Leapfrogging: one jump forward, or two jumps back?

Picture credit: T, via Flickr

Is the notion of ‘leapfrogging’ in healthcare, promoted by organisations including the World Economic Forum, as progressive as it seems? KCL graduate Laura Rahmeier takes a closer look at some leapfrogging initiatives and finds some positive and nuanced approaches, but also frequent reproduction of the same problematic neo-colonial structures as earlier forms of health cooperation.  

Leapfrogging solutions in healthcare

Many have celebrated Global Health for inaugurating a new era for health cooperation – one free of the paternalistic and imperial tendencies of earlier forms of cooperation between ‘the West and the Rest’. One more recent area of celebrated change is the promotion of non-traditional, innovative solutions through which Global Health is thought to sustainably tackle the new health challenges that developing countries are facing.

As one of these newly proposed solutions, the World Economic Forum has put forward a set of initiatives described as ‘leapfrogging’ solutions, which seek to use innovations to propel health systems along an envisioned path of health systems development, skipping over apparently problematic or unnecessary phases that took place in high-income countries. Examples of leapfrogging include: Mothers2Mothers’ peer-to-peer psychosocial support programme for HIV-positive mothers; Living Goods’ direct sales network of so-called health entrepreneurs, and Philips’ refurbished health facilities called Community Life Centres (CLCs). These innovations are presented as progressive and “transformative” approaches for health, but closer scrutiny reveals several troubling tendencies.

Re-structuring health as a domain for profit-making

Leapfrogging initiatives establish health as a domain for profit-making, aiming to tap into new revenue sources through business opportunities with a social and economic return on investment. Public-private partnership business structures – the cornerstone of most proposed leapfrogging initiatives – clearly operate on a profit motive, establishing healthcare receivers within the lowest socio-economic stratum as consumers to extract profit from and commercialising services usually free in public healthcare.

Take, Philips’ CLCs. While proposed as a solution to a public service shortfall and driven by the ambition to achieve long-term positive health results, Philips’ CLCs clearly operate on such a profit motive, seeking to extract revenue from consumers of a new market segment in the healthcare domain. Not only did Philips attempt to sell water and charge fees for additional services like ultrasounds – ultimately prohibited by government ministries – but they seek to create further demand for their own products sold in and around CLCs, and profit from infrastructure and service contracts with international organisations or governments, in order to ultimately demonstrate the short-term positive revenue flows that justify continuation of the project to the company. Rather than strengthening government-led social protection, they thus represent market-mediated schemes that turn healthcare receivers into market subjects.

Transforming community health workers into ‘entrepreneurs’

Intending to achieve project self-sufficiency, leapfrogging initiatives transform community health workers (CHWs) into competitive, self-responsible actors of the free market by making them healthcare ‘entrepreneurs’. Living Good’s women ‘health entrepreneurs’ for instance operate on a pay-for-performance model that seeks to eliminate “unproductive time” and encourages agents to ‘self-improve’ to avoid being fired for underperformance. Rather than being integrated into the public health sector, these women CHWs are – as ‘entrepreneurs’ – self-reliant for their own wellbeing and self-responsible for the provision of healthcare, enabling a shift in responsibility for welfare away from the state.

Underlying this project rationale is an understanding of women’s empowerment as the ability to make an economic contribution. Following Living Goods’ rhetoric, they empower women by enabling them to become entrepreneurs. In a similar vein, Mothers2Mothers uses highly economic language to describe women’s potential (“community’s greatest renewable resources” or “invaluable assets”) and seeks to professionalise mothers’ caring tendencies to achieve tangible economic return. Initiatives only recognise women’s contributions when they occur within market structures, fostering women’s empowerment due to its benefits for economic development rather than its intrinsic importance.

Integrating spaces into inegalitarian economic networks

Leapfrogging initiatives often seek to cure non-economic, often systemic, forms of oppression through market-integration. Just as Living Goods tries to relieve dysfunctional health systems by employing women as health entrepreneurs, Mothers2Mothers attempted to counter HIV/AIDS burdens by integrating mothers into the international fashion market. Doing so however, they operate under the illusion of smooth economic exchange that allows everyone to profit equally assuming that differences in wealth and power do not matter.

Again, the example of Philips’ CLCs serves to illustrate this point. By replicating their model in new markets, Philips intends to free populations from their healthcare poverty. The extension of Philips’ healthcare model to these new locations, however, squarely depends on recipient government’s ability to pay, ordaining the company with the power to decide who receives healthcare and who does not based on the ability of the receiving population – or of their governments – to contribute.

Decolonising Global Health

Leapfrogging initiatives in healthcare, while presenting themselves as progressive and transformative approaches, thus appear to be steeped in postcolonially problematic aspects. They exhibit neocolonial tendencies – the use of economic, political, cultural, or other pressures to control or influence societies in developing countries – by establishing health as a domain for profit-making and integrating new localities into inegalitarian economic networks. Imposing a market-orientation on healthcare, leapfrogging initiatives undermine their own assertions to promote health as a right, common good and central to human dignity.

All hope is not lost though. While a continued deconstruction of both material and discursive colonialities clearly remains imperative, thorough and critical reflection can also serve to significantly improve Global Health interventions through which ‘the West’ intervenes in the lives of ‘the Rest’, fostering decolonisation. Even leapfrogging initiatives demonstrate nuanced aspects, for instance by recognising the need for real partnership that involves collaboration as much as resistance. Yet, we must not settle for self-proclaimed ‘innovative’ approaches that only camouflage old patterns. Instead, current initiatives to decolonise Global Health, such as postcolonial critiques of Global Health projects, calls to decolonise curricula, conferences inquiring into ways to decolonise Global Health, and grassroots activism, need to continue challenging these claims.

This blogpost is based on research conducted as part of a Master’s dissertation at King’s College London which aimed to examine leapfrogging initiatives in healthcare from a postcolonial perspective. The project used a postcolonial analytical framework, based on an extensive literature review on postcolonial thought and its relation to health, and applied this framework to three case studies through a content analysis of policy documents and promotional materials.