Dr. Meredith G Marten

Anthropologists have studied medical pluralism since the earliest, colonial days of the discipline, and the development of medical anthropology as a specific subfield itself was established through interests in the diversity of healing beliefs and practices observed across cultures. Traditional and complementary medicine has long been acknowledged by global health professionals as well (even though it is often not formally recognized nor adequately supported). Many of these types of care, particularly when provided alongside high-quality biomedicine when needed, offer the kinds of holistic engagement that biomedicine often excludes, particularly as nonbiomedical care often attends to the social aspects of health and well-being that are missing from biomedical practice. Given these 'realities', in this chapter we argue that high-quality biomedical care be made more accessible and available to improve the health and well-being of people around the world. We also hope to demonstrate how medical pluralism can often be valuable in improving patients' health, and, when appropriate, we encourage global health practitioners' support of plural forms of care around the world.

Strengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

Accurate information about dietary determinants and behaviors of people in special populations is necessary for nutrition policy and effective nutrition intervention programs. The utility of an evaluation depends on its ability to provide reliable, reproducible, and timely information for making the needed decisions. Program evaluations fall into two general categories: (1) evaluations to improve an ongoing program and (2) evaluations to assess the impact of a program. Ongoing program evaluations are commonly referred to as "formative evaluations," while the impact assessments are called "summative evaluations" (see Sahn, Lockwood, and Scrimshaw 1984; Habicht, Pelto, and Lapp 2009; and Rossi and Freeman 1999 for guides to developing evaluation strategies). Whether data is being used for improvement or impact assessment, monitoring and evaluation requires appropriate indicators for the establishment of population baselines for the characteristic under consideration as well as follow-up evaluation. The indicators identified in chis chapter can be used for both estimating population baselines and assessing the impact of nutritional interventions (examples of nutritional program effectiveness assessments include Berri et al. 2004; Penny et al., 2005; Gibson 2011; Gunaratna et al. 2010; and Massee et al. 2012).