Global Health Research, Anthropology and Realist Enquiry Methodological Musings

Sara Van Belle

ABSTRACT: In this article, I set out to capture the dynamics of two streams within the ﬁ eld of global health research: realist research and medical anthropology. I critically discuss the development of methodology and practice in realist health research in low- and middle-income countries against the background of anthropological practice in global health to make claims on why realist enquiry has taken a high ﬂ ight. I argue that in order to provide a contribution to today’s complex global issues, we need to adopt a pragmatic stance and move past disciplinary silos: both methodologies have the potential to be well-suited to an analysis of deep layers of context and of key social mechanisms.

KEYWORDS: ethnography, global health, low- and middle-income countries, medical anthropology, realist evaluation

In recent years, realist enquiry became increas- (Van Belle et al. 2016). It aims at opening the black ingly popular in health programme evaluation and box between intervention and outcome by developing research as well as in healt h systems and policy re- explanations that take into account actors, contexts search in low- and middle-income countries (LMIC), and mechanisms in a confi gurational approach. Re- o en conducted by researchers from these countries cently, realist evaluation has evolved into a broader (Abejirinde et al. 2018; Kwamie et al. 2014; Prashanth fi eld of enquiry, moving beyond programme evalu- et al. 2014). In the process, questions were raised ation and encompassing reviews, syntheses and about the similarities and diff erences between real- realist research (Emmel et al. 2018). Health profes- ist enquiry and anthropological enquiry. Both ap- sionals and health practitioners are also a racted proaches are case-oriented and compare across cases. to this type of enquiry, applying it to the evaluation Cases are selected based on their richness and varia- and researching of operational issues. Part of the ap- tion. Both approaches consider the embeddedness peal of realist enquiry is that it provides a systematic of social action in context as a sine qua non of their approach to learning and that it suits complex inter- application: the context triggers certain mechanisms, ventions rather well. According to Geoff Wong and which in turn produce social action. Finally, both colleagues (2010), complex interventions ‘consist of methods use retroduction (backwards tracing from multiple human components that interact in a non- an empirically observed phenomenon to the mecha- linear fashion to produce outcomes which are highly nisms that produced this phenomenon) to a certain context-dependent’. In this defi nition, actors (and extent to explain social phenomena. their unpredictable behaviour), their interactions and Realist evaluation is an evaluation methodology their relationships make an intervention ‘complex’ from the family of theory-based evaluations, and is (Marchal et al. 2012). increasingly used to evaluate interventions in the Other methods commonly used to engage with fi eld of healthcare and international development the complexity of health systems and the delivery of

