Towards the definition of concepts in international health intervention: Participation, efficiency, equity, sustainability and scaling up

Abstract

This thesis explores definition of five concepts central to international health intervention, participation, efficiency, equity, scaling up and sustainability, within the case study of the Tanzanian Essential Health Interventions Project (TEHIP). Developed in response to the 1993 World Development Report and implemented in Tanzania during the era of health sector reform under structural adjustment, TEHIP offers an especially pertinent case within which to explore the language and health practices resulting from this particular history and ideology. Using key informant interviews and literature review, conceptual and applied definitions of the concepts were analyzed. A theoretical framework of health equity as social justice, offered by Amartya Sen, Fabienne Peter, and Thomas Pogge, was employed to examine assumptions and biases inherent in these concepts and their application. Despite significant health gains achieved by TEHIP, this theoretical analysis raises important questions and concerns about the rationale, design and implementation of the project. Keywords. Participation, efficiency, equity, sustainability, scaling up, health intervention, health system reform, Tanzania.