Exploring the effects of collaborative global health partnerships in the Ministry of Health and Child Care's monitoring and evaluation systems in Zimbabwe.

Abstract

Global Health Partnership support for monitoring and evaluation (M&E) policy and practice has strengthened Zimbabwe's public health system. Recent evidence suggests that hybrid governance systems such as partnerships can play an essential role in co-producing and co financing public health policies and programmes. Most public governance studies have embraced this approach as progressive. However, scholarly arguments on collaborative partnerships have missed an opportunity to fully investigate their effects on local health systems from a critical constructivist and dialogic policy approach to capture local partner reflexivity and resistance to external influence in public health policy planning and implementation. As a result, the current scholarly approaches to the collaborative partnership discourse have failed to account for the limits of agentive reflexivity in a global public health space tilting towards neoliberalism. This study used a qualitative case study approach, drawing from the Collaborative Governance of Partnership and Critical Discourse analytic frameworks to illuminate the effects of dialogic and discursive soft power encounters and its impact on M&E policy and practice in Zimbabwe. Data were collected using a documentary review of M&E policies and key informant interviews with Ministry of Health M&E staff. The findings suggest that collaborative partnerships for health have resulted in (un)intended effects that include digital exclusion of local partners, competition among partners, threats to sovereignty, fear of job losses, brain drain from government among other unanticipated challenges. As a result, the study argues that collaborative partnerships for M&E are contested spaces in which Global Health Partners(GHPs) revive old paternalistic aid tactics through control of governing rationalities that promote the local reproduction of neoliberal, market oriented ideas that influence and shape the ‘co-creation’ of M&E policies in Zimbabwe. The study further observes that the Ministry as a local partner apply various soft power strategies that include victimhood, extravesion,obsfucation and discourse control to counter GHP influence contrary to the key tenets of collaborative partnership for M&E. The study concludes that government counter-discourse and soft power strategies are perverse reflections and performative reproductions of neoliberal rationalities by converted local responsible agents who (un)knowingly contribute to maintaining partnership power imbalances in favour of Global Health Partners.