State and NGO coproduction of health care in the Gran Chaco

Abstract

The collaboration between state and civil society in the delivery of public services is paramount to sustainable and participatory development in rural areas with marginalized populations. Previous research identified complementarity and embeddedness as two essential features of successful coproduction. However, most of the literature on coproduction studies users and providers who share the same language and culture, even if power asymmetries are high. We combine the literatures on non-state social welfare provision and on coproduction to analyze a collaboration between states and non-governmental organizations (NGOs) in multicultural and multilingual contexts. In such contexts, we argue, embeddedness requires not only language interpreters but also intercultural policies and training, without which the benefits of coproduction are lost in translation.Our study is based on a recent collaboration between the states of Argentina, Bolivia, and Paraguay and two health care NGOs that provide prenatal care to women in the Gran Chaco. In this region, a large portion of the population is Indigenous and maternal and infant mortality are high. Based on participant observation and in-depth interviews, combined with observational data, we analyze the experiences of public health care providers and NGO doctors involved in the intervention. We evaluate if there is complementarity between the state and the NGOs regarding access to preventive health care, diagnosis and treatment, and human resources in the health sector. Finally, we analyze whether state or NGO actors are embedded in local civil society or Indigenous communities. We find that this medical intervention significantly improves access to and delivery of health care to pregnant women, and promotes attention to neglected diseases such as Chagas. It also improves local human resources in the health sector. Despite these benefits, it lacks an intercultural approach to health care, limiting its potential, but also opening new opportunities for future research and practice.