Postscript to Health ‘Anti-Reform’ In El Salvador: Community Health NGOs And The State In The Neoliberal Era

I wrote this article on the politics of health in post-war El Salvador immediately after my last stint of doctoral fieldwork in 1995 when I had followed controversies between radical health workers and the post-war government over pending neoliberal reforms. The reforms (ironically) ended funding for an effective network of health NGOs that were reducing rural maternal and child morbidity, and shifted funds to a dysfunctional health promoter program run by the Ministry of Health. The findings lent insights on the politics of development NGOs and the hypocrisies of neoliberal health reform. [A longer version of this article ran in Jim Yong Kim and colleagues’ Dying for Growth (2000).]

While surfing the net a few years later I learned that the article had gained a peculiar distinction. In a May 16th, 2006 post titled “Neoliberalism in Anthropology” on the blog Savage Minds, Kerim Friedman asked whether the conjunction noted by several scholars of new attention to neoliberalism was indicative of “a moment” in anthropology?” To find out, he ran a search on the AnthroSource database, noting that “While somewhat limited in scope, it should be able to reveal broad trends in the discipline.” Friedman searched for all articles in the past 100 years that used “neoliberalism” in the title, and came up with a grand total of  25 articles, “of which over half had been published in the past three years.” I was amused to see my article, originally published in PoLAR in 1998, on his list. So, a trendsetter I am, how nice!  At the time, my sense was more one of feeling oppressed by the ongoing “culture wars” which had marginalized political anthropology.

While El Salvador’s progressive health activists felt thwarted by multi-lateral lenders in 1995, by the end of the decade health reform had become the unlikely bailiwick symbolizing public discontent. In my recent book, Healing the Body Politic, the last chapter describes the rise of radicalized health professionals to national prominence (initially upstaging the FMLN) through leadership of the huge “White Marches” against privatization of the social security health system which shook up national politics and helped reinvigorate a leftist agenda.

The most impressive show of force since the civil war took place between September 2002 and June 2003 when a prolonged health strike shut down hospitals and clinics nationwide, and roadblocks interfered with business and tourism. The marches brought hundreds of thousands into the streets month after month dressed in white as a show of solidarity with hospital workers. Police raids on hospitals, arrests of doctors and hunger strikes became headline news. In June 2003 the progressive coalition won an important victory — not only did ARENA President Francisco Flores back down from his privatization agenda, but negotiators for the popular sector also got rare concessions from the World Bank that removed privatization conditions from loan agreements. In years that followed, ghosts of privatization continued to haunt the political agenda, but the mobilizations helped establish a new agenda for progressive change and a shift in public sympathies that eventually (in 2009) led to Mauricio Funes’ victory, displacing the ultra-conservative (and thoroughly corrupt) ARENA party from power.

Sandy Smith-Nonini is the author of Healing the Body Politic: El Salvador’s Popular Struggle for Health Rights from Civil War to Neoliberal Peace (Rutgers University Press, 2010).