Anthropology in Action, 26, no. 1 (Spring 2019): 42–51 © Berghahn Books and the Association for Anthropology in Action ISSN 0967-201X (Print) ISSN 1752-2285 (Online) doi:10.3167/aia.2019.260105 This article is distributed under the terms of the Creative Commons A ribution Noncommercial No Derivatives 4.0 International license (h ps://creativecommons.org/licenses/by-nc-nd/4.0/). For uses beyond those covered in the license contact Berghahn Books. Global Health Research, Anthropology and Realist Enquiry | AiA healthcare in LMIC include social science research nial past (Hannerz 2016). A er some meandering, I methods, such as grounded theory, participatory ended up in a department of public health of a Euro- action research, and ethnography (Green and Thoro- pean global health research institute in the mid-2000s good 1994; Liampu ong 2012). Ethnography has as a lecturer in medical anthropology and sociology. I been successfully applied to make sense of and im- found that medical anthropology practice applied to prove upon the management of health systems and health service delivery in LMIC was strangely devoid the implementation of health policies. Due to its prac- of the evolution described above. What happened titioners’ engagement with meaning, applied medical with post-colonialism in global health research? anthropology has a critical role to play in enabling community-based health systems that are founded upon people’s values and beliefs. Indeed, the Dec- Gridlock in Global Health Research: laration of Alma-Ata of 1978, with its focus on the The Enduring Struggle between Disciplines engagement of communities, provided a role for anthropologists in facilitating the responsiveness of Within tropical medicine (and in its leading schools healthcare services to community needs (Manderson in the United Kingdom), anthropology (in the Anglo- et al. 2016b). phone tradition) was traditionally understood as one In this article, I discuss critically the current devel- of the disciplines that contributed to disease control opment of methodology and practice in realist health programmes (Pool and Geissler 2005). Originally, research in LMIC against the background of applied medical anthropologists were to identify the local anthropological practice in global health to make meanings of disease, translate these into communica- claims on why realist enquiry has been taken up so tion and health-promotion strategies and manage the readily. I set out to capture the dynamics in these relationships with the community in the implemen- methodological streams within the fi eld of current tation of programmes (Heggenhougen and Pedersen global health research. I argue that realist enquiry 1997; Koss-Chioino 1997; Manderson 1998; Sommer- has been readily embraced because its philosophical feld 1998). Anthropologists were henceforth ‘increas- position between positivism and social constructiv- ingly employed in departments of tropical medicine, ism presents an easier entry point for biomedically hygiene and international health with an increasing trained practitioners than does applied anthropo- focus on community-based research in infectious dis- logical enquiry. I do not claim to be comprehensive ease control’ (Heggenhougen and Pedersen 1997). The in detailing disciplinary evolution – this is merely a historical trajectories of global health research institu- starting point for discussion. tions contributed to this state of aff airs, eff ectively ‘locking them in’ to a particular practice of interdisciplinary interaction (Foxon 2002). For some, social An Anthropologist’s Personal Journey scientists were ‘being employed as the handmaidens (in Methodology) of biomedicine’ (Parker et al. 2016). Interdisciplinary relationships and disciplinary power appeared to be I trained as a cultural anthropologist and political deeply engrained in academic institutions as part of scientist in the mid-1990s at the height of the cul- their organisational culture, and they were particu- tural studies movement in the United Kingdom and larly resistant to change. the emergence of the fi eld of post-colonial studies Compared to the Anglophone tradition of ap- (Gandhi 1998). These infl uences transformed the cur- plied medical anthropology, a diff erent route seems riculum of the master’s degree in anthropology at to have been taken by the Francophone tradition, my Belgian university, a change exemplifi ed by the where the discipline of medical sociology integrated fact that the master’s degree title ‘anthropology’ was with anthropology, thereby dampening the biomedi- dropped and changed to ‘comparative cultural stud- cal dominance in the fi eld (Carricaburu and Ménoret ies’. This move broadened the domain of enquiry to 2004). Francophone socio-anthropologists carried out include, amongst other important topics, the study research on, for instance, health systems and power of migration. Not much later came the start of a re- within healthcare organisations (Jaff ré and Olivier invention of anthropology as a discipline towards de Sardan 2003). Typically, they followed the path of a ‘globalised’ anthropology, which expanded its re- critical studies, incorporating the theories of Michel search subject and explored subjects such as migrant Foucault and Pierre Bourdieu (Fassin 2000) and identities, global networks, the digital revolution, critiquing the instrumentalisation of anthropology gender, and social exclusion, leaving behind its colo- (Gruénais 2012). Interesting recent developments in-

