Comparing health and education: Some possibilities of conceptual and methodological approaches to comparison in the study of transnational processes

Elaine Unterhalter and Jasmine Gideon

The aim of this paper is to build from the analysis made in our co-edited book Critical reflections on public private partnerships (Gideon and Unterhalter, 2021) to think though some possibilities for conceptual and methodological approaches to comparison in the study of transnational processes of privatization in education and health.

In the Introduction to our book, we discussed four approaches to comparison between some of the sectors in which public private partnerships (PPPs) had emerged. The forms of comparison we delineated may be roughly termed descriptive, mobile, mutable, and reflexive. The argument was broad brush stroke and sketched across a wide range of sectors (health, education, water and housing) and many forms of PPP.

In this paper we look more closely at these four forms of comparison considering a narrower group of relationships associated with the transnational processes of privatization in education and health, linked with the establishment of low fee private schools (lfps) and PPP hospitals in low and middle income countries.  A range of different perspectives on forms of the state emerges. We consider how, from particular perspectives of comparison, the global policy influence of representatives of large private corporations is and is not represented. In concluding we consider some generative features of comparative analysis in delineating the complexities of these relationships.

Descriptive comparison, which is the most widely used in comparing both education and health systems in different locales (but rarely between the two policy areas), yields insight into the demographics of who uses lfps and PPP hospitals and some of the health and education outcomes for these groups. The analysis tends to rest on rather ahistorical portrayals of the form of the state, and these studies do not tend to give insight into transnational processes or the interconnections between effects of privatization in education and health, and a range of political processes.

Mobile comparison has been used in critical education policy research to document how particular ideas promoting lfps have travelled through different centres of power with regard to policy making and the allocation of resources. These ideas have not been so assertively and flexibly promoted by a range of transnational agencies in relation to PPP hospital building, where the major promoters have been the World Bank or investors in infrastructure. Very flexible forms of PPP have been more prominent in other areas of health policy, for example menstrual hygiene management. This form of comparison thus highlights how forms of transnational privatization are different in different social sectors, and that the material relationships – a hospital may be built once in a generation, while a school, like a MHM project, could be quite quickly established – influence some of the form the mobility of discourses.

Mutable comparison considers how a policy or practice, say the form of PPP entailed in lfps and hospitals linked to private insurance schemes, might change as it moves from one context, say a capital city to a small town, or from the project of a multilateral funder to a locally based implementing partner or from one state formation associated with many democratising processes to one linked with authoritarian forms of government. This form of comparison pays particular attention to the complexities of context as these are what mutate the policy or practice. While very few studies of this type have been done either of lfps or PPP hospitals, conceptually and methodologically this kind of analysis would enable some documenting of the interconnections of transnational financing in education and health, considering how the dynamics around different forms of the state may shape this, and also some exploration of how the effects of privatization in one sector compound hardships experienced in the other.

Lastly, reflexive comparison, places centrally the question of which facet is being compared and why, noting some of the problematic or uncomfortable dynamics associated with the comparison as well as some of the illuminations. Examples of lfps set up by community members among refugee populations excluded from mainstream schools in a host country invite a different kind of reflexive comparison to those lfps established by venture capitalists. This work in education raises questions for thinking about how to theorise and document the health provision or lack of it for large refugee populations. This form of comparison raises questions about where transnational financing of PPPs in education and health does and does not go and why.

Our closer look at forms of conceptual and methodological comparison in these two instances of privatization in education and health highlight many underexplored areas. In conclusion we discuss how taking a comparative approach allows us to see  i) the compounding dynamic of inequalities in different sectors , ii) what one sector does and does not document, and what the implications of that are for understanding facets of privatisation, iii) the mobilities of capital and which social sectors are attractive where, for what reasons, and how what appear unmarketable features of education and health become investment opportunities in certain circumstance; associated with certain state formations iv)  how little the coalitions against privatization are documented and the socio-political contexts form which they arise.  We consider the ubiquitous discourses around privatisation tend to go unquestioned partly because of the small body of research looking only at certain dynamics usually linked to what is done, rather than what is not done.