Inaugural seminar by STIAS Director on his appointment as Professor Extraordinary in the Department of Sociology and Social Anthropology at Stellenbosch University
“Mainstream sociology has held on to the assumption that only objective, observable facts can best present an understanding of human behaviour. I have sought to put observation and reason to the test, from sexual and reproductive behaviour especially of adolescent and young mothers to addressing matters of global health. In this regard, I (re)imagine my research in familial relationships, sexual and reproductive health-seeking behaviour, and HIV & AIDS. Context, politics, expedience and an often socio-culturally informed appreciation of available (assumed or actual) safety-nets has presented a nimble-footed immersion into what has evolved into a medical sociology pathway,” said STIAS Director Edward K. Kirumira on the occasion of his inaugural seminar as Professor Extraordinary in the Department of Sociology and Social Anthropology at Stellenbosch University.
Kirumira traced the evolvement of these ideas through highlights from his illustrious career. Before joining STIAS, Kirumira was Professor of Sociology and Principal of the College of Humanities and Social Sciences at Makerere University, Uganda. He trained at Makerere, Exeter University, the London School of Hygiene and Tropical Medicine, the University of Copenhagen and Harvard University. He specialised in population and reproductive health, and has done extensive research on HIV/AIDS, health-seeking behaviour, poverty, rural-development studies, emergent diseases and population and international health.
Included among many prestigious appointments, Kirumira has been a member of the Partnership Committee for HIV & AIDS, Malaria and TB National Response of the Uganda AIDS Commission; and treasurer and council member of the Ugandan National Academy of Sciences. He also chaired the Uganda Central Co-ordinating Mechanism for the Global Fund for HIV/AIDS, TB and Malaria country programme.
He has carried out consultancies and technical assistance in programme development and project design, management and evaluation in many African countries including South Africa (where he contributed to the development of the government’s AIDS programme), as well as the US, Mexico, Denmark and the UK. He has led or participated in technical teams on behalf of the World Health Organization’s Global Programme on AIDS, the United Nations AIDS Programme, the UN Development Programme, the UN Population Fund, the Danish International Development Agency, the Swedish government, the US National Academies and the Ugandan government. He is also a founder member and chair of the Partnership for Africa’s Next Generation of Academics (PANGeA).
“I believe we all have a responsibility to add value beyond ourselves,” he said. “I came back with additional responsibilities from every university I studied at. I have found it difficult to say ‘No’. But I’ve been able to have cross pollination between my research work and academic administration.”
He credits his initial training in sociology at Makerere “in a strongly positivistic oriented department” as having inspired his understanding of the need for sociology to play out in the natural sciences – examining the social and structural drivers of disease beyond the biomedical markers.
His extensive experience in sexual and reproductive health as well as the lessons of the HIV/AIDS pandemic are important groundwork for developing conceptual frameworks for the global health challenges facing the word today.
“There is a need to re-imagine ideas and power relations in global health,” he said.
Politics and funding
As an example, he described the world of AIDS funding in Africa. “In the 1990s you could only get funding if you were working in HIV/AIDS. By 2010 nearly 99% of funding in sub-Saharan Africa was from a range of bilateral donors, increasingly the Global Fund and PEPFAR became the major ones. The TB programme in Uganda, for example, was almost 100% funded by the Global Fund!”
“When a pandemic or disease management is funded externally it’s affected by the global standing of the nation state. Global funders usually tier countries and economic growth means you no longer qualify for certain funding streams. Funders also often have parallel programmes in one country. They even collect different statistics and it becomes difficult to get strong national statistics to know where we are. This is playing out even more now in COVID-19. Many research-funding entities in Europe are also being absorbed as departments or sections into respective ministries of foreign affairs. This means funding has to be in line with the foreign policy frameworks.”
“There is political appropriation of global health,” he continued. “Like it was with HIV & AIDS, the focus on COVID-19 takes the spotlight away from other conditions. If international funders leave due to COVID-19 they will leave a problem in HIV and TB research and programming – potentially creating conditions for another spike. We have to start thinking how that can be addressed.”
He also pointed to the health effects of urbanisation and the fast-growing continental population. “A study comparing child health in Kibera, the biggest slum in Nairobi, compared to a rural area – showed that the health of the under-12s is much worse with urbanisation. The challenge is not just numbers but population health.”
The state and activism
He highlighted the need to understand more about community activism and health citizenship also by turning to the lessons of HIV & AIDS.
“The ideas of community health activism and health citizenship gained prominence from the AIDS field. HIV & AIDS happened at a time that many liberation-movement based governments came into power. This meant that these governments felt a responsibility to the citizens and wanted to look like they were serving all. This allowed the entrance of and space for civil society.”
“For COVID-19 states have appropriated the space,” he continued. “For example, food distribution during lockdown was via the state. This created a huge problem for health citizenship. This is also working into the vaccine nationalism space – which doesn’t make matters better.”
“COVID-19 also came at a time of various types of elections on the continent – which meant that activism was often seen as political mobilisation – real or not. The state appropriated the space for fear of what could happen if community networks did participate. Timing, context, politics and expediency all came into play.”
“We need to encourage a robust community response and reflect on the development of social safety nets. Familial and community relationships are a key loci for shaping and constructing health.”
Producing researchers for the future
Turning to the area of institutional strengthening, he pointed to the challenge of keeping the theoretical and conceptual grounding in fields like sociology research while also being responsible to the public.
“How to respond to a crisis while keeping other research going is the big question,” he said. “Allowing research beyond the flavour of the day. Institutional health is about human capital and institutional strengthening – producing the next generation of researchers. We need to do more despite the difficulty of sourcing funding to do this work.”
“For COVID-19 I keep going back to work I was involved in in 2004/5 on the threat of an influenza pandemic,” he said. “Asking myself why, when we predicted this could happen, were we not ready? And what do we need to do to be ready? We need to use data and in-country research experience to understand the drivers and context, and re-imagine in a nimble-footed treatise.”
He pointed, for example, to the area of health-systems strengthening for which it has always been a challenge to obtain donor funding – “often because health systems were seen as a toxic part of the AIDS pandemic response. Now in COVID-19 health-systems preparedness is absolutely fundamental to prevention and treatment.”
“We need to de-crisis. We have a mind-set of fixing – asking how do we fix things rather than how do we prepare for when something like COVID-19 happens. We need a paradigm shift. We can’t continue to operate in crisis mode.”
“We need to deconstruct crisis, strike it from the dictionary, and begin from the perspective that humanity is the crisis,” he added.
“All of this calls for agility in conversation and argument.”
Michelle Galloway: Part-time media officer at STIAS
Photograph: Anton Jordaan