| 43 AiA | Sara Van Belle

clude current work on socio-ecological systems (Sterk intervention triggers the mechanisms that explain et al. 2017), on ecohealth (Dakubo 2010), and on the how people responded to the intervention (or not) emerging discourse on planetary health and sustain- and thus created the outcome, thereby increasing the ability science (Brouselle and Butzbach 2018; Pa an- external validity of the results. This is why it is impor- yak and Haines 2017). Embracing an agenda broader tant to test the programme theory across a number of than health and fi rmly embedded in complexity sci- sites. Figure 1 presents the realist research cycle. I re- ence, these approaches address global problems and fer you to Sara Van Belle and colleagues (2016) and to appear to be less vexed by interdisciplinary struggle Sara Van Belle and colleagues (2017) for more details. (Montuori 2013). Initially, realist evaluation was not readily adopted A er having described the gridlock between two in global health research – its early applications were ‘cultures’ in much of Anglophone global health re- in the fi elds of social policy and crime prevention. search – a dominant biomedical one and an applied One of the fi rst publications in health to present the medical anthropological one – I now turn to realist potential of the methodology of a realist review was enquiry, which is perceived by some as building a that by Pawson and colleagues in the Journal of Health bridge between the two because of its position be- Services Research and Policy in 2005, in which the au- tween positivism and social constructivism (Gilson thors explicitly considered healthcare interventions 2012; Goertz and Mahoney 2012). as complex interventions working on complex social systems. This acknowledgement of the complexity of healthcare interventions coincided in the United Realism: An Aha Erlebnis in Kingdom with the critique on evidence-based medi- Global Health Research? cine and the randomised controlled trial (RCT) as the gold standard study design (Greenhalgh and Realist evaluation (Pawson and Tilley 1997) is an Russell 2009; Plsek and Greenhalgh 2001; Sturmberg approach based on scientifi c realism that combines and Martin 2013). In other sectors of social policy in a realist ontology with a weak relativist epistemol- the United Kingdom and in the United States, RCT- ogy. Methodologically, it seeks to establish causation based decision-making has been questioned within a by identifying the causal confi guration of interven- broader critique of new managerialism and perfor- tion, actors, context and mechanisms that underlies mance management (Radin 2007). outcomes. It is theory-driven in the sense that realist About ten years ago, the complexity of health in- research starts by eliciting the programme theory un- terventions and the subsequent need for alternative derlying the topic of investigation. This programme theory is best considered as a hypothesis that is built upon exploratory research, reviews of existing evidence and/or the assumptions of key stakeholders. Being method-neutral, realist researchers combine qualitative and quantitative methods of data collection and analysis in order to ‘test’ the hypothesis – the choice of methods follows from the research question. The ICAMO confi guration is the heuristic used to identify how the intervention I, in specifi c context C, through the actions of actors A, triggers mechanisms M to produce an outcome O (Marchal et al. 2018; Van Belle 2014). Research studies end by re- futing, confi rming or adapting the initial programme theory, which then sets off the next study in a process of accumulation through which at some point middle-range theories can emerge. Indeed, the work of Ray Pawson and Nick Tilley (1997) harkens back to the concept of middle-range theory as defi ned by Robert Merton (1949). From the realist perspective, one particular study will generate plausible explanations for what took place. Through accumulation, the researcher will identify the conditions in which the Figure 1. The realist research cycle (Marchal et al. 2012)

