(iPoster) Assembled (In)Access: The Borderlands of Health Care

• In Event: Poster Sessions: Health Politics and Policy & Wartime Violence, Armed Actors, and Civilian Agency
  In Poster Session: Poster Session: Health Politics and Policy

Abstract

As global events such as climate change-induced natural disasters, political emergencies, and infectious disease outbreaks push vulnerable populations across borders more frequently, health systems must grapple with new pressures around human rights provision given that citizenship rights become less relevant as populations become more mobile. Global health literatures highlight the ways in which transnational actors such as NGOs, aid agencies, and philanthropic groups provide care to those on the margins. Social policy studies, meanwhile, highlights the roles of national governments in designing health systems, and shaping access to care through state-based mechanisms. Yet, from the perspective of vulnerable populations residing in informal and/or under-resourced state environments, primary health care is frequently assembled from a variety of sources, including from foreign states, NGOs, charities, and foreign aid. These literatures primarily view access “from above,” analyzing decisions and systems created by powerful actors. This dissertation, instead, adopts a “bottom-up” approach, analyzing the decisions and systems through which vulnerable border populations access care. By comparing across the Haiti-Dominican Republic border, this project employs rich fieldwork data resulting from a year-long Fulbright grant. It includes data from an original health care access survey, focus groups, and interviews conducted in four rural border sites, as well as interview data conducted at the national and transnational scales. Findings show that despite different institutional and national contexts, residents on both sides of the border use similar strategies to assemble care across a patchwork of providers. This dissertation introduces the concept “Assembled Access” to describe the fragmented but adaptive practice of piecing together care from multiple sources, thereby offering a novel analytic lens for understanding health rights in a new era marked by migration, fragmentation, and securitization. By making care more incoherent, inconsistent, and inequitable for patient populations, piecing together services through “Assembled Access” puts reliable primary health care out-of-reach for many in LMICs.

Author

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