on donor programs. Focusing on AIDS projects in Malawi and Zambia, the book questions the role of Africans in a dynamic aid architecture and their responses to the myriad of opportunities and constraints that accompany it Front Matter....Pages i-xiv Dependent Agency and the AIDS Enterprise: Global Programs, Local Actions....Pages 1-31 Unique Opportunities in a Dynamic Aid Architecture: The Conditions for Agency....Pages 33-52 Performing, Extraverting, and Resisting: The Strategies of Dependent Agents....Pages 53-85 Complex Power on the Margins: The Implications of Dependent Agency....Pages 87-111 Back Matter....Pages 113-141