44 | Global Health Research, Anthropology and Realist Enquiry | AiA evaluation designs started resonating within the evaluation in global health, this vision is certainly not world of global health policy and systems research. shared by all. Some medical anthropologists might This brought realist evaluation, as an alternative ask: ‘What’s new? We’ve been doing this all along’. evaluation design, to the fore (Brainard and Hunter However, many biomedically trained researchers, 2016) next to other complexity-oriented approaches who relate to its blend of positivist ontology and rela- (Blanchet et al. 2017; Tracy et al. 2018). Finally, the tivist epistemology, fi nd RE a ractive. It also speaks much-used Health Policy and Systems Research: A to programme managers and decision-makers in Methodology Reader, which was developed by Lucy global health who recognise the limitations of project Gilson for the World Health Organization and the cycle management, logical framework approaches Alliance for Health Policy and Systems Research, and impact evaluations. Indeed, RE entered into the contributed to its increasing recognition in the world fi eld of global health research proposing alternative of global health research (Gilson 2012). ways to evaluation and evidence synthesis so as to inform decision-making. The catch phrases ‘opening From Realist Evaluation to Realist Research the black box’ (Astbury and Leeuw 2010; Harachi et Social scientists will be aware that the use of middle- al. 1999) and ‘what works for whom in what respects range theory and social mechanisms and the focus to what extent in which contexts and how’ captured on confi gurational causation instead of successionist the mood within a substantial part of the global causation are elements of analytical sociology (Harré health research and evaluation communities. and Moghaddam 2016; Hedström and Bearman 2009). This perception of innovation is arguably related Realist evaluation indeed sets out to provide an an- to how anthropology has been viewed in a global swer to the critique that social science research is too health fi eld traditionally dominated by the biomedi- descriptive and not suffi ciently explanatory. Realist cal sciences. I will discuss some explanations of the evaluation (RE) and synthesis are now expanding into relatively modest profi le of anthropology without realist research. The scope of the most recent RE con- developing the entire historical trajectory of anthro- ference in Brisbane in 2017 included realist research pology in global health. Others have reviewed this as did the recently published reference work Doing topic recently (Manderson et al. 2016;b Panter-Brick Realist Research (Emmel et al. 2018). This refl ects the and Eggerman 2018). First, the (stark) diff erence be- broader application of RE in global health research, tween the worlds of anthropological practice and of for instance in research on policy implementation, ac- biomedical sciences and clinical research may have countability (Van Belle 2014), programme implementa- made it challenging for biomedical researchers and tion (Mukumbang et al. 2018, 2016), hospital manage- practitioners in global health to actively engage with ment (Marchal 2011), district management (Kwamie anthropology. Second, much published ethnography 2016), capacity development (Prashanth et al. 2014), does not seem to fi t the recent guidelines regarding and health volunteerism (Vareilles et al. 2015). qualitative health research (Lewin et al. 2015) or the standards for the use of qualitative evidence in health decision-making, which require the ‘clear exposition The Position of (Medical) Anthropology of methods of data collection and analysis’ (Mays in the Current Global Health Landscape and Pope 2000). Indeed, the actual research process within anthropological practice is o en only curso- Before I start analysing the characteristics of applied rily described in published research, thus remain- (medical) anthropology in global health, I will fi rst ing implicit. Finally, medical anthropologists have explain the qualifi ers that I will use. Traditionally, portrayed themselves (and have been perceived as) a medical anthropology has explored social, cultural separate disciplinary community within global health and other dimensions of health and illness. I will research mainly ‘collaborating with clinical research- refer to ‘(medical) anthropology in global health’ to ers and epidemiologists’ (Hardon and Pool 2016). stress its broad, transdisciplinary, cross-cultural and From my personal experience, such disciplinary po- critical character, examining research issues at the in- sitioning is a defence against the dominant biomedi- terface of health and well-being, culture, society, and cally oriented organisational culture in many global the environment while zooming in on people’s par- health research institutes. This specifi c identifi cation ticular, context-specifi c experiences (Panter-Brick and on the basis of discipline is central to the medical Eggerman 2018). anthropology practice, as evidenced in the introduc- While I argued above that realist evaluation is an tion of The Routledge Handbook of Medical Anthropol- innovative methodological approach to research and ogy (Manderson et al. 2016a). It both mirrors and is

