Precarious Opportunities: Aspirations and Career Trajectories of Malawi’s Healthcare Workers

• In Event: 1261 - Social Dimensions of AIDS

Abstract

Humanitarian efforts to address the HIV epidemic has led to a proliferation of donor-funded NGO projects in low-income countries. While there is a broad literature on the implementation of HIV projects, we know less about how they affect the lives of workers themselves. How does the rise of the NGO field shape people’s aspirations and career trajectories? What does working for an NGO enable or constrain? Findings are based on in-depth interviews with healthcare workers in the NGO and government sector in Lilongwe, Malawi (N=44). Drawing on a pragmatist approach, I analyze aspirations and career choices as ends and means that develop within contexts. I find that entry into healthcare work was often random and a matter of taking an opportunity in a difficult labor market. Over time, however, the NGO field affected how people perceived their work. Those working in NGOs saw HIV work as their career – they reinterpreted past aspirations to create an identity as an HIV provider and saw themselves on a promotional pathway within the field. State healthcare providers felt that what was once a dream career now paled in comparison to the salary and benefits their NGO counterparts received. While respondents recognized the short-term and unstable nature of NGO work, they desired these positions. NGO work spoke to people’s hopes for upward mobility – jobs were associated with opportunities for advancing their education, careers, and livelihoods. The opportunities NGOs offered, however uncertain, shaped people’s perception of their work and how they weighed the costs/benefits of different career pursuits. This study shows that the rise of the NGO sector not only changes how healthcare is delivered, but it also transforms the people working within it.

Author

• Amy Zhou, Barnard College