Covid-19 pandemic: raising the stakes for a ‘local health’ perspective
By juliusmugwagwa, on 19 March 2020
By Dr Julius Mugwagwa, Lecturer in Innovation and Development at UCL STEaPP
For the last few years, I have been part of a group that has challenged the assumptions of ‘global health’ narratives. Together with colleagues Geoffrey Banda at the University of Edinburgh and Maureen Mackintosh at the Open University, we have drawn from our health sector research in Africa to argue that some of the key underlying assumptions of global health are fundamentally flawed. This includes the assumption that medical health technologies are readily available commodities; that utilisation and access can be generated in a timely manner from global pharmaceutical value chains; and that “global” advances in knowledge benefit all.
The current Covid-19 pandemic brings to the fore the stark reality of an ever-inevitable reversion to local capabilities for addressing local needs. In advancing the ‘local health’ perspective, our empirical and conceptual arguments from research on the African pharmaceutical, diagnostics and medical device sectors are rooted in a dialogue between proximity and positionality. “Proximity” refers to cumulative local interactions and mutual influences arising from co-location while “positionality” refers to the influence of location of agency on the framing of issues and priorities, with attendant claims to power and legitimacy in policy making.
Proximity can be analysed on three dimensions: geographical proximity, relational proximity and the values assigned to proximity – a key set of dimensions for the ‘social distancing’ strategy being deployed by many countries for Covid-19. In research, which will be vital if, or when, containing or delaying the coronavirus spread fails, geographical proximity is measured as a determinant or index of how easy it is to access different capabilities for conducting timely and appropriate research. In industrial development, proximity is an explanatory factor of the clustering of related industries. Industrial capabilities, and the instrumental role of proximity therein, are crucial in the containment, delay or research phases. It is equally important in the mitigation phase when supplies of different material inputs will be needed by the health sector to cope with the inevitable surge in demand for services. In advanced economies with strong and functional health systems, pharmaceutical and allied industries, we are already witnessing how geographical proximity generates more rapid and stable supply responses. This is a reflection of what has been called an industrial “atmosphere”. The cumulative benefits of local learning and spill-overs of tacit knowledge and relationships between universities, private sector and government, strengthen the scope for and confidence in a more agile response to local needs within local economies.
Positionality, defined by local power, agency and responsibility, is reflected in the Covid-19 pandemic through locally distinctive priorities and in sharply differentiated views on risk, security and timescales for decisions on and implementation of policy measures. Corroborating some of the findings from our research on health sector needs and pandemic preparedness, we have seen across the world increasing gravitation towards local scientific competence and production capacity, recognising a positionality-derived imperative on governments to protect their own populations first.
The distinctive local concerns from Covid-19 should be a loud wake-up, and ‘stay-awake’, call for countries, especially developing countries, to pull closer together policies for industry, financing, science and health around strengthening security of pharmaceutical supplies for local health care. Among others, this pandemic interconnects risk management with local health security, safety and responsibility, as is expected in contexts of uncertainty. It is increasingly clear that for local policy makers to assume greater responsibility for immediate, medium or even long term risk management, they need to draw on tried and tested technical and organisational capabilities in health, industry and related sectors. These capabilities take time to build and optimise locally, and are a function of relational proximity, which catalyses mutual understanding, legitimation and trust among actors in their collective response to local needs.
With countries shutting their borders to protect themselves and doing so in the confidence of being able to draw on locally-available capacities, the Covid-19 pandemic should also see a rethinking of palliative, poverty-reduction oriented development agendas. This could include a systematic structural transformation to higher productivity, higher knowledge and higher skill economic activities for low-income countries. While economic history fully justifies the emphasis on industrialisation, structural transformation and having a strong manufacturing sector as engines of economic development, the social development and anti-poverty international development discourse championed by the Millennium Development Goals in the early 2000’s did nothing to change the productive structure of developing countries. The current Sustainable Development Goals have raised expectations that they could result in structural transformation. Specifically, Goals 8 and 9 have reintroduced employment creation and inclusive and sustainable industrialisation, though some arguments have been made that the industrialisation agenda still remains marginal within the SDG network of goals.
Good for local, good for global
The ‘local health’ perspective calls for a distinctive shift in policy framing: it is not necessarily in conflict with “global health” frameworks but poses a challenge to some of their underlying assumptions as highlighted at the beginning. In particular, the ‘local health’ perspective, framed by concepts of proximity and positionality, and as clearly illuminated by the coronavirus outbreak, demonstrates that ultimately there is an imperative to work with and within local priorities, capabilities and distinct policy time scales. By strengthening and optimising local capabilities for mutually beneficial health sector, pharmaceutical and allied industry linkages, the results will be good for both local and global health.
 Mackintosh, M; Mugwagwa, J; Banda G; Tunguhole, J; Tibandebage, P; Wangwe, S; and Karimi Njeru, M (2018). Health-industry linkages for local health: reframing policies for African health system strengthening, Health Policy and Planning 33 (4), 602-610
 Boschma, R. (2005) Proximity and innovation: a critical assessment. Regional Studies 39(1), 61-74
 Mackintosh, M. Banda G. Tibandebage, P. Wamae, W. (eds.) (2016a) Making Medicines in Africa: The Political Economy of Industrializing for Local Health Palgrave Macmillan, London. Open access http://www.palgrave.com/us/book/9781137546463 .
 Mackintosh, Maureen; Mugwagwa, Julius; Banda, Geoffrey and Tunguhole, Jires (2017). Local production of pharmaceuticals and health system strengthening in Africa: An Evidence Brief. German Health Practice Collection (GHPC), Berlin.