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a reaction to the unique disciplinary positioning of the perspective of the actors themselves (Hammers- medical doctors. ley and Atkinson 2007). Post-modernists and post- Anthropological practice recently gained much colonialists have rejected naturalism on the grounds ground in the global health landscape with the Ebola that it is impossible to access the experiences of the epidemic in West Africa in 2014–2015. The epidemic ‘other’: they consider the ‘other’ as a social construct. put the spotlight on the key role that anthropologists Moreover, the post-colonial movement not only can play in social mobilisation and establishing com- critiqued naturalism, it also rejected anthropology’s munity relationships (Brown et al. 2015; Sáez et al. origins, which it felt were deeply enmeshed with 2014). An Ebola Response Anthropology Platform the colonial endeavour (Gandhi 1998; Hammersley was developed, which detailed the contribution of 1992). It should be noted, however, that absolute anthropologists to the identifi cation of cases, to the naturalism has been rejected by most anthropolo- management of the deceased, and to the caretaking gists, who argue that it is not possible to access social of the sick, as well as in the development of com- phenomena in their ‘natural’ se ing in a direct way. munication strategies and the development of pre- Today, much of anthropological practice and ethnog- paredness strategies (Ebola Response Anthropology raphy seeks to combine a naturalistic ontology with Platform 2018). In spite of this, some European an- a social constructivist epistemology. However, for thropologists involved in the containment of the epi- some authors, these stances are not entirely compat- demic felt personally confl icted about their role, as ible (Hammersley 2018). was evident in some oral accounts and interven- Scientifi c realism, the philosophical basis of RE, tions provided at the 2015 European Association of shares naturalism’s respect for empirical phenomena. Social Anthropologists (EASA) conference in Sus- Naturalism and realism also share the viewpoint sex (EASA Medical Anthropology Network and the that methods must be assessed in terms of their RAI Medical Anthropology Commi ee 2015). One fi t with the subject of study. Martyn Hammersley of the many ethical dilemmas surfacing in the West (1992), in his book What’s Wrong with Ethnography?, African Ebola outbreak was connected to (European) noted that ethnography has some surprisingly realist anthropologists being employed by international undertones. non-governmental organisations and humanitarian aid organisations to manage community relations. Causal Analysis in Ethnography Supposedly subscribing – through their actions – to One of the core methods of anthropological practice the values, cultures and operations of these organisa- is ethnography, which was once described by Jack tions, anthropologists became somewhat uncomfort- Katz (2001) as ‘luminous description’, a reworking of ably entangled in the political and power dynamics Cliff ord Geertz’s ‘thick description’. Katz argues that of the humanitarian aid context (Venables and Pelec- ethnography does not only aim at describing social ac- chia 2017). A number of anthropologists developed a tion – an o en-heard critique being that ethnography critical refl ection on what the contribution of anthro- is merely describing and not explaining – but also at pology should be in the containment of global epi- understanding causal relationships. In this view, the demic outbreaks, with the discourse becoming more ethnographer is interpreting social life and producing critical as time went on (Chandler et al. 2015; Hofman ‘thick interpretation’. She or he is searching for hid- and Au 2017; Manca 2017; Minor 2017; Wilkinson et den meanings underlying social action that subjects al. 2017). cannot fathom easily: ‘In any case, before thrashing about in arguments over whether we must or must not bring causal analysis to ethnography, we should The Nature of Anthropological Enquiry fi rst appreciate how subtly and usefully we are al- ready doing it’ (Katz 2001, p. 449). Katz proposes and Its Position on Causality diff erent criteria to evaluate the explanatory content of ethnography. First, ethnography should ideally be Origins in Naturalism case-oriented. Second, it should explain causal link- As opposed to realist research, the philosophical ages through methods such as contrasting diff erent origins of anthropological practice lie with (semi-) cases, portraying the unusual or the counter-intui- naturalism: remaining true to the actual nature of the tive, using longitudinal data (e.g. life histories), or social phenomenon under study. This means that one using retroduction to explain a social phenomenon aims to understand social life and the life-world from (Katz 2001).

