Health capability deprivations associated with USAID’s closure in an urban Swati community- a participatory ethnography
1
Independent, Manzini, Swaziland
Popul. Med. 2026;8(Supplement Supplement 1):A3197
ABSTRACT
BACKGROUND:
The closure of USAID resulted in numerous community-based programs intended to benefit marginalised people in Africa, concluding. The impacts, which are assumed significant, are poorly understood, which impairs effective policy and program responses. Our aim is to present policy relevant insights about the impact of USAID’s closure in urban Eswatini.
METHODS:
We conducted participatory ethnography in one Swati township. Data were collected by community co-researchers, using participant observation and individual interviews. All participants were women aged 21-66 and former recipients of USAID-funded programs. Four were visited regularly for 12 months and eight participated in once off interviews, after providing informed consent. Data were analysed thematically, informed by health capability theory, which defines 10 intrinsically valuable capabilities that are instrumental in attaining health.
RESULTS:
Participants were members of groups (sex workers, caregivers, and widows) targeted by USAID-funded programs due to their gendered socio-economic vulnerabilities. The diverse programs they received (mobile health clinics, community-based soup kitchens, sex education and livelihood support) all aimed to alleviate the symptoms, rather than address the structural causes, of systemic problems such as poverty, hunger and unemployment. Sudden program cessation following USAID’s closure, resulted in loss of hope, reduced access to education and health services, and increased poverty, which deprived women of capabilities (e.g. for life, bodily and emotional health). Participants coped by drawing on informal community-based social networks. However, the temporary “fixes” participants have arranged (e.g. begging for or borrowing money or food) are unsustainable and further undermine health capabilities (e.g. mutually-respectful affiliation).
CONCLUSIONS:
Significant negative impacts, which represent health capability deprivations resulted from USAID’s closure. The negative impacts occur partly because programs formerly funded by USAID did not develop instrumental health capabilities, such as political control, that addressed the structural roots of problems like hunger and unemployment.
The closure of USAID resulted in numerous community-based programs intended to benefit marginalised people in Africa, concluding. The impacts, which are assumed significant, are poorly understood, which impairs effective policy and program responses. Our aim is to present policy relevant insights about the impact of USAID’s closure in urban Eswatini.
METHODS:
We conducted participatory ethnography in one Swati township. Data were collected by community co-researchers, using participant observation and individual interviews. All participants were women aged 21-66 and former recipients of USAID-funded programs. Four were visited regularly for 12 months and eight participated in once off interviews, after providing informed consent. Data were analysed thematically, informed by health capability theory, which defines 10 intrinsically valuable capabilities that are instrumental in attaining health.
RESULTS:
Participants were members of groups (sex workers, caregivers, and widows) targeted by USAID-funded programs due to their gendered socio-economic vulnerabilities. The diverse programs they received (mobile health clinics, community-based soup kitchens, sex education and livelihood support) all aimed to alleviate the symptoms, rather than address the structural causes, of systemic problems such as poverty, hunger and unemployment. Sudden program cessation following USAID’s closure, resulted in loss of hope, reduced access to education and health services, and increased poverty, which deprived women of capabilities (e.g. for life, bodily and emotional health). Participants coped by drawing on informal community-based social networks. However, the temporary “fixes” participants have arranged (e.g. begging for or borrowing money or food) are unsustainable and further undermine health capabilities (e.g. mutually-respectful affiliation).
CONCLUSIONS:
Significant negative impacts, which represent health capability deprivations resulted from USAID’s closure. The negative impacts occur partly because programs formerly funded by USAID did not develop instrumental health capabilities, such as political control, that addressed the structural roots of problems like hunger and unemployment.
| eISSN: | 2654-1459 |
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