1. Dr Hayley MacGregor, 13 Dec 2011
Situating responsibility for the control of infectious disease: the work of lay HIV counsellors in South Africa
Hayley MacGregor
Dr Hayley MacGregor, 13 Dec 2011

2. Social Technological and Environmental Pathways to Sustainability
The ESRC STEPS Centre
Social
Technological and
Environmental
Pathways to
Sustainability

3. Dr Hayley MacGregor, 13 Dec 2011
STEPS Challenges
Understanding development-science interfaces in a highly dynamic world
Linking environmental sustainability with poverty reduction and social justice
Making science and technology work for the poor
Across 3 domains: Health, Agriculture and Water
Challenging conventional approaches of separate sectors and disciplinary silos
Dr Hayley MacGregor, 13 Dec 2011

4. Key features of STEPS Approach
Different FRAMINGS of systems: different ways of representing a system or problem
A politicised view of ‘systems’ and their dynamic environments
Acknowledging the politics of knowledge
Addressing governance: power, politics and institutions
Dr Hayley MacGregor, 13 Dec 2011

5. Dr Hayley MacGregor, 13 Dec 2011
A systems perspective
environment
System:
Social, institutional,
ecological and
technological
elements interacting
In dynamic ways
‘system’
How is this politicised perspective ‘operationalised’, so to speak, in our pathways approach?
Here, we recognise that while the world is endlessly complex and dynamic, it is useful for analytical and practical purposes to think in terms of systems – or social, ecological and technological elements interacting in dynamic ways in particular environments.
Dr Hayley MacGregor, 13 Dec 2011

6. Dr Hayley MacGregor, 13 Dec 2011
Integrating knowledge and values: Framing
Dimensions of framing
- Scale
- Boundaries
- Key elements and relationships
- Dynamics in play
Outputs
- Perspectives
- Interests
- Goals
Values
- Notions of relevant experience
Framings: Different ways of understanding or representing a system
and its relevant environment
But central to the pathways approach is the addition of a reflexive dimension, drawing on methodological constructivism in the social sciences. That is to recognise that there are multiple ways of understanding and representing a system; and that all analysis of a system involves framing.
Framing involves not just choices about which elements to highlight, and how to bound the system, at what scale, but also subjective and value judgements.
Such framings are produced by particular actors – whether different local people, scientific, policy or business actors, and co-constituted with their particular institutional, political and life settings.
Dr Hayley MacGregor, 13 Dec 2011

7. Dr Hayley MacGregor, 13 Dec 2011
Pathways Approach
In a given situation we might ask:
Who are the actors?
How is the system and goals for change FRAMED?
How is the ‘public’ constructed?
Identify PATHWAYS of response
Pay attention to alternative and marginalised perspectives
Constructing pathways to sustainability requires recognition and deliberation amongst multiple perspectives and possible pathways
Dr Hayley MacGregor, 13 Dec 2011

8. Dr Hayley MacGregor, 13 Dec 2011
Epidemics and policy
Epidemics: Science, Governance and Social Justice
Avian Influenza: Science, Policy and Politics
Dr Hayley MacGregor, 13 Dec 2011

9. Dr Hayley MacGregor, 13 Dec 2011
HIV: a chronic illness
Different framings of the problem of disease control
Different understandings of the role of lay HIV counsellors
Shifting meanings of ‘counselling’
A case study in Khayelitsha, Cape Town
Dr Hayley MacGregor, 13 Dec 2011

10. Dr Hayley MacGregor, 13 Dec 2011

11. Dr Hayley MacGregor, 13 Dec 2011

12. Qualitative Methodology
In depth interviews with 20 facility-based lay counsellors
Interviews with their supervisors in the contracting NGO
Participant observation of their training
Key informant interviews
Background of a new policy framework
Previous fieldwork in Khayelitsha
Dr Hayley MacGregor, 13 Dec 2011

13. The perspective of lay counsellors:
Hybrid notions of ‘counselling’
The importance of formal and informal care practices
Perception of themselves as brokers between the clinic and the community
Complex understandings of ‘responsibility’ for illness
Dr Hayley MacGregor, 13 Dec 2011

14. Their working conditions
Anxiety about task shifting and increasing responsibility
Anxiety about associated risks
The politics of professionalisation
Concerns about targets: ‘the stats’
Concerns about reduced time with clients: shifts in their practice and the effect on the nature of care
Dr Hayley MacGregor, 13 Dec 2011

15. Dr Hayley MacGregor, 13 Dec 2011
Conclusions
The importance of relationships with clients
The dangers of managerialism
Building on the idea of ‘brokers’: helping others negotiate the health system
Adequate supervision
A critical perspective on discourses of responsibility
Dr Hayley MacGregor, 13 Dec 2011

16. Dr Hayley MacGregor, 13 Dec 2011
A new policy framework
Re-engineering Primary Health Care in SA: the role of community careworkers?
UNAIDS/Cordaid cross-country study: case studies and identifying advocacy points with the help of an advisory board
The value of different kinds of evidence
Anthropology and interdisciplinarity
The politics of policy processes
Dr Hayley MacGregor, 13 Dec 2011

17. The STEPS Centre’s Approach
Working papers and briefings free to download on
Introduce how we have been thinking about these issues – pathways approach