46 | Global Health Research, Anthropology and Realist Enquiry | AiA

Differences, Similarities (and Weaknesses) realism’s layered ontology and generative causality. Realist explanations of social practice are grounded There are a number of similarities and diff erences in generative causality with social mechanisms at between realist enquiry and anthropological enquiry. the core (Maxwell 2012): underlying social mecha- Both approaches are case-oriented and compare nisms triggered by specifi c action generate social across cases. Cases are selected based on their rich- action in a specifi c context. The analytical strategy ness and variation. In their realist studies, both Bruno is rooted fi rmly in a specifi c philosophy of science, Marchal (2011) and Van Belle (2014) used a contras- as explained above. This is less so in the case of tive case study design to test an initial programme anthropology. theory that was developed on the basis of the litera- Arguably, ethnography would benefi t from a more ture. Marchal compared well-performing hospitals open and transparent stance on how one reaches the with bad performers to investigate the role of man- ‘why’ via the ‘how’, to avoid the criticism of ‘descrip- agement, while Van Belle contrasted a local urban tive capture’, certainly when one is combining a RCT health system with a rural one to examine public with ethnography (Glaser 2001; Hardon and Pool accountability. Both approaches consider the embed- 2016). In a policy environment still dominated by dedness of social action in context as a sine qua non: positivist perspectives, researchers need to ensure mechanisms are triggered only in some contexts and methodological rigour and be careful not to produce thus lead to social action. Finally, both use retroduc- ‘fake handbags’ or diluted versions of the original tion to explain social phenomena, even if Katz (2001) methodology (Hanefeld 2016). This would help in and Hammersley (2018) argue that this explanatory taking its well-deserved place in global health re- potential must be developed further in ethnography. search. Despite the fact that realists consider social Arguably, developing a be er interface between structure as ontologically real, in practice many re- realist research and anthropology would be ben- searchers tend to focus excessively in their analysis efi cial in several ways. Methodological experts re- on mechanisms at an individual, cognitive level. As a searching complex problems in complex systems result, they tend to fall back into methodological in- need to explore how to build theory in ‘applied fi elds dividualism. Realist enquiry would benefi t from fur- focused on action’ which lack the ‘theoretical sensi- ther deepening of the concepts and understandings tivity necessary (to build) conceptually rich theory’ of meso- and macro-level mechanisms. Ethnography (Glaser 1995). Both ethnography and realist research could contribute to such a deeper understanding could contribute to a deeper understanding of con- through exploring the generative nature of social text in global health research and action. A be er structures, such as, for example, social exclusion (Por- way to analyse layers of context (i.e. the interactions ter 1993). between micro-, meso- and macro-levels) is required to avoid misguided methodological individualism or reductionism underlying programmatic global Conclusion: A Convergence health choices. Understanding ‘deep’ context is also of Approaches? necessary in one of the more recent themes in global health research – namely, intersectionality and its In this article, I set out to describe and compare how impact on health outcomes (Romero 2018). How realist research and medical anthropology evolved do we analyse the impact of cross-generational and in the fi eld of global health research and how they historical layers of social injustice and inequities? are being adopted by researchers in this fi eld. Both How do we strengthen health systems in an inclu- approaches speak to the social complexity of health sive way to meet the universal health coverage goal and allow for a fl exible approach to its study. There of ‘leaving no one behind’ (WHO Regional Offi ce is a long-standing tendency to use standardised, for Africa 2017)? How to be er translate the lived fi xed, step-wise research designs (Hanefeld 2016). experience of vulnerable groups into participatory This is refl ected by a recent call from the Department action? What are the mechanisms underlying social for International Development / Wellcome Trust inclusion (Liampu ong 2007)? And what about the Joint Initiative on Epidemic Preparedness for the de- role of culture(s) and our position as cross-cultural velopment of standardised social science research researchers? protocols (Wellcome Trust 2018). The complex nature A fundamental diff erence with realist research of health, health systems and healthcare, however, is that anthropology as a discipline does not share demands research approaches that embrace causal

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complexity and allow for the use of fl exible designs. Astbury, B. and F. L. Leeuw (2010), ‘Unpacking Black It is here that both realist research and ethnography, Boxes: Mechanisms and Theory Building in Evalu- or more broadly, anthropology, thrive. Furthermore, ation’, American Journal of Evaluation 31, no. 3: 363– both approaches may contribute to be er theory 382. doi:10.1177/1098214010371972. development, a recognised priority in a fi eld where Blanchet, K., D. De Savigny and T. Adam (eds.) (2017), a focus on actionable results o en leads to research Applied Systems Thinking for Health Systems Research: that is under-theorised and built on assumptions that A Methodological Handbook (London: Open Univer- could easily be dispelled on the basis of social science sity Press). theories. Brainard, J. and P. R. Hunter (2016), ‘Do Complexity- Within the fi eld of global health research, it is Informed Health Interventions Work? A Scoping likely that we will see some convergence of the two Review’, Implementation Science 11, no. 127. doi:10 approaches – even when their philosophical origins .1186/s13012-016-0492-5. are diff erent. As the fi eld of global health research is fo- Brouselle, A. and C. Butzbach (2018), ‘Redesigning cused on applied research and action, and researchers Public Health for Planetary Health’, Lancet Planetary are expected to be able to work in multi-disciplinary Health 2, no. 5: e188–e189. doi:10.1016/S2542- teams, a pragmatic stance towards the application 5196(18)30054-8. of methodology is required, and this may stimulate Brown, H., A. Kelly, A. M. Sáez, E. Fichet-Calvet, exploring the interface between realist research and R. Ansumana, J. Bonwi . . . and N. Magassouba anthropology. We are at a point in time where we (2015), ‘Extending the “Social”: Anthropological should leverage the potential of realist research and Contributions to the Study of Viral Haemorrhagic contemporary anthropology to provide us a way out Fevers’, PLOS Neglected Tropical Diseases 9, no. 4. and into the baffl ing complexity of global issues. doi:10.1371/journal.pntd.0003651. Carricaburu, D. and M. Ménoret (2004), Sociologie de la Santé: Institutions, professions et maladies (Paris: Armand Colin). Acknowledgements Chandler, C., J. Fairhead, A. Kelly, M. Leach, F. Mar- tineau, E. Mokuwa . . . and A. Wilkinson (2015), Bruno Marchal, Isabelle Lange and Rodney Reynolds ‘Ebola: Limitations of Correcting Misinforma- edited this article and made corrections at the fi nal tion’, Lancet 385, no. 9975: 1275–1277. doi:10.1016/ stage. To them, I off er my sincere thanks. S0140-6736(14)62382-5. Dakubo, C. Y. (2010), Ecosystems and Human Health: A Critical Approach to Ecohealth Research and Practice SARA VAN BELLE is a cultural anthropologist and po- (New York: Springer). litical scientist with a PhD in public health from the EASA Medical Anthropology Network and the RAI London School of Hygiene and Tropical Medicine Medical Anthropology Commi ee, ‘MAGic2015, (LSHTM). She is a senior research fellow at the In- Anthropology and Global Health: Interrogating stitute of Tropical Medicine, Antwerp, an honorary Theory, Policy and Practice’, 9–11 September 2015, assistant professor at the LSHTM and a lecturer at University of Sussex, UK, Programme Booklet. Sciences Po Paris. Her research interests include ac- Ebola Response Anthropology Platform 2018, countability and governance within health systems www.ebola-anthropology.net (accessed 14 July and their implications for sexual and reproductive 2018). health and rights services in LMIC. Emmel, N., J. Greenhalgh, A. Manzano, M. Monaghan Email: [email protected] and S. Dalkin (eds.) (2018), Doing Realist Research (Los Angeles: Sage). Fassin, D. (2000), ‘Entre politiques du vivant et poli- References tiques de la vie: une antropologie de la santé’, Anthropologie et Sociétés 24, no. 1: 95–116. doi:10 Abejirinde, I. O., M. Zweekhorst, A. Bardají, R. .7202/0156638ar. Abugnaba-Abanga ,N. Apentibadek, V. De Brou- Foxon, T. J. (2002), ‘Technological and Institutional were, J. van Roosmalen and B. Marchal, ‘Unveiling ‘Lock-In’ as a Barrier to Sustainable Innovation’, IC- the Black Box of Diagnostic and Clinical Deci- CEPT Working Paper, November, h p://www.iccept sion Support Systems for Antenatal Care: Realist .ic.ac.uk/public.html (accessed 15 July 2018). Evaluation’, JMIR Mhealth Uhealth 6, no. 12: e11468. Gandhi, L. (1998), Postcolonial Theory: A Critical Intro- doi:10.2196/mhealth.11468. duction (New York: Columbia University Press).

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